1
|
Hwang S, Suk JW, Meffert H, Lerdahl A, Garvey WF, Edwards R, Delizza A, Soltis-Vaughan B, Cordts K, Leibenluft E, Blair RJR. Neural Responses to Intranasal Oxytocin in Youths With Severe Irritability. Am J Psychiatry 2024; 181:291-298. [PMID: 38419495 PMCID: PMC10984767 DOI: 10.1176/appi.ajp.20230174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
OBJECTIVE The authors investigated the neural impact of intranasal oxytocin on emotion processing areas in youths with severe irritability in the context of disruptive mood and behavior disorders. METHODS Fifty-two participants with severe irritability, as measured by a score ≥4 on the Affective Reactivity Index (ARI), with diagnoses of disruptive behavior disorders (DBDs) and/or disruptive mood dysregulation disorder (DMDD) were randomly assigned to treatment with intranasal oxytocin or placebo daily for 3 weeks. Assessments were conducted at baseline and at the end of the trial; the primary outcomes were measures of irritability on the ARI and ratings on the Clinical Global Impressions severity scale (CGI-S) focusing on DBD and DMDD symptoms, and secondary outcomes included the CGI improvement scale (CGI-I) and ratings of proactive and reactive aggressive behavior on the Reactive-Proactive Aggression Questionnaire. Forty-three participants (22 in the oxytocin group and 21 in the placebo group) completed pre- and posttreatment functional MRI (fMRI) scans with the affective Stroop task. RESULTS Youths who received oxytocin showed significant improvement in CGI-S and CGI-I ratings compared with those who received placebo. In the fMRI data, blood-oxygen-level-dependent (BOLD) responses to emotional stimuli in the dorsomedial prefrontal cortex and posterior cingulate cortex were significantly reduced after oxytocin compared with placebo. These BOLD response changes were correlated with improvement in clinical severity. CONCLUSIONS This study provides initial and preliminary evidence that intranasal oxytocin may induce neural-level changes in emotion processing in youths with irritability in the context of DBDs and DMDD. This may lead to symptom and severity changes in irritability.
Collapse
Affiliation(s)
- Soonjo Hwang
- Department of Psychiatry (Hwang, Lerdahl, Edwards), Department of Psychology (Delizza), and Department of Neurological Sciences (Soltis-Vaughan, Cordts), University of Nebraska Medical Center, Omaha; Digital Health Research Division, Korea Institute of Oriental Medicine, Daejeon, South Korea (Suk); Slimmer AI, Groningen, the Netherlands (Meffert); Cognitive Ability and Plasticity Lab, University of Sheffield, Sheffield, U.K. (Garvey); Section on Mood Dysregulation and Neuroscience, NIMH, Bethesda, Md. (Leibenluft); Child and Adolescent Mental Health Center, Mental Health Services, Capital Region of Denmark, Copenhagen (Blair)
| | - Ji-Woo Suk
- Department of Psychiatry (Hwang, Lerdahl, Edwards), Department of Psychology (Delizza), and Department of Neurological Sciences (Soltis-Vaughan, Cordts), University of Nebraska Medical Center, Omaha; Digital Health Research Division, Korea Institute of Oriental Medicine, Daejeon, South Korea (Suk); Slimmer AI, Groningen, the Netherlands (Meffert); Cognitive Ability and Plasticity Lab, University of Sheffield, Sheffield, U.K. (Garvey); Section on Mood Dysregulation and Neuroscience, NIMH, Bethesda, Md. (Leibenluft); Child and Adolescent Mental Health Center, Mental Health Services, Capital Region of Denmark, Copenhagen (Blair)
| | - Harma Meffert
- Department of Psychiatry (Hwang, Lerdahl, Edwards), Department of Psychology (Delizza), and Department of Neurological Sciences (Soltis-Vaughan, Cordts), University of Nebraska Medical Center, Omaha; Digital Health Research Division, Korea Institute of Oriental Medicine, Daejeon, South Korea (Suk); Slimmer AI, Groningen, the Netherlands (Meffert); Cognitive Ability and Plasticity Lab, University of Sheffield, Sheffield, U.K. (Garvey); Section on Mood Dysregulation and Neuroscience, NIMH, Bethesda, Md. (Leibenluft); Child and Adolescent Mental Health Center, Mental Health Services, Capital Region of Denmark, Copenhagen (Blair)
| | - Arica Lerdahl
- Department of Psychiatry (Hwang, Lerdahl, Edwards), Department of Psychology (Delizza), and Department of Neurological Sciences (Soltis-Vaughan, Cordts), University of Nebraska Medical Center, Omaha; Digital Health Research Division, Korea Institute of Oriental Medicine, Daejeon, South Korea (Suk); Slimmer AI, Groningen, the Netherlands (Meffert); Cognitive Ability and Plasticity Lab, University of Sheffield, Sheffield, U.K. (Garvey); Section on Mood Dysregulation and Neuroscience, NIMH, Bethesda, Md. (Leibenluft); Child and Adolescent Mental Health Center, Mental Health Services, Capital Region of Denmark, Copenhagen (Blair)
| | - William F Garvey
- Department of Psychiatry (Hwang, Lerdahl, Edwards), Department of Psychology (Delizza), and Department of Neurological Sciences (Soltis-Vaughan, Cordts), University of Nebraska Medical Center, Omaha; Digital Health Research Division, Korea Institute of Oriental Medicine, Daejeon, South Korea (Suk); Slimmer AI, Groningen, the Netherlands (Meffert); Cognitive Ability and Plasticity Lab, University of Sheffield, Sheffield, U.K. (Garvey); Section on Mood Dysregulation and Neuroscience, NIMH, Bethesda, Md. (Leibenluft); Child and Adolescent Mental Health Center, Mental Health Services, Capital Region of Denmark, Copenhagen (Blair)
| | - Ryan Edwards
- Department of Psychiatry (Hwang, Lerdahl, Edwards), Department of Psychology (Delizza), and Department of Neurological Sciences (Soltis-Vaughan, Cordts), University of Nebraska Medical Center, Omaha; Digital Health Research Division, Korea Institute of Oriental Medicine, Daejeon, South Korea (Suk); Slimmer AI, Groningen, the Netherlands (Meffert); Cognitive Ability and Plasticity Lab, University of Sheffield, Sheffield, U.K. (Garvey); Section on Mood Dysregulation and Neuroscience, NIMH, Bethesda, Md. (Leibenluft); Child and Adolescent Mental Health Center, Mental Health Services, Capital Region of Denmark, Copenhagen (Blair)
| | - Alison Delizza
- Department of Psychiatry (Hwang, Lerdahl, Edwards), Department of Psychology (Delizza), and Department of Neurological Sciences (Soltis-Vaughan, Cordts), University of Nebraska Medical Center, Omaha; Digital Health Research Division, Korea Institute of Oriental Medicine, Daejeon, South Korea (Suk); Slimmer AI, Groningen, the Netherlands (Meffert); Cognitive Ability and Plasticity Lab, University of Sheffield, Sheffield, U.K. (Garvey); Section on Mood Dysregulation and Neuroscience, NIMH, Bethesda, Md. (Leibenluft); Child and Adolescent Mental Health Center, Mental Health Services, Capital Region of Denmark, Copenhagen (Blair)
| | - Brigette Soltis-Vaughan
- Department of Psychiatry (Hwang, Lerdahl, Edwards), Department of Psychology (Delizza), and Department of Neurological Sciences (Soltis-Vaughan, Cordts), University of Nebraska Medical Center, Omaha; Digital Health Research Division, Korea Institute of Oriental Medicine, Daejeon, South Korea (Suk); Slimmer AI, Groningen, the Netherlands (Meffert); Cognitive Ability and Plasticity Lab, University of Sheffield, Sheffield, U.K. (Garvey); Section on Mood Dysregulation and Neuroscience, NIMH, Bethesda, Md. (Leibenluft); Child and Adolescent Mental Health Center, Mental Health Services, Capital Region of Denmark, Copenhagen (Blair)
| | - Katrina Cordts
- Department of Psychiatry (Hwang, Lerdahl, Edwards), Department of Psychology (Delizza), and Department of Neurological Sciences (Soltis-Vaughan, Cordts), University of Nebraska Medical Center, Omaha; Digital Health Research Division, Korea Institute of Oriental Medicine, Daejeon, South Korea (Suk); Slimmer AI, Groningen, the Netherlands (Meffert); Cognitive Ability and Plasticity Lab, University of Sheffield, Sheffield, U.K. (Garvey); Section on Mood Dysregulation and Neuroscience, NIMH, Bethesda, Md. (Leibenluft); Child and Adolescent Mental Health Center, Mental Health Services, Capital Region of Denmark, Copenhagen (Blair)
| | - Ellen Leibenluft
- Department of Psychiatry (Hwang, Lerdahl, Edwards), Department of Psychology (Delizza), and Department of Neurological Sciences (Soltis-Vaughan, Cordts), University of Nebraska Medical Center, Omaha; Digital Health Research Division, Korea Institute of Oriental Medicine, Daejeon, South Korea (Suk); Slimmer AI, Groningen, the Netherlands (Meffert); Cognitive Ability and Plasticity Lab, University of Sheffield, Sheffield, U.K. (Garvey); Section on Mood Dysregulation and Neuroscience, NIMH, Bethesda, Md. (Leibenluft); Child and Adolescent Mental Health Center, Mental Health Services, Capital Region of Denmark, Copenhagen (Blair)
| | - R J R Blair
- Department of Psychiatry (Hwang, Lerdahl, Edwards), Department of Psychology (Delizza), and Department of Neurological Sciences (Soltis-Vaughan, Cordts), University of Nebraska Medical Center, Omaha; Digital Health Research Division, Korea Institute of Oriental Medicine, Daejeon, South Korea (Suk); Slimmer AI, Groningen, the Netherlands (Meffert); Cognitive Ability and Plasticity Lab, University of Sheffield, Sheffield, U.K. (Garvey); Section on Mood Dysregulation and Neuroscience, NIMH, Bethesda, Md. (Leibenluft); Child and Adolescent Mental Health Center, Mental Health Services, Capital Region of Denmark, Copenhagen (Blair)
| |
Collapse
|
2
|
Seok JW, Soltis-Vaughan B, Lew BJ, Ahmad A, Blair RJR, Hwang S. Author Correction: Psychopharmacological treatment of disruptive behavior in youths: systematic review and network meta-analysis. Sci Rep 2024; 14:901. [PMID: 38195795 PMCID: PMC10776579 DOI: 10.1038/s41598-023-51047-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024] Open
Affiliation(s)
- Ji-Woo Seok
- Department of Psychiatry, University of Nebraska Medical Center, 985578 Nebraska Medical Center, Omaha, NE, 68198-5578, USA
- Digital Health Research Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
| | - Brigette Soltis-Vaughan
- Department of Psychiatry, University of Nebraska Medical Center, 985578 Nebraska Medical Center, Omaha, NE, 68198-5578, USA
| | - Brandon J Lew
- Department of Psychiatry, University of Nebraska Medical Center, 985578 Nebraska Medical Center, Omaha, NE, 68198-5578, USA
| | - Aatiya Ahmad
- Department of Psychiatry, University of Nebraska Medical Center, 985578 Nebraska Medical Center, Omaha, NE, 68198-5578, USA
| | - R J R Blair
- Child and Adolescent Mental Health Centre, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
| | - Soonjo Hwang
- Department of Psychiatry, University of Nebraska Medical Center, 985578 Nebraska Medical Center, Omaha, NE, 68198-5578, USA.
