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Psychological and Physiological Trauma Research
Seize Your Journeys
_______________________ Traumatic stress is found in many competent, healthy, strong, good people. No one can completely protect themselves from traumatic experiences. Many people have long-lasting problems following exposure to trauma. Up to 8% of persons will have PTSD at some time in their lives. People who react to traumas are not going crazy. What is happening to them is part of a set of common symptoms and problems that are connected with being in a traumatic situation, and thus, is a normal reaction to abnormal events and experiences. Having symptoms after a traumatic event is NOT a sign of personal weakness. Given exposure to a trauma that is bad enough, probably all people would develop PTSD. By understanding trauma symptoms better, a person can become less fearful of them and better able to manage them. By recognizing the effects of trauma and knowing more about symptoms, a person will be better able to decide about getting treatment. _______________________
FUNCTIONAL NEUROANATOMY In order to best understand this atlas it is important to have a sense of the functional neuroanatomy of the brain. Over the next several pages there is a brief summary of the 5 major brain systems that relate to behavior, along with the general location seen on SPECT of these areas.
The Deep Limbic System
Functions
Problems
The Basal Ganglia System
Functions
Problems
The Prefrontal Cortex
Functions
Problems
The Cingulate Gyrus
Problems
The Temporal Lobes
Functions
Problems
Non-dominant Side (usually the right)
Secure Attachments as a Defense Against Trauma “All people mature and thrive in a social context that has profound effects on how they cope with life’s stresses. Particularly early in life, the social context plays a critical role in fuffering an individual against stressful situations, and in building the psychological and biological capacities to deal with further stresses. The primary function of parents can be thought of as helping children modulate their arousal by attuned and well-timed provision of playing, feeding, comforting, touching, looking, cleaning, and resting—in short, by teaching them skills that will gradually help them modulate their own arousal. Secure attachment bonds serve as primary defenses against trauma-induced psychopathology in both children and adults (Finkelhor & Browne, 1984). In children who have been exposed to severe stressors, the quality of the parental bond is probably the single most important determinant of long-term damage (McFarlane, 1988).” van der Kolk, Bessel, Alexander C. McFarlane, and Lars Weisaeth, eds. 1996. Traumatic stress: The effects of overwhelming experience on mind, body, and society. New York and London: Guilford Press. .p. 185 _______________________
Sleep Disorders
“The sleep disorders are organized into four major sections according to presumed etiology. Primary Sleep Disorders are those in which none of the etiologies listed below (i.e., another mental disorder, a general medical condition, or a substance) is responsible. Primary Sleep Disorders are presumed to arise from endogenous abnormalities in sleep-wake generating or timing mechanisms, often complicated by conditioning factors. Primary Sleep Disorders in turn are divided into Dyssomnias (characterized by abnormalities in the amount, quality, or timing of sleep) and Parasomnias (characterized by abnormal behavioral or physiological events occurring in association with sleep, specific sleep stages, or sleep-awake transitions). Sleep Disorder Related to Another Mental Disorder involves a prominent complaint of sleep disturbance that results from a diagnosable mental disorder (often a Mood Disorder or Anxiety Disorder) but that is sufficiently severe to warrant independent clinical attention. Presumably, the pathophysiological mechanisms responsible for the mental disorder also affect sleep-awake regulation. Sleep Disorder Due to a General Medical Condition involves a prominent complaint of sleep disturbance that results from the direct physiological effects of a general medical condition on the sleep-wake system. Substance-Induced Sleep Disorder involves prominent complaints of sleep disturbance that result from the concurrent use, or recent discontinuation of use, of a substance (including medications). That systematic assessment in individuals who present with prominent complaints of sleep disturbance includes an evaluation of the specific type of sleep complaint and a consideration of concurrent mental disorders, general medical conditions, and substance (including medication) use that may be responsible for the sleep disturbance. Five distinct sleep stages can be measured by polysomnography: rapid eye movement (REM) sleep and four stages of non-rapid eye movement (NREM) sleep (stages 1, 2, 3, and 4). Stage 1 NREM sleep is a transition from wakefulness to sleep and occupies about 5% of time spent asleep in healthy adults. Stage 2 NREM sleep, which is characterized by specific EEG waveforms (sleep spindles and K complexes), occupies about 50% of time spent asleep. Stages 3 and 4 NREM sleep (also known collectively as slow-wave sleep) are the deepest levels of sleep and occupy about 10%-20% of sleep time. REM sleep, during which the majority of typical storylike dreams occur, occupies about 20%-25% of total sleep. These sleep stages have a characteristic temporal organization across the night. NREM stages 3 and 4 tend to occur in the first one-third to one-half of the night and increase in duration in response to sleep deprivation. REM sleep occurs cyclically throughout the night, alternating with NREM sleep about every 80-100 minutes. REM sleep periods increase in duration toward the morning. Human sleep also varies characteristically across the life span. After relative stability with large amounts of slow-wave sleep in childhood and early adolescence, sleep continuity and depth deteriorate across the adult age range. This deterioration is reflected by increased wakefulness and stage 1 sleep and decreased stages 3 and 4 sleep. Because of this, age must be considered in the diagnosis of a Sleep Disorder in any individual. Polysomnography is the monitoring of multiple electrophysiological parameters during sleep and generally includes measurement of EEG activity, electroculographic activity, and electromyographic activity. Additional polysomnographic measures may include oral or nasal airflow, respiratory effort, chest and abdominal wall movement, oxyhemoglobin saturation, or exhaled carbon dioxide concentration; these measures are used to monitor respiration during sleep and to detect the presence and severity of sleep apnea. Measurement of peripheral electromyographic activity may be used to detect abnormal movements during sleep. Most polysomnographic studies are conducted during the person’s usual sleeping hours—that is, at night. However, daytime polysomnographic studies also are used to quantify daytime sleepiness. The most common daytime procedure is the Multiple Sleep Latency Test (MSLT), in which the individual is instructed to lie down in a dark room and not resist falling asleep; this protocol is repeated fives times during the day. Sleep latency (the amount of time required to fall asleep) is measured on each trial and is used as an index of physiological sleepiness. The converse of the MSLT is also used: In the Repeated Test of Sustained Wakefulness (RTSW), the individual is placed in a quiet, dimly lit room and instructed to remain awake; this protocol is repeated several times during the day. Again, sleep latency is measured, but is it used here as an index of the individual’s ability to maintain wakefulness. Standard terminology for polysomnographic measures is used throughout the test in this section. Sleep continuity refers to the overall balance of sleep and wakefulness during a night of sleep. “Better” sleep continuity indicates consolidated sleep and wakefulness; “worse” sleep continuity indicates disrupted sleep with more wakefulness. Specific sleep continuity measures include sleep latency—the amount of time required to fall asleep (expressed in minutes); intermittent wakefulness—the amount of awake time after initial sleep onset (expressed in minutes); and sleep efficiency—the ratio of actual time spent asleep to time spent in bed (expressed as a percentage, with higher numbers indicating better sleep continuity). Sleep architecture refers to the amount and distribution of specific sleep stages. Sleep architecture measures include absolute amount of REM sleep and each NREM sleep stage (in minutes), relative amount of REM seep and NREM sleep stages (expressed as a percentage of total sleep time), and latency between sleep onset and the first REM period (REM latency). The text for each of the Sleep Disorders contains a section describing its relationship to corresponding disorders in The International Classification of Sleep Disorders: (ICSD) diagnostic and Coding Manual, published in 1990 by the American Sleep Disorders Association. _________________
Substance Dependence “Features The essential feature of Substance Dependence is a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues use of the substance despite significant substance-related problems. There is a pattern of repeated self-administration that can result in tolerance, withdrawal, and compulsive drug-taking behavior. A diagnosis of Substance Dependence can be applied to every class of substances except caffeine. The symptoms of Dependence are similar across the various categories of substances, but for certain classes some symptoms are less salient, and in a few instances not all symptoms apply (e.g., withdrawal symptoms are not specified for Hallucinogenic Dependence). Although not specifically listed as a criterion item, “craving” (a strong subjective drive to use the substance) is likely to be experienced by most (if not all) individuals with Substance Dependence. Dependence is defined as a cluster of three or more of the symptoms listed below occurring at any time in the same 12-month-period. Tolerance (Criterion 1) is the need for greatly increased amounts of the substance to achieve intoxication (or the desired effect) or a markedly diminished effect with continued use of the same amount of the substance. The degree to which tolerance develops varies greatly across substances. Furthermore, for a specific drug, varied degrees of tolerance may develop for its different central nervous system effects. For example, for opioids, tolerance to respiratory depression and tolerance to analgesia develop at different rates. Individuals with heavy use of opioids and stimulants can develop substantial (e.g., 10-f0ld) levels of tolerance, often to a dosage that would be lethal to a nonuser. Alcohol tolerance can also be pronounced, but is usually less extreme than for amphetamine. Many individuals who smoke cigarettes consume more than 20 cigarettes a day, an amount that would have produced symptoms of toxicity when they first started smoking. Individuals with heavy use of cannabis or phencyclidine (PCP) are generally not aware of having developed tolerance (although it has been demonstrated in animal studies and in some individuals). Tolerance may be difficult to determine by history alone when the substance used is illegal and perhaps mixed with various diluents or with other substances. In such situations, laboratory tests may be helpful (e.g., high blood levels of the substance coupled with little evidence of intoxication suggest that tolerance is likely). Tolerance must also be distinguished from individual variability in the initial sensitivity to the effects of particular substances. For example, some first-time drinkers show very little evidence of intoxication with three or four drink, whereas others of similar weight and drinking histories had slurred speech and incoordination. Withdrawal (Criterion 2a) is a maladaptive behavioral change, with physiological and cognitive concomitants, that occurs when blood or tissue concentrations of a substance decline in an individual who had maintained prolonged heavy use of the substance. After developing unpleasant withdrawal symptoms, the persons is likely to take the substance to relieve or to avoid those symptoms (Criterion 2b), typically using the substance throughout the day beginning soon after awakening. Withdrawal symptoms, which are generally the opposite of the acute effects of the substance, vary greatly across the calluses of substances, and separate criteria sets for Withdrawal are provided for most of the classes. Marked and generally easily measured physiological signs of withdrawal are common with alcohol, opioids, and sedatives, hypnotics, and anxiolytics. Withdrawal signs and symptoms are often present, but may be less apparent, with stimulants such as amphetamines and cocaine, as well as with nicotine and cannabis. No significant withdrawal is seen even after repeated use of hallucinogens. Withdrawal from phencyclidine and related substances has not yet been described in humans (although it has been demonstrated in animals). Neither tolerance nor withdrawal is necessary or sufficient for a diagnosis of Substance Dependence. However, for most classes of substances, a past history of tolerance or withdrawals is associated with a more severe clinical course (i.e., an earlier onset of Dependence, higher levels of substance intake, and a greater number of substance-related problems). Some individuals (e.g., those with Cannabis Dependence) show a pattern of compulsive use without obvious signs of tolerance or withdrawal. Conversely, some general medical and postsurgical patients without Opioid Dependence may develop a tolerance to prescribed opioids and experience withdrawal symptoms without showing any signs of compulsive use. The specifiers With Physiological Dependence and Without Physiological Dependence are provided to indicate the presence or absence of tolerance or withdrawal. The following items describe the pattern of compulsive substance use that is characteristic of Dependence. The individual may take the substance in larger amounts or over a longer period than was originally intended (e.g., continuing to drink until severely intoxicated despite having set a limit of only one drink) (Criterion 3). The individual may express a persistent desire to cut down or regulate substance use. Often, there have been many unsuccessful efforts to decrease or discontinue use (Criterion 4). The individual may spend a great deal of time obtaining the substance, using the substance, or recovering from its effects (Criterion 5). In some instances of Substance Dependence, virtually all of the person’s daily activities revolve around the substance. Important social, occupational, ore recreational activities may be given up or reduced because of substance use (Criterion 6). The individual may withdraw from family activities and hobbies in order to use the substance in private or to spend more time with substance-using friends. Despite recognizing the contributing role of the substance to a psychological or physical problem (e.g., sever depressive symptoms or damage to organ systems), the person continues to use the substance (Criterion 7). The key issue in evaluating this criterion is not eh existence of the problem, but rather the individual’s failure to abstain from using the substance despite having evidence of the difficulty it is causing.
Specifiers Tolerance and withdrawal may be associated with a higher risk for immediate general medical problems and a higher relapse rate. Specifiers are provided to note their presence or absence: With Physiological Dependence. This specifier should be used when Substance Dependence is accompanied by evidence of tolerance (Criterion 1) or withdrawal (Criterion 2). Without Physiological Dependence. This specifier should be used when there is no evidence of tolerance (Criterion 1) or withdrawal (Criterion 2). In these individuals, Substance Dependence is characterized by a pattern of compulsive use (at least three items from Criteria 3-7).”
Diagnostic and Statistical Manual of Mental Disorders. 2000. 4th ed. Washington, D.C.: American Psychiatric Association. P. 193-195.
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PTSD, DID, and EMDR Posttraumatic Stress Disorder "The essential feature of Posttraumatic Stress Disorder us the development of characteristic symptoms following exposure to an extreme traumatic stressor involving direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one's physical integrity; or witnessing an event that involves death, injury, or a threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate (Criteria A1). The person's response to the event must involve intense fear, helplessness, or horror (or in children, the response must involve disorganized or agitated behavior) (Criterion A2). The characteristic symptoms resulting from the exposure to the extreme trauma include persistent reexperiencing of the traumatic event (Criterion E), and the disturbance must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning (Criterion F). Traumatic events that are experienced directly include, but are not limited to, military combat, violent personal assault (sexual assault, physical attack, robbery, mugging), being kidnapped, being taken hostage, terrorist attack, torture, incarceration as a prisoner of war or in a concentration camp, natural or manmade disasters, severe automobile accidents, or being diagnosed with a life-threatening illness. For children, sexually traumatic events may include developmentally inappropriate sexual experiences without threatened or actual violence or injury. Witnessed events include, but are not limited to, observing the serious injury or unnatural death of another person due to violent assault, accident, war, or disaster or unexpectedly witnessing a dead body or body parts. Events experienced by others that are learned about include, but are not limited to, violent personal assault, serious accident, or serious injury experienced y a family member or a close friend; learning about the sudden, unexpected death of a family member or a close friend; or learning that one's child has a life threatening disease. The disorder may be especially sever or long lasting when the stressor is of human design (e.g., torture, rape). the likelihood of developing this disorder may increase as the intensity of and physical proximity to the stressor increase. The traumatic event can be reexperienced in various ways. Commonly the person has recurrent and intrusive recollections of the event (Criterion B1) or recurrent distressing dreams during which the event can be replayed or otherwise represented (Criterion B2). In rare instances, the person experiences dissociative states that last from a few seconds to several hours, or even days, during which components of the event are relived and the person behaves as though experiencing the event at that moment (Criterion B3). These episodes, often referred to as "flashbacks," are typically brief but can be associated with prolonged distress and heightened arousal. Intense psychological distress (Criterion B4) or physiological reactivity (Criterion B5) often occurs when the person is exposed to triggering events that resemble or symbolize an aspect of the traumatic event (e.g., anniversaries of the traumatic event; cold, snowy weather or uniformed guards for survivors of death camps in cold climates; hot, humid weather for combat veterans of the South Pacific; entering any elevator for an woman who was reaped in an elevator). Stimuli associated with the trauma are persistently avoided. The person commonly makes deliberate efforts to avoid thoughts, feelings, or conversations about the traumatic event (Criterion C1) and to avoid activities, situations, or people who around recollections of it (Criterion C2). This avoidance of reminders may include amnesia for an important aspect of the traumatic event (Criterion C3). Diminished responsiveness to the external work, referred to as "psychic numbing" or "emotional anesthesia," usually begins soon after the traumatic event. The individual may complain of having markedly diminished interest or participation in previously enjoyed activities (Criterion C4), of feeling detached or estranged from other people (Criterion C5), or of having markedly reduced ability to feel emotions (especially those associated with intimacy, tenderness and sexuality) (Criterion C6). The individual may have a sense of a foreshortened future (e.g., not expecting to have a career, marriage, children, or a normal life span) (Criterion C7). The individual has persistent symptoms of anxiety or increased arousal that were not present before the trauma. these symptoms may include difficulty falling or staying asleep that may be to recurrent nightmares during which the traumatic event is relived (Criterion D1), hypervigilance (Criterion D4), and exaggerated startle response (Criterion D5). Some individuals report irritability or outburst of anger (Criterion D2) or difficulty concentrating or completing tasks (Criterion D3)."
