Enhanced reactive inhibition in adolescents with non-suicidal self-injury disorder

AIM

To investigate whether the core of the pathophysiology underlying non-suicidal self-injury (NSSI) relates to poor impulse control due to impaired motor inhibition (i.e. the ability to inhibit a preplanned motor response).

METHOD

We conducted a case-control study to compare the proficiency of two domains of motor inhibition, that is, reactive and proactive inhibition, by giving the reaching arm version of the stop-signal task and a go-only task to 28 drug-naive adolescents with NSSI disorder (NSSID) (mean age [SD] 15 years 8 months [1 year 4 months]; three males and 25 females) and 28 typically developing adolescents (mean age 15 years 8 months [1 year 5 months]; three males and 25 females).

RESULTS

Reactive inhibition, as determined by the duration of the stop-signal reaction time, was enhanced in adolescents with NSSID compared to typically developing controls (194.2 [22.5 ms] vs 217.5 [17.3 ms], p < 0.001). By contrast, proactive inhibition was similar in both groups. Lastly, the level of impulsivity, assessed using the Barratt Impulsiveness Scale Version 11, did not differ between typically developing adolescents and adolescents with NSSID. However, adolescents with NSSID were more impulsive than controls in a subscale of the UPPS-P Impulsive Behavior Scale.

INTERPRETATION

NSSID is not driven by heightened motor impulsivity. Instead, adolescents with NSSID exhibited greater proficiency in reactive inhibition, a proxy for motor impulsivity. We suggest that the enhancement of reactive inhibition strengthens action control, allowing adolescents to suppress their self-protection instinct and perform NSSI behaviours.

Investigating the impact of surgical masks on behavioral reactions to facial emotions in the COVID-19 era

Introduction

The widespread use of surgical masks during the COVID-19 pandemic has posed challenges in interpreting facial emotions. As the mouth is known to play a crucial role in decoding emotional expressions, its covering is likely to affect this process. Recent evidence suggests that facial expressions impact behavioral responses only when their emotional content is relevant to subjects' goals. Thus, this study investigates whether and how masked emotional faces alter such a phenomenon.

Methods

Forty participants completed two reaching versions of the Go/No-go task in a counterbalanced fashion. In the Emotional Discrimination Task (EDT), participants were required to respond to angry, fearful, or happy expressions by performing a reaching movement and withholding it when a neutral face was presented. In the Gender Discrimination Task (GDT), the same images were shown, but participants had to respond according to the poser's gender. The face stimuli were presented in two conditions: covered by a surgical mask (masked) or without any covering (unmasked).

Results

Consistent with previous studies, valence influenced behavioral control in the EDT but not in the GDT. Nevertheless, responses to facial emotions in the EDT exhibited significant differences between unmasked and masked conditions. In the former, angry expressions led to a slowdown in participants' responses. Conversely, in the masked condition, behavioral reactions were impacted by fearful and, to a greater extent, by happy expressions. Responses to fearful faces were slower, and those to happy faces exhibited increased variability in the masked condition compared to the unmasked condition. Furthermore, response accuracy to masked happy faces dramatically declined compared to the unmasked condition and other masked emotions.

Discussion

In sum, our findings indicate that surgical masks disrupt reactions to emotional expressions, leading people to react less accurately and with heightened variability to happy expressions, provided that the emotional dimension is relevant to people's goals.

Effects of dopaminergic treatment on inhibitory control differ across Hoehn and Yahr stages of Parkinson's disease

Motor inhibitory control, a core component of cognitive control, is impaired in Parkinson's disease, dramatically impacting patients' abilities to implement goal-oriented adaptive strategies. A progressive loss of the midbrain's dopamine neurons characterizes Parkinson's disease and causes motor features responsive to dopaminergic treatments. Although such treatments restore motor symptoms, their impact on response inhibition is controversial. Most studies failed to show any effect of dopaminergic medicaments, although three studies found that these drugs selectively improved inhibitory control in early-stage patients. Importantly, all previous studies assessed only one domain of motor inhibition, i.e. reactive inhibition (the ability to react to a stop signal). The other domain, i.e. proactive inhibition (the ability to modulate reactive inhibition pre-emptively according to the current context), was utterly neglected. To re-examine this issue, we recruited cognitively unimpaired Parkinson's patients under dopaminergic treatment in the early (Hoehn and Yahr, 1-1.5, n = 20), intermediate (Hoehn and Yahr 2, n = 20), and moderate/advanced (Hoehn and Yahr, 2.5-3, n = 20) stages of the disease. Using a cross-sectional study design, we compared their performance on a simple reaction-time task and a stop-signal task randomly performed twice on dopaminergic medication (ON) and after medication withdrawal (OFF). Normative data were collected on 30 healthy controls. Results suggest that medication effects are stage-dependent. In Hoehn and Yahr 1-1.5 patients, drugs selectively impair reactive inhibition, leaving proactive inhibition unaffected. In the ON state, Hoehn and Yahr two patients experienced impaired proactive inhibition, whereas reactive inhibition is no longer affected, as it deteriorates even during the OFF state. By contrast, Hoehn and Yahr 2.5-3 patients exhibited less efficient reactive and proactive inhibition in the OFF state, and medication slightly improved proactive inhibition. This evidence aligns with the dopamine overdose hypothesis, indicating that drug administration may overdose intact dopamine circuitry in the earliest stages, impairing associated cognitive functions. In later stages, the progressive degeneration of dopaminergic neurons prevents the overdose and can exert some beneficial effects. Thus, our findings suggest that inhibitory control assessment might help tailor pharmacological therapy across the disease stage to enhance Parkinson's disease patients' quality of life by minimizing the hampering of inhibitory control and maximizing the reduction of motor symptoms.

