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Bhakat P, Das K. Status of mental health among college and university students during first and second wave of COVID-19 outbreak in India: A cross-sectional study. J Affect Disord Rep 2023; 12:100494. [PMID: 36777966 PMCID: PMC9894831 DOI: 10.1016/j.jadr.2023.100494] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 02/05/2023] Open
Abstract
Background India has been badly affected by Covid-19 not only in terms of human lives but also has a long-term effect on mental health of the population. This paper is an attempt to understand the psychological effects of the pandemic on the college and university students in India after the second wave of COVID-19 outbreak and its associated factors. Method A web-based survey was conducted to collect information from the students both at individual and household level. The study applied binary and multivariate logistic regression to estimate the adjusted and unadjusted marginal effects of the predictor variables. Result Results show a significant increase in mental health concerns during the second wave of the pandemic, as compared to the first year. The key factors contributing to the higher prevalence of depression, anxiety, and stress are the difficulties faced in the adaptation to the new way of learning, fear of discontinuation of education due to financial constraints faced by household, limited physical interaction, and prolonged screen-time during the pandemic. Limitation The study has some limitations regarding selection of the sample as the survey was web-based. Also, the mental health situation of the students is self-reported and the study does not consider the prevailing mental health issues before the pandemic. Conclusion The study recommends initiatives like offering counselling classes and strategies to cope up with mental health disorders. Further, there is a need to conduct follow-up studies to assess the long-term impacts of prolonged home quarantine on the mental health of the students.
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Key Words
- Anxiety
- BAI, Beck Anxiety Inventory
- BDI, Beck Depression Inventory
- CBI-S, Copenhagen Burnout Inventory Scale
- CDI-S, Children's Depression Inventory
- CES-D, Center for Epidemiological Studies-Depression Scale
- CES-DC, Center for Epidemiological Studies-Depression Scale for Children
- COVID-19
- DASS-21, Depression Anxiety Stress Scales
- Depression
- EDI-3, Eating Disorder Inventory-3
- EHQ, Eating Habits Questionnaire
- ESS, Epworth Sleepiness Scale
- GAD-7, Generalized Anxiety Disorder
- ISI-7, Insomnia Severity Index
- India
- KPDS-6, Kessler Psychological Distress Scale
- Mental health
- OCI-R, Obsessive-Compulsive Inventory –Revised
- PHQ-9, Patient Health Questionnaire-9 Scale
- SCARED, Screen for Child Anxiety Related Emotional Disorders
- Second wave
- Stress
- WEMWBS, Warwick-Edinburgh Mental Well-Being Scale
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Affiliation(s)
- Priya Bhakat
- Priya Bhakat is associated with Southeast Regional Service Commission, New Brunswick, Canada
| | - Kakoli Das
- Kakoli Das is a Senior Doctoral Scholar at Institute of Development Studies Kolkata & Assistant Professor, CDOE, Vidyasagar University, India
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Nogami W, Nakagawa A, Kato N, Sasaki Y, Kishimoto T, Horikoshi M, Mimura M. Efficacy and Acceptability of Remote Cognitive Behavioral Therapy for Patients With Major Depressive Disorder in Japanese Clinical Settings: A Case Series. Cogn Behav Pract 2022; 30:S1077-7229(22)00080-3. [PMID: 36059862 PMCID: PMC9417319 DOI: 10.1016/j.cbpra.2022.04.002] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 04/14/2022] [Indexed: 11/26/2022]
Abstract
Remote cognitive and behavioral therapy (CBT) via videoconference has been garnering attention as a means of improving access to CBT for depression, in particular during the coronavirus disease 2019 pandemic. However, there is a lack of evidence supporting its implementation in Japanese clinical settings. This case series aimed to establish preliminary evidence of whether remote CBT can be an effective therapy for major depression in Japanese clinical settings. Five patients who met the diagnostic criteria for major depressive disorder were enrolled and underwent remote CBT via videoconference and face-to-face assessment interviews. The results showed that remote CBT via videoconference improved depressive symptoms, enabling a relatively high level of patient satisfaction and working alliance. Moreover, detailed feedback from our patients showed that continuous monitoring was preferable for increasing treatment engagement. Further research is warranted to test the efficacy and acceptability of remote CBT via videoconference for treating major depression.
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Affiliation(s)
- Waka Nogami
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo
| | - Atsuo Nakagawa
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo
- Department of Neuropsychiatry, St. Marianna University School of Medicine, Kawasaki
| | - Noriko Kato
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo
- National Center for Cognitive Behavioral Therapy and Research, National Center of Neurology and Psychiatry, Kodaira, Tokyo
| | - Yohei Sasaki
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo
| | - Taishiro Kishimoto
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo
- Hills Joint Research Laboratory for Future Preventive Medicine and Wellness, Keio University School of Medicine, Tokyo
| | - Masaru Horikoshi
- National Center for Cognitive Behavioral Therapy and Research, National Center of Neurology and Psychiatry, Kodaira, Tokyo
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo
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Diaz K, Kohut ML, Russell DW, Stegemöller EL. Peripheral inflammatory cytokines and motor symptoms in persons with Parkinson's disease. Brain Behav Immun Health 2022; 21:100442. [PMID: 35308082 PMCID: PMC8927904 DOI: 10.1016/j.bbih.2022.100442] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 02/28/2022] [Accepted: 03/03/2022] [Indexed: 12/11/2022] Open
Abstract
Background Many of the motor symptoms of Parkinson's disease (PD) impact quality of life and are not fully ameliorated by current pharmacological and surgical treatments. A better understanding of the pathophysiology underlying these symptoms is needed. Previous research has suggested that inflammation may play a significant role in PD pathophysiology and progression, but there is limited research exploring how inflammation directly relates to motor symptoms in PD. Thus, the purpose of this study was to evaluate associations between peripheral immune inflammatory markers and motor symptoms of PD, specifically, tremor, bradykinesia, and postural and gait instability. We hypothesized that peripheral inflammatory cytokines would predict the severity of motor symptoms in persons with PD, and that there will be higher levels of peripheral inflammatory cytokine markers in persons with PD when compared to age-matched healthy older adults. Methods Twenty-six participants with PD and fourteen healthy older adults completed the study. For participants with PD, the motor section of the Unified Parkinson's Disease Rating Scale (UPDRS) was recorded and scored by two Movement Disorders Neurologists masked to the study. A blood sample was collected from both participants with PD and the healthy older adults. Through the MILLIPLEX® map High Sensitivity Human Cytokine Kit, key inflammation-related markers were analyzed (TNF-α, IFN-γ, IL-1β, IL-8, IL-2, IL-7, IL-5, IL-13, IL, 4, IL-10 IL-12p70, GM-CSF, and IL-6). Results Results revealed significantly higher levels of IL-6 in persons with PD when compared to healthy older adults (p = 0.005). Moreover, results revealed that higher levels of IL-4 (p = 0.011) and lower levels of IFNγ (p = 0.003) significantly predicted more severe tremor in persons with PD. No other associations between the peripheral inflammation markers and other motor symptoms were observed. Conclusions Overall, these results are consistent with a growing body of literature that implicates inflammatory cytokines in the PD, and further suggests that inflammatory cytokines, or lack thereof, may be associated with tremor in persons with PD.