Dissociative Identity Disorder (DID) "The essential feature of Dissociative identity Disorder is the presence of two or more distinct identities or personality states (Criterion A) that recurrently take control of behavior (Criterion B). There is an inability to recall important personal information, the extent of which is too great to be explained by ordinary forgetfulness (Criterion C). The disturbance is not due tot eh direct physiological effects of a substance or a general medical condition (Condition D.). In children, the symptoms cannot be attributed to imaginary playmates or other fantasy play. Dissociative Identity Disorder reflects a failure to integrate various aspects of identity, memory, and consciousness. Each personality state may be experienced as if it has a distinct personal history, self-image, and identity, including a separate name. Usually there is a primary identity that carries the individual's given name and is passive, dependent, guilty, and depressed. The alternate identities frequently have different names and characteristics that contrast with the primary identity (e.g., are hostile, controlling, and self-destructive). Particular identities may emerge in specific circumstances and may differ in reported age and gender, vocabulary, general knowledge, or predominant affect. Alternate identities are experienced as taking control in sequence, ore at the expense of the other, and may deny knowledge of one another, be critical of one another, or appear to be in open conflict. Occasionally, one or more powerful identities allocate time to the others. Aggressive or hostile identities may at times interrupt activities or place the others in uncomfortable situations. Individuals with this disorder experience frequent gaps in memory for personal history, both remote and recent. The amnesia is frequently asymmetrical. The more passive identities tend to have more constricted memories, whereas the more hostile, controlling, or "protector" identities have more complete memories. An identity that is not in control may nonetheless gain access to consciousness by producing auditory or visual hallucinations (e.g., a voice giving instructions). Evidence of amnesia may be uncovered by reports from others who have witnessed behavior that is disavowed by the individual or by the individual's own discoveries (e.g., finding items of clothing at home that the individual cannot remember having bought). There may be loss of memory not only for recurrent periods of time, but also an overall loss of biographical memory for some extended period of childhood, adolescence, or even adulthood. Transitions among identities are often triggered by psychosocial stress. The time required to switch from one identity to another is usually a matter of seconds, but, less frequently, may b gradual. Behavior that may be frequently associated with identity switches include rapid blinking, facial changes, changes in voice or demeanor, or disruption in the individual's train of thoughts. The number of identities reported ranges from 2 to more than 100. Half of reported cases include the individuals with 10 or fewer identities." Diagnostic and Statistical Manual of Mental Disorders. 2000. 4th ed. Washington, D.C.: American Psychiatric Association. EMDR Eye Movement Desensitization and Reprocessing "Eye Movement Desensitization and Reprocessing (EMDR)1 integrates elements of many effective psychotherapies in structured protocols that are designed to maximize treatment effects. These include psychodynamic, cognitive behavioral, interpersonal, experiential, and body-centered therapies2. EMDR is an information processing therapy and uses an eight phase approach. During EMDR1 the client attends to past and present experiences in brief sequential doses while simultaneously focusing on an external stimulus. Then the client is instructed to let new material become the focus of the next set of dual attention. This sequence of dual attention and personal association is repeated many times in the session. Eight Phases of Treatment The first phase is a history taking session during which the therapist assesses the client's readiness for EMDR and develops a treatment plan. Client and therapist identify possible targets for EMDR processing. These include recent distressing events, current situations that elicit emotional disturbance, related historical incidents, and the development of specific skills and behaviors that will be needed by the client in future situations. During the second phase of treatment, the therapist ensures that the client has adequate methods of handling emotional distress and good coping skills, and that the client is in a relatively stable state. If further stabilization is required, or if additional skills are needed, therapy focuses on providing these. The client is then able to use stress reducing techniques whenever necessary, during or between sessions. However, one goal is not to need these techniques once therapy is complete. In phase three through six, a target is identified and processed using EMDR procedures. These involve the client identifying the most vivid visual image related to the memory (if available), a negative belief about self, related emotions and body sensations. The client also identifies a preferred positive belief. The validity of the positive belief is rated, as is the intensity of the negative emotions. After this, the client is instructed to focus on the image, negative thought, and body sensations while simultaneously moving his/her eyes back and forth following the therapist's fingers as they move across his/her field of vision for 20-30 seconds or more, depending upon the need of the client. Athough eye movements are the most commonly used external stimulus, therapists often use auditory tones, tapping, or other types of tactile stimulation. The kind of dual attention and the length of each set is customized to the need of the client. The client is instructed to just notice whatever happens. After this, the clinician instructs the client to let his/her mind go blank and to notice whatever thought, feeling, image, memory, or sensation comes to mind. Depending upon the client's report the clinician will facilitate the next focus of attention. In most cases a client-directed association process is encouraged. This is repeated numerous times throughout the session. If the client becomes distressed or has difficulty with the process, the therapist follows established procedures to help the client resume processing. When the client reports no distress related to the targeted memory, the clinician asks him/her to think of the preferred positive belief that was identified at the beginning of the session, or a better one if it has emerged, and to focus on the incident, while simultaneously engaging in the eye movements. After several sets, clients generally report increased confidence in this positive belief. The therapist checks with the client regarding body sensations. If there are negative sensations, these are processed as above. If there are positive sensations, they are further enhanced. In phase seven, closure, the therapist asks the client to keep a journal during the week to document any related material that may arise and reminds the client of the self-calming activities that were mastered in phase two. The next session begins with phase eight, re-evaluation of the previous work, and of progress since the previous session. EMDR treatment ensures processing of all related historical events, current incidents that elicit distress, and future scenarios that will require different responses. The overall goal is produce the most comprehensive and profound treatment effects in the shortest period of time, while simultaneously maintaining a stable client within a balanced system. After EMDR processing, clients generally report that the emotional distress related to the memory has been eliminated, or greatly decreased, and that they have gained important cognitive insights. Importantly, these emotional and cognitive changes usually result in spontaneous behavioral and personal change, which are further enhanced with standard EMDR procedures." www.emdr.com __________________ Major Depressive Disorder “Diagnostic Features The essential feature of Major Depressive Disorder is a clinical course that is characterized by one or more Major Depressive Episodes without a history of Manic, Mixed, or Hypomanic Episodes (Criteria A and C). Episodes of Substance-Induced Mood Disorder (due to the direct physiological effects of a drug of abuse, a medication, or toxin exposure) or of Mood Disorder Due to a General Medical Condition do not count toward a diagnosis of Major Depressive Disorder. In addition, the episodes must not be better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified (Criterion B). The fourth digit in the diagnostic code for Major Depressive Disorder indicates whether it is a Single Episode (used only for first episodes) or Recurrent. It is sometimes difficult to distinguish between a single episode with waxing and waning symptoms and two separate episodes. For purposes of this manual, an episode is considered to have ended when the full criteria for eh Major Depressive Episode have not been met for at least 2 consecutive months. During this 2-month period, there is either complete resolution of symptoms or the presence of depressive symptoms that no longer meet the full criteria for a Major Depressive Episode (In Partial Remission). The fifth digit in the diagnostic code for Major Depressive Disorder indicates the current state of the disturbance. If the criteria for a Major Depressive Disorder are met, the severity of the episode is notes as Mild, Moderate, Severe Without Psychotic Features, or Severe With Psychotic Features. If the criteria for a Major Depressive Episode are not currently met, the fifth digit is used to indicate whether the disorder is In Partial Remission or In Full Remission. If Manic, Mixed, or Hypomanic Episodes develop in the course of Major Depressive Disorder, the diagnosis is changed to a Bipolar Disorder. However, if manic or hypomanic symptoms occur as a direct effect of antidepressant treatment, use of other medications, substance use, or toxin exposure, the diagnosis of Major Depressive Disorder remains appropriate and an addition diagnosis of Substance-induced Mood Disorder, With Manic features (or With Mixed Features), should be noted. Similarly, if manic or hypomanic symptoms occur as a direct effect of a general medical condition, the diagnosis of Major Depressive Disorder remains appropriate and an additional diagnosis of Mood Disorder Due to a General Medical Condition, With Manic Features (or With Mixed Features), should be noted.” p. 369 “Course Major Depressive Disorder may begin at any age, with an average age at onset in the mid-20s. Epidemiological data suggest that the age at onset is decreasing for those born more recently. The course of Major Depressive Disorder, Recurrent, is variable. Some people have isolated episodes that are separated by many years without any depressive symptoms, whereas others have clusters of episodes, and still others have increasingly frequent episodes as they grow older. Some evidence suggests that the periods of remission generally last longer early in the course of the disorder. The number of prior episodes predicts the likelihood of developing a subsequent Major Depressive Episode. At least 60% of individuals with Major Depresssive Disorder, Single Episode, can be expected to have a second episode. Individuals who have had tow episodes have a 70% chance of having a third, and individuals who have had three episodes have a 90% chance of having a fourth. About 5%-10% of individuals with Major Depressive Disorder, single Episode, subsequently develop a Manic Episode (i.e., develop Bipolar I Disorder). Major Depressive Episodes may end completely (in about two-thirds of cases), or only partially or not at all (in about one-third of cases). For individuals who have only partial remission, there is a greater likelihood of developing additional episodes and of continuing the pattern of partial interepisode recovery. The longitudinal course specifiers With Full Interepisode Recovery and Without Full Interepisode Recovery may therefore have prognostic value. A number of individuals have pre-existing Dysthymic Disorder prior to the onset of Major Depressive Disorder, single Episode. Some evidence suggests that these individuals are more likely to have additional Major Depressive Episodes, have poorer interepisode recovery, and may require additional acute-phase treatment and a longer period of continuing treatment to attain and maintain a more thorough and longer-lasting euthymic state. Follow-up naturalistic studies suggested that 1 year after the diagnosis of a major Depressive Episode, 40% of individuals still have symptoms that are sufficiently severe to meet criteria for a full Major Depressive Episode, roughly 20% continue to have some symptoms that no longer meet full criteria for a Major Depressive Episode (i.e., major Depressive Disorder, In Partial Remission), and 40% have no Mood Disorder. The severity of the initial Major Depressive Episode appears to predict persistence. Chronic general medical conditions are also a risk factor for more persistent episodes. Episodes of Major Depressive Disorder often follow a severe psychosocial stressor, such as the death of a loved one or divorce. Studies suggest that psychosocial events 9stressors) may play a more significant role in the precipitation of the first or second episodes of Major Depressive Disorder and may play less of a role in the onset of subsequent episodes. Chronic general medical conditions and Substance Dependence (particularly Alcohol or Cocaine Dependence) may contribute to the onset or exacerbation of Major Depressive Disorder. It is difficult to predict whether the first episode of a Major Depressive Disorder in a young person will ultimately evolve into a Bipolar Disorder. Some data suggest that the acute onset of severe depression, especially with psychotic features and psychomotor retardation, in a young person without prepubertal psychopathology is more likely to predict a bipolar disorder. A family history of Bipolar Disorder may also be suggestive of subsequent development of Bipolar Disorder.” p. 372-373
Diagnostic and statistical manual of mental disorders. 2000. 4th ed. Washington, D.C.: American Psychiatric Association.