Unveiling the influence of task-relevance of emotional faces on behavioral reactions in a multi-face context using a novel Flanker-Go/No-go task

Recent research indicates that emotional faces affect motor control only when task-relevant. However, these studies utilized a single-face presentation, which does not accurately mirror real-life situations wherein we frequently engage with multiple individuals simultaneously. To overcome this limitation, we gave 40 participants two versions of a novel Flanker-Go/No-go task, where we presented three-face stimuli with a central target and two task-irrelevant flankers that could be congruent or incongruent with the target for valence and gender. In the Emotional Discrimination Task (EDT), participants had to respond to fearful or happy targets and refrain from moving with neutral ones. In the Gender Discrimination Task (GDT), the same images were shown, but participants had to respond according to the target's gender. In line with previous studies, we found an effect of valence only in EDT, where fearful targets increased reaction times and omission error rates compared to happy faces. Notably, the flanker effect, i.e., slower and less accurate responses in incongruent than congruent conditions, was not found. This likely stems from the higher perceptual complexity of faces than that of stimuli traditionally used in the Eriksen Flanker task (letters or signs), leading to a capacity limit in face feature processing.

Beyond Reactive Inhibition: Unpacking the Multifaceted Nature of Motor Inhibition

Inhibition is a pillar of cognitive control, i [...].

Angry and happy expressions affect forward gait initiation only when task relevant

Whole-body movements represent an ecologically valid model for assessing the effect of emotional stimuli valence on approach/avoidance reactions as they entail a change of the physical distance between such stimuli and the self. However, research in this field has provided inconsistent results as the task relevance of the emotional content of the stimuli was not properly controlled, and very often, it is impossible to dissociate the effect of arousal from that of valence. To overcome these limitations, we studied the effect of facial emotional expressions (anger and happiness) on forward gait initiation using an experimental paradigm that allows us to compare the impact of the stimuli emotional content when they are task relevant and when they are not. We found that angry and happy expressions altered forward gait initiation parameters differently only when relevant for ongoing goals. In particular, both the reaction times and the percentages of omission errors increased when the go signal was an angry face compared to when the go signal was a happy face. These results indicate that forward step movements share the same features as reaching arm movements regarding emotional stimuli, that is, facial emotions do not automatically influence behavioral responses. Instead, their effects depend critically on their conscious appraisal. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Emotional body postures affect inhibitory control only when task-relevant

A classical theoretical frame to interpret motor reactions to emotional stimuli is that such stimuli, particularly those threat-related, are processed preferentially, i.e., they are capable of capturing and grabbing attention automatically. Research has recently challenged this view, showing that the task relevance of emotional stimuli is crucial to having a reliable behavioral effect. Such evidence indicated that emotional facial expressions do not automatically influence motor responses in healthy young adults, but they do so only when intrinsically pertinent to the ongoing subject's goals. Given the theoretical relevance of these findings, it is essential to assess their generalizability to different, socially relevant emotional stimuli such as emotional body postures. To address this issue, we compared the performance of 36 right-handed participants in two different versions of a Go/No-go task. In the Emotional Discrimination task, participants were required to withhold their responses at the display of emotional body postures (fearful or happy) and to move at the presentation of neutral postures. Differently, in the control task, the same images were shown, but participants had to respond according to the color of the actor/actress' t-shirt, disregarding the emotional content. Results showed that participants made more commission errors (instances in which they moved even though the No-go signal was presented) for happy than fearful body postures in the Emotional Discrimination task. However, this difference disappeared in the control task. Such evidence indicates that, like facial emotion, emotional body expressions do not influence motor control automatically, but only when they are task-relevant.

White matter alterations in drug-naïve children with Tourette syndrome and obsessive-compulsive disorder

Tourette syndrome (TS) and early-onset obsessive-compulsive disorder (OCD) are frequently associated and conceptualized as distinct phenotypes of a common disease spectrum. However, the nature of their relationship is still largely unknown on a pathophysiological level. In this study, early structural white matter (WM) changes investigated through diffusion tensor imaging (DTI) were compared across four groups of drug-naïve children: TS-pure (n = 16), TS+OCD (n = 14), OCD (n = 10), and 11 age-matched controls. We analyzed five WM tracts of interest, i.e., cortico-spinal tract (CST), anterior thalamic radiations (ATR), inferior longitudinal fasciculus (ILF), corpus callosum (CC), and cingulum and evaluated correlations of DTI changes to symptom severity. Compared to controls, TS-pure and TS+OCD showed a comparable pattern of increased fractional anisotropy (FA) in CST, ATR, ILF and CC, with FA changes displaying negative correlation to tic severity. Conversely, in OCD, FA decreased in all WM tracts (except for the cingulum) compared to controls and negatively correlated to symptoms. We demonstrate different early WM microstructural alterations in children with TS-pure/TS+OCD as opposed to OCD. Our findings support the conceptualization of TS+OCD as a subtype of TS while suggesting that OCD is characterized by independent pathophysiological mechanisms affecting WM development.

Happy facial expressions impair inhibitory control with respect to fearful facial expressions but only when task-relevant

The ability to generate appropriate responses, especially in social contexts, requires integrating emotional information with ongoing cognitive processes. In particular, inhibitory control plays a crucial role in social interactions, preventing the execution of impulsive and inappropriate actions. In this study, we focused on the impact of facial emotional expressions on inhibition. Research in this field has provided highly mixed results. In our view, a crucial factor explaining such inconsistencies is the task-relevance of the emotional content of the stimuli. To clarify this issue, we gave two versions of a Go/No-go task to healthy participants. In the emotional version, participants had to withhold a reaching movement at the presentation of emotional facial expressions (fearful or happy) and move when neutral faces were shown. The same pictures were displayed in the other version, but participants had to act according to the actor's gender, ignoring the emotional valence of the faces. We found that happy expressions impaired inhibitory control with respect to fearful expressions, but only when they were relevant to the participants' goal. We interpret these results as suggesting that facial emotions do not influence behavioral responses automatically. They would instead do so only when they are intrinsically germane for ongoing goals. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The Cerebellum in Drug-naive Children with Tourette Syndrome and Obsessive–Compulsive Disorder