| |
Collapse
|
3
|
Seok JW, Soltis-Vaughan B, Lew BJ, Ahmad A, Blair RJR, Hwang S. Psychopharmacological treatment of disruptive behavior in youths: systematic review and network meta-analysis. Sci Rep 2023; 13:6921. [PMID: 37117632 PMCID: PMC10147946 DOI: 10.1038/s41598-023-33979-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 04/21/2023] [Indexed: 04/30/2023] Open
Abstract
To conduct a systematic review of the comparative efficacy of various psychotropic medications for the treatment of disruptive behavior (DBs) in youths. To this aim, we systematically reviewed randomized clinical trials (RCTs) of various psychotropic medications targeting symptoms of DBs and applied network meta-analysis to investigate their relative efficacy. Fifty-five RCTs meeting the inclusion criteria were selected. To predict and interpret relative treatment efficacy, we compared the efficacy of various psychotropic medications prescribed for DB symptoms based on their mechanism of action. Network meta-analysis revealed that for reducing DBs, second-generation antipsychotics, stimulants, and non-stimulant ADHD medications were more efficacious than placebo, and second-generation antipsychotics were the most efficacious. The dopaminergic modulation of top-down inhibitory process by these medications is discussed in this review. This study offers information on the relative efficacy of various psychotropic medications for the treatment of DB, and insight into a potential neurobiological underpinning for those symptoms. It also illustrates the potential utility of these neurobiological mechanisms as a target for future treatment studies.
Collapse
Affiliation(s)
- Ji-Woo Seok
- Department of Psychiatry, University of Nebraska Medical Center, 985578 Nebraska Medical Center, Omaha, NE, 68198-5578, USA
- Digital Health Research Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
| | - Brigette Soltis-Vaughan
- Department of Psychiatry, University of Nebraska Medical Center, 985578 Nebraska Medical Center, Omaha, NE, 68198-5578, USA
| | - Brandon J Lew
- Department of Psychiatry, University of Nebraska Medical Center, 985578 Nebraska Medical Center, Omaha, NE, 68198-5578, USA
| | - Aatiya Ahmad
- Department of Psychiatry, University of Nebraska Medical Center, 985578 Nebraska Medical Center, Omaha, NE, 68198-5578, USA
| | - R J R Blair
- Child and Adolescent Mental Health Centre, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
| | - Soonjo Hwang
- Department of Psychiatry, University of Nebraska Medical Center, 985578 Nebraska Medical Center, Omaha, NE, 68198-5578, USA.
| |
Collapse
|
4
|
Hubbard NA, Miller KB, Aloi J, Bajaj S, Wakabayashi KT, Blair RJR. Evaluating instrumental learning and striatal-cortical functional connectivity in adolescent alcohol and cannabis use. Addict Biol 2023; 28:e13258. [PMID: 36577718 PMCID: PMC10173870 DOI: 10.1111/adb.13258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 11/03/2022] [Accepted: 11/08/2022] [Indexed: 12/03/2022]
Abstract
Adolescence is a vulnerable time for the acquisition of substance use disorders, potentially relating to ongoing development of neural circuits supporting instrumental learning. Striatal-cortical circuits undergo dynamic changes during instrumental learning and are implicated in contemporary addiction theory. Human studies have not yet investigated these dynamic changes in relation to adolescent substance use. Here, functional magnetic resonance imaging was used while 135 adolescents without (AUD-CUDLow ) and with significant alcohol (AUDHigh ) or cannabis use disorder symptoms (CUDHigh ) performed an instrumental learning task. We assessed how cumulative experience with instrumental cues altered cue selection preferences and functional connectivity strength between reward-sensitive striatal and cortical regions. Adolescents in AUDHigh and CUDHigh groups were slower in learning to select optimal instrumental cues relative to AUD-CUDLow adolescents. The relatively fast learning observed for AUD-CUDLow adolescents coincided with stronger functional connectivity between striatal and frontoparietal regions during early relative to later periods of task experience, whereas the slower learning for the CUDHigh group coincided with the opposite pattern. The AUDHigh group not only exhibited slower learning but also produced more instrumental choice errors relative to AUD-CUDLow adolescents. For the AUDHigh group, Bayesian analyses evidenced moderate support for no experience-related changes in striatal-frontoparietal connectivity strength during the task. Findings suggest that adolescent cannabis use is related to slowed instrumental learning and delays in peak functional connectivity strength between the striatal-frontoparietal regions that support this learning, whereas adolescent alcohol use may be more closely linked to broader impairments in instrumental learning and a general depression of the neural circuits supporting it.
Collapse
Affiliation(s)
- NA Hubbard
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE
| | - KB Miller
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE
| | - J Aloi
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN
| | - S Bajaj
- Center for Neurobehavioral Research in Children, Boys Town National Research Hospital, Boys Town, NE
| | - KT Wakabayashi
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE
| | - RJR Blair
- Child and Adolescent Mental Health Centre, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
| |
Collapse
|
5
|
Gwilym BL, Pallmann P, Waldron CA, Thomas-Jones E, Milosevic S, Brookes-Howell L, Harris D, Massey I, Burton J, Stewart P, Samuel K, Jones S, Cox D, Clothier A, Edwards A, Twine CP, Bosanquet DC, Benson R, Birmpili P, Blair R, Bosanquet DC, Dattani N, Dovell G, Forsythe R, Gwilym BL, Hitchman L, Machin M, Nandhra S, Onida S, Preece R, Saratzis A, Shalhoub J, Singh A, Forget P, Gannon M, Celnik A, Duguid M, Campbell A, Duncan K, Renwick B, Moore J, Maresch M, Kamal D, Kabis M, Hatem M, Juszczak M, Dattani N, Travers H, Shalan A, Elsabbagh M, Rocha-Neves J, Pereira-Neves A, Teixeira J, Lyons O, Lim E, Hamdulay K, Makar R, Zaki S, Francis CT, Azer A, Ghatwary-Tantawy T, Elsayed K, Mittapalli D, Melvin R, Barakat H, Taylor J, Veal S, Hamid HKS, Baili E, Kastrisios G, Maltezos C, Maltezos K, Anastasiadou C, Pachi A, Skotsimara A, Saratzis A, Vijaynagar B, Lau S, Velineni R, Bright E, Montague-Johnstone E, Stewart K, King W, Karkos C, Mitka M, Papadimitriou C, Smith G, Chan E, Shalhoub J, Machin M, Agbeko AE, Amoako J, Vijay A, Roditis K, Papaioannou V, Antoniou A, Tsiantoula P, Bessias N, Papas T, Dovell G, Goodchild F, Nandhra S, Rammell J, Dawkins C, Lapolla P, Sapienza P, Brachini G, Mingoli A, Hussey K, Meldrum A, Dearie L, Nair M, Duncan A, Webb B, Klimach S, Hardy T, Guest F, Hopkins L, Contractor U, Clothier A, McBride O, Hallatt M, Forsythe R, Pang D, Tan LE, Altaf N, Wong J, Thurston B, Ash O, Popplewell M, Grewal A, Jones S, Wardle B, Twine C, Ambler G, Condie N, Lam K, Heigberg-Gibbons F, Saha P, Hayes T, Patel S, Black S, Musajee M, Choudhry A, Hammond E, Costanza M, Shaw P, Feghali A, Chawla A, Surowiec S, Encalada RZ, Benson R, Cadwallader C, Clayton P, Van Herzeele I, Geenens M, Vermeir L, Moreels N, Geers S, Jawien A, Arentewicz T, Kontopodis N, Lioudaki S, Tavlas E, Nyktari V, Oberhuber A, Ibrahim A, Neu J, Nierhoff T, Moulakakis K, Kakkos S, Nikolakopoulos K, Papadoulas S, D'Oria M, Lepidi S, Lowry D, Ooi S, Patterson B, Williams S, Elrefaey GH, Gaba KA, Williams GF, Rodriguez DU, Khashram M, Gormley S, Hart O, Suthers E, French S. Short-term risk prediction after major lower limb amputation: PERCEIVE study. Br J Surg 2022; 109:1300-1311. [PMID: 36065602 DOI: 10.1093/bjs/znac309] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 05/06/2022] [Accepted: 07/31/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND The accuracy with which healthcare professionals (HCPs) and risk prediction tools predict outcomes after major lower limb amputation (MLLA) is uncertain. The aim of this study was to evaluate the accuracy of predicting short-term (30 days after MLLA) mortality, morbidity, and revisional surgery. METHODS The PERCEIVE (PrEdiction of Risk and Communication of outcomE following major lower limb amputation: a collaboratIVE) study was launched on 1 October 2020. It was an international multicentre study, including adults undergoing MLLA for complications of peripheral arterial disease and/or diabetes. Preoperative predictions of 30-day mortality, morbidity, and MLLA revision by surgeons and anaesthetists were recorded. Probabilities from relevant risk prediction tools were calculated. Evaluation of accuracy included measures of discrimination, calibration, and overall performance. RESULTS Some 537 patients were included. HCPs had acceptable discrimination in predicting mortality (931 predictions; C-statistic 0.758) and MLLA revision (565 predictions; C-statistic 0.756), but were poor at predicting morbidity (980 predictions; C-statistic 0.616). They overpredicted the risk of all outcomes. All except three risk prediction tools had worse discrimination than HCPs for predicting mortality (C-statistics 0.789, 0.774, and 0.773); two of these significantly overestimated the risk compared with HCPs. SORT version 2 (the only tool incorporating HCP predictions) demonstrated better calibration and overall performance (Brier score 0.082) than HCPs. Tools predicting morbidity and MLLA revision had poor discrimination (C-statistics 0.520 and 0.679). CONCLUSION Clinicians predicted mortality and MLLA revision well, but predicted morbidity poorly. They overestimated the risk of mortality, morbidity, and MLLA revision. Most short-term risk prediction tools had poorer discrimination or calibration than HCPs. The best method of predicting mortality was a statistical tool that incorporated HCP estimation.