________________ Major Depressive Disorder “Diagnostic Features The essential feature of Major Depressive Disorder is a clinical course that is characterized by one or more Major Depressive Episodes without a history of Manic, Mixed, or Hypomanic Episodes (Criteria A and C). Episodes of Substance-Induced Mood Disorder (due to the direct physiological effects of a drug of abuse, a medication, or toxin exposure) or of Mood Disorder Due to a General Medical Condition do not count toward a diagnosis of Major Depressive Disorder. In addition, the episodes must not be better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified (Criterion B). The fourth digit in the diagnostic code for Major Depressive Disorder indicates whether it is a Single Episode (used only for first episodes) or Recurrent. It is sometimes difficult to distinguish between a single episode with waxing and waning symptoms and two separate episodes. For purposes of this manual, an episode is considered to have ended when the full criteria for eh Major Depressive Episode have not been met for at least 2 consecutive months. During this 2-month period, there is either complete resolution of symptoms or the presence of depressive symptoms that no longer meet the full criteria for a Major Depressive Episode (In Partial Remission). The fifth digit in the diagnostic code for Major Depressive Disorder indicates the current state of the disturbance. If the criteria for a Major Depressive Disorder are met, the severity of the episode is notes as Mild, Moderate, Severe Without Psychotic Features, or Severe With Psychotic Features. If the criteria for a Major Depressive Episode are not currently met, the fifth digit is used to indicate whether the disorder is In Partial Remission or In Full Remission. If Manic, Mixed, or Hypomanic Episodes develop in the course of Major Depressive Disorder, the diagnosis is changed to a Bipolar Disorder. However, if manic or hypomanic symptoms occur as a direct effect of antidepressant treatment, use of other medications, substance use, or toxin exposure, the diagnosis of Major Depressive Disorder remains appropriate and an addition diagnosis of Substance-induced Mood Disorder, With Manic features (or With Mixed Features), should be noted. Similarly, if manic or hypomanic symptoms occur as a direct effect of a general medical condition, the diagnosis of Major Depressive Disorder remains appropriate and an additional diagnosis of Mood Disorder Due to a General Medical Condition, With Manic Features (or With Mixed Features), should be noted.” p. 369 “Course Major Depressive Disorder may begin at any age, with an average age at onset in the mid-20s. Epidemiological data suggest that the age at onset is decreasing for those born more recently. The course of Major Depressive Disorder, Recurrent, is variable. Some people have isolated episodes that are separated by many years without any depressive symptoms, whereas others have clusters of episodes, and still others have increasingly frequent episodes as they grow older. Some evidence suggests that the periods of remission generally last longer early in the course of the disorder. The number of prior episodes predicts the likelihood of developing a subsequent Major Depressive Episode. At least 60% of individuals with Major Depresssive Disorder, Single Episode, can be expected to have a second episode. Individuals who have had tow episodes have a 70% chance of having a third, and individuals who have had three episodes have a 90% chance of having a fourth. About 5%-10% of individuals with Major Depressive Disorder, single Episode, subsequently develop a Manic Episode (i.e., develop Bipolar I Disorder). Major Depressive Episodes may end completely (in about two-thirds of cases), or only partially or not at all (in about one-third of cases). For individuals who have only partial remission, there is a greater likelihood of developing additional episodes and of continuing the pattern of partial interepisode recovery. The longitudinal course specifiers With Full Interepisode Recovery and Without Full Interepisode Recovery may therefore have prognostic value. A number of individuals have pre-existing Dysthymic Disorder prior to the onset of Major Depressive Disorder, single Episode. Some evidence suggests that these individuals are more likely to have additional Major Depressive Episodes, have poorer interepisode recovery, and may require additional acute-phase treatment and a longer period of continuing treatment to attain and maintain a more thorough and longer-lasting euthymic state. Follow-up naturalistic studies suggested that 1 year after the diagnosis of a major Depressive Episode, 40% of individuals still have symptoms that are sufficiently severe to meet criteria for a full Major Depressive Episode, roughly 20% continue to have some symptoms that no longer meet full criteria for a Major Depressive Episode (i.e., major Depressive Disorder, In Partial Remission), and 40% have no Mood Disorder. The severity of the initial Major Depressive Episode appears to predict persistence. Chronic general medical conditions are also a risk factor for more persistent episodes. Episodes of Major Depressive Disorder often follow a severe psychosocial stressor, such as the death of a loved one or divorce. Studies suggest that psychosocial events 9stressors) may play a more significant role in the precipitation of the first or second episodes of Major Depressive Disorder and may play less of a role in the onset of subsequent episodes. Chronic general medical conditions and Substance Dependence (particularly Alcohol or Cocaine Dependence) may contribute to the onset or exacerbation of Major Depressive Disorder. It is difficult to predict whether the first episode of a Major Depressive Disorder in a young person will ultimately evolve into a Bipolar Disorder. Some data suggest that the acute onset of severe depression, especially with psychotic features and psychomotor retardation, in a young person without prepubertal psychopathology is more likely to predict a bipolar disorder. A family history of Bipolar Disorder may also be suggestive of subsequent development of Bipolar Disorder.” p. 372-373 Diagnostic and statistical manual of mental disorders. 2000. 4th ed. Washington, D.C.: American Psychiatric Association. ________________ DID-PTSD-EMDR Dissociative Identity Disorder (DID) "The essential feature of Dissociative identity Disorder is the presence of two or more distinct identities or personality states (Criterion A) that recurrently take control of behavior (Criterion B). There is an inability to recall important personal information, the extent of which is too great to be explained by ordinary forgetfulness (Criterion C). The disturbance is not due tot eh direct physiological effects of a substance or a general medical condition (Condition D.). In children, the symptoms cannot be attributed to imaginary playmates or other fantasy play. Dissociative Identity Disorder reflects a failure to integrate various aspects of identity, memory, and consciousness. Each personality state may be experienced as if it has a distinct personal history, self-image, and identity, including a separate name. Usually there is a primary identity that carries the individual's given name and is passive, dependent, guilty, and depressed. The alternate identities frequently have different names and characteristics that contrast with the primary identity (e.g., are hostile, controlling, and self-destructive). Particular identities may emerge in specific circumstances and may differ in reported age and gender, vocabulary, general knowledge, or predominant affect. Alternate identities are experienced as taking control in sequence, ore at the expense of the other, and may deny knowledge of one another, be critical of one another, or appear to be in open conflict. Occasionally, one or more powerful identities allocate time to the others. Aggressive or hostile identities may at times interrupt activities or place the others in uncomfortable situations. Individuals with this disorder experience frequent gaps in memory for personal history, both remote and recent. The amnesia is frequently asymmetrical. The more passive identities tend to have more constricted memories, whereas the more hostile, controlling, or "protector" identities have more complete memories. An identity that is not in control may nonetheless gain access to consciousness by producing auditory or visual hallucinations (e.g., a voice giving instructions). Evidence of amnesia may be uncovered by reports from others who have witnessed behavior that is disavowed by the individual or by the individual's own discoveries (e.g., finding items of clothing at home that the individual cannot remember having bought). There may be loss of memory not only for recurrent periods of time, but also an overall loss of biographical memory for some extended period of childhood, adolescence, or even adulthood. Transitions among identities are often triggered by psychosocial stress. The time required to switch from one identity to another is usually a matter of seconds, but, less frequently, may b gradual. Behavior that may be frequently associated with identity switches include rapid blinking, facial changes, changes in voice or demeanor, or disruption in the individual's train of thoughts. The number of identities reported ranges from 2 to more than 100. Half of reported cases include the individuals with 10 or fewer identities." Diagnostic and Statistical Manual of Mental Disorders. 2000. 4th ed. Washington, D.C.: American Psychiatric Association. PTSD, DID, and EMDR Posttraumatic Stress Disorder "The essential feature of Posttraumatic Stress Disorder us the development of characteristic symptoms following exposure to an extreme traumatic stressor involving direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one's physical integrity; or witnessing an event that involves death, injury, or a threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate (Criteria A1). The person's response to the event must involve intense fear, helplessness, or horror (or in children, the response must involve disorganized or agitated behavior) (Criterion A2). The characteristic symptoms resulting from the exposure to the extreme trauma include persistent reexperiencing of the traumatic event (Criterion E), and the disturbance must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning (Criterion F). Traumatic events that are experienced directly include, but are not limited to, military combat, violent personal assault (sexual assault, physical attack, robbery, mugging), being kidnapped, being taken hostage, terrorist attack, torture, incarceration as a prisoner of war or in a concentration camp, natural or manmade disasters, severe automobile accidents, or being diagnosed with a life-threatening illness. For children, sexually traumatic events may include developmentally inappropriate sexual experiences without threatened or actual violence or injury. Witnessed events include, but are not limited to, observing the serious injury or unnatural death of another person due to violent assault, accident, war, or disaster or unexpectedly witnessing a dead body or body parts. Events experienced by others that are learned about include, but are not limited to, violent personal assault, serious accident, or serious injury experienced y a family member or a close friend; learning about the sudden, unexpected death of a family member or a close friend; or learning that one's child has a life threatening disease. The disorder may be especially sever or long lasting when the stressor is of human design (e.g., torture, rape). the likelihood of developing this disorder may increase as the intensity of and physical proximity to the stressor increase. The traumatic event can be reexperienced in various ways. Commonly the person has recurrent and intrusive recollections of the event (Criterion B1) or recurrent distressing dreams during which the event can be replayed or otherwise represented (Criterion B2). In rare instances, the person experiences dissociative states that last from a few seconds to several hours, or even days, during which components of the event are relived and the person behaves as though experiencing the event at that moment (Criterion B3). These episodes, often referred to as "flashbacks," are typically brief but can be associated with prolonged distress and heightened arousal. Intense psychological distress (Criterion B4) or physiological reactivity (Criterion B5) often occurs when the person is exposed to triggering events that resemble or symbolize an aspect of the traumatic event (e.g., anniversaries of the traumatic event; cold, snowy weather or uniformed guards for survivors of death camps in cold climates; hot, humid weather for combat veterans of the South Pacific; entering any elevator for an woman who was reaped in an elevator). Stimuli associated with the trauma are persistently avoided. The person commonly makes deliberate efforts to avoid thoughts, feelings, or conversations about the traumatic event (Criterion C1) and to avoid activities, situations, or people who around recollections of it (Criterion C2). This avoidance of reminders may include amnesia for an important aspect of the traumatic event (Criterion C3). Diminished responsiveness to the external work, referred to as "psychic numbing" or "emotional anesthesia," usually begins soon after the traumatic event. The individual may complain of having markedly diminished interest or participation in previously enjoyed activities (Criterion C4), of feeling detached or estranged from other people (Criterion C5), or of having markedly reduced ability to feel emotions (especially those associated with intimacy, tenderness and sexuality) (Criterion C6). The individual may have a sense of a foreshortened future (e.g., not expecting to have a career, marriage, children, or a normal life span) (Criterion C7). The individual has persistent symptoms of anxiety or increased arousal that were not present before the trauma. these symptoms may include difficulty falling or staying asleep that may be to recurrent nightmares during which the traumatic event is relived (Criterion D1), hypervigilance (Criterion D4), and exaggerated startle response (Criterion D5). Some individuals report irritability or outburst of anger (Criterion D2) or difficulty concentrating or completing tasks (Criterion D3)."
EMDR Eye Movement Desensitization and Reprocessing "Eye Movement Desensitization and Reprocessing (EMDR)1 integrates elements of many effective psychotherapies in structured protocols that are designed to maximize treatment effects. These include psychodynamic, cognitive behavioral, interpersonal, experiential, and body-centered therapies2. EMDR is an information processing therapy and uses an eight phase approach. During EMDR1 the client attends to past and present experiences in brief sequential doses while simultaneously focusing on an external stimulus. Then the client is instructed to let new material become the focus of the next set of dual attention. This sequence of dual attention and personal association is repeated many times in the session. Eight Phases of Treatment The first phase is a history taking session during which the therapist assesses the client's readiness for EMDR and develops a treatment plan. Client and therapist identify possible targets for EMDR processing. These include recent distressing events, current situations that elicit emotional disturbance, related historical incidents, and the development of specific skills and behaviors that will be needed by the client in future situations. During the second phase of treatment, the therapist ensures that the client has adequate methods of handling emotional distress and good coping skills, and that the client is in a relatively stable state. If further stabilization is required, or if additional skills are needed, therapy focuses on providing these. The client is then able to use stress reducing techniques whenever necessary, during or between sessions. However, one goal is not to need these techniques once therapy is complete. In phase three through six, a target is identified and processed using EMDR procedures. These involve the client identifying the most vivid visual image related to the memory (if available), a negative belief about self, related emotions and body sensations. The client also identifies a preferred positive belief. The validity of the positive belief is rated, as is the intensity of the negative emotions. After this, the client is instructed to focus on the image, negative thought, and body sensations while simultaneously moving his/her eyes back and forth following the therapist's fingers as they move across his/her field of vision for 20-30 seconds or more, depending upon the need of the client. Athough eye movements are the most commonly used external stimulus, therapists often use auditory tones, tapping, or other types of tactile stimulation. The kind of dual attention and the length of each set is customized to the need of the client. The client is instructed to just notice whatever happens. After this, the clinician instructs the client to let his/her mind go blank and to notice whatever thought, feeling, image, memory, or sensation comes to mind. Depending upon the client's report the clinician will facilitate the next focus of attention. In most cases a client-directed association process is encouraged. This is repeated numerous times throughout the session. If the client becomes distressed or has difficulty with the process, the therapist follows established procedures to help the client resume processing. When the client reports no distress related to the targeted memory, the clinician asks him/her to think of the preferred positive belief that was identified at the beginning of the session, or a better one if it has emerged, and to focus on the incident, while simultaneously engaging in the eye movements. After several sets, clients generally report increased confidence in this positive belief. The therapist checks with the client regarding body sensations. If there are negative sensations, these are processed as above. If there are positive sensations, they are further enhanced. In phase seven, closure, the therapist asks the client to keep a journal during the week to document any related material that may arise and reminds the client of the self-calming activities that were mastered in phase two. The next session begins with phase eight, re-evaluation of the previous work, and of progress since the previous session. EMDR treatment ensures processing of all related historical events, current incidents that elicit distress, and future scenarios that will require different responses. The overall goal is produce the most comprehensive and profound treatment effects in the shortest period of time, while simultaneously maintaining a stable client within a balanced system. After EMDR processing, clients generally report that the emotional distress related to the memory has been eliminated, or greatly decreased, and that they have gained important cognitive insights. Importantly, these emotional and cognitive changes usually result in spontaneous behavioral and personal change, which are further enhanced with standard EMDR procedures." www.emdr.com