Tourette syndrome (TS) and obsessive–compulsive disorder (OCD) are two neurodevelopmental disorders characterized by repetitive behaviors. Our recent study in drug-naive children with TS and OCD provided evidence of cerebellar involvement in both disorders. In addition, cerebellar functional connectivity (FC) was similar in TS patients without comorbidities (TSpure) and TS patients with OCD comorbidity (TS + OCD), but differed in pure OCD patients. To investigate in detail the cerebellar involvement in the pathophysiology of TS and OCD, we explored cerebellar structural and functional abnormalities in drug-naive children with TSpure, TS + OCD, and OCD and assessed possible correlations with severity scores. We examined 53 drug-naive children, classified as TSpure (n = 16), TS + OCD (n = 14), OCD (n = 11), or controls (n = 12). All subjects underwent a multimodal 3T magnetic resonance imaging examination. Cerebellar lobular volumes and quantitative diffusion tensor imaging parameters of cerebellar peduncles were used as measures of structural integrity. The dentate nucleus was selected as a region of interest to examine cerebello-cerebral functional connectivity alterations. Structural analysis revealed that both TSpure and TS + OCD patients had higher fractional anisotropy in cerebellar peduncles than controls. Conversely, OCD patients were characterized by lower fractional anisotropy than both controls and TSpure and TS + OCD patients. Lastly, cerebellar functional connectivity analysis revealed significant alterations in the cerebello-thalamo-cortical circuit in TSpure, TS + OCD, and OCD patients. Early cerebellar structural and functional changes in drug-naive pediatric TSpure, TS + OCD, and OCD patients support a primary role of the cerebellum in the pathophysiology of these disorders.

Inhibitory control and impulsive responses in neurodevelopmental disorders

The impairment of inhibitory control is often assumed to be the core deficit of several neurodevelopmental disorders characterized by poor impulse control. However, could the same deficit explain different clinical phenotypes? Evidence from behavioural studies is very mixed. This is partly because inhibition is a highly complex executive function. Thus, the different types of tasks that generically tap into inhibitory control are likely to provide different outcomes. Additionally, sample inhomogeneity in terms of age, comorbidity, and medical treatment are confounding factors. Therefore, to make a reliable assessment of the deficit of inhibitory control in a given disorder, the same task and samples with similar characteristics must be employed. This article reviews and discusses studies on five neurodevelopmental disorders with impaired impulse control where these criteria have been used: Tourette syndrome; obsessive-compulsive disorder; attention-deficit/hyperactivity disorder; primary motor stereotypies; and autism spectrum disorder. Overall, they suggest that the mechanisms underlying the inability to control urges are extremely heterogeneous and cannot be ascribed to a general impairment of inhibition. These findings do not support the hypothesis that inhibitory deficits represent a transdiagnostic feature of neurodevelopmental disorders with poor impulse control. WHAT THIS PAPER ADDS: The mechanisms underlying the inability to control urges in neurodevelopmental disorders are heterogeneous. Inhibition impairments cannot generally explain all neurodevelopmental disorders characterized by poor urge control.

Non-suicidal self-injury and impulsivity: Study of inibithory control in adolescent population

Introduction

Non-suicidal self-injury (NSSI) is a clinical condition defined as intentional, self-inflicted act causing pain or superficial damage without suicidal intents (12-35% of the adolescent community). Several findings show a high correlation between NSSI and impairments in the impulsivity control.

Objectives

The goal of our study is to evaluate the role of impulsivity in NSSI adolescents, relatively to the inhibitory control, in order to investigate if it can represent a neurocognitive risk factor underlying maladaptive behaviours and which psychopathological dimensions can be associated with this neurobiological process.

Methods

30 NNSI inpatients (age range: 12 to 18 years), drug-free, were compared with an age-matched control group, using two behavioural paradigms for the study of inhibitory control: the Stop Signal task and the emotive go/Nogo. Psychopathological traits were evaluated by self-report questionnaires for impulsivity dimensions, suicidality and self-injurious acts. Statistical analyses were performed with SPSS program (p =0.05).

Results

NSSI patients did not present impairments in the global inhibitory control but they had longer movement times in both paradigms and faster reaction times in the Go/no-go behavioural paradigm. Therefore, NSSI patients tended to be impulsive at an early stage of movement (rapid TR) and have to slow down in a second phase (TM slow) in order to have time to rework the cognitive processes underlying movement.

Conclusions

The impulsivity dimension is a complex construct that involves multiple interconnected factors. The study of neuro-cognitive and psychopathological aspects and how they are interconnected is necessary to draw new perspectives on the etiopathogenesis of NNSI.

Threatening Facial Expressions Impact Goal-Directed Actions Only if Task-Relevant

Facial emotional expressions are a salient source of information for nonverbal social interactions. However, their impact on action planning and execution is highly controversial. In this vein, the effect of the two threatening facial expressions, i.e., angry and fearful faces, is still unclear. Frequently, fear and anger are used interchangeably as negative emotions. However, they convey different social signals. Unlike fear, anger indicates a direct threat toward the observer. To provide new evidence on this issue, we exploited a novel design based on two versions of a Go/No-go task. In the emotional version, healthy participants had to perform the same movement for pictures of fearful, angry, or happy faces and withhold it when neutral expressions were presented. The same pictures were shown in the control version, but participants had to move or suppress the movement, according to the actor’s gender. This experimental design allows us to test task relevance’s impact on emotional stimuli without conflating movement planning with target detection and task switching. We found that the emotional content of faces interferes with actions only when task-relevant, i.e., the effect of emotions is context-dependent. We also showed that angry faces qualitatively had the same effect as fearful faces, i.e., both negative emotions decreased response readiness with respect to happy expressions. However, anger has a much greater impact than fear, as it increases both the rates of mistakes and the time of movement execution. We interpreted these results, suggesting that participants have to exploit more cognitive resources to appraise threatening than positive facial expressions, and angry than fearful faces before acting.

Loss in grey matter in a small network of brain areas underpins poor reactive inhibition in Obsessive-Compulsive Disorder patients

Reactive inhibition correlates with the severity of symptoms in paediatric patients with Obsessive-Compulsive Disorder (OCD) though not in those with Tourette syndrome (TS). Here we assessed whether structural alterations in both grey (GM) and white matter (WM) volumes correlate with a measure of reactive inhibition, i.e. the stop-signal reaction time (SSRT), and with clinical scale scores. Nine OCD and 11 TS uncomplicated drug-naïve paediatric patients and 12 age-matched controls underwent 3T magnetic resonance imaging scanning. Between-group differences in GM and WM volumes across the whole brain were assessed. Outside the scanner, patients performed a reaching version of the stop-signal task. Both behavioural inhibitory control and neuroimaging measures were normal in TS patients. By contrast, OCD patients exhibited a significant loss in GM volume in five areas. The GM volume of the left inferior frontal gyrus was inversely correlated with the length of the SSRT, the left mid-cingulate gyrus and the right middle frontal gyrus were inversely correlated with the severity of OCD symptoms, and the left insula and the right medial orbitofrontal gyrus were inversely correlated with both. These results indicate that cortical areas showing GM loss in OCD patients are also involved in the network subserving reactive inhibition.