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Affiliation(s)
- K Diaz
- Department of Kinesiology, Iowa State University, Ames, IA, USA
| | - M L Kohut
- Department of Kinesiology, Iowa State University, Ames, IA, USA
| | - D W Russell
- Department of Human Development & Family Studies, Iowa State University, Ames, IA, USA
| | - E L Stegemöller
- Department of Kinesiology, Iowa State University, Ames, IA, USA
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Rajpurohit S, Musunuri B, Basthi Mohan P, Shetty S. Novel Drugs for the Management of Hepatic Encephalopathy: Still a Long Journey to Travel. J Clin Exp Hepatol 2022; 12:1200-1214. [PMID: 35814520 PMCID: PMC9257922 DOI: 10.1016/j.jceh.2022.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/24/2022] [Indexed: 12/12/2022] Open
Abstract
Hepatic encephalopathy (HE) is one of the reversible complications of chronic liver disease, associated with a higher mortality rate. In current clinical practice, treatment with rifaximin and lactulose/lactitol is the first line of treatment in HE. With the advance in pathophysiology, a new class of ammonia lowering drugs has been revealed to overcome the hurdle and disease burden. The mechanism of the novel agents differs significantly and includes the alteration in intestinal microbiota, intestinal endothelial integrity, oxidative stress, inflammatory markers, and modulation of neurotoxins. Most of the trials have reported promising results in the treatment and prevention of HE with fecal microbiota transplantation, albumin, probiotics, flumazenil, polyethylene glycol, AST-120, glycerol phenylbutyrate, nitazoxanide, branched-chain amino acid, naloxone, and acetyl-l-carnitine. However, their clinical use is limited due to the presence of major drawbacks in their study design, sample size, safety profile, bias, and heterogenicity. This study will discuss the novel therapeutic targets for HE in liver cirrhosis patients with supporting clinical trial data.
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Key Words
- ALC, acetyl-L-carnitine
- BCAA, branched-chain amino acid
- BD, twice a day
- BDI, Beck Depression Inventory
- BUN, blood urea nitrogen
- CHESS, Clinical Hepatic Encephalopathy Staging Scale
- CLDQ, Chronic Liver Disease Questionnaire
- ECT, estimated completion time
- EEG, electroencephalogram
- FMT, fecal microbiota transplantation
- GPB, glycerol phenylbutyrate
- HESA, Hepatic Encephalopathy Scoring Algorithm
- HRQOL, health-related quality of life
- IV, intravenous
- MED, Modified Encephalopathy Scale
- MELD, Model for End-stage Liver Disease
- MMSE, Mini-Mental State Examination
- NTZ, nitazoxanide
- Nal, naloxone
- OD, once a day
- ORT, object recognition test
- PEG, polyethylene glycol
- QID, four times a day
- QOL, quality of life
- RBNS, Repeatable Battery for the Assessment of Neuropsychological Status
- RCT, randomized control trial
- RT-qPCR, real-time quantitative polymerase chain reaction
- TID, three times a day
- VSL#3, high concentration probiotic preparations
- hepatic encephalopathy
- liver cirrhosis
- novel drugs
- treatment outcome
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Affiliation(s)
| | | | | | - Shiran Shetty
- Address for correspondence: Shiran Shetty, Department of Gastroenterology and Hepatology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India.
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Abstract
Background Skin diseases that cause chronic pruritus can have negative effects on a patient's quality of life. Objective We evaluated the associations between chronic pruritus and psychological conditions including insomnia and depression. Methods This study included responses from 91 participants with chronic pruritus (response rate: 74.6%). A survey including questionnaires regarding data on demographic characteristics, intensity of pruritus using the visual analog scale (VAS) and the 4-item itch questionnaire, and the degrees of insomnia and depression measured by the Insomnia Severity Index and Beck Depression Inventory, respectively. Results Patients with symptoms of insomnia or depression had significantly more intense pruritus than patients without psychological symptoms (insomnia, VAS median [interquartile range]: 7.0 [5.0-8.25] vs. 5.0 [3.0-7.5]; depression, VAS median [interquartile range]: 7.5 [5.0-8.25] vs. 5.0 [3.0-7.0]). Multivariable analyses revealed that patients with moderate to severe pruritus were more likely to have depression than those with mild pruritus (odds ratio: 10.95; 95% confidence interval: 2.24-53.06). There were no differences in the severity of insomnia and depression among skin diseases. Limitations This study had a cross-sectional design and limited generalizability. Conclusion Chronic pruritus is significantly associated with insomnia and depression, regardless of the etiology.