Collapse
Affiliation(s)
- Brenig L Gwilym
- South East Wales Vascular Network, Aneurin Bevan University Health Board, Royal Gwent Hospital, Newport, UK
| | | | | | | | | | | | - Debbie Harris
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Ian Massey
- Artificial Limb and Appliance Centre, Rookwood Hospital, Cardiff and Vale University Health Board, Cardiff, UK
| | - Jo Burton
- Artificial Limb and Appliance Centre, Rookwood Hospital, Cardiff and Vale University Health Board, Cardiff, UK
| | - Phillippa Stewart
- Artificial Limb and Appliance Centre, Rookwood Hospital, Cardiff and Vale University Health Board, Cardiff, UK
| | - Katie Samuel
- Department of Anaesthesia, North Bristol NHS Trust, Bristol, UK
| | - Sian Jones
- c/o INVOLVE Health and Care Research Wales, Cardiff, UK
| | - David Cox
- c/o INVOLVE Health and Care Research Wales, Cardiff, UK
| | - Annie Clothier
- South East Wales Vascular Network, Aneurin Bevan University Health Board, Royal Gwent Hospital, Newport, UK
| | - Adrian Edwards
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Christopher P Twine
- Bristol, Bath and Weston Vascular Network, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - David C Bosanquet
- South East Wales Vascular Network, Aneurin Bevan University Health Board, Royal Gwent Hospital, Newport, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Blair R, Harkin DW, Lim A, Johnston D, McFetridge L, Mitchell H. Open Surgery for Abdominal Aortic Aneurysm: 994 Consecutive Patient Outcomes. Eur J Vasc Endovasc Surg 2022. [DOI: 10.1016/j.ejvs.2022.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
7
|
Butt S, Dawe R, Blair R, Ibbotson S. A new approach to actinic folliculitis: prophylactic narrowband ultraviolet B phototherapy. Clin Exp Dermatol 2021; 46:675-679. [PMID: 33215732 DOI: 10.1111/ced.14518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 11/13/2020] [Accepted: 11/17/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND We have observed an increasing number of patients referred to the Scottish Photobiology Service (SPS), who were later diagnosed with actinic folliculitis (AF) and had positive phototesting results. Treatment options for AF are limited, with only a few reports in the literature. The use of prophylactic narrowband ultraviolet B (NB-UVB) phototherapy for AF has not previously been described, and we report on this for the first time. AIM To analyse the clinical characteristics, phototesting results and responses to treatment for patients with AF diagnosed by the SPS. METHODS We undertook a retrospective review over 10 years of all case notes of patients who were assessed and diagnosed with AF through the SPS, based at the Photobiology Unit, Dundee, UK. RESULTS All 10 patients were women. Mean age of onset was 25 years and mean time to referral for investigation was 7 years. The commonest site involved was the face, with the main clinical feature being monomorphic pustules appearing after sunlight exposure. The eruption could be provoked with iterative doses of broadband UVA irradiation in five patients. All patients were offered photoprotective advice and prophylactic NB-UVB phototherapy. Five patients proceeded with phototherapy; four of these completed the desensitization course and all four reported either a delay in symptom onset or total prevention of rash induction, with complete efficacy of desensitization maintained for 3 years in one patient. CONCLUSION We demonstrate the successful use of UVA provocation testing as a diagnostic tool in AF. Additionally, we recommend the use of prophylactic NB-UVB phototherapy in AF as an effective and well-tolerated approach.
Collapse
Affiliation(s)
- S Butt
- Photobiology Unit, Dermatology Department, University of Dundee, Ninewells Hospital & Medical School, Dundee, UK
| | - R Dawe
- Photobiology Unit, Dermatology Department, University of Dundee, Ninewells Hospital & Medical School, Dundee, UK
| | - R Blair
- Dermatology Department, Royal Alexandra Hospital, Paisley, UK
| | - S Ibbotson
- Photobiology Unit, Dermatology Department, University of Dundee, Ninewells Hospital & Medical School, Dundee, UK
| |
Collapse
|
8
|
Patterson F, Brewer B, Blair R, Zantah M, Gangemi A, Grandner M, Satti A. INCREASED SLEEP EFFICIENCY ASSOCIATED WITH INCREASED LUNG FUNCTION IN AFRICAN AMERICAN LIGHT SMOKERS: RESULTS FROM A PROSPECTIVE COHORT EXAMINATION. Chest 2020. [DOI: 10.1016/j.chest.2020.05.354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
9
|
Affiliation(s)
- V. Ravindran
- Department of Animal Science, University of British Columbia, Vancouver, British Columbia, Canada V6T 2A2
| | - R. Blair
- Department of Animal Science, University of British Columbia, Vancouver, British Columbia, Canada V6T 2A2
| |
Collapse
|
10
|
Affiliation(s)
- R. Blair
- Nutrition Section, Agricultural Research Council Poultry Research Centre, Edinburgh. EH9 3JS, Scotland
| |
Collapse
|
11
|
Affiliation(s)
- V. Ravindran
- Department of Animal Science, University of Peradeniya, Sri Lanka
| | - R. Blair
- Department of Animal Science, University of British Columbia, Vancouver V6T 2A2, Canada
| |
Collapse
|
12
|
Affiliation(s)
- V. Ravindran
- Department of Animal Science, University of British Columbia, Vancouver, British Columbia, Canada V6T 2A2
| | - R. Blair
- Department of Animal Science, University of British Columbia, Vancouver, British Columbia, Canada V6T 2A2
| |
Collapse
|
13
|
Blair RJR. Traits of empathy and anger: implications for psychopathy and other disorders associated with aggression. Philos Trans R Soc Lond B Biol Sci 2019; 373:rstb.2017.0155. [PMID: 29483341 DOI: 10.1098/rstb.2017.0155] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2017] [Indexed: 12/22/2022] Open
Abstract
Empathy and anger are two social emotions that modulate an individual's risk for aggression. Empathy is an emotional reaction to another individual's emotional state. Anger is an emotional reaction to threat, frustration or social provocation. Reduced empathy, seen in psychopathy, increases the risk for goal-directed aggression. Atypically increased anger (i.e. irritability), seen in conditions like disruptive mood dysregulation disorder and borderline personality disorder, increases the risk for reactive aggression. In this paper, I will outline core neurocognitive functions that correspond to empathy and which are compromised in individuals with psychopathic traits. In addition, I will outline neurocognitive functions involved in either the generation or regulation of anger and which are compromised in psychiatric conditions at increased risk for irritability/reactive aggression. It can be hoped that improved understanding of empathy and anger will lead to better assessment tools and improved interventions to reduce aggression risk.This article is part of the theme issue 'Diverse perspectives on diversity: multi-disciplinary approaches to taxonomies of individual differences'.