Unilateral Stimulation of Subthalamic Nucleus Does Not Affect Inhibitory Control

Despite the relevance of inhibitory control in shaping our behavior its neural substrates are still hotly debated. In this regard, it has been suggested that inhibitory control relies upon a right-lateralized network which involves the right subthalamic nucleus (STN). To assess the role of STN, we took advantage of a relatively rare model, i.e., advanced Parkinson's patients who received unilateral deep-brain stimulation (DBS) of the STN either of the left (n = 10) or of the right (n = 10) hemisphere. We gave them a stop-signal reaching task, and we compared patients' performance in two experimental conditions, DBS-ON and DBS-OFF. In addition, we also tested 22 age-matched healthy participants. As expected, we found that inhibitory control is impaired in Parkinson's patients with respect to healthy participants. However, neither reactive nor proactive inhibition is improved when either the right or the left DBS is active. We interpreted these findings in light of the fact that previous studies, exploiting exactly the same task, have shown that only bilateral STN DBS restores a near-normal inhibitory control. Thus, although null results have to be interpreted with caution, our current findings confirm that the right STN does not play a key role in suppressing pending actions. However, on the ground of previous studies, it is very likely that this subcortical structure is part of the brain network subserving inhibition but to implement this executive function both subthalamic nuclei must be simultaneously active. Our findings are of significance to other researchers studying the effects of STN DBS on key executive functions, such as impulsivity and inhibition and they are also of clinical relevance for determining the therapeutic benefits of STN DBS as they suggest that, at least as far as inhibitory control is concerned, it is better to implant DBS bilaterally than unilaterally.

The Weight of Emotions in Decision-Making: How Fearful and Happy Facial Stimuli Modulate Action Readiness of Goal-Directed Actions

Modern theories of behavioral control converge with the idea that goal-directed/voluntary behaviors are intimately tied to the evaluation of resources. Of key relevance in the decision-making processes that underlie action selection are those stimuli that bear emotional content. However, even though it is acknowledged that emotional information affects behavioral control, the exact way in which emotions impact on action planning is largely unknown. To clarify this issue, I gave an emotional version of a go/no-go task to healthy participants, in which they had to perform the same arm reaching movement when pictures of fearful or happy faces were presented, and to withhold it when pictures of faces with neutral expressions were presented. This task allows for the investigation of the effects of emotional stimuli when they are task-relevant without conflating movement planning with target detection and task switching. It was found that both the reaction times (RTs) and the percentages of errors increased when the go-signal was the image of a fearful looking face, as opposed to when the go-signal was a happy looking face. Importantly, to control for the role of the features of the stimuli, I ran a control task in which the same pictures were shown; however, participants had to move/withhold the commanded movement according to gender, disregarding the emotional valence. In this context, the differences between RTs and error percentages between the fearful and happy faces disappeared. On the one hand, these results suggest that fearful facial stimuli are likely to capture and hold attention more strongly than faces that express happiness, which could serve to increase vigilance for detecting a potential threat in an observer’s environment. On the other hand, they also suggest that the influence of fearful facial stimuli is not automatic, but it depends on the task requirements.

Frontal Functional Connectivity of Electrocorticographic Delta and Theta Rhythms during Action Execution Versus Action Observation in Humans

We have previously shown that in seven drug-resistant epilepsy patients, both reaching-grasping of objects and the mere observation of those actions did desynchronize subdural electrocorticographic (ECoG) alpha (8-13 Hz) and beta (14-30) rhythms as a sign of cortical activation in primary somatosensory-motor, lateral premotor and ventral prefrontal areas (Babiloni et al., 2016a). Furthermore, that desynchronization was greater during action execution than during its observation. In the present exploratory study, we reanalyzed those ECoG data to evaluate the proof-of-concept that lagged linear connectivity (LLC) between primary somatosensory-motor, lateral premotor and ventral prefrontal areas would be enhanced during the action execution compared to the mere observation due to a greater flow of visual and somatomotor information. Results showed that the delta-theta (<8 Hz) LLC between lateral premotor and ventral prefrontal areas was higher during action execution than during action observation. Furthermore, the phase of these delta-theta rhythms entrained the local event-related connectivity of alpha and beta rhythms. It was speculated the existence of a multi-oscillatory functional network between high-order frontal motor areas which should be more involved during the actual reaching-grasping of objects compared to its mere observation. Future studies in a larger population should cross-validate these preliminary results.

Developmental Coordination Disorder Affects the Processing of Action-Related Verbs

Processing action-language affects the planning and execution of motor acts, which suggests that the motor system might be involved in action-language understanding. However, this claim is hotly debated. For the first time, we compared the processing of action-verbs in children with Developmental Coordination Disorder (DCD), a disease that specifically affects the motor system, with children with a typical development (TD). We administered two versions of a go/no-go task in which verbs expressing either hand, foot or abstract actions were presented. We found that only when the semantic content of a verb has to be retrieved, TD children showed an increase in reaction times if the verb involved the same effector used to give the response. In contrast, DCD patients did not show any difference between verb categories irrespective of the task. These findings suggest that the pathological functioning of the motor system in individuals with DCD also affects language processing.