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Affiliation(s)
- Jaein Lee
- Department of Dermatology, National Medical Center, Seoul, Korea
| | - Hyunyi Suh
- Widwin Dermatologic Clinic, Seoul, Korea
| | - Hyejung Jung
- Department of Dermatology, National Medical Center, Seoul, Korea
| | - Miyoun Park
- Department of Dermatology, National Medical Center, Seoul, Korea
| | - Jiyoung Ahn
- Department of Dermatology, National Medical Center, Seoul, Korea
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van Veenendaal NR, van Kempen AA, Franck LS, O'Brien K, Limpens J, van der Lee JH, van Goudoever JB, van der Schoor SR. Hospitalising preterm infants in single family rooms versus open bay units: A systematic review and meta-analysis of impact on parents. EClinicalMedicine 2020; 23:100388. [PMID: 32548575 PMCID: PMC7284081 DOI: 10.1016/j.eclinm.2020.100388] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Many parents develop stress-related symptoms and depression when their preterm infant is hospitalised in the neonatal intensive care unit (NICU) after birth. We reviewed the evidence of parent well-being with preterm infants hospitalised in single family rooms (SFRs) or in open bay neonatal units (OBUs). METHODS For this systematic review and meta-analysis, we searched MEDLINE, EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Clinicaltrials.gov, and International Clinical Trials Registry Platform (ICTRP) databases from inception through 22 November 2019 using controlled terms and text words related to prematurity and NICU-design. We included randomised and non-randomised studies comparing outcomes in parents with preterm infants admitted to SFRs or OBUs. Methodological quality was assessed using Cochrane Collaboration's Risk of Bias Tool for randomised controlled trials and the Risk of Bias Tool for Non-Randomised Studies of Interventions (ROBINS-I). Outcomes included: parental stress, satisfaction, participation (presence/involvement/skin-to-skin care), self-efficacy, parent-infant-bonding, depression, anxiety, post-traumatic stress, empowerment, and degree of family-centred care. Summary estimates were calculated using random effects models with standardised mean differences (SMDs). PROSPERO registration: CRD42016050643. FINDINGS We identified 614 unique publications. Eleven study populations (1, 850 preterm infants, 1, 549 mothers and 379 fathers) were included. All but one study were at serious to critical risk of bias. SFRs were associated with higher levels of parental presence, involvement, and skin-to-skin care. Upon discharge, SFRs were associated with lower stress levels (n = 828 parents, SMD-0·30,95%CI -0·50;-0·09, p<0·004, I2=46%), specifically NICU-related stress (n = 573, SMD-0·42,95%CI -0·61;-0·23, p<0·0001, I2=0%). In majority of studies higher levels of empowerment, family-centred care, and satisfaction was present with SFRs. No differences were found for anxiety, parent-infant bonding, or self-efficacy. Depression was high (up to 29%) but not different between settings. No studies described post-traumatic stress. INTERPRETATION Single family rooms seem to facilitate parental presence, involvement, skin-to-skin care, and reduce NICU-related parental stress.
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Key Words
- AA, at admission
- BA, before-after study
- BDI, Beck Depression Inventory
- CI, confidence interval
- EPDS, Edinburgh Postnatal Depression Scale
- FCC, Family-Centred Care
- FCCS, Family-Centred Care Survey
- MPAS, Maternal Postnatal Attachment Scale
- Mo, months
- NA, not applicable
- NICU, Neonatal Intensive Care Unit
- NR, not reported
- NRPI, non-randomised prospective intervention study
- NRRI, non-randomised retrospective intervention study
- OBU, Open Bay Unit
- PES, Parent Expectations Scale
- PG, Press Ganey NICU Survey
- PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-analysis
- PROSPERO, International Prospective Register of Systematic Reviews
- PSI, Parental Stress Index
- PSS-NICU, Parental Stressor Scale – NICU
- RCT, Randomised Controlled Trial
- ROBINS-I, Risk of Bias in Non-randomised Studies of Interventions
- RoB, Risk of Bias
- SD, standard deviation
- SFR, Single Family Room
- SMD, standardised mean difference
- SPSQ, Swedish Parental Stress Index
- STAI, State-Trait Anxiety Inventory
- Wks, weeks
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Affiliation(s)
- Nicole R. van Veenendaal
- Department of Pediatrics/Neonatology, OLVG, Amsterdam, Netherlands
- Amsterdam UMC, University of Amsterdam, Vrije Universiteit, Emma Children's Hospital, Amsterdam, Netherlands
| | | | - Linda S. Franck
- School of Nursing, University of California San Francisco, San Francisco, CA, United States
| | - Karel O'Brien
- Department of Pediatrics, Mount Sinai Hospital, Toronto, Canada
| | - Jacqueline Limpens
- Medical Library Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Johanna H. van der Lee
- Amsterdam UMC, University of Amsterdam, Vrije Universiteit, Emma Children's Hospital, Amsterdam, Netherlands
- Knowledge Institute of the Dutch Association of Medical Specialists, Utrecht, The Netherlands
| | - Johannes B. van Goudoever
- Amsterdam UMC, University of Amsterdam, Vrije Universiteit, Emma Children's Hospital, Amsterdam, Netherlands
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Shrestha D, Rathi S, Grover S, Taneja S, Duseja A, Chawla YK, Dhiman RK. Factors Affecting Psychological Burden on the Informal Caregiver of Patients With Cirrhosis: Looking Beyond the Patient. J Clin Exp Hepatol 2020; 10:9-16. [PMID: 32025162 PMCID: PMC6995890 DOI: 10.1016/j.jceh.2019.06.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 06/13/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND AIMS Cirrhosis leads to considerable morbidity and mortality, compromises quality of life, and often necessitates assistance in activities of daily living. An informal caregiver bears the psychological burden of coping with the needs of the patient and the knowledge of morbid prognosis of a loved one. This aspect is rarely recognized and almost never addressed in a clinical practice. METHODS This cross-sectional study assessed the factors influencing psychological burden of cirrhosis on the caregivers in a predominantly lower-middle socioeconomic class Indian population. Patients underwent psychometric tests [Psychometric Hepatic Encephalopathy Score (PHES)], and questionnaires for quantifying caregiver burden [Perceived Caregiver Burden (PCB) and Zarit Burden Interview (ZBI)] and assessing depression [Beck Depression Inventory (BDI)] and anxiety [Beck Anxiety Inventory (BAI)] were administered. RESULTS One hundred patients with cirrhosis [70% male, 27% with past hepatic encephalopathy (HE), and 53% with minimal HE] and their caregivers (66% women, 81% spouse, 26.51 years of mean relationship) were evaluated. Caregiver burden scores were higher in patients with previous overt HE than in those without previous overt HE [PCB (74.63 vs. 66.15, P = 0.001), ZBI (27.93 vs. 21.11, P = 0.023), BDI (11.63 vs. 8.96, P = 0.082), and BAI (11.37 vs. 8.12, P = 0.027)]. Similarly, caregivers of patients with minimal HE had higher caregiver burden that those of patients who did not have minimal HE [PCB (70.74 vs. 65.85, P = 0.027), ZBI (26 vs. 19.51, P = 0.015)]. Burden scores correlated well with each other and with liver disease severity scores and negatively correlated with socioeconomic status. Repeated hospital admissions, alcohol as etiology, and lower socioeconomic status were the independent predictors of caregiver burden. CONCLUSION Higher perceived burden is common in caregivers of patients with cirrhosis. Repeated hospital admissions, alcoholism, and lower socioeconomic status influence caregiver burden.