Collapse
Affiliation(s)
- R J R Blair
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Omaha, NE 68131, USA
| |
Collapse
|
14
|
Hwang S, Meffert H, Parsley I, Tyler PM, Erway AK, Botkin ML, Pope K, Blair RJR. Segregating sustained attention from response inhibition in ADHD: An fMRI study. Neuroimage Clin 2019; 21:101677. [PMID: 30682530 PMCID: PMC6352299 DOI: 10.1016/j.nicl.2019.101677] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 01/10/2019] [Accepted: 01/13/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND The functional significance of the impairment shown by patients with ADHD on response inhibition tasks is unclear. Dysfunctional behavioral and BOLD responses to rare no-go cues might reflect disruption of response inhibition (mediating withholding the response) or selective attention (identifying the rare cue). However, a factorial go/no-go design (involving high and low frequency go and no-go stimuli) can disentangle these possibilities. METHODS Eighty youths [22 female, mean age = 13.70 (SD = 2.21), mean IQ = 104.65 (SD = 13.00); 49 with diagnosed ADHD] completed the factorial go/no-go task while undergoing fMRI. RESULTS There was a significant response type-by-ADHD symptom severity interaction within the left anterior insula cortex; increasing ADHD symptom severity was associated with decreased recruitment of this region to no-go cues irrespective of cue frequency. There was also a significant frequency-by-ADHD symptom severity interaction within the left superior frontal gyrus. ADHD symptom severity showed a quadratic relationship with responsiveness to low frequency cues (irrespective of whether these cues were go or no-go); within this region, at lower levels of symptom severity, increasing severity was associated with increased BOLD responses but at higher levels of symptom severity, decreasing BOLD responses. CONCLUSION The current study reveals two separable forms of dysfunction that together probably contribute to the impairments shown by patients with ADHD on go/no-go tasks.
Collapse
Affiliation(s)
- Soonjo Hwang
- University of Nebraska Medical Center, Omaha, NE, USA.
| | | | - Ian Parsley
- University of Nebraska Medical Center, Omaha, NE, USA
| | - Patrick M Tyler
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Anna K Erway
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Mary L Botkin
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Kayla Pope
- Creighton University, Department of Psychiatry, Omaha, NE, USA
| | - R J R Blair
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USA
| |
Collapse
|
15
|
Hwang S, Meffert H, VanTieghem MR, Sinclair S, Bookheimer SY, Vaughan B, Blair RJR. Dysfunctional Social Reinforcement Processing in Disruptive Behavior Disorders: An Functional Magnetic Resonance Imaging Study. Clin Psychopharmacol Neurosci 2018; 16:449-460. [PMID: 30466217 PMCID: PMC6245284 DOI: 10.9758/cpn.2018.16.4.449] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 09/12/2017] [Accepted: 11/13/2017] [Indexed: 11/25/2022]
Abstract
Objective Prior functional magnetic resonance imaging (fMRI) work has revealed that children/adolescents with disruptive behavior disorders (DBDs) show dysfunctional reward/non-reward processing of non-social reinforcements in the context of instrumental learning tasks. Neural responsiveness to social reinforcements during instrumental learning, despite the importance of this for socialization, has not yet been previously investigated. Methods Twenty-nine healthy children/adolescents and 19 children/adolescents with DBDs performed the fMRI social/non-social reinforcement learning task. Participants responded to random fractal image stimuli and received social and non-social rewards/non-rewards according to their accuracy. Results Children/adolescents with DBDs showed significantly reduced responses within the caudate and posterior cingulate cortex (PCC) to non-social (financial) rewards and social non-rewards (the distress of others). Connectivity analyses revealed that children/adolescents with DBDs have decreased positive functional connectivity between the ventral striatum (VST) and the ventromedial prefrontal cortex (vmPFC) seeds and the lateral frontal cortex in response to reward relative to non-reward, irrespective of its sociality. In addition, they showed decreased positive connectivity between the vmPFC seed and the amygdala in response to non-reward relative to reward. Conclusion These data indicate compromised reinforcement processing of both non-social rewards and social non-rewards in children/adolescents with DBDs within core regions for instrumental learning and reinforcement-based decision-making (caudate and PCC). In addition, children/adolescents with DBDs show dysfunctional interactions between the VST, vmPFC, and lateral frontal cortex in response to rewarded instrumental actions potentially reflecting disruptions in attention to rewarded stimuli.
Collapse
Affiliation(s)
- Soonjo Hwang
- Department of Psychiatry, University of Nebraska Medical Center, Omaha, NE, USA
| | - Harma Meffert
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USA
| | | | - Stephen Sinclair
- Department of Health and Human Services, Section on Affective Cognitive Neuroscience, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Susan Y Bookheimer
- University of California and Brain Research Institute, Los Angeles, CA, USA
| | - Brigette Vaughan
- Department of Psychiatry, University of Nebraska Medical Center, Omaha, NE, USA
| | - R J R Blair
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USA
| |
Collapse
|
16
|
Cecilione JL, Rappaport LM, Verhulst B, Carney DM, Blair RJR, Brotman MA, Leibenluft E, Pine DS, Roberson-Nay R, Hettema JM. Test-retest reliability of the facial expression labeling task. Psychol Assess 2017; 29:1537-1542. [PMID: 28230406 PMCID: PMC5568997 DOI: 10.1037/pas0000439] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Recognizing others' emotional expressions is vital for socioemotional development; impairments in this ability occur in several psychiatric disorders. Further study is needed to map the development of this ability and to evaluate its components as potential transdiagnostic endophenotypes. Before doing so, however, research is required to substantiate the test-retest reliability of scores of the face emotion identification tasks linked to developmental psychopathology. The current study estimated test-retest reliability of scores of one such task, the facial expression labeling task (FELT) among a sample of twin children (N = 157; ages 9-14). Participants completed the FELT at two visits two to five weeks apart. Participants discerned the emotion presented of faces depicting six emotions (i.e., happiness, anger, sadness, fear, surprise, and disgust) morphed with a neutral face to provide 10 levels of increasing emotional expressivity. The present study found strong test-retest reliability (Pearson r) of the FELT scores across all emotions. Results suggested that data from this task may be effectively analyzed using a latent growth curve model to estimate overall ability (i.e., intercept; r's = 0.76-0.85) and improvement as emotions become clearer (i.e., linear slope; r's = 0.69-0.83). Evidence of high test-retest reliability of this task's scores informs future developmental research and the potential identification of transdiagnostic endophenotypes for child psychopathology. (PsycINFO Database Record
Collapse
Affiliation(s)
- Jennifer L Cecilione
- Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Virginia Commonwealth University
| | - Lance M Rappaport
- Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Virginia Commonwealth University
| | - Brad Verhulst
- Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Virginia Commonwealth University
| | - Dever M Carney
- Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Virginia Commonwealth University
| | - R J R Blair
- Section on Affective Cognitive Neuroscience, National Institute of Mental Health, National Institutes of Health
| | - Melissa A Brotman
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health
| | - Ellen Leibenluft
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health
| | - Daniel S Pine
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health
| | - Roxann Roberson-Nay
- Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Virginia Commonwealth University
| | - John M Hettema
- Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Virginia Commonwealth University
| |
Collapse
|
17
|
Blair R, Mccann C, McNally S, McCain S. To Evaluate the Appropriateness of MRCP Requests In Acute Surgical Admissions At A District General Hospital Over a One Year Period, and Assess the Compliance With AUGIS Guidelines. Int J Surg 2017. [DOI: 10.1016/j.ijsu.2017.08.479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
18
|
Affiliation(s)
- A. Randhawa
- Dermatology Department; Queen Elizabeth University Hospital; 1345 Govan Road Glasgow G51 4TF UK
| | - R. Blair
- Dermatology Department; Queen Elizabeth University Hospital; 1345 Govan Road Glasgow G51 4TF UK
| | - G. Wylie
- Dermatology Department; Queen Elizabeth University Hospital; 1345 Govan Road Glasgow G51 4TF UK
| |
Collapse
|
19
|
Abstract
In this paper it is proposed that important components of moral development and moral judgment rely on two forms of emotional learning: stimulus-reinforcement and response-outcome learning. Data in support of this position will be primarily drawn from work with individuals with the developmental condition of psychopathy as well as fMRI studies with healthy individuals. Individuals with psychopathy show impairment on moral judgment tasks and a pronounced increased risk for instrumental antisocial behavior. It will be argued that these impairments are developmental consequences of impaired stimulus-aversive conditioning on the basis of distress cue reinforcers and response-outcome learning in individuals with this disorder.