Interfacing to the brain's motor decisions

It has been long known that neural activity, recorded with electrophysiological methods, contains rich information about a subject's motor intentions, sensory experiences, allocation of attention, action planning, and even abstract thoughts. All these functions have been the subject of neurophysiological investigations, with the goal of understanding how neuronal activity represents behavioral parameters, sensory inputs, and cognitive functions. The field of brain-machine interfaces (BMIs) strives for a somewhat different goal: it endeavors to extract information from neural modulations to create a communication link between the brain and external devices. Although many remarkable successes have been already achieved in the BMI field, questions remain regarding the possibility of decoding high-order neural representations, such as decision making. Could BMIs be employed to decode the neural representations of decisions underlying goal-directed actions? In this review we lay out a framework that describes the computations underlying goal-directed actions as a multistep process performed by multiple cortical and subcortical areas. We then discuss how BMIs could connect to different decision-making steps and decode the neural processing ongoing before movements are initiated. Such decision-making BMIs could operate as a system with prediction that offers many advantages, such as shorter reaction time, better error processing, and improved unsupervised learning. To present the current state of the art, we review several recent BMIs incorporating decision-making components.

Can we resist another person's gaze?

Adaptive adjustments of strategies are needed to optimize behavior in a dynamic and uncertain world. A key function in implementing flexible behavior and exerting self-control is represented by the ability to stop the execution of an action when it is no longer appropriate for the environmental requests. Importantly, stimuli in our environment are not equally relevant and some are more valuable than others. One example is the gaze of other people, which is known to convey important social information about their direction of attention and their emotional and mental states. Indeed, gaze direction has a significant impact on the execution of voluntary saccades of an observer since it is capable of inducing in the observer an automatic gaze-following behavior: a phenomenon named social or joint attention. Nevertheless, people can exert volitional inhibitory control on saccadic eye movements during their planning. Little is known about the interaction between gaze direction signals and volitional inhibition of saccades. To fill this gap, we administered a countermanding task to 15 healthy participants in which they were asked to observe the eye region of a face with the eyes shut appearing at central fixation. In one condition, participants were required to suppress a saccade, that was previously instructed by a gaze shift toward one of two peripheral targets, when the eyes were suddenly shut down (social condition, SC). In a second condition, participants were asked to inhibit a saccade, that was previously instructed by a change in color of one of the two same targets, when a change of color of a central picture occurred (non-social condition, N-SC). We found that inhibitory control was more impaired in the SC, suggesting that actions initiated and stopped by social cues conveyed by the eyes are more difficult to withhold. This is probably due to the social value intrinsically linked to these cues and the many uses we make of them.

Is art therapy a reliable tool for rehabilitating people suffering from brain/mental diseases?

Whether art therapy can be an effective rehabilitative treatment for people with brain or mental diseases (e.g., dementia, Alzheimer's disease, Parkinson's disease, autism, schizophrenia) is a long-standing and highly debated issue. On the one hand, several observational studies and anecdotal evidence enthusiastically support the effectiveness of arts-based therapy. On the other hand, few rigorous clinical investigations have been performed, and there is too little empirical evidence to allow a full assessment of the risks and benefits of this intervention. Nevertheless, there is a progressively increasing demand for the development of appropriate complementary therapies to improve the personal and social lives of patients with neurodegenerative diseases. This is because conventional medical treatments are aimed at alleviating symptoms but cannot arrest or reverse the degenerative process. Thus, as disease progresses and adverse effects emerge, patients' quality of life dramatically decreases; when this occurs patients seek different forms of intervention. Art therapy is a potentially appealing treatment because of its more holistic approach to healthcare. However, as with any medicine, its effects must be tested by using standard, rigorous scientific approaches. This report describes the current state of research into art therapy and outlines many key factors that future research should consider, all of which are directly or indirectly related to the neural mechanism underlying behavioral changes: brain plasticity. Artistic performance could promote some form of brain plasticity that, to some extent, might compensate for the brain damage caused by the disease.

Should I stay or should I go? Conceptual underpinnings of goal-directed actions

All actions, even the simplest like moving an arm to grasp a pen, are associated with energy costs. Thus all mobile organisms possess the ability to evaluate resources and select those behaviors that are most likely to lead to the greatest accrual of valuable items (reward) in the near or, especially in the case of humans, distant future. The evaluation process is performed at all possible stages of the series of decisions that lead to the building of a goal-directed action or to its suppression. This is because all animals have a limited amount of energy and resources; to survive and be able to reproduce they have to minimize the costs and maximize the outcomes of their actions. These computations are at the root of behavioral flexibility. Two executive functions play a major role in generating flexible behaviors: (i) the ability to predict future outcomes of goal-directed actions; and (ii) the ability to cancel them when they are unlikely to accomplish valuable results. These two processes operate continuously during the entire course of a movement: during its genesis, its planning and even its execution, so that the motor output can be modulated or suppressed at any time before its execution. In this review, functional interactions of the extended neural network subserving generation and inhibition of goal-directed movements will be outlined, leading to the intriguing hypothesis that the performance of actions and their suppression are not specified by independent sets of brain regions. Rather, it will be proposed that acting and stopping are functions emerging from specific interactions between largely overlapping brain regions, whose activity is intimately linked (directly or indirectly) to the evaluations of pros and cons of an action. Such mechanism would allow the brain to perform as a highly efficient and flexible system, as different functions could be computed exploiting the same components operating in different configurations.

Modulation of arm reaching movements during processing of arm/hand-related action verbs with and without emotional connotation

The theory of embodied language states that language comprehension relies on an internal reenactment of the sensorimotor experience associated with the processed word or sentence. Most evidence in support of this hypothesis had been collected using linguistic material without any emotional connotation. For instance, it had been shown that processing of arm-related verbs, but not of those leg-related verbs, affects the planning and execution of reaching movements; however, at present it is unknown whether this effect is further modulated by verbs evoking an emotional experience. Showing such a modulation might shed light on a very debated issue, i.e. the way in which the emotional meaning of a word is processed. To this end, we assessed whether processing arm/hand-related verbs describing actions with negative connotations (e.g. to stab) affects reaching movements differently from arm/hand-related verbs describing actions with neutral connotation (e.g. to comb). We exploited a go/no-go paradigm in which healthy participants were required to perform arm-reaching movements toward a target when verbs expressing emotional hand actions, neutral hand actions or foot actions were shown, and to refrain from moving when no-effector-related verbs were presented. Reaction times and percentages of errors increased when the verb involved the same effector as used to give the response. However, we also found that the size of this interference decreased when the arm/hand-related verbs had a negative emotional connotation. Crucially, we show that such modulation only occurred when the verb semantics had to be retrieved. These results suggest that the comprehension of negatively valenced verbs might require the simultaneous reenactment of the neural circuitry associated with the processing of the emotion evoked by their meaning and of the neural circuitry associated with their motor features.