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Affiliation(s)
- Deepa Shrestha
- Department of Internal Medicine, Postgraduate Institution of Medical Education and Research, Chandigarh, India
| | - Sahaj Rathi
- Department of Hepatology, Postgraduate Institution of Medical Education and Research, Chandigarh, India
| | - Sandeep Grover
- Department of Psychiatry, Postgraduate Institution of Medical Education and Research, Chandigarh, India
| | - Sunil Taneja
- Department of Hepatology, Postgraduate Institution of Medical Education and Research, Chandigarh, India
| | - Ajay Duseja
- Department of Hepatology, Postgraduate Institution of Medical Education and Research, Chandigarh, India
| | - Yogesh K. Chawla
- Department of Hepatology, Postgraduate Institution of Medical Education and Research, Chandigarh, India
| | - Radha K. Dhiman
- Department of Hepatology, Postgraduate Institution of Medical Education and Research, Chandigarh, India,Address for correspondence: Radha K Dhiman, MD, DM, FAMS, FACG, FRCP Edin, FRCP London, FAASLD Professor and Head, Department of Hepatology Post Graduate Institute of Medical Education and Research, Chandigarh, India.
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Toyooka T, Wada K, Otani N, Tomiyama A, Takeuchi S, Tomura S, Nishida S, Ueno H, Nakao Y, Yamamoto T, Mori K. Potential Risks and Limited Indications of the Supraorbital Keyhole Approach for Clipping Internal Carotid Artery Aneurysms. World Neurosurg X 2019; 2:100025. [PMID: 31218296 PMCID: PMC6580886 DOI: 10.1016/j.wnsx.2019.100025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 02/15/2019] [Indexed: 11/17/2022] Open
Abstract
Background Internal carotid artery (ICA) aneurysm may be a good target for supraorbital keyhole clipping. We discuss the surgical indications and risks of keyhole clipping for ICA aneurysms based on long-term clinical and radiologic results. Methods This was a retrospective analysis of 51 patients (aged 35–75 years, mean 62 years) with ICA aneurysms (mean 5.8 ± 1.8 mm) who underwent clipping via the supraorbital keyhole approach between 2005 and 2017. Neurologic and cognitive functions were examined by several methods, including the modified Rankin Scale and Mini-Mental Status Examination. The state of clipping was assessed 1 year and then every few years after the operation. Results Complete clipping was confirmed in 45 patients (88.2%), dog-ear remnants behind the clip persisted in 4 patients, and wrapping was performed in 2 patients. Mean duration of postoperative hospitalization was 3.4 ± 6.9 days. The mean clinical follow-up period was 6.6 ± 3.2 years. The overall mortality was 0, and overall morbidity (modified Rankin Scale score ≥2 or Mini-Mental Status Examination <24) was 3.9%. Completely clipped aneurysms did not show any recurrence during the mean follow-up period of 6.3 ± 3.1 years, but the 2 (3.9%) aneurysms with neck remnants showed regrowth. Conclusions The risk of neck remnant behind the clip blade is a drawback of supraorbital keyhole clipping. The surgical indication requires preoperative simulation and careful checking of the clip blade state is essential.
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Key Words
- 3D, 3-Dimensional
- AcomA, Anterior communicating artery
- AntChoA, Anterior choroidal artery
- BDI, Beck Depression Inventory
- CT, Computed tomography
- CTA, Computed tomography angiography
- Clipping
- DSA, Digital subtraction angiography
- DWI, Diffusion-weighted imaging
- HAM-D, Hamilton Depression Scale
- HDS-R, Revised Hasegawa Dementia Scale
- ICA, Internal carotid artery
- ISUIA, International Study of Unruptured Intracranial Aneurysms
- Internal carotid artery
- Keyhole surgery
- MCA, Middle cerebral artery
- MMSE, Mini-Mental Status Examination
- MRI, Magnetic resonance imaging
- NIHSS, National Institutes of Health Stroke Scale
- PcomA, Posterior communicating artery
- UCA, Unruptured cerebral aneurysm
- Unruptured cerebral aneurysm
- mRS, Modified Rankin Scale
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Affiliation(s)
- Terushige Toyooka
- Department of Neurosurgery, Tokyo General Hospital, Tokyo, Japan.,Department of Neurosurgery, National Defense Medical College, Saitama, Japan
| | - Kojiro Wada
- Department of Neurosurgery, National Defense Medical College, Saitama, Japan
| | - Naoki Otani
- Department of Neurosurgery, National Defense Medical College, Saitama, Japan
| | - Arata Tomiyama
- Department of Neurosurgery, National Defense Medical College, Saitama, Japan
| | - Satoru Takeuchi
- Department of Neurosurgery, National Defense Medical College, Saitama, Japan
| | - Satoshi Tomura
- Department of Neurosurgery, National Defense Medical College, Saitama, Japan
| | - Sho Nishida
- Department of Neurosurgery, National Defense Medical College, Saitama, Japan
| | - Hideaki Ueno
- Department of Neurosurgery, Juntendo University, Shizuoka Hospital, Shizuoka, Japan
| | - Yasuaki Nakao
- Department of Neurosurgery, Juntendo University, Shizuoka Hospital, Shizuoka, Japan
| | - Takuji Yamamoto
- Department of Neurosurgery, Juntendo University, Shizuoka Hospital, Shizuoka, Japan
| | - Kentaro Mori
- Department of Neurosurgery, Tokyo General Hospital, Tokyo, Japan.,Department of Neurosurgery, National Defense Medical College, Saitama, Japan
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9
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Alshelh Z, Di Pietro F, Mills EP, Vickers ER, Peck CC, Murray GM, Henderson LA. Altered regional brain T2 relaxation times in individuals with chronic orofacial neuropathic pain. Neuroimage Clin 2018; 19:167-173. [PMID: 30035014 PMCID: PMC6051476 DOI: 10.1016/j.nicl.2018.04.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 01/15/2018] [Revised: 04/10/2018] [Accepted: 04/12/2018] [Indexed: 01/12/2023]
Abstract
The neural mechanisms underlying the development and maintenance of chronic pain following nerve injury remain unclear. There is growing evidence that chronic neuropathic pain is associated with altered thalamic firing patterns, thalamocortical dysrhythmia and altered infra-slow oscillations in ascending pain pathways. Preclinical and post-mortem human studies have revealed that neuropathic pain is associated with prolonged astrocyte activation in the dorsal horn and we have suggested that this may result in altered gliotransmission, which results in altered resting neural rhythm in the ascending pain pathway. Evidence of astrocyte activation above the level of the dorsal horn in living humans is lacking and direct measurement of astrocyte activation in living humans is not possible, however, there is evidence that regional alterations in T2 relaxation times are indicative of astrogliosis. The aim of this study was to use T2 relaxometry to explore regional brain anatomy of the ascending pain pathway in individuals with chronic orofacial neuropathic pain. We found that in individuals with trigeminal neuropathic pain, decreases in T2 relaxation times occurred in the region of the spinal trigeminal nucleus and primary somatosensory cortex, as well as in higher order processing regions such as the dorsolateral prefrontal, cingulate and hippocampal/parahippocampal cortices. We speculate that these regional changes in T2 relaxation times reflect prolonged astrocyte activation, which results in altered brain rhythm and ultimately the constant perception of pain. Blocking prolonged astrocyte activation may be effective in preventing and even reversing the development of chronic pain following neural injury. Reduced T2 relaxation time in the ascending pain pathway in chronic orofacial pain. These reductions may be associated with astrogliosis. Increase astrocyte activity associated with chronic orofacial pain.