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NeuroBiology of Trauma
Magnetic Resonance Imagingand Trauma
Title: Computed tomography and magnetic resonance imaging. Author(s): Charletta, Dale A., Baylor Coll of Medicine, Dept of Radiology, Houston, TX, US; Bennett, David A.; Wilson, Robert Smith Source: Parks, Randolph W. (Ed); Zec, Ronald F. (Ed); et al; 1993. Neuropsychology of Alzheimer's disease and other dementias. London: Oxford University Press. pp. 534-561 Abstract: [provide] a brief introduction to the basic concepts underlying computerized tomography (CT) and magnetic resonance imaging (MRI) [followed by] a more detailed discussion of the diagnostic utility of these procedures in specific dementing diseases / Alzheimer's disease (AD) / vascular dementia [multi-infarct dementia, Binswanger's disease] / Pick's disease / Huntington's disease / Creutzfeldt-Jakob disease / Parkinson's disease / mass lesions / trauma / acquired immune deficiency virus / hydrocephalic dementia / dysmyelinating disease / alcohol dementia _____
Title: Three-dimensional image analysis of trauma-induced degenerative changes: An aid to neuropsychological assessment. Author(s): Bigler, Erin D., Brigham Young U, Coll of Family, Home & Social Sciences, Provo, UT, US Source: Archives of Clinical Neuropsychology, Vol 7(5), Sep-Oct 1992. pp. 449-456. Publisher: US: Elsevier Science/Pergamon. Abstract: Presents a case study involving a 39-yr-old man who suffered a severe closed head injury at age 39 yrs. Three-dimensional (3D) reconstruction of the day of injury computerized tomography (CT) findings are presented, and the degenerative changes identified by magnetic resonance imaging (MRI) 18 mo postinjury are noted. The method allows the clinician to examine 3D changes in the ventricular system as an aid in identifying regions of structural damage in 1 view rather than the need to view multiple images with the traditional 2-dimensional presentation of CT or MR images. In this case study the neuropsychological deficits implicated generalized cerebrocortical dysfunction, and the 3D image analysis correspondingly indicated generalized parenchymal tissue loss. _____
Title: Palilalia after traumatic intracerebral hemorrhage (a case report). Author(s): Ibayashi, Katsuhiko, Niigata U, Brain Research Inst, Dept of Neurosurgery, Niigata, Japan; Tanaka, Ryuichi; Peng, Fred C. C.; Joanette, Yves; Lecours, Andre R. Source: Journal of Neurolinguistics, Vol 7(3), Jul 1992. pp. 241-249. Publisher: England: Elsevier Science. Abstract: This report refers to the 4-year long diachronic observation of a case of a 22-yr-old right-handed male with acquired palilalia caused by intracerebral hemorrhage due to head trauma. It was approximately 7 months after his trauma that the patient began exhibiting striking palilalia behavior along with echolalia and a global deterioration of mental activities. Palilalia was still present 2 years later in spite of some degree of general improvement. A peculiarity of this patient was that palilalia occurred in response to relatively complex questions whereas it was hardly present in response to simpler ones. Contrary to observations made in other cases of palilalia, instrumental sound analyses revealed that articulation speed, although somewhat fast, did not keep increasing as palilalic utterances went on, and that vocal intensity remained within normal ranges, i.e. did not decrease from the onset of a given palilalic utterance to its end. CT-scan and magnetic resonance imaging (MRI) imaging showed the brain lesion to be almost restricted to the cortex of the right frontal convexity and its underlying white matter. It is suggested that palilalia is, in certain cases, caused by a disturbance of higher motor speech control mechanisms. _____
Title: Neuroimaging and neuropsychological functioning following closed head injury: CT, MRI, and SPECT. Author(s): Wilson, J. T., U Stirling, Scotland; Wyper, D. Source: Journal of Head Trauma Rehabilitation, Vol 7(2), Jun 1992. pp. 29-39. Publisher: US: Aspen Publishers. Abstract: Summarizes the utility of computerized tomography (CT), magnetic resonance imaging (MRI), and single photon emission CT (SPECT) in illuminating causes of psychological impairment after head injury and shaping expectations for recovery and rehabilitation. CT is relatively insensitive to abnormalities after head injury, and work has concentrated on the neuropsychological significance of hematoma, ventricular enlargement, and atrophy. MRI is more sensitive and reveals patterns of lesions after trauma. MRI should allow a complete categorization of structural changes after trauma that will parallel neuropathologic classifications. This will help clarify the neuropsychological significance of different forms of injury. SPECT and related techniques will illuminate functional residuals of structural lesions; they have the potential to document the distribution of specific neurotransmitters and receptors. _____
Title: Demencia postraumatica: Deficits corticales en los TCE sin lesiones focales: Estudio de dos casos. Translated Title: Postraumatic dementia: Cortical deficits on Cerebro-Encephalo Trauma (CET) without focal lesions: Two case studies. Author(s): Jodar, M., U Barcelona, Spain; Junque, C. Source: Revista de Psicologia General y Aplicada, Vol 45(2), Apr 1992. pp. 177-182. Publisher: Spain: Promolibro. Abstract: Deficits in attention, memory and mental speed, and personality changes are the cognitive sequelae more frequently reported after head injury without severe brain lesions. They have been described as a consequence of the level and durations of the coma state. A study of 2 17-yr-old traumatic patients without severe focal lesions who suffered general cortical functions are presented. Their cognitive functions were measured with several tests during the study. Results suggest a similar neuropsychological pattern as observed in posttraumatic dementia state. The neuropsychological impairment in these patients was more important than the expected, according to the degree of coma sequelae and the loss of focal cerebral tissue, and is related with cortical atrophy in computerized tomography (CT) and magnetic resonance imaging (MRI) studies. (English abstract) _____
Title: Does Swedish amateur boxing lead to chronic brain damage? II. A retrospective study with CT and MRI. Author(s): Haglund, Yvonne, Karolinska Hosp, Dept of Orthopaedic Surgery Section of Sports Medicine, Stockholm, Sweden; Bergstrand, G. Source: Acta Neurologica Scandinavica, Vol 82(5), Nov 1990. pp. 297-302. Publisher: Denmark: Munksgaard Scientific Journals. Abstract: Examined whether morphological changes could be demonstrated among 50 former amateur boxers (aged 26-41 yrs) using computerized tomography (CT) and magnetic resonance imaging (MRI). 25 soccer players and 25 track and field athletes in the same age-range were used for comparison. No significant differences were found between boxers and controls in the width of the ventricular system, anterior horn index, width of cortical sulci, signs of vermian atrophy, or the occurrence of a cavum septum pellucidum. A cavum septum pellucidum was found more often in the controls than in the boxers and is probably not a sign of earlier head trauma. MRI confirmed no more findings than did CT in this retrospective study. _____
Title: Significance of MRI in clarifying whether neuropsychological deficits after head injury are organically based. Author(s): Wilson, J. T., U Stirling, Scotland Source: Neuropsychology, Vol 4(4), 1990. pp. 261-269. Publisher: US: American Psychological Assn. Abstract: Reviews evidence from studies using magnetic resonance imaging (MRI) that bears on the problem of determining the extent of brain damage. It is argued that it is a mistake to focus narrowly on the results of computerized tomography (CT) examination or records of coma. Studies using MRI show that neither a normal CT scan nor a history of short or negligible loss of consciousness precludes the presence of significant brain damage after trauma. Information from a variety of sources should be considered, and posttraumatic amnesia should not be overlooked. _____
Title: Neuroanatomy and neuropathology: Computed tomography and magnetic resonance imaging correlates. Author(s): Rutledge, J. N., Capital Radiology of Austin, Austin, TX, US Source: Bigler, Erin D. (Ed); Yeo, Ronald A. (Ed); et al; 1989. Neuropsychological function and brain imaging. Critical issues in neuropsychology. New York, NY, US: Plenum Press. pp. 13-46 Abstract: embryology / neuroimaging / midbrain / diencephalon / telencephalon / neuropathology / congenital disease / vasculopathies / trauma / infectious diseases / white-matter diseases _____
Title: Clinical uses of CT and MRI in the brain. Author(s): Dillon, William P. , U California, Assistant Professor of Radiology, San Francisco, CA, US Source: Flach, Frederic (Ed); 1988. Psychobiology and psychopharmacology. Directions in psychiatry monograph series, No. 2. New York, NY, US: W. W. Norton & Co, Inc. pp. 233-241 Abstract: computed tomography (CT) scanners / head trauma / cerebrovascular ischemia / degenerative disease / sciatica / low back pain / magnetic resonance imaging of the CNS _____
Title: Cavum vergae: Association with neurologic abnormality and diagnosis by magnetic resonance imaging. Author(s): Miller, Marvin E., U Rochester School of Medicine & Dentistry; Kido, Daniel; Horner, Frederick Source: Archives of Neurology, Vol 43(8), Aug 1986. pp. 821-823. Publisher: US: American Medical Assn. Abstract: Studied 10 children (newborn to 9 yrs) with cavum vergae (CV) or CV and cavum septum pellucidum to examine a possible association between CV and neurologic dysfunction. Five Ss had delayed development, 4 had macrocephaly, 2 had learning disabilities, 2 had abnormal EEGs, and 1 had Apert's syndrome. No cases of CV were found in 50 children who had brain computer tomography (CT) scans for head trauma. Results suggest that CV is a nonspecific CT finding that can be associated with neurologic abnormality.
Magnetic Resonance Imaging and Trauma II
Title: The Nature of Traumatic Memories: A 4-T fMRI Functional Connectivity Analysis. Author(s): Lanius, Ruth A., ruth.lanius@lhsc.on.ca; Williamson, Peter C.; Densmore, Maria; Boksman, Kristine; Neufeld, R. W.; Gati, Joseph S.; Menon, Ravi S. Address: Lanius, Ruth A., Dept of Psychiatry, London Health Sciences Ctr, 339 Windermere Rd, P.O. Box 5339, London, ON, Canada, N6A 5A5, ruth.lanius@lhsc.on.ca Source: American Journal of Psychiatry, Vol 161(1), Jan 2004. pp. 36-44. Publisher: US: American Psychiatric Assn. Abstract: Used functional connectivity analyses (FCAs) to assess interregional brain activity correlations during the recall of traumatic memories in traumatized Ss with and without posttraumatic stress disorder (PTSD). Both 4-T functional magnetic resonance imaging (fMRI) and FCAs were used to assess interregional brain activity correlations during symptom provocation in 11 traumatized Ss with and 13 without PTSD. The use of FCAs in addition to subtraction analyses allowed assessment of specific brain regions involved in the recall of traumatic events and of the neuronal networks underlying the recall of such events. Significant between-group differences in functional connectivity were found: Non-PTSD Ss had greater correlation than the PTSD Ss in the left superior frontal gyrus, left anterior cingulate gyrus, left striatum, left parietal lobe, and left insula. In contrast, the PTSD Ss showed greater correlation than the non-PTSD Ss in the right posterior cingulate gyrus, right caudate, right parietal lobe, and right occipital lobe. The differences in brain connectivity between PTSD and comparison Ss may account for the nonverbal nature of traumatic memory recall in PTSD Ss, compared to a more verbal pattern of traumatic memory recall in comparison Ss. _____
Title: Major Depression Following Traumatic Brain Injury. Author(s): Jorge, Ricardo E., ricardo-jorge@uiowa.edu, Department of Psychiatry, University of Iowa, Iowa City, IA, US; Robinson, Robert G., Department of Psychiatry, University of Iowa, Iowa City, IA, US; Moser, David, Department of Psychiatry, University of Iowa, Iowa City, IA, US; Tateno, Amane, Department of Psychiatry, University of Iowa, Iowa City, IA, US; Crespo-Facorro, Benedicto, Department of Psychiatry, University of Iowa, Iowa City, IA, US; Arndt, Stephan, Department of Psychiatry, University of Iowa, Iowa City, IA, US Address: Jorge, Ricardo E., MEB/Psychiatry Research, 500 Newton Rd, Iowa City, IA, US, 52242, ricardo-jorge@uiowa.edu Source: Archives of General Psychiatry, Vol 61(1), Jan 2004. pp. 42-50. Publisher: US: American Medical Assn. Abstract: Determined the clinical, neuropsychological, and structural neuroimaging correlates of major depression occurring after traumatic brain injury (TBI). The study group consisted of 91 patients with TBI, and 27 patients with multiple traumas but without evidence of central nervous system injury constituted the control group. The patients' conditions were evaluated at baseline and at 3, 6, and 12 months after the traumatic episode. Neuropsychological testing and quantitative magnetic resonance imaging were performed at the 3-month follow-up visit. Major depressive disorder was observed in 30 of 91 patients during the first year after sustaining a TBI. Major depressive disorder was significantly more frequent among patients with TBI than among the controls. Patients with TBI who had major depression were more likely to have a personal history of mood and anxiety disorders than patients who did not have major depression. Patients with major depression exhibited comorbid anxiety (76.7%) and aggressive behavior (56.7%). Patients with major depression had significantly greater impairment in executive functions than their non-depressed counterparts. Major depression was associated with poorer social functioning at the 6- and 12- month follow-up. _____
Title: Decrements in volume of anterior ventromedial temporal lobe and olfactory dysfunction in schizophrenia. Author(s): Turetsky, Bruce I., turetsky@bbl.med.upenn.edu, U Pennsylvania, Dept of Psychiatry, Schizophrenia Research Ctr, Philadelphia, PA, US; Moberg, Paul J., U Pennsylvania, Dept of Psychiatry, Schizophrenia Research Ctr, Philadelphia, PA, US; Roalf, David R., U Pennsylvania, Dept of Psychiatry, Schizophrenia Research Ctr, Philadelphia, PA, US; Arnold, Steven E., U Pennsylvania, Dept of Psychiatry, Schizophrenia Research Ctr, Philadelphia, PA, US; Gur, Raquel E., U Pennsylvania, Dept of Psychiatry, Schizophrenia Research Ctr, Philadelphia, PA, US; Address: Turetsky, Bruce I., Neuropsychiatry Program, Department of Psychiatry, University of Pennsylvania, 10th Floor, Gates Bldg., Philadelphia, PA, US, 19104, turetsky@bbl.med.upenn.edu Source: Archives of General Psychiatry, Vol 60(12), Dec 2003. pp. 1193-1200. Publisher: US: American Medical Assn. Abstract: Determined whether patients with schizophrenia exhibit volumetric deficits in the anterior ventromedial temporal lobe, the target for neuronal inputs from the olfactory bulb, and whether these are related to olfactory performance deficits. Design was a cohort study of patients and healthy control subjects who underwent both 1-mm spoiled-gradient echo magnetic resonance imaging and behavioral tests of olfaction and memory. Fifty-two patients with a DSM-IV diagnosis of schizophrenia and 38 healthy control subjects participated. Individuals were excluded for history of head trauma, significant substance abuse, and medical conditions affecting brain function or olfactory capacity. Patients with schizophrenia have reduced cortical volumes in brain regions that receive afferents directly from the olfactory bulb. Behavioral olfactory deficits are related to structural brain abnormalities in these regions. _____