Collapse
Affiliation(s)
- R J R Blair
- Section on Affective Cognitive Neuroscience, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA.
| |
Collapse
|
20
|
Hwang S, White SF, Nolan ZT, Craig Williams W, Sinclair S, Blair RJR. Executive attention control and emotional responding in attention-deficit/hyperactivity disorder--A functional MRI study. Neuroimage Clin 2015; 9:545-54. [PMID: 26640766 PMCID: PMC4632075 DOI: 10.1016/j.nicl.2015.10.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 08/24/2015] [Accepted: 10/05/2015] [Indexed: 11/23/2022]
Abstract
Background There are suggestions that patients with attention-deficit/hyperactivity disorder (ADHD) show impairment in executive attention control and emotion regulation. This study investigated emotion regulation as a function of the recruitment of executive attention in patients with ADHD. Methods Thirty-five healthy children/adolescents (mean age = 13.91) and twenty-six children/adolescents with ADHD (mean age = 14.53) participated in this fMRI study. They completed the affective Stroop paradigm viewing positive, neutral and negative images under varying cognitive loads. A 3-way ANOVA (diagnosis-by-condition-by-emotion) was conducted on the BOLD response data. Following this, 2 3-way ANOVAs (diagnosis-by-condition-by-emotion) were applied to context-dependent psychophysiological interaction (gPPI) analyses generated from a dorsomedial frontal cortex and an amygdala seed (identified from the BOLD response ANOVA main effects of condition and emotion respectively). Results A diagnosis-by-condition interaction within dorsomedial frontal cortex revealed reduced recruitment of dorsomedial frontal cortex as a function of increased task demands in the children/adolescents with ADHD relative to healthy children/adolescents. The level of reduction in recruitment of dorsomedial frontal cortex was significantly correlated with symptom severity (total and hyperactivity) measured by Conner's Parent Report Scale in the children/adolescents with ADHD. In addition, analysis of gPPI data from a dorsomedial frontal cortex seed revealed significant diagnosis-by-condition interactions within lateral frontal cortex; connectivity between dorsomedial frontal cortex and lateral frontal cortex was reduced in the patients with ADHD relative to comparison youth during congruent and incongruent task trials relative to view trials. There were no interactions of group, or main effect of group, within the amygdala in the BOLD response ANOVA (though children/adolescents with ADHD showed increased responses to positive images within temporal cortical regions during task trials; identified by the diagnosis-by-condition-by-emotion interaction). However, analysis of gPPI data from an amygdala seed revealed decreased connectivity between amygdala and lentiform nucleus in the presence of emotional stimuli in children/adolescents with ADHD (diagnosis-by-emotion interaction). Conclusion The current study demonstrated disrupted recruitment of regions implicated in executive function and impaired connectivity within those regions in children/adolescents with ADHD. There were also indications of heightened representation of emotional stimuli in patients with ADHD. However, as the findings were specific for positive stimuli, the suggestion of a general failure in emotion regulation in ADHD was not supported. ADHD showed decreased dorsomedial frontal cortex activity with increased cognitive demand. Decreased dorsomedial frontal cortex activity was correlated with symptom severity of ADHD. Connectivity of dorsomedial frontal cortex–lateral frontal cortex was compromised in ADHD. ADHD showed increased activities in emotional responding areas to positive emotional stimuli.
Collapse
Affiliation(s)
- Soonjo Hwang
- Section on Affective Cognitive Neuroscience, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | - Stuart F White
- Section on Affective Cognitive Neuroscience, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | - Zachary T Nolan
- Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - W Craig Williams
- Department of Psychology, Stanford University, Stanford, CA, USA
| | - Stephen Sinclair
- Section on Affective Cognitive Neuroscience, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | - R J R Blair
- Section on Affective Cognitive Neuroscience, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| |
Collapse
|
21
|
Abstract
In this review an RDoC approach is applied to psychopathic traits. Two core neuro-cognitive systems relevant to the emergence of psychopathic traits are considered. These are the response to other individuals' emotional displays and reinforcement-based decision-making.
Collapse
Affiliation(s)
- R J R Blair
- Section of Affective Cognitive Neuroscience, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA.
| |
Collapse
|
22
|
Blair R, Collins A, Harkin DW. Complex EVAR for abdominal aorto-iliac aneurysm (AAIA) is associated with high rate of endoleak and less aortic sac shrinkage compared to conventional EVAR for AAA. Ir J Med Sci 2014; 184:871-5. [PMID: 25322958 DOI: 10.1007/s11845-014-1210-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 10/06/2014] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Endovascular repair (EVAR) for large abdominal aortic aneurysm (AAA) in anatomically suitable patients is associated with low early mortality and morbidity. However, EVAR is associated with a significant risk of late complication and a high cumulative re-intervention rate. Many large experienced centres have offered complex EVAR to challenging aortic anatomies such as abdominal aorto-iliac aneurysm (AAIA). We hypothesised that complex EVAR, for AAIA, would be associated with an increased risk of late graft-related complications. METHODS The design was a Retrospective Clinical Cohort Study. From a prospective computerised database we identified consecutive patients undergoing EVAR in a single institution between 2008 and 2009. We retrieved analysis clinical data and digital Computed Tomographic Angiography (CTA) scans carried out pre-, early post-, and late post-EVAR. We compared patients undergoing complex EVAR for AAIA with those undergoing conventional standard EVAR for AAA. RESULTS We identified 93 consecutive patients undergoing EVAR, 13 patients were excluded (3 eEVAR, 1 TEVAR, 9 data could not be retrieved) leaving 80 patients for analysis, 63 male and 17 female, average age 74.5 years (range 57-86), average follow-up 38 months (range 27-50), primary EVAR success was 100% and there was no mortality. Complex EVAR, EVAR plus internal iliac artery embolisation (+IIAE) and extension of the ipsilateral graft limb to the external iliac artery, for AAIA were carried out in 19/80 patients. After standard EVAR, late post-EVAR AAA sac diameter was significantly reduced in EVAR (63.24 ± 9.76 vs 54.26 ± 13.70, p < 0.001) but not after complex EVAR+IIAE (58.89 ± 16.39 vs 52.35 ± 12.75, p = 0.62). Endoleak these were significantly more common in the complex EVAR+IIAE, 5/19 (26.32%), as compared to the standard EVAR, 11/61 (18.03%), p < 0.01. Interestingly, inferior mesenteric artery (IMA) Patency was much commoner after complex EVAR+IIAE (15/19, 78.95%) compared EVAR (29/61, 47.54%), p < 0.01. CONCLUSION EVAR can be carried out with low early mortality but has a significant risk of late complication, the commonest of which is endoleak. Complex EVAR for abdominal aorto-iliac aneurysm can be carried out with comparable results to conventional EVAR. However, high rates of persistent endoleak and inferior mesenteric artery patency, and lack of aneurysm sac shrinkage, would suggest they may be at increased risk of late complications and may benefit from enhanced and extended radiological surveillance.
Collapse
Affiliation(s)
- R Blair
- Belfast Vascular Centre, Royal Victoria Hospital, Belfast, BT12 6BA, UK
| | - A Collins
- Belfast Vascular Centre, Royal Victoria Hospital, Belfast, BT12 6BA, UK
| | - D W Harkin
- Belfast Vascular Centre, Royal Victoria Hospital, Belfast, BT12 6BA, UK.
| |
Collapse
|
23
|
Hwang S, White SF, Nolan ZT, Sinclair S, Blair RJR. Neurodevelopmental changes in the responsiveness of systems involved in top down attention and emotional responding. Neuropsychologia 2014; 62:277-85. [PMID: 25128588 DOI: 10.1016/j.neuropsychologia.2014.08.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 07/03/2014] [Accepted: 08/01/2014] [Indexed: 11/30/2022]
Abstract
In this study, we aimed to investigate age related changes in systems implicated in top down attention and the implications of this for amygdala responses to emotional distracters. Fifty-one healthy subjects including 18 children (aged 10-14), 15 adolescents (aged 14-18), and 18 young adults (aged 18-25) completed the affective Stroop paradigm while undergoing functional MRI. While achieving comparable behavioral performance, children, relative to adolescents and adults, showed increased activation in areas including anterior cingulate gyrus and precentral gyrus in task relative to view trials. In addition, children showed increased activation within the amygdala and fusiform gyrus in response to emotional stimuli. Notably, the group difference within the amygdala was particularly pronounced during task trials. Also children showed increased connectivity between amygdala and superior frontal gyrus and bilateral postcentral gyrii in response to negative task trials. These data are consistent with previous work indicating less consolidated functional integrity in regions implicated in top down attention in children relative to older participants and extend this work by indicating that this less consolidated functional integrity leads to reduced automatic emotion regulation as a function of top down attention. Given that reduced automatic emotion regulation as a function of top down attention is considered a risk factor for the development of anxiety disorders, these data may contribute to an understanding of the increased risk for the development of these disorders at this age.
Collapse
Affiliation(s)
- Soonjo Hwang
- Section on Affective Cognitive Neuroscience, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA.
| | - Stuart F White
- Section on Affective Cognitive Neuroscience, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | - Zachary T Nolan
- Section on Affective Cognitive Neuroscience, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | - Stephen Sinclair
- Section on Affective Cognitive Neuroscience, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | - R J R Blair
- Section on Affective Cognitive Neuroscience, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| |
Collapse
|
24
|
Abstract
The disruptive behavior disorders include Conduct Disorder (CD), Oppositional Defiant Disorder (ODD), and Attention Deficit Hyperactivity Disorder (ADHD). These disorders are highly comorbid with each other as well as with mood and anxiety disorders and personality disorders (particularly borderline personality disorder). The goal of this chapter is to consider these disorders from an RDoC(ish) approach. In other words, we will outline four functional processes and the behavioral implications of dysfunction within these processes. Moreover, we will briefly consider how dysfunction in one might increase the risk for the development of rather different behavioral problems that have been previously associated with rather different disorders. Our goal is to identify neurocognitive-based functional targets for treatment.