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Affiliation(s)
- Z Alshelh
- Department of Anatomy and Histology, Sydney Medical School, University of Sydney, 2006, Australia
| | - F Di Pietro
- Department of Anatomy and Histology, Sydney Medical School, University of Sydney, 2006, Australia
| | - E P Mills
- Department of Anatomy and Histology, Sydney Medical School, University of Sydney, 2006, Australia
| | - E R Vickers
- Department of Anatomy and Histology, Sydney Medical School, University of Sydney, 2006, Australia
| | - C C Peck
- Faculty of Dentistry, University of Sydney, 2006, Australia
| | - G M Murray
- Faculty of Dentistry, University of Sydney, 2006, Australia
| | - L A Henderson
- Department of Anatomy and Histology, Sydney Medical School, University of Sydney, 2006, Australia.
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Abstract
Background The Cognitive Avoidance Theory of Worry argues that worry is a cognitive strategy adopted to control the physiological arousal associated with anxiety. According to this theory, pathological worry, as in Generalized Anxiety Disorder (GAD), is verbal in nature, negative and abstract, rather than concrete. Neuroimaging studies link the expression of worry to characteristic modes of brain functional connectivity, especially in relation to the amygdala. However, the distinctive features of worry (verbal, abstract, negative), and their relationship to physiological arousal, have not so far been mapped to brain function. Methods We addressed this omission by undertaking a resting-state functional magnetic resonance neuroimaging study of 19 patients with GAD and 21 controls, before and after induction of perseverative cognitions, while measuring emotional bodily arousal from heart rate (HR). Seed-based analyses quantified brain changes in whole brain functional connectivity from the amygdala. Results In GAD, the induction increased negative thoughts and their verbal content. In line with predictions, the verbal expression of worry in GAD was associated with higher HR at baseline and attenuated HR increases after induction of perseverative cognitions. Within brain, the increased use of words during worry, and the associated dampening of HR after induction were mediated by the strength of functional connectivity between the amygdala and default mode network ‘hubs’ and the opercular cortex. The negative content of worry was further related to functional communication between amygdala and cingulo-opercular and temporal cortices. Conclusions Findings provide a neurobiological basis for the impact of verbal worry on HR in GAD. More negative worrisome thoughts have more words in GAD and more images in controls. Thinking in words is associated with reduced cardiac reactivity during worry. Verbal, abstract, and negative features of worry have unique neural correlates. Amygdala functional connectivity mediates use of words and HR decrease during worry. A neurobiological basis for the impact of verbal worry on HR in GAD is provided.
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Key Words
- Amygdala
- BDI, Beck Depression Inventory
- BOLD, blood oxygenation level dependent
- DMN, default mode network
- EPI, echoplanar imaging
- Functional connectivity
- GAD, Generalized Anxiety Disorder
- Generalized anxiety disorder
- HC, Healthy Controls
- HR, heart rate
- Heart rate
- NYC-Q, New York Cognition Questionnaire
- New York Cognition Questionnaire
- PCC, posterior cingulate cortex
- PSWQ, Penn State Worry Questionnaire
- RRS, Ruminative Response Scale
- SCID, Structured Clinical Interview for DSM
- STAI, Spielberger State Trait Anxiety Inventory
- Worry
- rsfMRI, resting-state functional magnetic resonance neuroimaging
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Affiliation(s)
- Elena Makovac
- Neuroimaging Laboratory, IRCCS Santa Lucia Foundation, Rome, Italy; Psychiatry, BSMS, Department of Neuroscience, Brighton and Sussex Medical School (BSMS), University of Sussex, Brighton, UK; Centre for Neuroimaging Science, King's College London, London, UK
| | - Jonathan Smallwood
- Department of Psychology, York Neuroimaging Centre, University of York, York, UK
| | - David R Watson
- Psychiatry, BSMS, Department of Neuroscience, Brighton and Sussex Medical School (BSMS), University of Sussex, Brighton, UK
| | - Frances Meeten
- Psychiatry, BSMS, Department of Neuroscience, Brighton and Sussex Medical School (BSMS), University of Sussex, Brighton, UK; Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Hugo D Critchley
- Psychiatry, BSMS, Department of Neuroscience, Brighton and Sussex Medical School (BSMS), University of Sussex, Brighton, UK; Sackler Centre for Consciousness Science, University of Sussex, Brighton, UK; Sussex Partnership NHS Foundation Trust Sussex, Sussex, UK
| | - Cristina Ottaviani
- Neuroimaging Laboratory, IRCCS Santa Lucia Foundation, Rome, Italy; Department of Psychology, Sapienza University of Rome, Rome, Italy.