Title: Resting Regional Cerebral Perfusion in Recent Posttraumatic Stress Disorder. Author(s): Bonne, Omer, Department of Psychiatry, Hadassah University Hospital, Jerusalem, Israel; Gilboa, Asaf , Department of Psychiatry, Hadassah University Hospital, Jerusalem, Israel; Louzoun, Yoram , Department of Nuclear Medicine, Hadassah University Hospital, Jerusalem, Israel; Brandes, Dalia, Department of Psychiatry, Hadassah University Hospital, Jerusalem, Israel; Yona, Ilan , Department of Psychiatry, Hadassah University Hospital, Jerusalem, Israel; Lester, Hava, Department of Nuclear Medicine, Hadassah University Hospital, Jerusalem, Israel; Barkai, Gavriel , Department of Psychiatry, Hadassah University Hospital, Jerusalem, Israel; Freedman, Nanette , Department of Nuclear Medicine, Hadassah University Hospital, Jerusalem, Israel; Chisin, Roland , Department of Nuclear Medicine, Hadassah University Hospital, Jerusalem, Israel; Shalev, Arieh Y., Department of Psychiatry, Hadassah University Hospital, Jerusalem, Israel Address: Bonne, Omer, Mood and Anxiety Disorders Program, National Institute of Mental Health, 15K North Drive, Room 200, Bethesda, MD, US, 20892-2670 Source: Biological Psychiatry, Vol 54(10), Nov 2003. pp. 1077-1086. Publisher: United Kingdom: Elsevier Science. Abstract: Brain imaging research in posttraumatic stress disorder has been largely performed on patients with chronic disease, often heavily medicated, with current or past alcohol and substance abuse. Additionally, virtually only activation brain imaging paradigms have been done in posttraumatic stress disorder, whereas in other mental disorders both resting and activation studies have been performed. Twenty-eight (11 posttraumatic stress disorder) trauma survivors underwent resting state hexamethylpropyleneamineoxime single photon emission computed tomography and magnetic resonance imaging 6 months after trauma. Eleven nontraumatized subjects served as healthy controls. Regional cerebral blood flow in the cerebellum was higher in posttraumatic stress disorder than in both control groups. Regional cerebral blood flow in right precentral, superior temporal, and fusiform gyri in posttraumatic stress disorder was higher than in healthy controls. Cerebellar and extrastriate regional cerebral blood flow were positively correlated with continuous measures of depression and posttraumatic stress disorder. Cortisol level in posttraumatic stress disorder was negatively correlated with medial temporal lobe perfusion. Anterior cingulate perfusion and cortisol level were positively correlated in... _____
Title: Researchers probe depression in children. Author(s): Voelker, Rebecca Source: JAMA: Journal of the American Medical Association , Vol 289(23), Jun 2003. pp. 3078-3079. Publisher: US: American Medical Assn. Abstract: Researchers have attempted to determine whether depression in children really is the same disorder as in adolescents and adults, or if there are important differences. What they are finding is a mixed picture. One element that some experts say distinguishes depression in very young children is abuse, neglect, and a variety of psychiatric illnesses in parents. Some researchers suggest that genetic vulnerability coupled with early trauma during a critical period of development can lead to changes in the brain that set the stage for depression. A list of depressive symptoms that may be more common in children and adolescents is presented. It is noted that the use of antidepressant medications in children and adolescents has emerged as one of the most prominent treatment issues in the last decade. Even though research has shown the efficacy of some antidepressant medications as well as cognitive-behavioral therapy in children, a wide range of unanswered questions in etiology, treatment, and prevention remain. The use of magnetic resonance imaging to examine brain structure abnormalities that may be associated with early onset depression is also discussed. _____
Title: Unsuspected Atypical Hemispheric Dominance for Language as Determined by fMRI: Comment. Author(s): Derakhshan, Iraj Source: Epilepsia , Vol 44(5), May 2003. pp. 734-734. Publisher: United Kingdom: Blackwell Publishing. Abstract: Letter to editor by the current author commenting on an article "Unsuspected atypical hemispheric dominance for language as determined by fMRI" by Spreer J, Quiske A, Altenmuller DM, et al.. The article by Spreer et al. on unsuspected atypical dominance for language in a right-handed patient is of interest for two main reasons, their reliance on Wada test to tell them something solid on laterality of movement control, and their emphasis on family history of sinistrality in their patient. Their patient is an example of those who are incongruent in behavioral and neural handedness. These "fake-handers" for a variety of reasons have decided to operate against their natural mandate.The so-called pathological handedness is not among these reasons because the latter entity does not exist. The patient of Spreers et al. was an incongruous righthander. These are the same group who are named crossed aphasic with a right-sided cortical lesion and left-sided paralysis, rare among the right-handers and common among the left-handers. This new understanding, with overwhelming support from the literature, obviates the respected authors' need to resort to highly dubious speculations about their patient who sustained a head trauma at age 10 years. _____
Title: Selectively reduced regional cortical volumes in post-traumatic stress disorder. Author(s): Rauch, Scott L., rauch@psych.mgh.harvard.edu, Psychiatric Neuroimaging Research Group, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, US; Shin, Lisa M., Psychiatric Neuroimaging Research Group, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, US; Segal, Ethan, Psychiatric Neuroimaging Research Group, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, US; Pitman, Roger K., Psychiatric Neuroimaging Research Group, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, US Carson, Margaret A. , VA Research Service and St. Anselm College, Manchester, NH, US; McMullin, Katherine, Psychiatric Neuroimaging Research Group, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, US; Whalen, Paul J. , Departments of Psychiatry and Psychology, University of Wisconsin, Madison, WI, US; Makris, Nikos , Center for Morphometric Analysis, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, US; Address: Rauch, Scott L., Psychiatric Neuroimaging Research Group, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, 13th St., Bldg 149, CNY-9, Charlestown, MA, US, 02129, rauch@psych.mgh.harvard.edu Source: Neuroreport: For Rapid Communication of Neuroscience Research, Vol 14(7), May 2003. pp. 913-916. Publisher: US: Lippincott Williams & Wilkins. Abstract: Different subterritories of anterior cingulate cortex (ACC) and adjacent ventromedial frontal cortex have been shown to serve distinct functions. This scheme has influenced contemporary pathophysiologic models of psychiatric disorders. Prevailing neuro-circuitry models of post-traumatic stress disorder (PTSD) implicate dysfunction within pregenual ACC and subcallosal cortex(SC), as well as amygdala and hippocampus. In the current study, cortical parcellation of magnetic resonance imaging data was performed to test for volumetric differences in pregenual ACC and SC, between women with PTSD and trauma-exposed women without PTSD. The PTSD group exhibited selectively decreased pregenual ACC and SC volumes. These results are consistent with contemporary schemes regarding functional and structural dissection of frontal cortex, and suggest specific regional cortical pathology in PTSD. _____
Title: Individual differences in a husband and wife who developed PTSD after a motor vehicle accident: A functional MRI case study. Author(s): Lanius, Ruth A., ruth.lanius@lhsc.on.ca; Hopper, James W.; Menon, Ravi S. Address: Lanius, Ruth A., Dept of Psychiatry, London Health Sciences Ctr, 339 Windermere Rd, PO Box 5339, London, ON, Canada, N6A 5A5, ruth.lanius@lhsc.on.ca Source: American Journal of Psychiatry, Vol 160(4), Apr 2003. pp. 667-669. Publisher: US: American Psychiatric Assn. Abstract: This report describes a husband and wife with acute posttraumatic stress disorder (PTSD) who exhibited different subjective, psychophysiological, and neurobiological responses to traumatic script-drive imagery that caused them to reexperience their traumas. The couple, who had been trapped in their car during a serious motor vehicle accident, was assessed for responses with heart-rate monitor and functional magnetic resonance imaging. It is concluded that PTSD patients can have very different responses, both subjectively and biologically, while reexperiencing traumatic events. _____
Title: Posttraumatic epilepsy: Neuroradiologic and neuropsychological assessment of long-term outcome. Author(s): Mazzini, Letizia , mazzini.1@libero.it, "San Giovanni Bosco" Hosp, Dept of Neurology, Torino, Italy; Cossa, Federico Maria , Scientific Inst of Veruno (No), Inst of Care & Research (IRCCS), "Fondazione S. Maugeri", Neuropsychology Unit, Novara, Italy; Angelino, Elisabetta , Scientific Inst of Veruno (No), Inst of Care & Research (IRCCS), "Fondazione S. Maugeri", Psychology Service, Novara, Italy; Campini, Riccardo , Scientific Inst of Veruno (No), Inst of Care & Research (IRCCS), "Fondazione S. Maugeri", Nuclear Medicine Service, Novara, Italy; Pastore, Ilaria , U "Amedeo Avogadro", Dept of Neurology, Novara, Italy; Monaco, Francesco , U "Amedeo Avogadro", Dept of Neurology, Novara, Italy; Address: Mazzini, Letizia, Dept of Neurology, "San Giovanni Bosco" Hosp, Largo del Donatore di Sangue 3, 10154, Torino, Italy, mazzini.1@libero.it Source: Epilepsia, Vol 44(4), Apr 2003. pp. 569-574. Publisher: United Kingdom: Blackwell Publishing. Abstract: Examined the incidence and the risk factors of posttraumatic epilepsy (PTE) in rehabilitation patients; defined the influence of PTE for late clinical and functional outcome; and assessed the cognitive and behavioral features of the patients with PTE. Patients were examined with (a) cognitive and behavioral examinations, which included a clinical interview and psychometric tests performed by an expert clinical psychologist; (b) single-photon emission computed tomography (SPECT) and magnetic resonance imaging (MRI); and (c) functional evaluation including the Glasgow Outcome Scale (GOS) and the Functional Independence Measure (FIM). Results show that of the 143 patients examined in this study, in 27, seizures developed after a mean time from trauma of 11.9 1 8.6 months. The occurrence of PTE was correlated with the hypoperfusion in temporal lobes, the degree of hydrocephalus, the evidence of intracerebral hematoma, and operative brain injury. Patients with epilepsy showed a significantly higher incidence of personality disorders. The disinhibited behavior, irritability, and agitated and aggressive behavior were significantly more frequent and severe in PTE patients. PTE also was significantly correlated with a worse functional outcome 1 year after the trauma. _____
Title: Recall of emotional states in posttraumatic stress disorder: An fMRI investigation. Author(s): Lanius, Ruth A., U Western Ontario, Dept of Psychiatry, London, ON, Canada; Williamson, Peter C. , U Western Ontario, Dept of Psychiatry, London, ON, Canada; Hopper, James , Boston U School of Medicine, Dept of Psychiatry, Boston, MA, US; Densmore, Maria, U Western Ontario, Dept of Psychiatry, London, ON, Canada; Boksman, Kristine , U Western Ontario, Dept of Psychology, London, ON, Canada; Gupta, Madhulika A., U Western Ontario, Dept of Psychiatry, London, ON, Canada; Neufeld, Robert W. J., U Western Ontario, Dept of Psychology, London, ON, Canada; Gati, Joseph S., U Western Ontario, Medical Biophysics, London, ON, Canada; Menon, Ravi S., U Western Ontario, Medical Biophysics, London, ON, Canada; Address: Lanius, Ruth A., U Western Ontario, London Health Sciences Ctr, 339 Windermere Road, PO Box 5339, London, ON, Canada, N6A 5A5 Source: Biological Psychiatry, Vol 53(3), Feb 2003. pp. 204-210. Journal URL: http://www.elsevier.com/inca/publications/store/5/0/5/7/5/0/ Publisher: US: Elsevier Science. Abstract: Examined the neuronal circuitry underlying different emotional states (neutral, sad, anxious, and traumatic) in posttraumatic stress disorder (PTSD) in 10 traumatized subjects versus 10 traumatized subjects without PTSD. All Ss had suffered from sexual abuse/assault during childhood or motor vehicle accidents in adulthoood. Subjects were studied using the script-driven symptom provocation paradigm adapted to functional magnetic resonance imaging (fMRI) at a 4 Tesla field strength. Compared to the trauma-exposed comparison group, PTSD subjects showed significantly less activation of the thalamus and the anterior cingulate gyrus (area 32) in all three emotional states (sad, anxious, and traumatic). These findings suggest thalamic and anterior cingulate dysfunction in the recollection of traumatic as well as other negative events. Thalamic and anterior cingulate dysfunction may underlie emotion dysregulation often observed clinically in PTSD. _____
Title: Brain morphometry in female victims of intimate partner violence with and without posttraumatic stress disorder. Author(s): Fennema-Notestine, Christine , Veterans Affairs San Diego Healthcare System, San Diego, CA, US; Stein, Murray B., Veterans Affairs San Diego Healthcare System, San Diego, CA, US; Kennedy, Colleen M., Veterans Affairs San Diego Healthcare System, San Diego, CA, US; Archibald, Sarah L., U California, Dept of Psychiatry, La Jolla, CA, US; Jernigan, Terry L., Veterans Affairs San Diego Healthcare System, San Diego, CA, US Address: Fennema-Notestine, Christine, U California, Dept of Psychiatry, 9500 Gilman Dr, La Jolla, CA, US, 92093-0985 Source: Biological Psychiatry, Vol 52(11), Dec 2002. pp. 1089-1101. Key Concepts: neuroanatomical morphometry; adult female intimate partner violence; posttraumatic stress disorder; hippocampal & mesial temporal lobe volumes Abstract: Examined neuroanatomical morphometry in adult female victims of intimate partner violence (IPV) with and without posttraumatic stress disorder (PTSD). 17 nonvictimized comparison subjects and 22 victims of IPV, 11 with and 11 without PTSD, were studied. Using quantitative magnetic resonance imaging, three mesial temporal lobe areas were measured: hippocampus, amygdala, and parahippocampal gyrus. Relationships of morphometric measures to symptoms, abuse history, and neuropsychologicalfunctio were examined. IPV subjects with PTSD did not demonstrate significant smaller hippocampal or other mesial temporal lobe volumes. Overall, IPV subjects had smaller supratentorial cranial vaults and smaller frontal and occipital gray matter volumes relative to nonvictimized comparison subjects. Supratentorial cranial vault volume was negatively correlated with severity of childhood physical abuse, but not with intimate partner violence or PTSD severity. These findings are inconsistent with prior reports of smaller hippocampal volumes in patients with PTSD. Rather, the findings point to cerebral abnormalities that may reflect the influence of early trauma on neurodevelopmental processes or denote brain morphometric characteristics of persons at increased risk for serious psychosocial adversity. _____
Title: Temporal lobe structural lesion in a case of posttraumatic stress disorder. Author(s): Seedat, Soraya, U Stellenbosch, Dept of Psychiatry, Cape Town, South Africa; van der Westhuizen, Stephan, U Stellenbosch, Dept of Psychiatry, Cape Town, South Africa; Matthey, Marius, U Stellenbosch, Dept of Psychiatry, Cape Town, South Africa; Stein, Dan J., U Stellenbosch, Dept of Psychiatry, Cape Town, South Africa Source: Journal of Neuropsychiatry & Clinical Neurosciences, Vol 14(2), Spr 2002. pp. 240-241. Publisher: US: American Psychiatric Press. Abstract: Few studies have documented gross structural abnormalities in posttraumatic stress disorder (PTSD). Of particular interest in the few studies of this kind is the finding of reduced hippocampal volume in PTSD, and a question that arises is whether hippocampal injury is an outcome of the disorder or is a preexisting vulnerability to its development. The author reports briefly the highlights of magnetic resonance imaging (MRI) findings of mesial temporal sclerosis (MTS) in a 16-yr-old female with chronic, treatment-resistant PTSD following being raped by her grandfather at age 6 yrs. Treatments included drug therapy and cognitive behavior therapy. MRI findings included mesial temporal sclerosis, right hippocampal atrophy and amygdala asymmetry. In some cases of PTSD, psychological trauma predates neuronal changes, but in other cases, underlying neuronal dysfunction may predispose the development of PTSD. The question of a relationship between MTS and PTSD cannot be answered by the data at hand. Nevertheless, this case demonstrates a possible link between gross neurological lesions, more subtle impairments, and PTSD. _____