Effects of probability bias in response readiness and response inhibition on reaching movements

It is solidly established that unequal stimulus frequencies lead to faster responses to the more likely stimulus; however, the effect of this probability bias on response inhibition is still debated. To tackle this issue, we administered two versions of the stop-signal task to 18 right-handed healthy subjects. In one version, we manipulated the frequency of right and left targets appearance when subjects were required to produce speeded responses (no-stop trials) with the right arm, whereas stop signals occurred with equal frequencies after right or left targets (no-stop signal bias). In the other version, we manipulated the frequency of appearance of stop signals after right or left targets, whereas no-stop trials toward right or left targets had the same frequency (stop-signal bias). Surprisingly, we found a very modest, if any, increase in response readiness toward the more frequent stimulus. However, the no-stop signal bias had an effect on the speed of inhibitory control, as subjects were always faster to suppress a movement toward the side where targets were less likely to occur. Differently, the stop-signal bias had a much more powerful effect. In fact, subjects were faster to withhold movements toward the side where targets were more frequent, while they exhibited longer reaction times for reaches toward the more likely targets. Overall, these results suggest that action preparation and action inhibition are independent competing processes, but subjects tend to place automatically greater importance on the stop task.

Stimulation of subthalamic nuclei restores a near normal planning strategy in Parkinson's patients

A fundamental function of the motor system is to gather key information from the environment in order to implement behavioral strategies appropriate to the context. Although several lines of evidence indicate that Parkinson's disease affects the ability to modify behavior according to task requirements, it is currently unknown whether deep brain stimulation (DBS) of the subthalamic nucleus (STN) affects context-related planning. To explore this issue, we asked 12 Parkinson's patients with bilateral STN DBS and 13 healthy subjects to execute similar arm reaching movements in two different paradigms: go-only and countermanding tasks. In the former task patients had to perform speeded reaching movements to a peripheral target. In contrast, in the countermanding task participants had to perform the same reaches unless an infrequent and unpredictable stop-signal was shown during the reaction time (RT) indicating that they should withhold the ongoing action. We compared the performance of Parkinson's patients in different DBS conditions. We found that patients with both DBS-ON behaved similarly to healthy subjects, in that RTs of no-stop trial increased while movement times (MTs) decreased with respect to those of go-only-trials. However, when both DBS were off, both RTs and MTs were longer in no-stop trials than in go-only trials. These findings indicate that bilateral DBS of STN can partially restore the appropriate motor strategy according to the given cognitive contexts.

Stop-event-related potentials from intracranial electrodes reveal a key role of premotor and motor cortices in stopping ongoing movements

In humans, the ability to withhold manual motor responses seems to rely on a right-lateralized frontal–basal ganglia–thalamic network, including the pre-supplementary motor area and the inferior frontal gyrus (IFG). These areas should drive subthalamic nuclei to implement movement inhibition via the hyperdirect pathway. The output of this network is expected to influence those cortical areas underlying limb movement preparation and initiation, i.e., premotor (PMA) and primary motor (M1) cortices. Electroencephalographic (EEG) studies have shown an enhancement of the N200/P300 complex in the event-related potentials (ERPs) when a planned reaching movement is successfully stopped after the presentation of an infrequent stop-signal. PMA and M1 have been suggested as possible neural sources of this ERP complex but, due to the limited spatial resolution of scalp EEG, it is not yet clear which cortical areas contribute to its generation. To elucidate the role of motor cortices, we recorded epicortical ERPs from the lateral surface of the fronto-temporal lobes of five pharmacoresistant epileptic patients performing a reaching version of the countermanding task while undergoing presurgical monitoring. We consistently found a stereotyped ERP complex on a single-trial level when a movement was successfully cancelled. These ERPs were selectively expressed in M1, PMA, and Brodmann's area (BA) 9 and their onsets preceded the end of the stop process, suggesting a causal involvement in this executive function. Such ERPs also occurred in unsuccessful-stop (US) trials, that is, when subjects moved despite the occurrence of a stop-signal, mostly when they had long reaction times (RTs). These findings support the hypothesis that motor cortices are the final target of the inhibitory command elaborated by the frontal–basal ganglia–thalamic network.

Neural correlates of cognitive control of reaching movements in the dorsal premotor cortex of rhesus monkeys

Canceling a pending movement is a hallmark of voluntary behavioral control because it allows us to quickly adapt to unattended changes either in the external environment or in our thoughts. The countermanding paradigm allows the study of inhibitory processes of motor acts by requiring the subject to withhold planned movements in response to an infrequent stop-signal. At present the neural processes underlying the inhibitory control of arm movements are mostly unknown. We recorded the activity of single units in the rostral and caudal portion of the dorsal premotor cortex (PMd) of monkeys trained in a countermanding reaching task. We found that among neurons with a movement-preparatory activity, about one-third exhibit a modulation before the behavioral estimate of the time it takes to cancel a planned movement. Hence these neurons exhibit a pattern of activity suggesting that PMd plays a critical role in the brain networks involved in the control of arm movement initiation and suppression.

Deep brain stimulation of subthalamic nuclei affects arm response inhibition in Parkinson's patients

The precise localizations of the neural substrates of voluntary inhibition are still debated. It has been hypothesized that, in humans, this executive function relies upon a right-lateralized pathway comprising the inferior frontal gyrus and the presupplementary motor area, which would control the neural processes for movement inhibition acting through the right subthalamic nucleus (STN). We assessed the role of the right STN, via a countermanding reaching task, in 10 Parkinson's patients receiving high-frequency electrical stimulation of the STN of both hemispheres (deep brain stimulation, DBS) and in 13 healthy subjects. We compared the performance of Parkinson's patients in 4 experimental conditions: DBS-ON, DBS-OFF, DBS-OFF right, and DBS-OFF left. We found that 1) inhibitory control is improved only when both DBS are active, that is, the reaction time to the stop signal is significantly shorter in the DBS-ON condition than in all the others, 2) bilateral stimulation of STN restores the inhibitory control to a near-normal level, and 3) DBS does not cause a general improvement in task-related motor function as it does not affect the length of the reaction times of arm movements, that is, in our experimental context, STN seems to play a selective role in response inhibition.