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11
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Kvamme TL, Schmidt C, Strelchuk D, Chang-Webb YC, Baek K, Voon V. Sexually dimorphic brain volume interaction in college-aged binge drinkers. Neuroimage Clin 2015; 10:310-7. [PMID: 26900571 PMCID: PMC4724035 DOI: 10.1016/j.nicl.2015.12.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [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: 09/24/2015] [Revised: 11/10/2015] [Accepted: 12/07/2015] [Indexed: 12/04/2022]
Abstract
Background Binge consumption of alcohol is a major societal problem associated with important cognitive, physiological and neurotoxic consequences. Converging evidence highlights the need to assess binge drinking (BD) and its effects on the developing brain while taking into account gender differences. Here, we compared the brain volumetric differences between genders in college-aged binge drinkers and healthy volunteers. Method T1-weighted magnetic resonance imaging (MRI) images of 30 binge drinkers (18 males) and 46 matched healthy volunteers (23 males) were examined using voxel-based morphometry. The anatomical scans were covaried with Alcohol Use Disorders Identification Test (AUDIT) scores. Whole brain voxel-wise group comparisons were performed using a cluster extent threshold correction. Results Several large clusters qualified with group-by-gender interactions were observed in prefrontal, striatal and medial temporal areas, whereby BD females had more volume than non-BD females, while males showed the inverse pattern of decreased volume in BD males and increased volume in non-BD males. AUDIT scores negatively correlated with volume in the right superior frontal cortex and precentral gyrus. Conclusions These findings dovetail with previous studies reporting that a state effect of BD in college-aged drinkers and the severity of alcohol use are associated with volumetric alterations in the cortical and subcortical areas of the brain. Our study indicates that these widespread volumetric changes vary differentially by gender, suggesting either sexual dimorphic endophenotypic risk factors, or differential neurotoxic sensitivities for males and females. We examined brain volumetric differences between genders in college-aged binge drinkers and healthy volunteers. Gender significantly moderated brain volumetric differences in prefrontal, striatal and medial temporal areas. The severity of alcohol use in binge drinkers is associated with brain volumetric changes in the superior frontal cortex and precentral gyrus.
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Key Words
- AAL, Automatic Anatomical Labeling
- AUDIT, Alcohol Use Disorders Identification Test
- AUDs, alcohol-use disorders
- Adolescence
- Alcohol
- BD, binge drinking
- BDI, Beck Depression Inventory
- Binge drinking
- FWE, familywise error
- GLM, general linear model
- Gender
- HV, healthy volunteer
- ICBM, International Consortium for Brain Mapping
- IFG, inferior frontal gyrus
- MNI, Montreal Neurological Institute
- MRI, magnetic resonance imaging
- Magnetic resonance imaging
- NIAAA, National Institute of Alcoholism and Alcohol Abuse
- Neurodevelopment
- PFC, prefrontal cortex
- SPM, Statistical Parametric Mapping
- STAI, Spielberger Trait Anxiety Inventory
- SVCs, small volume corrections
- Striatum
- UPPS-P, UPPS-P Impulsive Behavior
- Voxel-based morphometry
- WBIC, Wolfson Brain Imaging Center
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Affiliation(s)
- Timo L Kvamme
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom; Cognitive Neuroscience Research Unit, Department of Communication and Psychology, Aalborg University, Aalborg, Denmark; Center of Functionally Integrative Neuroscience, MINDLab, Aarhus University, Aarhus C, Denmark
| | - Casper Schmidt
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom; Cognitive Neuroscience Research Unit, Department of Communication and Psychology, Aalborg University, Aalborg, Denmark; Center of Functionally Integrative Neuroscience, MINDLab, Aarhus University, Aarhus C, Denmark
| | - Daniela Strelchuk
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | | | - Kwangyeol Baek
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Valerie Voon
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom; Behavioural and Clinical Neurosciences Institute, University of Cambridge, Cambridge, United Kingdom; NIHR Biomedical Research Council, University of Cambridge, United kingdom
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12
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Makovac E, Meeten F, Watson DR, Garfinkel SN, Critchley HD, Ottaviani C. Neurostructural abnormalities associated with axes of emotion dysregulation in generalized anxiety. Neuroimage Clin 2015; 10:172-81. [PMID: 26759791 PMCID: PMC4683456 DOI: 10.1016/j.nicl.2015.11.022] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [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: 10/01/2015] [Revised: 11/25/2015] [Accepted: 11/29/2015] [Indexed: 12/30/2022]
Abstract
BACKGROUND Despite the high prevalence of generalized anxiety disorder (GAD) and its negative impact on society, its neurobiology remains obscure. This study characterizes the neurostructural abnormalities associated with key symptoms of GAD, focusing on indicators of impaired emotion regulation (excessive worry, poor concentration, low mindfulness, and physiological arousal). METHODS These domains were assessed in 19 (16 women) GAD patients and 19 healthy controls matched for age and gender, using questionnaires and a low demand behavioral task performed before and after an induction of perseverative cognition (i.e. worry and rumination). Continuous pulse oximetry was used to measure autonomic physiology (heart rate variability; HRV). Observed cognitive and physiological changes in response to the induction provided quantifiable data on emotional regulatory capacity. Participants underwent structural magnetic resonance imaging; voxel-based morphometry was used to quantify the relationship between gray matter volume and psychological and physiological measures. RESULTS Overall, GAD patients had lower gray matter volume than controls within supramarginal, precentral, and postcentral gyrus bilaterally. Across the GAD group, increased right amygdala volume was associated with prolonged reaction times on the tracking task (indicating increased attentional impairment following the induction) and lower scores on the 'Act with awareness' subscale of the Five Facets Mindfulness Questionnaire. Moreover in GAD, medial frontal cortical gray matter volume correlated positively with the 'Non-react mindfulness' facet. Lastly, smaller volumes of bilateral insula, bilateral opercular cortex, right supramarginal and precentral gyri, anterior cingulate and paracingulate cortex predicted the magnitude of autonomic change following the induction (i.e. a greater decrease in HRV). CONCLUSIONS Results distinguish neural structures associated with impaired capacity for cognitive, attentional and physiological disengagement from worry, suggesting that aberrant competition between these levels of emotional regulation is intrinsic to symptom expression in GAD.