Title: Autonomic auras: Left hemispheric predominance of epileptic generators of cold shivers and goose bumps? Author(s): Stefan, H., Ctr Epilepsy, Dept of Neurology, Erlangen, Germany; Pauli, E., Ctr Epilepsy, Dept of Neurology, Erlangen, Germany; Kerling, F. , Ctr Epilepsy, Dept of Neurology, Erlangen, Germany; Schwarz, A.; Koebnick, C. , Medical Informatics Biometry & Epidemiology, Erlangen, Germany Address: Stefan, H., U Erlangen-Nuernberg, Ctr Epilepsy, Dept of Neurology, Schwabachanlage 6, 91054, Erlangen, Germany, hermann.stefan@neuro.imed.uni-erlangen.de Source: Epilepsia , Vol 43(1), Jan 2002. pp. 41-45. Publisher: US: Blackwell Science Boston. Abstract: Autonomic seizures in temporal lobe epilepsies associated with cold shivers and goose bumps as a principal ictal sign or aura have only rarely been studied. Sixteen patients (aged 28-75 yrs) with autonomic auras [cold shivers or cold sweats (n=11), goose bumps (n=4), one patient showed both ictal signs] were analyzed. Lesions were detected in 12 patients. The etiology was heterogeneous [cryptogenic, arteriovenous-malformation cyst, trauma, hippocampal sclerosis]. Eight patients underwent epilepsy surgery. The localization and lateralization of the focal epileptic activity in the temporal lobes was determined either by magnetic resonance imaging lesions, EEG, ictal signs, or single-photon emission computed tomography imaging. The patients with temporal lobe epilepsies associated with cold shivers and/or goose bumps showed a left hemispheric predominance of the focal abnormality in the temporal lobe. _____
Title: Atesli silah yaralanmasini takiben duygudurum bozuklugu: Bir olgu sunumu. Translated Title: Mood disorder following gun shot: A case presentation. Author(s): Guelpek, Demet , Ege U, Tip Fakueltesi Psikiyatri AD, Bornova-IZMIR, Turkey; Bora, Emre, Ege U, Tip Fakueltesi Psikiyatri AD, Bornova-IZMIR, Turkey; Bayraktar, Erhan, Ege U, Tip Fakueltesi Psikiyatri AD, Bornova-IZMIR, Turkey Address: Guelpek, Demet, Ege U, Tip Fakueltesi Psikiyatri AD, Bornova-IZMIR, Turkey, drdemetgulpek@hotmail.com Source: Klinik Psikofarmakoloji Buelteni, Vol 12(1), 2002. pp. 26-30. Publisher: Turkey: Kure Iletisim Grubu AS. Abstract: Secondary mood disorders are a well known consequence of head trauma. Although self-limiting mania following head trauma is also relatively common, bipolar mania is much more rare. The authors discuss a case of secondary mood disorder following a gun shot to the head. Magnetic resonance imaging (MRI) revealed a gross right basotemporal cortex lesion and corticosubcortical atrophy. Neuropsychological evaluation revealed an apparent visual memory loss and frontosubcortical dysfunction. This case may help to clarify the biological mechanisms underlying bipolar disorder. _____
Title: Attenuation of frontal asymmetry in pediatric posttraumatic stress disorder. Author(s): Carrion, Victor G., Stanford U, School of Medicine, Dept of Psychiatry & Behavioral Sciences, Stanford, CA, US; Weems, Carl F.; Eliez, Stephan; Patwardhan, Anil; Brown, Wendy; Ray, Rebecca D.; Reiss, Allan L. Address: Carrion, Victor G., Div of Child & Adolescent Psychiatry & Child Development, Stanford U, Stanford, CA, US, 94305-5719 Source: Biological Psychiatry, Vol 50(12), Dec 2001. pp. 943-951. Publisher: US: Elsevier Science. Abstract: Present brain imaging findings from a study of children with posttraumatic stress disorder (PTSD) symptoms. 24 children between the ages of 7 and 14 with a history of trauma and PTSD symptoms were assessed with the Clinician-Administered PTSD Scale for Children and Adolescents. The sample underwent magnetic resonance imaging in a 1.5 T scanner. Brain images were analyzed by raters blind to diagnostic status using well-standardized methods, and images were compared with age- and gender-matched healthy control Ss. The clinical group demonstrated attenuation of frontal lobe asymmetry and smaller total brain and cerebral volumes when compared with the control group. There were no statistically significant differences in hippocampal volume between clinical and control Ss. _____
Title: Longitudinal MRI study of hippocampal volume in trauma survivors with PTSD. Author(s): Bonne, Omer, Hadassah U Hosp, Dept of Psychiatry, Jerusalem, Israel; Brandes, Dalia; Gilboa, Asaf; Gomori, J. Moshe; Shenton, Martha E.; Pitman, Roger K.; Shalev, Arieh Y. Source: American Journal of Psychiatry , Vol 158(8), Aug 2001. pp. 1248-1251. Publisher: US: American Psychiatric Assn. Abstract: The authors prospectively explored whether a reduction in the volume of the hippocampus occurs in recent trauma survivors whodevelop posttraumatic stress disorder (PTSD). 37 survivors of traumatic events (mean age 33.7 yrs) were assessed within a week of the traumatic event and 6 mo later. The assessment included magnetic resonance imaging (MRI) of the brain (including 124 coronal slices of 1.5-mm thickness), psychometric testing, and structured clinical interviews. The Clinician-Administered PTSD Scale conferred PTSD diagnoses at 6 mo. Results show that 10 Ss (27%) had PTSD at 6 mo. The Ss with PTSD did not differ from those without PTSD in hippocampal volume (right or left) at 1 wk or 6 mo. There was no reduction in hippocampal volume in the PTSD subjects between 1 wk and 6 mo. The authors conclude that smaller hippocampal volume is not a necessary risk factor for developing PTSD and does not occur within 6 mo of expressing the disorder. This brain abnormality might occur in individuals with chronic or complicated PTSD. _____
Title: Severe amnesia in epilepsy: Causes, anatomopsychological considerations, and treatment. Author(s): Guerreiro, Carlos A. M., McGill U, Dept of Neurology & Neurosurgery, Montreal Neurological Inst & Hosp, Montreal, PQ, Canada; Jones-Gotman, Marilyn, McGill U, Dept of Neurology & Neurosurgery, Montreal Neurological Inst & Hosp, Montreal, PQ, Canada; Andermann, Frederick , McGill U, Dept of Neurology & Neurosurgery, Montreal Neurological Inst & Hosp, Montreal, PQ, Canada; Bastos, Alexandre, McGill U, Dept of Neurology & Neurosurgery, Montreal Neurological Inst & Hosp, Montreal, PQ, Canada; Cendes, Fernando, McGill U, Dept of Neurology & Neurosurgery, Montreal Neurological Inst & Hosp, Montreal, PQ, Canada Address: Jones-Gotman, Marilyn, Montreal Neurological Inst, 3801 University Street, Montreal, PQ, Canada, H3A 2B4, mjg@ego.psych.mcgill.ca Source: Epilepsy & Behavior, Vol 2(3,Part1), Jun 2001. pp. 224-246. Publisher: US: Academic Press. Abstract: This article reports five patients (aged 25-52 yrs) with pronounced memory loss who had extensive neuropsychological and electroencephalographic testing. magnetic resonance imaging (MRI) was also performed in four of the patients, MRI volumetric measurements of amygdala and hippocampal formation in three, and measurements of entorhinal cortex in two. The amnesia occurred after head trauma in one patient, following encephalitis in one, after partial status epilepticus in two, and after unilateral surgical resection in a woman with bilateral lesions. On the basis of these studies it was impossible to distinguish the role of recurrent temporal lobe epileptic seizures as distinct from underlying lesions in the genesis and course of memory loss. The authors reviewed the anatomical substrate, neuropsychological, and other investigations and the etiological factors leading to the amnesia in these patients, together with current concepts regarding possible causes of such severe memory dysfunction. In patients with this degree of memory deficit, temporal resection in an attempt to control seizures did not lead to a measurable increase in memory problems. It also, however, did not bring about worthwhile improvement in seizure control. _____
Title: Event-related potentials in posttraumatic headache. Author(s): Alberti, Andrea, U Perugia, Dept of Neuroscience, Perugia, Italy; Sarchielli, Paola; Mazzotta, Giovanni; Gallai, Virgilio Source: Headache, Vol 41(6), Jun 2001. pp. 579-585. Publisher: US: Blackwell Publishing. Abstract: Assessed the impairment of cognitive functions occurring in patients with posttraumatic headache as a consequence of a minor cranial trauma in the absence of organic damage involving the central nervous system. 25 Ss (aged 16-55 yrs) were examined between 3 and 6 mo after the traumatic event. Ss underwent electroencephalography and brain stem auditory evoked potentials; magnetic resonance imaging (MRI) was performed to exclude the presence of cerebral lesions. The mean latency of P300 was increased in both central electrodes (Cz and Pz) in patients with posttraumatic syndrome compared with controls; assuming the value of mean +-2 SD was the cutoff point between normal and abnormal results, the P300 latency results were altered in 13 patients (52%). In the patient group, a significant correlation was demonstrated between Zung Depression Scale score and P3 and N2 wave latencies and between Zung Anxiety Scale scores and P3 wave latencies. Data suggest the usefulness of the P300 event-related potential in evaluating cognitive disturbances in patients affected by posttraumatic syndrome. Alteration of cognitive potential in such patients, even in the absence of lesions detectable by neuroimaging, indicate the functional impairment of specific cerebral areas that can occur after a traumatic event. _____
Title: Magnetoencephalography and magnetic source imaging in children. Author(s): Otsubo, Hiroshi, Hosp for Sick Children, Div of Neurology, Dept of Pediatrics, Toronto, ON, Canada; Snead, O. Carter III Address: Snead, O. Carter, III, The Hospital for Sick Children, Division of Neurology, 555 University Avenue, Toronto, ON, Canada, M5G 1X8, carter.snead@sickkids.on.ca Source: Journal of Child Neurology , Vol 16(4), Apr 2001. pp. 227-235. Publisher: Canada: BC Decker. Abstract: Magnetoencephalography is a technique that detects the magnetic fields associated with the intracellular current flow within neurons, unlike electroencephalography, which measures extracellular volume currents. Superconducting quantum interference devices are used to amplify these very small magnetic field signals. Magnetic source imaging is the combination of functional data derived from magnetoencephalographic recordings coregistered with structural magnetic resonance imaging (MRI). The utility of magnetic source imaging lies in the combination of the submillisecond temporal resolution of magnetoencephalography with the precise anatomic images provided by MRI. As such, magnetic source imaging is a useful tool for noninvasive localization of the epileptogenic zone in children who are candidates for epilepsy surgery. Similarly, using magnetoencephalographic recordings with evoked and event-related potentials, magnetic source imaging holds great promise as a noninvasive method for precise localization of somatosensory, motor, language, visual, and auditory cortex. Finally, magnetic source imaging is proving a valuable research tool in the investigation of epilepsy, head trauma, brain plasticity, and disorders of language, memory, cognition, and executive function in children. _____
Title: Foreign accent-like syndrome during psychotic exacerbations. Author(s): Reeves, Roy R., Jacksons Veterans Affairs Medical Ctr, Jackson, MS, US; Norton, John W. Source: Neuropsychiatry, Neuropsychology, & Behavioral Neurology, Vol 14(2), Apr-Jun 2001. pp. 135-138. Publisher: US: Lippincott Williams & Wilkins. Abstract: Describes the neurologic and psychiatric findings in a patient with foreign accent-like syndrome occurring during episodes of psychotic exacerbation. Foreign accent syndrome has been reported in several patients with disorders such as cerebral infarction, cerebral hemorrhage, and head trauma but not in a patient whose primary problem was psychosis. Most patients with this syndrome exhibit some degree of aphasia, and some are dysarthric. A male schizophrenic patient with foreign accent like syndrome occurring during a psychotic exacerbation was evaluated by examination and interview, language testing, magnetic resonance imaging, electroencephalography, and other investigative methods. The patient exhibited a prominent British accent, which persisted throughout the duration of his psychotic exacerbation and resolved with improvement of his psychosis. Magnetic resonance imaging revealed no lesions, and no abnormality of language or articulation was present. A single-photon emission computed tomography scan could not be obtained. This represents the first reported case of a patient with foreign accent-like syndrome during psychotic exacerbations. _____
Title: To do or not to do? Magnetic resonance imaging in mild traumatic brain injury. Author(s): Voller, B., U Vienna, Dept of Neurorehabilitation, Vienna, Austria; Auff, E.; Schnider, P.; Aichner, Franz Source: Brain Injury , Vol 15(2), Feb 2001. pp. 107-115. Publisher: US: Taylor & Francis. Abstract: Clinical quantification of mild traumatic brain injury (MTBI) patients should be based on Glasgow coma scale score, duration of loss of consciousness and post-traumatic amnesia. In addition, a short practicable neuropsychological test might be useful in detecting minor memory and attentional deficits. An magnetic resonance imaging (MRI) appears to be the most sensitive imaging method for assessing MTBI so far, but information regarding a visualized lesion is not usually utilized in the classification of MTBI. MRI should, therefore, play a major role in any MTBI classification scheme. An appropriate MRI protocol has to be chosen using at least T-sub-1 weighted, T-sub-1 weighted, proton density and gradient-echo sequence images, all in at least 2 planes, in order to detect and classify all lesions precisely. Owing to the fact that acute lesions may be missed, it is advisable to perform MRI in the first 2 weeks following trauma. Further research is necessary to clarify the relationship between chronic symptoms after MTBI and MRI abnormalities. It may, thus, be possible to provide optimal strategies for emergency department management, to define a group of patients with a need for acute and rehabilitative intervention after MTBI, and to predict their outcome. _____
Title: Investigating the pathogenesis of posttraumatic stress disorder with neuroimaging. Author(s): Pitman, Roger K., PTSD Research Lab, Charlestown, MA, US; Shin, Lisa M.; Rauch, Scott L. Source: Journal of Clinical Psychiatry, Vol 62(Suppl17), 2001. Special Issue: Understanding posttraumatic stress disorder. pp. 47-54. Publisher: US: Physicians Postgraduate Press. Abstract: Reviews structural and functional neuroimaging studies in posttraumatic stress disorder (PTSD) and discusses their relevance to the emerging neuroscientific understanding of the pathogenesis of PTSD. Structural abnormalities in PTSD found with magnetic resonance imaging (MRI) include nonspecific white matter lesions and decreased hippocampal volume. These abnormalities may reflect pretrauma vulnerability to develop PTSD, or may be a consequence of traumatic exposure, PTSD, and/or PTSD sequelae. Functional neuroimaging symptom provocation and cognitive activation paradigms using positive emission tomography measurement of regional cerebral blood flow have shown greater activation of the amygdala and anterior paralimbic structures, greater deactivation of Broca's region (motor speech) and other nonlimbic cortical regions, and failure of activation of the cingulate cortex in response to trauma-related stimuli in individuals with PTSD. Functional MRI research has shown the amygdala to be hyperresponsive to fear-related stimuli in this disorder. Research with PET suggests that cortical, notably hippocampal, metabolism is suppressed to a greater extent by pharmacologic stimulation of the noradrenergic system in persons with PTSD. _____
Title: mGluR5 antagonists 2-methyl-6-(phenylethynyl)-pyridine and (E)-2-methyl-6-(2-phenylethenyl)-pyridine reduce traumatic neuronal injury in vitro and in vivo by antagonizing N-methyl-d-aspartate receptors. Author(s): Movsesyan, Vilen A., Georgetown U, Dept of Neuroscience, Inst for Cognitive & Computational Sciences, Washington, DC, US; O'Leary, Deirdre M.; Fan, Lei; Bao, Weili; Mullins, Paul G.; Knoblach, Susan M.; Faden, Alan I. Source: Journal of Pharmacology & Experimental Therapeutics , Vol 296(1), Jan 2001. pp. 41-47. Publisher: US: American Society for Pharmacology & Experimental Therapeutics ASPET. Abstract: The effect of selective group I metabotropic glutamate receptor subtype 5 (mGluR5) antagonists 2-methyl-6-(phenylethynyl)pyridine (MPEP) and (E)-2-methyl-6-(2-phenylethenyl)-pyridine (SIB-1893) on neuronal cell survival and post-traumatic recovery was examined using rat in vitro and in vivo trauma models. Treatment with MPEP and SIB-1893 showed significant neuroprotective effects in rat cortical neuronal cultures subjected to mechanical injury. Application of the antagonists also attenuated glutamate- and N-methyl-D-aspartate (NMDA)-induced neuronal cell death in vitro. Intracerebroventricular administration of MPEP to rats markedly improved motor recovery and reduced deficits of spatial learning after lateral fluid percussion induced traumatic brain injury. Lesion volumes as assessed by magnetic resonance imaging were also substantially reduced by MPEP treatment. Electrophysiological and pharmacological studies indicate that MPEP and SIB-1893 also inhibit NMDA receptor activity at higher concentrations that are neuroprotective. Taken together, these data suggest that MPEP and SIB-1893 may have therapeutic potential in brain injury, although the mechanisms of neuroprotective action for these drugs may reflect their ability to modulate NMDA receptor activity. _____