Active theater as a complementary therapy for Parkinson's disease rehabilitation: a pilot study

Most medical treatments of Parkinson's disease (PD) are aimed at the reduction of motor symptoms. However, even when motor improvements are evident, patients often report a deterioration of their daily lives. Thus, to achieve a global improvement in personal well-being, not only drugs, but also complementary therapies, such as physical exercise, occupational and speech therapy, and active music therapy, have been used. We hypothesized that theater could reduce clinical disability and improve the quality of life of PD patients (primary end points) more efficiently than other complementary therapies because (1) in order to impersonate a character, patients are forced to regain the control of their bodies; and (2) while being part of a group, patients have a high degree of social interaction. The need to regain the control of their bodies and their social functioning is very likely to deeply motivate patients. To assess this hypothesis, we ran a randomized, controlled, and single-blinded study that lasted 3 years, on 20 subjects affected by a moderate form of idiopathic PD, in stable treatment with L-dopa and L-dopa agonists, and without severe sensory deficits. Ten patients were randomly assigned to an active theater program (in which patients were required to participate), while the others underwent physiotherapy (control group), the most common nonpharmacological treatment for PD rehabilitation. Patients of both groups were evaluated at the beginning of each year, using five clinical rating scales (Unified ParkinsonParkinson'ss Disease Rating Scale [UPDRS], Schwab and England Scale, ParkinsonParkinson'ss Disease Quality of Life [PDQ39] Scale, Epworth Sleepiness Scale, and Hamilton Depression Rating Scale). The theater patients showed progressive improvements and, at the end of the third year, they showed significant improvements in all clinical scales. Conversely, the control patients did not exhibit significant ameliorations with time. Thus, the present study provides the first scientific evidence that active theater, coupled with conventional medical treatments, represents a valid complementary therapeutic intervention for PD treatment.

Hippocampal, amygdala, and neocortical synchronization of theta rhythms is related to an immediate recall during rey auditory verbal learning test

It is well known that theta rhythms (3-8 Hz) are the fingerprint of hippocampus, and that neural activity accompanying encoding of words differs according to whether the items are later remembered or forgotten ["subsequent memory effect" (SME)]. Here, we tested the hypothesis that temporal synchronization of theta rhythms among hippocampus, amygdala, and neocortex is related to immediate memorization of repeated words. To address this issue, intracerebral electroencephalographic (EEG) activity was recorded in five subjects with drug-resistant temporal lobe epilepsy (TLE), under presurgical monitoring routine. During the recording of the intracerebral EEG activity, the subjects performed a computerized version of Rey auditory verbal learning test (RAVLT), a popular test for the clinical evaluation of the immediate and delayed memory. They heard the same list of 15 common words for five times. Each time, immediately after listening the list, the subjects were required to repeat as many words as they could recall. Spectral coherence of the intracerebral EEG activity was computed in order to assess the temporal synchronization of the theta (about 3-8 Hz) rhythms among hippocampus, amygdala, and temporal-occipital neocortex. We found that theta coherence values between amygdala and hippocampus, and between hippocampus and occipital-temporal cortex, were higher in amplitude during successful than unsuccessful immediate recall. A control analysis showed that this was true also for a gamma band (40-45 Hz). Furthermore, these theta and gamma effects were not observed in an additional (control) subject with drug-resistant TLE and a wide lesion to hippocampus. In conclusion, a successful immediate recall to the RAVLT was associated to the enhancement of temporal synchronization of the theta (gamma) rhythms within a cerebral network including hippocampus, amygdala, and temporal-occipital neocortex.

Context influences on the preparation and execution of reaching movements

The ability of rapidly adapting our motor behaviour in order to face the unpredictable changes in the surrounding environment is fundamental for survival. To achieve such a high level of efficiency our motor system has to assess continuously the context in which it acts, gathering all available information that can be relevant for planning goal-oriented movements. One still-debated aspect of movement organization is the nature and timing of motor planning. While motor plans are often taken to be concerned with the setting of kinematic parameters as a function of perceptual and motor factors, it has been suggested that higher level, cognitive factors may also affect planning. To explore this issue further, we asked 18 right-handed human participants to perform speeded hand-reaching movement toward a visual target in two different experimental settings, a reaction time (RT) paradigm (go-only task) and a countermanding paradigm. In both tasks participants executed the same movements, but in the countermanding task no-stop trials were randomly intermixed with stop trials. In stop trials participants were required to withhold the ongoing movement whenever a stop signal was shown. It is known that the presence of stop trials induces a consistent increase of the RTs of no-stop trials with respect to the RTs of go-only trials. However, nothing is known about a similar effect for movement times (MTs). We found that RTs and MTs exhibit opposing tendencies, so that a decrease in the RT correspond to an increase in the MT and vice versa. This tendency was present in all our participants and significant in 90% of them. Furthermore we found a moderate, but again very consistent, anticorrelation between RTs and MTs on a trial-by-trial base. These findings are consistent with strategic changes in movement programmes for the very same movements under different cognitive contexts, requiring different degrees of feedback-driven control during movement.

Neurons in area V4 of the macaque translate attended visual features into behaviorally relevant categories

Neural processing at most stages of the primate visual system is modulated by selective attention, such that behaviorally relevant information is emphasized at the expenses of irrelevant, potentially distracting information. The form of attention best understood at the cellular level is when stimuli at a given location in the visual field must be selected (space-based attention). In contrast, fewer single-unit recording studies have so far explored the cellular mechanisms of attention operating on individual stimulus features, specifically when one feature (e.g., color) of an object must guide behavioral responses while a second feature (e.g., shape) of the same object is potentially interfering and therefore must be ignored. Here we show that activity of neurons in macaque area V4 can underlie the selection of elemental object features and their "translation" into a categorical format that can directly contribute to the control of the animal's behavior.