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Key Words
- ACC, anterior cingulate cortex
- Attentional deficit
- BDI, Beck Depression Inventory
- DLPFC, dorsolateral prefrontal cortex
- DMPFC, dorsomedial prefrontal cortex
- FFMQ, Five Facets Mindfulness Questionnaire
- GAD, generalized anxiety disorder
- Generalized anxiety disorder
- HC, healthy controls
- HRV, heart rate variability
- Heart rate variability
- IBI, Inter-beat-intervals
- ICV, intra-cranial volume
- MNI, Montreal Neurological Institute
- Magnetic resonance imaging
- Mindfulness
- PCC, posterior cingulate cortex
- PFC, prefrontal cortex
- Perseverative cognition
- RMSSD, root mean square successive difference
- ROI, region-of-interest
- RT, reaction times
- SCID, Structured Clinical Interview for DSMIV
- STAI, State-Trait Anxiety Inventory
- VAS, visual-analogue scales
- VBM, voxel-based morphometry
- mOFC, medial orbitofrontal cortex
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Affiliation(s)
- Elena Makovac
- Neuroimaging Laboratory, IRCCS Santa Lucia Foundation, Rome, Italy; Clinical Imaging Sciences Centre, Brighton and Sussex Medical School, University of Sussex, Falmer, UK
| | - Frances Meeten
- Clinical Imaging Sciences Centre, Brighton and Sussex Medical School, University of Sussex, Falmer, UK; Kings College London, London, UK
| | - David R Watson
- Clinical Imaging Sciences Centre, Brighton and Sussex Medical School, University of Sussex, Falmer, UK
| | - Sarah N Garfinkel
- Clinical Imaging Sciences Centre, Brighton and Sussex Medical School, University of Sussex, Falmer, UK; Sackler Centre for Consciousness Science, University of Sussex, UK
| | - Hugo D Critchley
- Clinical Imaging Sciences Centre, Brighton and Sussex Medical School, University of Sussex, Falmer, UK; Sackler Centre for Consciousness Science, University of Sussex, UK; Sussex Partnership NHS Foundation Trust, Sussex, UK
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13
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Kern KC, Gold SM, Lee B, Montag M, Horsfall J, O'Connor MF, Sicotte NL. Thalamic-hippocampal-prefrontal disruption in relapsing-remitting multiple sclerosis. Neuroimage Clin 2014; 8:440-7. [PMID: 26106524 PMCID: PMC4473119 DOI: 10.1016/j.nicl.2014.12.015] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 07/06/2014] [Accepted: 12/21/2014] [Indexed: 01/22/2023]
Abstract
Background Cortical, thalamic and hippocampal gray matter atrophy in relapsing–remitting MS (RRMS) is associated cognitive deficits. However, the role of interconnecting white matter pathways including the fornix, cingulum, and uncinate fasciculus (UF) is less well studied. Objective To assess MS damage to a hippocampal–thalamic–prefrontal network and the relative contributions of its components to specific cognitive domains. Methods We calculated diffusion tensor fractional anisotropy (FA) in the fornix, cingulum and UF as well as thalamic and hippocampal volumes in 27 RRMS patients and 20 healthy controls. A neuropsychological battery was administered and 4 core tests known to be sensitive to MS changes were used to assess cognitive impairment. To determine the relationships between structure and cognition, all tests were grouped into 4 domains: attention/executive function, processing speed, verbal memory, and spatial memory. Univariate correlations with structural measures and depressive symptoms identified potential contributors to cognitive performance and subsequent linear regression determined their relative effects on performance in each domain. For significant predictors, we also explored the effects of laterality and axial versus radial diffusivity. Results RRMS patients had worse performance on the Symbol Digit Modalities Test, but no significant impairment in the 4 cognitive domains. RRMS had reduced mean FA of all 3 pathways and reduced thalamic and hippocampal volumes compared to controls. In RRMS we found that thalamic volume and BDI predicted attention/executive function, UF FA predicted processing speed, thalamic volume predicted verbal memory, and UF FA and BDI predicted spatial memory. Conclusions Hippocampal–thalamic–prefrontal disruption affects cognitive performance in early RRMS with mild to minimal cognitive impairment, confirming both white and gray matter involvement in MS and demonstrating utility in assessing functional networks to monitor cognition. We detect limbic white matter and gray matter insult in early RRMS patients with mild to minimal cognitive impairment. Thalamic atrophy and uncinate fasciculus microstructural changes are associated with cognitive performance in early RRMS. Depressive symptomatology also independently predicts cognitive performance
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Key Words
- AD, axial diffusivity
- BDI, Beck Depression Inventory
- BSRT, Buschke Selective Reminding Test
- BVMT, Brief Visuospatial Memory Test
- BVRT, Benton Visual Retention Test
- CVLT-II, California Verbal Learning Test II
- Cognition
- DTI, diffusion tensor imaging
- Diffusion tensor imaging
- EDSS, Expanded Disability Status Scale
- FA, fractional anisotropy
- FAST, FMRIB's Automated Segmentation Tool
- FLAIR, Fluid Attenuated Inversion Recovery
- FOV, field of view
- FSL, Functional MRI of the Brain Software Library
- GM, gray matter
- Limbic system
- MPRAGE, Magnetization Prepared Rapid Acquisition Gradient Echo
- MRI
- MRI, magnetic resonance image
- Memory
- Multiple sclerosis
- NEX, number of excitations
- PASAT, Paced Auditory Serial Addition Test
- RAVLT, Rey Auditory Verbal Learning Test
- RD, radial diffusivity
- ROI, region of interest
- RRMS, relapsing remitting multiple sclerosis
- SDMT, Symbol Digit Modalities Test
- TBSS, Tract-based Spatial Statistics
- TE, echo time
- TI, inversion time
- TR, repetition time
- UF, uncinate fasciculus
- WAIS, Wechsler Adult Intelligence Scale
- WM, white matter.