Title: A peptide derived from activity-dependent neuroprotective protein (ADNP) ameliorates injury response in closed head injury in mice. Author(s): Beni-Adani, Liana, Hebrew U Hadassah Medical Ctr, Dept of Neurosurgery, Jerusalem, Israel; Gozes, Illana; Cohen, Yoram; Assaf, Yaniv; Steingart, Ruth A.; Brenneman, Douglas E.; Eizenberg, Oded; Trembolver, Victoria; Shohami, Esther Source: Journal of Pharmacology & Experimental Therapeutics , Vol 296(1), Jan 2001. pp. 57-63. Publisher: US: American Society for Pharmacology & Experimental Therapeutics ASPET. Abstract: Brain injury induces disruption of the blood-brain barrier, edema, and release of autodestructive factors that produce delayed neuronal damage. NAPSVIPQ (NAP), a femtomolaracting peptide, is shown to be neuroprotective in a mouse model of closed head injury. NAP injection after injury reduced mortality and facilitated neurobehavioral recovery. Edema was reduced by 70% in the NAP-treated mice. Furthermore, in vivo magnetic resonance imaging demonstrated significant brain-tissue recovery in the NAP-treated animals. NAP treatment decreased tumor necrosis factor-alphalevels in the injured brain and was shown to protect pheochromocytoma (PC12 cells) against tumor necrosis factor-alpha-induced toxicity. Thus, NAP provides significant amelioration from the complex array of injuries elicited by head trauma. _____
Title: fMRI response during visual motion stimulation in patients with late whiplash syndrome. Author(s): Freitag, Peter, U Hosp Basel, Dept of Neuroradiology, Basel, Switzerland; Greenlee, M. W.; Wachter, K.; Ettlin, Th. M.; Radue, E. W. Source: Neurorehabilitation & Neural Repair , Vol 15(1), 2001. pp. 31-37. Publisher: US: Demos Publications. Abstract: Examined 5 symptomatic patients with late whiplash syndrome (aged 31-58 yrs), 5 asymptomatic patients after whiplash trauma, and a control group of 7 volunteers without the history of trauma. Tests for visual motion perception and functional magnetic resonance imaging (fMRI) Measurements during visual motion stimulation were performed. Symptomatic patients showed a significant reduction in their ability to perceive coherent visual motion compared with controls, whereas the asymptomatic patients did not show this effect. fMRI activation was similar during random dot motion in all 3 groups, but was significantly decreased during coherent dot motion in the symptomatic patients compared with the other 2 groups. Reduced psychophysical motion performance and reduced fMRI responses in symptomatic patients with late whiplash syndrome both point to a functional impairment in cortical areas sensitive to coherent motion. Larger studies are needed to confirm these clinical and functional imaging results to provide a possible additional diagnostic criterion for the evaluation of patients with late whiplash syndrome. _____
Title: Magnetic resonance imaging volumes of the hippocampus and the amygdala in women with borderline personality disorder and early traumatization. Author(s): Driessen, Martin, Luebeck School of Medicine, Dept of Psychiatry, Luebeck, Germany; Herrmann, Joerg; Stahl, Kerstin; Zwaan, Martin; Meier, Szilvia; Hill, Andreas; Osterheider, Marita; Petersen, Dirk Source: Archives of General Psychiatry, Vol 57(12), Dec 2000. pp. 1115-1122. Publisher: US: American Medical Assn. Abstract: Examined volumes of the hippocampus and the amygdala, neuropsychological functioning, and history of childhood traumatization in 21 female patients (aged 21-40 yrs) with borderline personality disorder (BPD). The authors analyzed the interrelationships between volumes and neuropsychological functioning, as well as between measured volumes and the extent of childhood experiences. Ss completed the Structured Clinical Interview for DSM-IV Personality Disorders, neuropsychological test batteries, and the Childhood Trauma Questionnaire. magnetic resonance imaging (MRI) scans and MRI-based volumetric measurements were performed. Results show volumes of the hippocampus in the BPD group nearly 16% smaller than those of the healthy control Ss even when controlling for brain volume. Similar, but less pronounced results were found with regard to the amygdala, with volumes nearly 8% smaller. The hypothesis of stress- or trauma-induced volume reductions in BPD (at least those of the hippocampus) can only in part be supported by the negative correlations between volumes of the hippocampus and the extent and duration of self-reported traumatic experiences, because these correlations were found only with regard to the whole sample but not when the BPD and the healthy groups were analyzed separately. _____
Title: Trauma, stress and multiple sclerosis. Author(s): Martinelli, V., Institute S. Raffaele, Dept of Neurology, Milan, Italy; Source: Neurological Sciences, Vol 21(4,Suppl2), 2000. Special Issue: The prognosis of multiple sclerosis. pp. S849-S852. Publisher: US: Springer Publishing. Abstract: It has been suggested that physical trauma, involving the cervical spinal cord or the brain, and psychological stress may precede multiple sclerosis (MS) onset or may influence the disease course, although this hypothesis has mainly come from anecdotal case reports or small studies. So far there are no studies providing a clear causative relationship between physical trauma (especially head trauma) and MS onset, exacerbation or progression of the disease. On the other hand, recent magnetic resonance imaging (MRI) and experimental studies, supporting the important role of nervous and immune system interactions, particularly by the hypothalamic-pituitary-adrenal axis and by the sympathetic nervous pathways, seem to demonstrate a significant correlation between stress and MS exacerbations. Further frequent MRI and immunological evaluations should be warranted to objectively document the temporal association between stress and clinical and/or sub-clinical disease activity. _____
Title: Neuroimaging and behavioral correlates of recovery from mnestic block syndrome and other cognitive deteriorations. Author(s): Markowitsch, Hans J., U Bielefeld, Dept of Physiological Psychology, Bielefeld, Germany; Kessler, Josef; Weber-Luxenburger, Gerald; Van der Ven, Christian; Albers, Matthias; Heiss, Wolf-Dieter Source: Neuropsychiatry, Neuropsychology, & Behavioral Neurology, Vol 13(1), Jan 2000. pp. 60-66. Publisher: US: Lippincott Williams & Wilkins. Abstract: On the basis of the assumption that trauma and stress conditions can alter the functions of the nervous systems, the authors report on a 23-yr-old male patient whom they studied 2 and 12 mo after he suffered "mnestic block syndrome" and additional cognitive deterioration symptoms. The authors used magnetic resonance imaging (MRI) and fluorodeoxyglucose positron emission tomography for neural and detailed neuropsychological testing for cognitive deficits. The patient initially manifested severe intellectual decline, including severe anterograde and retrograde amnesia. His symptoms were correlated with major, although selective, reductions in his brain metabolism. Presently, he shows a normal brain metabolism and has regained parts of his memory and many of his other intellectual capabilities. Nevertheless, he still has long-term memory impairments. This case demonstrates a close relation between brain metabolism and cognitive performance, with major deficits of both at 2 mo and major recovery of both at 12 mo after a shocking event. It can serve as an example for possible stress-related deteriorations in certain brain regions, which can be partly corrected by psychotherapeutic interventions, passing time, and favorable environmental conditions. _____
Title: Refractory symptomatic schizophrenia resulting from frontal lobe lesion: Response to clozapine. Author(s): Burke, John G., U Leicester, Faculty of Medicine, Dept of Psychiatry, Leicester, England; Dursun, Serdar M.; Reveley, Michael A. Source: Journal of Psychiatry & Neuroscience, Vol 24(5), Nov 1999. pp. 456-61. Publisher: Canada: Canadian Medical Assn. Abstract: A 34-yr-old man with a 1-yr history of persistent auditory hallucinations and passivity delusions had failed to respond to a variety of conventional antipsychotic medications. He had a history of head trauma 8 yrs before the onset of psychiatric symptoms. Recent investigations revealed a post-traumatic infarct, situated in the left frontal lobe, on an magnetic resonance imaging (MRI) scan. Treatment with clozapine for more than 2 yrs resulted in a marked improvement in his psychotic symptoms. The localization of the brain lesion may be related to the etiology of his symptoms and to the clinical response to clozapine. _____
Title: Functional magnetic resonance imaging of personality switches in a woman with dissociative identity disorder. Author(s): Tsai, Guochuan E., McLean Hosp, Mailman Research Ctr, Lab of Molecular & Psychiatric Neuroscience, Belmont, MA, US; Condie, Donald; Wu, Ming-Ting; Chang, I-Wen Source: Harvard Review of Psychiatry, Vol 7(2), Jul-Aug 1999. pp. 119-122. Publisher: England: Oxford Univ Press. Abstract: Investigated the neuronal substrate involved in the personality switches of dissociative identity disorder (DID) by conducting an functional magnetic resonance imaging (MRI) of a 47-yr-old with DID while she was switching personalities. It was found that bilateral reduction of hippocampal volume in this S with comorbid posttraumatic stress disorder (PTSD) and DID, consistent with the reported reduction of hippocampal volume in patients with PTSD secondary to childhood trauma. In addition functional MRI during volitionally induced personality switch showed changes in hippocampal and medial temporal activity correlated with the switch, suggesting that personality switch may result from changes in hippocampal and temporal function. _____
Title: Developmental traumatology: II. Brain development. Author(s): De Bellis, Michael D., U Pittsburgh Medical Ctr, Western Psychiatric Inst & Clinic, Developmental Traumatology Lab, Pittsburgh, PA, US; Keshavan, Matcheri S.; Clark, Duncan B.; Casey, B. J.; Giedd, Jay N.; Boring, Amy M.; Frustaci, Karin; Ryan, Neal D. Source: Biological Psychiatry, Vol 45(10), May 1999. pp. 1271-1284. Publisher: US: Elsevier Science. Abstract: Previous investigations suggest that maltreated children with a diagnosis of posttraumatic stress disorder (PTSD) evidence alterations of biological stress systems. In this study, 44 maltreated children and adolescents (aged 6.7-17 yrs) with PTSD and 61 healthy matched controls underwent comprehensive psychiatric and neuropsychological assessments and an anatomical magnetic resonance imaging (MRI) brain scan. Results show that PTSD Ss had smaller intracranial and cerebral volumes than matched controls. The total midsagittal area of corpus callosum and middle and posterior regions remained smaller; while right, left, and total lateral ventricles were proportionally larger than controls, after adjustment for intracranial volume. Brain volume robustly and positively correlated with age of onset of PTSD trauma and negatively correlated with duration of abuse. Symptoms of intrusive thoughts, avoidance, hyperarousal or dissociation correlated positively with ventricular volume, and negatively with brain volume and total corpus callosum and regional measures. It is concluded that the overwhelming stress of maltreatment experiences in childhood is associated with adverse brain development. _____
Title: Amygdalar volume and emotional memory in Alzheimer's disease. Author(s): Mori, Etsuro, Hyogo Inst for Aging Brain & Cognitive Disorders, Dept of Clinical Neurosciences, Japan; Ikeda, Manabu; Hirono, Nobutsugu; Kitagaki, Hajime; Imamura, Toru; Shimomura, Tatsuo Source: American Journal of Psychiatry, Vol 156(2), Feb 1999. pp. 216-222. Publisher: US: American Psychiatric Assn. Abstract: Experimental work in animals and humans has demonstrated that the amygdaloid complex plays a crucial role in emotional memory, i.e., memory of events arousing strong emotions. The aim of this study was to elucidate the relationship between medial temporal damage and impaired memory of real-life emotional events in patients with Alzheimer's disease. In 36 patients (aged 52-87 yrs) with probable Alzheimer's disease who experienced the 1995 earthquake in Kobe, Japan, memories of events surrounding the earthquake were examined as an index of emotional memory with the use of a semistructured interview, and amygdalar and hippocampal volumes were quantified by magnetic resonance imaging (MRI). The effects of the atrophy of these structures on recall performance were determined. Irrespective of generalized brain atrophy and cognitive impairments, emotional memory was correlated more with normalized amygdalar volume (right and left averaged) than with normalized hippocampal volume. General knowledge of the earthquake was correlated with neither amygdalar nor hippocampal volume. The results indicate that impairment of emotional event memory in patients with Alzheimer's disease is related to intensity of amygdalar damage and provide evidence of the amygdala's involvement in emotional memory in humans. _____
Title: Head trauma and intellectual status: Relation to quantitative magnetic resonance imaging findings. Author(s): Bigler, Erin D., Brigham Young U, Dept of Psychology, Provo, UT, US; Johnson, Sterling C.; Blatter, Duane D. Source: Applied Neuropsychology, Vol 6(4), 1999. pp. 217-225. Publisher: US: Lawrence Erlbaum. Abstract: Contrasted 2 groups that sustained somewhat similar moderate to severe closed-head traumatic brain injury (TBI), but were deliberately selected to be different with regard to postinjury intellectual status--one group average or above, the other below. The purpose of the comparison was to describe any morphological characteristics of the 2 groups ascertained from quantitative magnetic resonance (QMR) imaging. 35 TBI participants with Full Scale IQ (FSIQ) less than 90 (mean age 27.2 yrs) were compared with 33 TBI participants whose FSIQ was above 90 (mean age 33.6 yrs). A group of normal volunteer participants, age and gender matched, constituted a third magnetic resonance comparison group. All participants received uniform MRI from which QMR analysis was performed. Both TBI groups received neuropsychological testing in the course of clinical follow-up. Morphological comparisons between groups were made using multivariate analysis of variance. The TBI group with an IQ less than or equal to 90 had significantly enlarged third and temporal horn compartments. Total intracranial volume was smaller in this group as well. Lower psychometric intelligence postinjury may be associated with more temporal lobe atrophy and subcortical pathology. Smaller premorbid brain size may be another risk factor. _____
Title: The effects of stress on memory and the hippocampus throughout the life cycle: Implications for childhood development and aging. Author(s): Bremner, J. Douglas, Yale Psychiatric Inst, New Haven, CT, US; Narayan, Meena Source: Development & Psychopathology, Vol 10(4), Fal 1998. Special Issue: Risk, trauma, and memory. pp. 871-885. Publisher: US: Cambridge Univ Press. Abstract: Studies in animals showing hippocampal atrophy and associated memory deficits in stress and aging have implications for stress and aging in humans. Clinical studies in traumatized human populations with posttraumatic stress disorder (PTSD) have replicated studies in animals, showing reduction in volume of the hippocampus measured with magnetic resonance imaging and associated memory deficits. Trauma at different stages of development (early childhood abuse versus trauma in later life due to combat) may influence the nature of memory deficits and hippocampal atrophy. Studies in aging human subjects are consistent with animal studies, although future research is needed in this area. The similarities between biological findings related to cortisol and the hippocampus in stress and aging in both animal and human studies raises the question of whether PTSD can be seen as a form of accelerated aging. Evidence that stress affects the hippocampus and the capacity for learning has broad implications for public health policy, underlying the need for additional resources in this important area and a reexamination of our understanding of factors influencing academic achievement. _____
Title: CT or MRI in posttraumatic headache. Author(s): Saggese, Javier A., Churruca-Visca Hosp, Headache & Pain Section, Neurology Div, Buenos Aires, Argentina; Bruera, Osvaldo C. Source: Headache, Vol 38(7), Jul-Aug 1998. pp. 554-555. Publisher: US: Blackwell Publishing. Abstract: Discusses the different findings obtained from a CT and an magnetic resonance imaging (MRI) in a 56-yr-old man with head trauma and loss of consciousness suffered in a crash. The initial CT scan, performed several hrs after the crash, showed only pathology related to an old injury. The S was previously a kind and calm person, but following the accident, he became hypomanic and delirious, and suffered insomnia, impaired memory, anxiety, anger, and persistent headache. Despite treatment for anxiety, his condition worsened with the onset of paranoid and depressive thoughts; 15 days later, a further CT was obtained, showing no changes. 20 days after the trauma, an MRI was performed because a mild left hemiparesis was noted. This showed a subdural hematoma compressing the left frontal and temporal lobes with partial collapse of the frontal and temporal horns of ipsilateral lateral ventricle and effacement of the cortical sulci. The authors stress the importance of clinical and neuropsychological evaluations and followup neuroimaging in diagnosing brain trauma. _____