Collapse
Affiliation(s)
- R J R Blair
- Department of Health and Human Services, Section on Affective Cognitive Neuroscience, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA,
| | | | | | | |
Collapse
|
25
|
|
26
|
Marsh AA, Finger EC, Fowler KA, Adalio CJ, Jurkowitz ITN, Schechter JC, Pine DS, Decety J, Blair RJR. Empathic responsiveness in amygdala and anterior cingulate cortex in youths with psychopathic traits. J Child Psychol Psychiatry 2013; 54:900-10. [PMID: 23488588 PMCID: PMC3716835 DOI: 10.1111/jcpp.12063] [Citation(s) in RCA: 143] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/03/2013] [Indexed: 12/30/2022]
Abstract
BACKGROUND Psychopathic traits are associated with increases in antisocial behaviors such as aggression and are characterized by reduced empathy for others' distress. This suggests that psychopathic traits may also impair empathic pain sensitivity. However, whether psychopathic traits affect responses to the pain of others versus the self has not been previously assessed. METHOD We used whole-brain functional magnetic resonance imaging to measure neural activation in 14 adolescents with oppositional defiant disorder or conduct disorder and psychopathic traits, as well as 21 healthy controls matched on age, gender, and intelligence. Activation in structures associated with empathic pain perception was assessed as adolescents viewed photographs of pain-inducing injuries. Adolescents imagined either that the body in each photograph was their own or that it belonged to another person. Behavioral and neuroimaging data were analyzed using random-effects analysis of variance. RESULTS Youths with psychopathic traits showed reduced activity within regions associated with empathic pain as the depicted pain increased. These regions included rostral anterior cingulate cortex, ventral striatum (putamen), and amygdala. Reductions in amygdala activity particularly occurred when the injury was perceived as occurring to another. Empathic pain responses within both amygdala and rostral anterior cingulate cortex were negatively correlated with the severity of psychopathic traits as indexed by PCL:YV scores. CONCLUSIONS Youths with psychopathic traits show less responsiveness in regions implicated in the affective response to another's pain as the perceived intensity of this pain increases. Moreover, this reduced responsiveness appears to predict symptom severity.
Collapse
Affiliation(s)
- Abigail A Marsh
- Department of Psychology, Georgetown University, Washington, DC 20057, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Blair KS, Otero M, Teng C, Jacobs M, Odenheimer S, Pine DS, Blair RJR. Dissociable roles of ventromedial prefrontal cortex (vmPFC) and rostral anterior cingulate cortex (rACC) in value representation and optimistic bias. Neuroimage 2013; 78:103-10. [PMID: 23567883 DOI: 10.1016/j.neuroimage.2013.03.063] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2012] [Revised: 02/10/2013] [Accepted: 03/23/2013] [Indexed: 10/27/2022] Open
Abstract
Optimistic bias (OB) is seen when individuals underestimate their probability of experiencing negative life events and overestimate their probability of experiencing positive life events. A reduced OB has been linked with increased depression symptoms. However, given the relevance of this information to mood and anxiety disorders, little is currently known regarding the neurobiology of OB. In the current study, we examine the neural basis of OB in healthy individuals (n=33) during probability estimation of future positive and negative events occurring to themselves relative to other, comparable individuals. In line with previous work, subjects showed significant OB; they considered themselves significantly more likely to experience future positive and significantly less likely to experience future negative events relative to comparable others. Positive, relative to negative events, un-modulated by subjects' probability estimates, were associated with significantly greater activity within the ventromedial prefrontal cortex (vmPFC) and posterior cingulate cortex (PCC). Moreover, responses within both regions to positive events negatively related to the healthy subjects' self reports of depression symptoms. However, there was no significant modulation of activity in either region by the subject's OB, objectified as the level to which they thought the event was more likely [positive events] or less likely [negative events] to occur to them relative to comparable others. In contrast, activity within the rostral anterior cingulate cortex (rACC) was positively modulated by OB for positive events and activity within the anterior insula and dorsomedial prefrontal cortex (dmPFC) was negatively modulated by OB for negative events. However, there was no significant relationship between responsiveness within these regions and self reports of depression symptoms. The data are discussed with reference to current models of vmPFC, rACC and anterior insula functioning.
Collapse
Affiliation(s)
- Karina S Blair
- National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD 20892, USA.
| | | | | | | | | | | | | |
Collapse
|
28
|
Blair RJR. Commentary: disregard for others: empathic dysfunction or emotional volatility? The relationship with future antisocial behavior - reflections on Rhee et al. (2013). J Child Psychol Psychiatry 2013. [PMID: 23194463 DOI: 10.1111/jcpp.12026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- R J R Blair
- Unit of Affective Cognitive Neuroscience, National Institute of Mental Health, NIH, Department of Health and Human Services, Bethesda, MD 20892, USA.
| |
Collapse
|
29
|
Thomas LA, Kim P, Bones BL, Hinton KE, Milch HS, Reynolds RC, Adleman NE, Marsh AA, Blair RJR, Pine DS, Leibenluft E. Elevated amygdala responses to emotional faces in youths with chronic irritability or bipolar disorder. Neuroimage Clin 2013; 2:637-645. [PMID: 23977455 PMCID: PMC3746996 DOI: 10.1016/j.nicl.2013.04.007] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
A major controversy in child psychiatry is whether bipolar disorder (BD) presents in children as severe, non-episodic irritability (operationalized here as severe mood dysregulation, SMD), rather than with manic episodes as in adults. Both classic, episodic BD and SMD are severe mood disorders characterized by deficits in processing emotional stimuli. Neuroimaging techniques can be used to test whether the pathophysiology mediating these deficits are similar across the two phenotypes. Amygdala dysfunction during face emotion processing is well-documented in BD, but little is known about amygdala dysfunction in chronically irritable youth. We compared neural activation in SMD (n = 19), BD (n = 19), and healthy volunteer (HV; n = 15) youths during an implicit face-emotion processing task with angry, fearful and neutral expressions. In the right amygdala, both SMD and BD exhibited greater activity across all expressions than HV. However, SMD and BD differed from each other and HV in posterior cingulate cortex, posterior insula, and inferior parietal lobe. In these regions, only SMD showed deactivation in response to fearful expressions, whereas only BD showed deactivation in response to angry expressions. Thus, during implicit face emotion processing, youth with BD and those with SMD exhibit similar amygdala dysfunction but different abnormalities in regions involved in information monitoring and integration. Youths with severe mood dysregulation (SMD), bipolar disorder (BD), controls. Implicit face-emotion processing fMRI task with angry, fearful, neutral emotions. In R amygdala, SMD and BD had greater activity across all expressions vs controls. In whole brain analysis SMD had decreased, BD increased activity vs. other groups.
Collapse
Affiliation(s)
- Laura A Thomas
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland ; National Institute on Drug Abuse, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Hicks S, Scahill RI, Dumas E, Durr A, Blair R, Levitt BR, Roos RAC, Tabrizi SJ, Kennard C. OCULOMOTOR DEFICITS IN PREMANIFEST AND EARLY HUNTINGTON'S DISEASE AND THEIR STRUCTURAL BRAIN CORRELATES: THE LONGITUDINAL TRACK-HD STUDY. J Neurol Neurosurg Psychiatry 2012. [DOI: 10.1136/jnnp-2012-304200a.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
31
|
|
32
|
Abstract
The goal of this paper is to consider anger from a cognitive neuroscience perspective. Five main claims are made: first, reactive aggression is the ultimate behavioral expression of anger and thus we can begin to understand anger by understanding reactive aggression. Second, neural systems implicated in reactive aggression (amygdala, hypothalamus, and periaqueductal gray; the basic threat system) are critically implicated in anger. Factors such as exposure to extreme threat that increase the responsiveness of these systems, should be (and are in the context of posttraumatic stress disorder), associated with increased anger. Third, regions of frontal cortex implicated in regulating the basic threat system, when dysfunctional (e.g., in the context of lesions) should be associated with increased anger. Fourth, frustration occurs when an individual continues to do an action in the expectation of a reward but does not actually receive that reward, and is associated with anger. Individuals who show impairment in the ability to alter behavioral responding when actions no longer receive their expected rewards should be (and are in the context of psychopathy) associated with increased anger. Fifth, someone not doing what another person wants them to do (particularly if this thwarts the person's goal) is frustrating and consequently anger inducing. The response to such a frustrating social event relies on the neural architecture implicated in changing behavioral responses in nonsocial frustrating situations. WIREs Cogn Sci 2012, 3:65-74. doi: 10.1002/wcs.154 This article is categorized under: Psychology > Brain Function and Dysfunction.
Collapse
Affiliation(s)
- R J R Blair
- National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| |
Collapse
|
33
|
Blair KS, Geraci M, Korelitz K, Otero M, Towbin K, Ernst M, Leibenluft E, Blair RJR, Pine DS. The pathology of social phobia is independent of developmental changes in face processing. Am J Psychiatry 2011; 168:1202-9. [PMID: 21632650 PMCID: PMC3248999 DOI: 10.1176/appi.ajp.2011.10121740] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE While social phobia in adolescence predicts the illness in adulthood, no study has directly compared the neural responses in social phobia in adults and adolescents. The authors examined neural responses to facial expressions in adults and adolescents with social phobia to determine whether the neural correlates of adult social phobia during face processing also manifest in adolescent social phobia. METHOD Blood-oxygen-level-dependent (BOLD) responses were compared in 39 medication-free participants with social phobia (25 adults and 14 adolescents) and 39 healthy comparison subjects (23 adults and 16 adolescents) matched on age, IQ, and gender. During fMRI scans, participants saw angry, fearful, and neutral expression stimuli while making a gender judgment. RESULTS Significant diagnosis-by-emotion interactions were observed within the amygdala and the rostral anterior cingulate cortex, as has previously been hypothesized. In these regions, both the adolescent and adult social phobia patients showed significantly increased BOLD responses relative to their respective age-matched comparison subjects, and there was no evidence of age-related modulation of between-group differences. These enhanced responses occurred specifically when viewing angry (rostral anterior cingulate cortex) and fearful (amygdala and rostral anterior cingulate cortex) expressions but not when viewing neutral expressions. In addition, the severity of social phobia was significantly correlated with the enhanced rostral anterior cingulate cortex response in the adults. CONCLUSIONS The neural correlates of adult social phobia during face processing also manifest in adolescents. Neural correlates that are observed in adult social phobia may represent the persistence of profiles established earlier in life rather than adaptive responses to such earlier perturbations or maturational changes. These cross-sectional observations might encourage longitudinal fMRI studies of adolescent social phobia.