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Affiliation(s)
- Kyle C. Kern
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Stefan M. Gold
- Institute for Neuroimmunology and Clinical Multiple Sclerosis Research, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Brian Lee
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Michael Montag
- Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA
| | - Jessica Horsfall
- Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Nancy L. Sicotte
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA
- Corresponding Author: Department of Neurology, Cedars-Sinai Medical Center, Rm 6414, 127 S. San Vicente Blvd., AHSP, Los Angeles, CA 90048, USA. Tel.:1-310 423 1320.
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14
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Riwkes S, Goldstein A, Gilboa-Schechtman E. The temporal unfolding of face processing in social anxiety disorder--a MEG study. Neuroimage Clin 2014; 7:678-87. [PMID: 25844308 PMCID: PMC4377840 DOI: 10.1016/j.nicl.2014.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [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: 06/06/2014] [Revised: 10/10/2014] [Accepted: 11/01/2014] [Indexed: 11/04/2022]
Abstract
The current study is the first to use magnetoencephalography (MEG) to examine how individuals with social anxiety disorder (SAD) process emotional facial expressions (EFEs). We expected that, compared to healthy controls (HCs), participants with SAD will show an early (<200 ms post-stimulus) over-activation in the insula and the fusiform gyrus (FG, associated with the N170/M170 component), and later (>200 ms post-stimulus) over-activation in the dorsolateral prefrontal cortex (DLPFC). Individuals with SAD (n = 12) and healthy controls (HCs, n = 12) were presented with photographs of facial displays during MEG recording. As compared to the HC group, the SAD group showed a reduced M170 (right FG under-activation around 130–200 ms); early reduced activation in the right insula, and lower insular sensitivity to the type of EFE displayed. In addition, the SAD group showed a late over-activation in the right DLPFC. This unique EFE processing pattern in SAD suggests an early under-activation of cortical areas, possibly related to reduced emphasis on high spatial frequency information and greater early emphasis on low spatial frequency information. The late DLPFC over-activation in the SAD group may correlate to failures of cognitive control in this disorder. The importance of a temporal perspective for the understanding of facial processing in psychopathology is underlined. This study is the first to use MEG to study social anxiety disorder (SAD). SADs and controls viewed emotional facial expressions during MEG. Compared to controls, SADs showed reduced M170 (early fusiform gyrus activity). SADs presented a late over-activation in the right dorsolateral prefrontal cortex. The late frontal over-activity may correlate to failures of cognitive control in SAD.
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Key Words
- AFNI, analysis of functional neuroimages
- BDI, Beck Depression Inventory
- Cognitive control
- DLPFC, dorsolateral prefrontal cortex
- EEG, electroencephalography
- EFE, emotional facial expressions
- FG, fusiform gyrus
- FMRI, functional magnetic resonance imaging
- FNE, fear of negative evaluation
- Facial processing
- HC, healthy control
- HSF, high spatial frequency
- LSAS, Liebowitz Social Anxiety Scale
- LSF, low spatial frequency
- MEG, magnetoencephalography
- Magnetoenchephalography
- Regulation
- SA, social anxiety
- SAD, social anxiety disorder
- SAM, synthetic aperture modeling
- Social anxiety
- TMS, transcranial magnetic stimulation
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Affiliation(s)
- Sharon Riwkes
- Department of Psychology, Bar Ilan University, Ramat Gan 52900, Israel
| | - Abraham Goldstein
- Department of Psychology, Bar Ilan University, Ramat Gan 52900, Israel
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15
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Mole TB, MacIver K, Sluming V, Ridgway GR, Nurmikko TJ. Specific brain morphometric changes in spinal cord injury with and without neuropathic pain. Neuroimage Clin 2014; 5:28-35. [PMID: 24936434 PMCID: PMC4055864 DOI: 10.1016/j.nicl.2014.05.014] [Citation(s) in RCA: 39] [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] [Received: 03/13/2014] [Revised: 05/17/2014] [Accepted: 05/21/2014] [Indexed: 12/04/2022]
Abstract
Why only certain patients develop debilitating pain after spinal chord injury and whether structural brain changes are implicated remain unknown. The aim of this study was to determine if patients with chronic, neuropathic below-level pain have specific cerebral changes compared to those who remain pain-free. Voxel-based morphometry of high resolution, T1-weighted images was performed on three subject groups comprising patients with pain (SCI-P, n = 18), patients without pain (SCI-N, n = 12) and age- and sex-matched controls (n = 18). The SCI-P group was first compared directly with the SCI-N group and then subsequently with controls. Overall, grey and white matter changes dependent on the presence of pain were revealed. Significant changes were found within the somatosensory cortex and also in corticospinal tracts and visual-processing areas. When the SCI-P group was directly compared with the SCI-N group, reduced grey matter volume was found in the deafferented leg area of the somatosensory cortex bilaterally. This region negatively correlated with pain intensity. Relative to controls, grey matter in this paracentral primary sensory cortex was decreased in SCI-P but conversely increased in SCI-N. When compared with controls, discrepant corticospinal tract white matter reductions were found in SCI-P and in SCI-N. In the visual cortex, SCI-N showed increased grey matter, whilst the SCI-N showed reduced white matter. In conclusion, structural changes in SCI are related to the presence and degree of below-level pain and involve but are not limited to the sensorimotor cortices. Pain-related structural plasticity may hold clinical implications for the prevention and management of refractory neuropathic pain. Voxel-based morphometry was performed on spinal cord injury patients and controls. Patients with below-level neuropathic pain had reduced somatosensory cortex volume. Patients without pain had increased somatosensory cortex volume. Other structural changes were also found outside the sensorimotor cortices. Structural brain changes showed associations with the degree of neuropathic pain.
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Affiliation(s)
- Tom B Mole
- Department of Psychiatry, University of Cambridge, Addenbrooke's Hospital, Level E4, Box 189, Hills Road, Cambridge CB2 2QQ, UK
| | - Kate MacIver
- Unit of Neuroscience, School of Clinical Sciences, Pain Research Institute, Lower Lane, Liverpool L9 7AL, UK
| | - Vanessa Sluming
- Department of Molecular and Cellular Physiology, Institute of Translational Medicine (PGR), University of Liverpool, Whelan Building, Liverpool L69 3GB, UK
| | - Gerard R Ridgway
- Wellcome Trust Centre for Neuroimaging, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK
| | - Turo J Nurmikko
- Walton Centre for Neurology and Neurosurgery NHS Trust, Lower Lane, Fazakerley, Liverpool L9 7JL, UK
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