Alpha1 Adrenoceptors in Human Urinary Tract: Expression, Distribution and Clinical Implications

Adrenergic receptors (ARs) are a class of proteins belonging to the G protein-coupled receptor family. Pharmacological and molecular studies allowed dividing ARs into three different categories: α1, α2 and β. In this review, we focused on α1 ARs and α1 AR antagonists, since α 1 ARs play an important role in the pathophysiology of a number of urinary tract (UT) dysfunctions. α1 ARs are widely expressed in human UT; in particular, the three ureter areas (distal, medial and proximal) show different patterns of receptor expression (i.e. distal > medial = proximal), giving the molecular basis for the use of α1 ARs antagonist in the expulsive therapy of distal ureter calculi. Bladder areas are characterized by important differences among trigone, detrusor and neck, the first showing a different pattern of expression compared to the other parts. Further, there are evidences of both density and subtype gender-dependent expressions. α1 ARs expression in prostate and detrusor is a widely investigated area of research, mainly due to the clinical impact of benign prostatic hyperplasia (BPH). Urethra has not been well studied in human, although it plays a role in the control of continence.

Studies carried out on α1 AR subtype expression in the UT indicate that, although the presence of each subtype is observed, α1A firstly and then α1D ARs seem to be more expressed than α1B ARs. Thus, drugs that demonstrate high α1A/D AR selectivity have drawn the researchers’ attention. As it relates specifically to the α1 AR antagonists used in the treatment of lower UT symptoms, the concept of uroselectivity has been operationally defined; indeed, in a number of recent publications uroselectivity has been defined as the degree to which a given compound inhibits norepinephrine-induced increase in urinary muscle contractions and/or its propensity to generate unwanted cardiovascular effects, such as decreases in blood pressure.

Inhibitory control of reaching movements in humans

Behavioral flexibility provides a very large repertoire of actions and strategies, however, it carries a cost: a potential interference between different options. The voluntary control of behavior starts exactly with the ability of deciding between alternatives. Certainly inhibition plays a key role in this process. Here we examined the inhibitory control of reaching arm movements with the countermanding paradigm. Right-handed human subjects were asked to perform speeded reaching movements toward a visual target appearing either on the same or opposite side of the reaching arm (no-stop trials), but to withhold the commanded movement whenever an infrequent stop signal was presented (stop trials). As the delay between go and stop signals increased, subjects increasingly failed to inhibit the movement. From this inhibitory function and the reaction times of movements in no-stop trials, we estimated the otherwise unobservable duration of the stopping process, the stop signal reaction time (SSRT). We found that the SSRT for reaching movements was, on average, 206 ms and that it varied with the reaching arm and the target position even though the stop signal was a central stimulus. In fact, subjects were always faster to withhold reaching movements toward visual targets appearing on the same side of the reaching arm. This behavior strictly parallels the course of the reaction times of no-stop trials. These data show that the stop and go processes interacting in this countermanding task are independent, but most likely influenced by a common factor when under the control of the same hemisphere. In addition, we show that the point beyond which the response cannot be inhibited, the so-called point-of-no-return that divides controlled and ballistic phases of movement processing, lies after the inter-hemispheric transfer.

Alpha1 Adrenoceptor Subtypes in Human Urinary Bladder: Sex and Regional Comparison

The aim of this work is to report a detailed study of the presence of α1 AR subtypes in human urinary bladder areas involved in the micturition (i.e. detrusor, trigone and neck), investigating whether or not there are differences between sexes.

Methods

Urinary bladder specimens were obtained as discarded tissue after cystectomy for vesical carcinoma (17 men and 14 women). Molecular characterization of α1 AR subtypes was done by semi-quantitative RT-PCR. The α1 AR protein expression was studied by saturation binding curves using the α1 AR antagonist 125I-HEAT and by western blot. Analysis of data was performed using the GraphPad PRISM 4 software.

Results

Results obtained indicated that α1 AR proteins were detectable in each bladder area. In both sexes, the detrusor and the neck expressed similar levels of α1 ARs: respectively, detrusor: 14.6 ± 1.2 in men and 13.1 ± 1.1 fmol/mg prot in women; neck: 16.9±3.2 in men and 17.5 ± 4.1 fmol/mg prot in women. In the trigone, significantly higher α1 ARs were found in women compared to men (20.6 ± 1.1 vs 11.7 ± 0.7 fmol/mg prot). Subtype analysis indicated that in women, each area was endowed with mRNA and protein encoding for each α1 AR subtype. The men detrusor expressed α1A and α1D ARs, while in the trigone and the neck, each subtype was present.

Conclusions

A selective distribution of α1 ARs did exist between sexes and between the different areas involved in micturition, supporting evidence which indicates a role of different α1 AR subtypes in the pathophysiology of the lower urinary tract symptoms.

Evidence for the Presence of α1 Adrenoceptor Subtypes in the Human Ureter

Several studies proposed a role for α1 adrenoceptors (α1 ARs) in the ureteral physiology, indicating that they are present in the ureter; however, few studies have been made to identify α1 AR subtypes present in this area. Thus, this study was carried out to characterize the α1 AR subtype gene and protein expression in proximal, medial and distal region of the human ureter.

Methods

Molecular characterization of α1 AR subtypes was done by semi-quantitative RT-PCR. The α1 AR protein expression was studied by saturation binding curves using the α1 AR antagonist 125I-HEAT. Analysis of data was performed using the GraphPad PRISM 4 software.

Results

Analysis of saturation binding curves revealed an heterogeneous distribution of α1 AR binding sites; the Bmax for the distal ureter was indeed 52.5 ±5.4 fmol/mg prot, while a lower similar density of α1 ARs was demonstrated in the medial (25.2 ±1.7 fmol/mg prot) and proximal (23.4 ±0.4 fmol/mg prot) ureters. Molecular characterization of α1 AR subtypes indicated that each receptor was present, although with differences in term of the amount expressed.

Conclusions

Human ureter was endowed with each α1 AR subtype, although α1D and α1A ARs were prevalent over α1B ARs. Radioligand binding results revealed that there were no significant differences in the Kd between ureteral regions, while an heterogeneous distribution of α1 AR binding sites was detected, with the highest density of α1 ARs in the distal ureter and a lower similar density in the medial and proximal ureter.