Collapse
Affiliation(s)
- Karina S. Blair
- Mood & Anxiety Program, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
,Correspondence concerning the article should be addressed to Karina S. Blair, Mood & Anxiety Program, National Institute of Mental Health, 15K North Drive, MSC 2670, Bethesda, Maryland 20892; ; phone (301) 451-5088
| | - Marilla Geraci
- Mood & Anxiety Program, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Katherine Korelitz
- Mood & Anxiety Program, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Marcela Otero
- Mood & Anxiety Program, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Ken Towbin
- Mood & Anxiety Program, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Monique Ernst
- Mood & Anxiety Program, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Ellen Leibenluft
- Mood & Anxiety Program, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - RJR Blair
- Mood & Anxiety Program, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Daniel S. Pine
- Mood & Anxiety Program, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| |
Collapse
|
34
|
Marsh AA, Crowe SL, Yu HH, Gorodetsky EK, Goldman D, Blair RJR. Serotonin transporter genotype (5-HTTLPR) predicts utilitarian moral judgments. PLoS One 2011; 6:e25148. [PMID: 21998637 PMCID: PMC3187753 DOI: 10.1371/journal.pone.0025148] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Accepted: 08/29/2011] [Indexed: 11/18/2022] Open
Abstract
Background The psychological and neurobiological processes underlying moral judgment have been the focus of extensive recent research. Here we show that serotonin transporter (5-HTTLPR) genotype predicts responses to moral dilemmas featuring foreseen harm to an innocent. Methodology/Principal Findings Participants in this study judged the acceptability of actions that would unintentionally or intentionally harm an innocent victim in order to save others' lives. An analysis of variance revealed a genotype × scenario interaction, F(2, 63) = 4.52, p = .02. Results showed that, relative to long allele homozygotes (LL), carriers of the short (S) allele showed particular reluctance to endorse utilitarian actions resulting in foreseen harm to an innocent individual. LL genotype participants rated perpetrating unintentional harm as more acceptable (M = 4.98, SEM = 0.20) than did SL genotype participants (M = 4.65, SEM = 0.20) or SS genotype participants (M = 4.29, SEM = 0.30). No group differences in moral judgments were observed in response to scenarios featuring intentional harm. Conclusions/Significance The results indicate that inherited variants in a genetic polymorphism that influences serotonin neurotransmission influence utilitarian moral judgments as well. This finding is interpreted in light of evidence that the S allele is associated with elevated emotional responsiveness.
Collapse
Affiliation(s)
- Abigail A Marsh
- Department of Psychology, Georgetown University, Washington, District of Columbia, United States of America.
| | | | | | | | | | | |
Collapse
|
35
|
|
36
|
Blair RJR. Commentary: are callous unemotional traits all in the eyes? Examining eye contact in youth with conduct problems and callous unemotional traits-reflections on Dadds et al. (2011). J Child Psychol Psychiatry 2011; 52:246-7. [PMID: 21294727 DOI: 10.1111/j.1469-7610.2010.02364.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- R J R Blair
- National Institute of Mental Health, Bethesda, MD 20892-2670, USA.
| |
Collapse
|
37
|
Marsh AA, Kozak MN, Wegner DM, Reid ME, Yu HH, Blair RJR. The neural substrates of action identification. Soc Cogn Affect Neurosci 2010; 5:392-403. [PMID: 20150343 PMCID: PMC2999755 DOI: 10.1093/scan/nsq004] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2008] [Accepted: 11/24/2009] [Indexed: 11/13/2022] Open
Abstract
Mentalization is the process by which an observer views a target as possessing higher cognitive faculties such as goals, intentions and desires. Mentalization can be assessed using action identification paradigms, in which observers choose mentalistic (goals-focused) or mechanistic (action-focused) descriptions of targets' actions. Neural structures that play key roles in inferring goals and intentions from others' observed or imagined actions include temporo-parietal junction, ventral premotor cortex and extrastriate body area. We hypothesized that these regions play a role in action identification as well. Data collected using functional magnetic resonance imaging (fMRI) confirmed our predictions that activity in ventral premotor cortex and middle temporal gyrus near the extrastriate body area varies both as a function of the valence of the target and the extent to which actions are identified as goal-directed. In addition, the inferior parietal lobule is preferentially engaged when participants identify the actions of mentalized targets. Functional connectivity analyses suggest support from other regions, including the medial prefrontal cortex and amygdala, during mentalization. We found correlations between action identification and Autism Quotient scores, suggesting that understanding the neural correlates of action identification may enhance our understanding of the underpinnings of essential social cognitive processes.
Collapse
Affiliation(s)
- Abigail A Marsh
- Department of Psychology, Georgetown University, 37th and O St. NW, Washington, DC 20057, USA.
| | | | | | | | | | | |
Collapse
|
38
|
Abstract
This article is an author response to Harenski and Kiehl's (2010) commentary on Blair (2010).
Collapse
Affiliation(s)
- R J R Blair
- Mood and Anxiety Program, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD 20892-2670, USA.
| |
Collapse
|
39
|
Affiliation(s)
- R J R Blair
- Mood and Anxiety Program, National Institute of Mental Health, National Institutes of Health, 15k North Drive, Bethesda MD 20892, USA.
| |
Collapse
|
40
|
Luo Q, Cheng X, Holroyd T, Majestic C, Schechter J, Blair RJR. Emotional automaticity? It is a matter of timing --- spatiotemporal dynamics of the amygdala in the gamma band. Neuroimage 2009. [DOI: 10.1016/s1053-8119(09)72013-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
41
|
Abstract
BACKGROUND Social dominance and physical size are closely linked. Nonverbal dominance displays in many non-human species are known to increase the displayer's apparent size. Humans also employ a variety of nonverbal cues that increase apparent status, but it is not yet known whether these cues function via a similar mechanism: by increasing the displayer's apparent size. METHODOLOGY/PRINCIPAL FINDING We generated stimuli in which actors displayed high status, neutral, or low status cues that were drawn from the findings of a recent meta-analysis. We then conducted four studies that indicated that nonverbal cues that increase apparent status do so by increasing the perceived size of the displayer. Experiment 1 demonstrated that nonverbal status cues affect perceivers' judgments of physical size. The results of Experiment 2 showed that altering simple perceptual cues can affect judgments of both size and perceived status. Experiment 3 used objective measurements to demonstrate that status cues change targets' apparent size in the two-dimensional plane visible to a perceiver, and Experiment 4 showed that changes in perceived size mediate changes in perceived status, and that the cue most associated with this phenomenon is postural openness. CONCLUSIONS/SIGNIFICANCE We conclude that nonverbal cues associated with social dominance also affect the perceived size of the displayer. This suggests that certain nonverbal dominance cues in humans may function as they do in other species: by creating the appearance of changes in physical size.
Collapse
Affiliation(s)
- Abigail A Marsh
- Department of Psychology, Georgetown University, Washington, DC, United States of America.
| | | | | | | |
Collapse
|
42
|
Marsh AA, Blair KS, Jones MM, Soliman N, Blair RJR. Dominance and submission: the ventrolateral prefrontal cortex and responses to status cues. J Cogn Neurosci 2009; 21:713-24. [PMID: 18578604 DOI: 10.1162/jocn.2009.21052] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Status hierarchies constitute a fundamental organizing principle of human society. However, little is known about the neural systems that process nonverbal cues that indicate status. Preliminary neuropsychological work has suggested a role for the ventrolateral and ventromedial prefrontal cortex (VLPFC/VMPFC) and the superior temporal cortex (STC). We used functional magnetic resonance imaging to delineate the nature of these roles. Analyses revealed signal changes in the right VLPFC in connection with two primary functions attributed to status cues. Status cues moderate behavior and the right VLPFC showed increased signal for high-status relative to neutral and low-status cues. The VLPFC also showed increased signal for high-status cues displayed by individuals of the opposite gender to the perceiver; this may be relevant to the role status cues play in moderating mate choice behavior. Connectivity results indicated significant positive connectivity between the VLPFC and both the VMPFC and the STC. We suggest that the VLPFC retrieves information from these regions when processing hierarchy cues to facilitate socially adaptive behavior.
Collapse
Affiliation(s)
- Abigail A Marsh
- Mood & Anxiety Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA.
| | | | | | | | | |
Collapse
|
43
|
Abstract
Psychopathy is a developmental disorder marked by emotional hypo-responsiveness and an increased risk for antisocial behavior. Influential attention-based accounts of psychopathy have long been made; however, these accounts have made relatively little reference to general models of attention in healthy individuals. This review has three aims: (1) to summarize current cognitive neuroscience data on differing attentional systems; (2) to examine the functional integrity of these attentional systems in individuals with psychopathy; and (3) to consider the implications of these data for attention and emotion dysfunction accounts of psychopathy.
Collapse
Affiliation(s)
- R J R Blair
- Mood and Anxiety Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA.
| | | |
Collapse
|
44
|
Affiliation(s)
- R J R Blair
- Mood and Anxiety Program, Department of Health and Human Services, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA.
| |
Collapse
|
45
|
Guyer AE, Lau JYF, McClure-Tone EB, Parrish J, Shiffrin ND, Reynolds RC, Chen G, Blair RJR, Leibenluft E, Fox NA, Ernst M, Pine DS, Nelson EE. Amygdala and ventrolateral prefrontal cortex function during anticipated peer evaluation in pediatric social anxiety. ACTA ACUST UNITED AC 2008; 65:1303-12. [PMID: 18981342 DOI: 10.1001/archpsyc.65.11.1303] [Citation(s) in RCA: 259] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Amygdala and ventrolateral prefrontal cortex (vlPFC) dysfunction manifests in adolescents with anxiety disorders when they view negatively valenced stimuli in threatening contexts. Such fear-circuitry dysfunction may also manifest when anticipated social evaluation leads socially anxious adolescents to misperceive peers as threatening. OBJECTIVE To determine whether photographs of negatively evaluated smiling peers viewed during anticipated social evaluation engage the amygdala and vlPFC differentially in adolescents with and without social anxiety. DESIGN Case-control study. SETTING Government clinical research institute. PARTICIPANTS Fourteen adolescents with anxiety disorders associated with marked concerns of social evaluation and 14 adolescents without a psychiatric diagnosis matched on sex, age, intelligence quotient, and socioeconomic status. MAIN OUTCOME MEASURES Blood oxygenation level-dependent signal measured with event-related functional magnetic resonance imaging. Before and during neuroimaging scans, participants anticipating social evaluation completed peer- and self-appraisals. Event-related analyses were tailored to participants' ratings of specific peers. RESULTS Participants classified 40 pictures of same-age peers as ones with whom they did or did not want to engage in a social interaction. Anxious adolescents showed greater amygdala activation than healthy adolescents when anticipating evaluation from peers previously rated as undesired for an interaction. Psychophysiological interaction connectivity analyses also revealed a significant positive association between amygdala and vlPFC activation in anxious vs healthy adolescents in response to these stimuli. CONCLUSIONS Anticipating social evaluation from negatively perceived peers modulates amygdala and vlPFC engagement differentially in anxious and healthy adolescents. Amygdala and vlPFC dysfunction manifests in adolescent anxiety disorders in specific contexts of anticipated peer evaluation.
Collapse
Affiliation(s)
- Amanda E Guyer
- Mood and Anxiety Program, National Institute of Mental Health, National Institutes of Health, 15K North Dr, Room 208, Bethesda, MD 20892-2670, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Blair K, Geraci M, Devido J, McCaffrey D, Chen G, Vythilingam M, Ng P, Hollon N, Jones M, Blair RJR, Pine DS. Neural response to self- and other referential praise and criticism in generalized social phobia. ACTA ACUST UNITED AC 2008; 65:1176-84. [PMID: 18838634 DOI: 10.1001/archpsyc.65.10.1176] [Citation(s) in RCA: 130] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Generalized social phobia (GSP) is characterized by fear/avoidance of social situations. Previous studies have examined the neural responses in GSP to one class of social stimuli, facial expressions. However, studies have not examined the neural response in GSP to another equally important class of social stimuli, the communication of praise or criticism. OBJECTIVE To examine the neural response to receipt of praise or criticism in GSP; specifically, to determine whether patients with GSP show an increased response to the receipt of both praise and criticism and whether self-relevance modulates this relationship. DESIGN Case-control study. SETTING Government clinical research institute. PARTICIPANTS Unmedicated individuals with GSP (n = 17) and age-, IQ-, and sex-matched healthy comparison individuals (n = 17). MAIN OUTCOME MEASURE Blood oxygenation level-dependent signal, as measured via functional magnetic resonance imaging. During functional magnetic resonance imaging scans, individuals read positive (eg, You are beautiful), negative (eg, You are ugly), and neutral (eg, You are human) comments that could be either about the self or about somebody else (eg, He is beautiful). RESULTS Hypothesized significant group x valence x referent interactions were observed within regions of the medial prefrontal cortex and bilateral amygdala. In these regions, the patients with GSP showed significantly increased blood oxygenation level-dependent responses, relative to comparison individuals, to negative comments (criticism) referring to themselves. However, in contrast, there were no significant group differences with respect to negative comments referring to others or neutral or positive comments referring to self or others. CONCLUSIONS These results implicate the medial prefrontal cortex, involved in the representation of the self, together with the amygdala, in the pathophysiology of GSP. Further, findings demonstrate a meaningful effect of psychological context on neural-circuitry hyperactivity in GSP.
Collapse
Affiliation(s)
- Karina Blair
- Mood and Anxiety Program, National Institute of Mental Health, 15K North Dr, MSC 2670, Bethesda, MD 20892, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Blair RJR. The amygdala and ventromedial prefrontal cortex: functional contributions and dysfunction in psychopathy. Philos Trans R Soc Lond B Biol Sci 2008; 363:2557-65. [PMID: 18434283 DOI: 10.1098/rstb.2008.0027] [Citation(s) in RCA: 175] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The current paper examines the functional contributions of the amygdala and ventromedial prefrontal cortex (vmPFC) and the evidence that the functioning of these systems is compromised in individuals with psychopathy. The amygdala is critical for the formation of stimulus-reinforcement associations, both punishment and reward based, and the processing of emotional expressions. vmPFC is critical for the representation of reinforcement expectancies and, owing to this, decision making. Neuropsychological and neuroimaging data from individuals with psychopathy are examined. It is concluded that these critical functions of the amygdala and vmPFC, and their interaction, are compromised in individuals with the disorder. It is argued that these impairments lead to the development of psychopathy.
Collapse
Affiliation(s)
- R J R Blair
- Mood & Anxiety Program, National Institute of Mental Health, National Institutes of Health, 15k North Drive, Bethesda, MD 20892, USA.
| |
Collapse
|
48
|
Abstract
Empathy is a lay term that is becoming increasingly used in the field of cognitive neuroscience. In this paper, it is argued that empathy is a loose collection of partially dissociable neurocognitive systems. Two forms of 'emotional' empathy were considered: First, responding to emotional expressions, particularly angry expressions, leading to response reversal. Secondly, responding to emotional expressions, particularly fearful and sad expressions, leading to stimulus-reinforcement learning. The implications of these forms of empathy for understanding specific psychiatric conditions are briefly considered.
Collapse
Affiliation(s)
- R J R Blair
- Mood and Anxiety Disorders Program, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, 15K North Drive, Room 206, MSC 2670, Bethesda, MD 20892-2670, USA
| |
Collapse
|
49
|
Chong CH, Zulkifli I, Blair R. Effects of Dietary Inclusion of Palm Kernel Cake and Palm Oil, and Enzyme Supplementation on Performance of Laying Hens. Asian Australas J Anim Sci 2008. [DOI: 10.5713/ajas.2008.70581] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
50
|
Marsh AA, Finger EC, Mitchell DGV, Reid ME, Sims C, Kosson DS, Towbin KE, Leibenluft E, Pine DS, Blair RJR. Reduced amygdala response to fearful expressions in children and adolescents with callous-unemotional traits and disruptive behavior disorders. Am J Psychiatry 2008; 165:712-20. [PMID: 18281412 DOI: 10.1176/appi.ajp.2007.07071145] [Citation(s) in RCA: 494] [Impact Index Per Article: 30.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Extensive work implicates abnormal amygdala activation in emotional facial expression processing in adults with callous-unemotional traits. However, no research has examined amygdala response to emotional facial expressions in adolescents with disruptive behavior and callous-unemotional traits. Moreover, despite high comorbidity of callous-unemotional traits and attention deficit hyperactivity disorder (ADHD), no research has attempted to distinguish neural correlates of pediatric callous-unemotional traits and ADHD. METHOD Participants were 36 children and adolescents (ages 10-17 years); 12 had callous-unemotional traits and either conduct disorder or oppositional defiant disorder, 12 had ADHD, and 12 were healthy comparison subjects. Functional MRI was used to assess amygdala activation patterns during processing of fearful facial expressions. Patterns in the callous-unemotional traits group were compared with those in the ADHD and comparison groups. RESULTS In youths with callous-unemotional traits, amygdala activation was reduced relative to healthy comparison subjects and youths with ADHD while processing fearful expressions, but not neutral or angry expressions. Functional connectivity analyses demonstrated greater correlations between the amygdala and the ventromedial prefrontal cortex in comparison subjects and youths with ADHD relative to those with callous-unemotional traits. Symptom severity in the callous-unemotional traits groups was negatively correlated with connectivity between amygdala and ventromedial prefrontal cortex. CONCLUSIONS This is the first study to demonstrate reduced amygdala responsiveness in youths with callous-unemotional traits. These findings support the contention that callous and unemotional personality traits are associated with reduced amygdala response to distress-based social cues.
Collapse
Affiliation(s)
- Abigail A Marsh
- Mood and Anxiety Program, NIMH, 15K North Dr., MSC 2670, Bethesda, MD 20892, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|