Title: Amnestic people with Alzheimer's disease who remembered the Kobe earthquake. Author(s): Ikeda, Manabu , Ehime U, School of Medicine, Dept of neuropsychiatry, Ehime, Japan; Mori, Etsuro; Hirono, Nobutsugu; Imamura, Toru; Shimomura, Tatsuo; Ikejiri, Yoshitaka; Yamashita, Hikari Source: British Journal of Psychiatry, Vol 172, May 1998. pp. 425-428. Publisher: England: Royal Coll of Psychiatrists. Abstract: Emotional memory is a special category of memory for events arousing strong emotions. To investigate the effects of emotional involvement on memory retention in individuals with Alzheimer's disease, the authors studied peoples' memories of distressing experiences during a devastating earthquake. 51 subjects (aged 54-87 yrs) with probable Alzheimer's disease who experienced the Kobe earthquake at home in the greater Kobe area were studied. Memories of the earthquake were assessed 6 and 10 wks after the disaster in semistructured interviews, and were compared with memories of a magnetic resonance imaging (MRI) examination given after the earthquake. 44 of the subjects remembered the earthquake and 16 of subjects remembered the MRI experience. Factual content of the earthquake was lost in most of the subjects. It was concluded that fear reinforces memory retention of an episode in subjects with Alzheimer's disease but does not enhance retention of its context, despite repeated exposure to the information. _____
Title: Quantitative proton MRS predicts long-term outcome following traumatic brain injury. Author(s): Friedman, Seth David , U New Mexico, US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering, Vol 58(10-B), Apr 1998. pp. 5691. Publisher: US: Univ Microfilms International. Abstract: Neuropsychological dysfunction is a common result of traumatic brain injury (TBI). While conventional tools such as the Glasgow Coma Scale, computed tomography, and magnetic resonance imaging provide essential information for acute intervention, none relate well to neuropsychological dysfunction following trauma. This difficulty is likely due to the limitation of structural imaging techniques in resolving the widespread cellular injury found in autopsy studies. Proton magnetic resonance spectroscopy (1H MRS) provides a non-invasive assessment of injury at the cellular level. Three studies were conducted to investigate the relationship between MRS measures of injury to normal-appearing brain following TBI and neuropsychological functioning. First, we designed and tested the reproducibility of a quantitative spectroscopic exam employing rigorous patient localization guidelines and automated data analysis, for detecting changes within an individual. Highly reproducible concentration measurements were demonstrated over time confirming the power and sensitivity of MRS as a clinical tool. In Experiment 2, ten TBI patients were studied using paired MRS and neuropsychological assessment when patients were adequately oriented for testing. MRS measures were performed in normal-appearing parietal-occipital white matter. A composite measure of neuropsychological function was calculated from z-scored individual tests to assess global brain function. Marked neurometabolite changes were present in normal-appearing tissue consistent with histological investigations of axonal injury. NAA and Cre levels were strongly related to a neuropsychological performance, supporting the hypothesis that diffuse injury is an important contributor to behavioral dysfunction. Experiment 3 followed thirteen TBI patients over time, investigating the utility of early MRS measures in white and grey matter to predict neuropsychological performance at outcome (3-6 months post-injury). MRS white matter levels did not predict outcome. However, grey matter NAA levels were strongly predictive of neuropsychological performance at outcome. In contrast, Glasgow Coma Score, the most common clinical measure for predicting outcome, was unrelated to neuropsychological measures. In conclusion, MRS can be acquired using conventional MR scanners in minimal additional time, providing a unique method of assessing the extent of diffuse injury following head trauma, a component of injury which may be the most critical factor in understanding resultant neuropsychological dysfunction. _____
Title: Hemophilia growth and development study: Relationships between neuropsychological, neurological, and MRI findings at baseline. Author(s): Sirois, Patricia A., Tulane U Medical Ctr, Section of Hematology/Medical Oncology, New Orleans, LA, US; Usner, Dale W.; Hill, Suzanne D.; Mitchell, Wendy D.; Bale, James F. Jr.; Loveland, Katherine A.; Stehbens, James A.; Donfield, Sharyne M.; Maeder, Margaret A.; Amodei, Nancy; Contant, Charles F. Jr.; Nelson, Marvin D. Jr.; Willis, John K. Source: Journal of Pediatric Psychology, Vol 23(1), Feb 1998. pp. 45-56. Publisher: England: Oxford Univ Press. Abstract: Examined the effects of HIV infection on children's development by identifying neurological and environmental variables (e.g., parents' education, academic problems) associated with neuropsychological measures of cognitive development in HlV-seronegative and HlV-seropositive children and adolescents with hemophilia. Participants included 298 males (aged 7-19 yrs). The neurological examinations included assessments of muscle bulk, cranial nerve and motor functions, reflexes, and coordination and gait. An magnetic resonance imaging (MRI) was performed on each S. Least squares modeling was used to determine whether there was a difference at baseline in mean neuropsychological test scores by HIV status, age, and neurological baseline findings, adjusting for selected environmental and medical history variables. The Ss were within age expectations for general intelligence. Variables associated with lowered neuropsychological performance included academic problems, coordination and/or gait abnormalities, parents' education, and previous head trauma. Hemophilia-related morbidity has a subtle adverse influence on cognitive performance. HIV infection was not associated with neuropsychological dysfunction in this group even when MRI abnormalities were present. _____
Title: Hippocampal volume in women victimized by childhood sexual abuse. Author(s): Stein, Murray B., Veterans Affairs Medical Ctr, Psychiatry Service, La Jolla, CA, US; Koverola, C.; Hanna, C.; Torchia, M. G.; et al. Source: Psychological Medicine, Vol 27(4), Jul 1997. pp. 951-959. Publisher: US: Cambridge Univ Press. Abstract: Studied hippocampal volume, measured using quantitative magnetic resonance imaging (MRI), in 21 women who reported being severely sexually abused in childhood and 21 sociodemographically similar women without abuse histories. Sexually abused Ss showed significantly reduced (5% smaller) left-sided hippocampal volume compared to non-victimized Ss. Hippocampal volume was also smaller on the right side, but this failed to reach statistical significance. Left-sided hippocampal volume correlated highly with dissociative symptom severity, but not with indices of explicit memory functioning. These findings, which are generally consistent with prior reports of reduced hippocampal volume in combat veterans with posttraumatic stress disorder (PTSD), suggest that diminished hippocampal size may be either a consequence of trauma exposure or a risk factor for the development of psychiatric complications following trauma exposure. The observed relationship between symptom severity and hippocampal volume suggests that mesial temporal lobe dysfunction may directly mediate certain aspects of PTSD and dissociative disorder symptomatology. _____
Title: A review of mild head trauma: II. Clinical implications. Author(s): Binder, Laurence M., Oregon Health Sciences U, Portland, OR, US; Source: Journal of Clinical & Experimental Neuropsychology, Vol 19(3), Jun 1997. pp. 432-457. Publisher: Netherlands: Swets & Zeitlinger. Abstract: Reviews literature in order to assist the clinician evaluating an adult patient with persistent symptoms after mild head trauma (MHT). On a chronic basis, 7-8% of mild head trauma (MHT) patients remain symptomatic and 14% are disabled from work. magnetic resonance imaging (MRI) studies of acutely injured persons may show lesions that are not detected in usual clinical practice. It is likely that the effects of these lesions dissipate with time, consistent with the neuropsychological data. The association between MHT and cognitive deficits, symptoms, and disability may not be causal; data suggest that MHT patients have more psychosocial problems prior to injury than do non-injured persons. The examiner of the MHT patient with chronic complaints must consider alternative medical and psychiatric explanations and perform a differential diagnosis. Presently, there is little evidence for neurological causation of most persisting complaints. _____
Title: Structural brain changes in PTSD. Does trauma alter neuroanatomy? Author(s): Stein, Murray B., US Dept of Veterans Affairs Medical Ctr, Dept of Psychiatry, San Diego, CA, US; Hanna, Cindy; Koverola, Catherine; Torchia, Mark; et al. Source: Yehuda, Rachel (Ed); McFarlane, Alexander C. (Ed); 1997. Psychobiology of posttraumatic stress disorder. Annals of the New York Academy of Sciences, Vol. 821. New York, NY, US: New York Academy of Sciences. pp. 76-82 Abstract: This chapter examines structural brain changes in posttraumatic stress disorder (PTSD) with a focus on abnormal hippocampal morphology and functioning in adults. The chapter examines the following topics: preclinical rationale; neuropsychologic functioning in PTSD and neuroanatomy in PTSD: assessing structure with magnetic resonance imaging (MRI) and H-MRS (proton magnetic resonance spectroscopy). _____
Title: Magnetic resonance imaging study of hippocampal volume in chronic, combat-related posttraumatic stress disorder. Author(s): Gurvits, Tamara V., VA Medical Ctr, Manchester, NH, US; Shenton, Martha E.; Hokama, Hiroto; Ohta, Hirokazu Source: Biological Psychiatry , Vol 40(11), Dec 1996. pp. 1091-1099. Publisher: US: Elsevier Science. Abstract: Used quantitative volumetric magnetic resonance imaging techniques to explore the neuroanatomic correlates of chronic, combat-related posttraumatic stress disorder (PTSD) in 7 Vietnam veterans with PTSD compared with 7 non-PTSD combat veterans and 8 normal non veterans. Both left and right hippocampi were significantly smaller in the PTSD Ss compared to the Combat Control and normal Ss, even after adjusting for age, whole brain volume, and lifetime alcohol consumption. There were no statistically significant group differences in intracranial cavity, whole brain, ventricles, ventricle:brain ratio, or amygdala. Subarachnoidal cerebrospinal fluid was increased in both veteran groups. Our finding of decreased hippocampal volume in PTSD subjects is consistent with results of other investigations which utilized only trauma-unexposed control groups. Hippocampal volume was directly correlated with combat exposure, which suggests that traumatic stress may damage the hippocampus. Alternatively, smaller hippocampi volume may be a pre-existing risk factor for combat exposure and/or the development of PTSD upon combat exposure. _____
Title: Neuropsychological findings in a patient with Kernohan's notch. Author(s): Clement, Veronica L., Baylor Coll of Medicine, Inst for Rehabilitation & Research, Houston, TX, US; Sherer, Mark Source: Applied Neuropsychology, Vol 3(2), May 1996. pp. 55-57. Publisher: US: Lawrence Erlbaum. Abstract: Describes the case of a 36-yr-old right-handed man who developed a left epidural hematoma after suffering head trauma from a blunt instrument. Sequelae 2 mo postinjury included left hemiparesis, dysphonic speech, severe naming/word-finding deficits, and severe memory impairment. The S's symptom pattern presented somewhat of a mystery as his cognitive deficits appeared consistent with left hemisphere damage, while his left motor symptoms suggested right hemisphere damage. Medical records were inconsistent. Deficits on neuropsychological testing at 3 mo postinjury included impairment in verbal and visual memory, confrontation naming, and left-sided motor function. Attention, visual-spatial skills, nonverbal problem solving, and right motor speed and coordination were intact. A herniation syndrome, Kernohan's notch, was considered to be the most likely explanation. Subsequent magnetic resonance imaging (MRI) confirmed a lesion in the right cerebral crus. The pattern of neuropsychological finding in this patient is discussed. _____
Title: Persistent retrograde amnesia following a minor trauma. Author(s): De Renzi, Ennio, Clinica Neurologica, Modena, Italy; Lucchelli, Federica; Muggia, Silvia; Spinnler, Hans Source: Cortex , Vol 31(3), Sep 1995. pp. 531-542. Publisher: Italy: Masson Italia Periodici srl. Abstract: Reports dense retrograde amnesia (RA) following a motor accident, in a 19-yr-old man. Intelligence, anterograde memory (unknown name-activity, famous name-activity congruous, and famous name-activity incongruous associations), and retrograde memory (memory of autobiographical events, public events and famous persons, encyclopedic notions, verbal and visual semantics, and procedural memory) were examined. computerized tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography scans were negative. Follow-up was conducted 7, 13, 21 and 29 mo post-onset. Ability to acquire verbal, visual and spatial information was excellent, in contrast to profound autobiographical RA, and impaired memory of public events and people. Encyclopedic notions were well preserved. He was able to relearn facts or episodes of his past life, and integrate them in the frame of his autobiography. Since RA persisted unmodified at 29 mo, diagnosis of Transient Global Amnesia is suggested. _____
Title: 18-Fluorodeoxyglucose positron emission tomography in children and adolescents with traumatic brain injury. Author(s): Worley, Gordon, Duke U Medical Center, Durham, NC, US; Hoffman, John M.; Paine, Susan S.; Kalman, Sophia L.; et al. Source: Developmental Medicine & Child Neurology, Vol 37(3), Mar 1995. pp. 213-220. Publisher: US: Cambridge Univ Press. Abstract: 22 previously normal children and adolescents (aged 4 mo to 19 yrs 4 mo) who suffered traumatic brain injury had positron emission tomography (PET) during rehabilitation 1-5 mo after injury. Outcome was assessed at a median of 25 mo after brain injury. 16 Ss had computerized tomography (CT) or magnetic resonance imaging (MRI) within 24 days of PET, and 11 Ss had a 2nd PET at outcome. PET earlier than 12 wks after head trauma correlated with outcome. PET scores improved significantly between rehabilitation and outcome for the 11 Ss who had 2 PETs, but improvement was not associated with improvement in clinical condition. The data suggest that routine PET during rehabilitation is no more useful than contemporaneous CT or MRI for prediction of outcome. (French, German & Spanish abstracts) _____
Title: Visual hallucinations with written words in a case of left parietotemporal lesion. Author(s): Rousseaux, Marc, Centre Hosp Regional et Universitaire, Service de Reeducation et Convalescence Neurologiques, Hopital Huriez, Lille, France; Debrock, Dominique; Cabaret, Maryline; Steinling, Marc Source: Journal of Neurology, Neurosurgery & Psychiatry, Vol 57(10), Oct 1994. pp. 1268-1271. Publisher: England: BMJ Publishing Group. Abstract: Describes the case of a 15-yr old ambidextrous male patient who presented with left temporoparietal lesions after head trauma. Seizures associated with visual hallucinations of written words arose 6 mo later. EEG showed spike and wave complexes with phase opposition over the left parietal area. On magnetic resonance imaging (MRI) a posttraumatic porencephalic lesion was seen in area 7 and the superior part of area 39 of Brodmann; on T2 sequences, it was surrounded by a hyperecho predominating in the inferior part of the parietal lobe and extending in the posteroexternal temporal cortex. _____
Title: Syndrome de deconnexion interhemispherique post-traumatique. Translated Title: Hemispheric disconnection syndrome of traumatic origin. Author(s): Ceccaldi, Mathieu, Ctr Hospitalier Universitaire Timone, Service de Neurologie et de Neuropsychologie, Marseille, France; Royere, M. L.; Danoy, M. C.; Poncet, M. Source: Revue Neurologique , Vol 150(3), 1994. pp. 229-232. Publisher: France: Masson Editeur. Abstract: Presents a case report on a 27-yr-old left-handed man with a partial hemispheric disconnection syndrome following severe cranial trauma. Clinical symptoms included left-hand agraphia, left-hand tactile anomia, left visual field anomia, left visual field alexia, and partial left-ear extinction for verbal material. Magnetic resonance imaging revealed a lesion involving the trunk of the corpus callosum. (English abstract) _____
Title: Neurological dysfunction in borderline patients and Axis II control subjects. Author(s): Zanarini, Mary C., Harvard Medical School, Boston, MA, US; Kimble, Catherine R.; Williams, Amy A. Source: Silk, Kenneth R. (Ed); 1994. Biological and neurobehavioral studies of borderline personality disorder. Progress in psychiatry, No. 45. Washington, DC, US: American Psychiatric Association. pp. 159-175 Abstract: assess the rate and type of neurological dysfunction in a large sample of criteria-defined borderline patients / this study was designed to build upon earlier studies . . . in 4 important ways /[perform] diagnostic assessments . . . with semi-structured interviews of demonstrated reliability / [study] control patients meeting Diagnostic and Statistical Manual of Mental Disorders-III (DSM-III) and/or DSM-III-R criteria for a full range of Axis II disorders / [obtain] EEG and computerized tomography (CT)/magnetic resonance imaging (MRI) reports as well as information concerning neurological examination, seizure history, and head trauma history / determine whether there was any significant relationship between a reported history of childhood abuse and adult neurological dysfunction / [Ss were 296 18-60 yr old inpatients] _____
Title: Brain lesions in alcoholics. Author(s): Charness, Michael E., Harvard Medical School, Brockton-West Roxbury Veterans Affairs Medical Ctr, West Roxbury, MA, US Source: Alcoholism: Clinical & Experimental Research , Vol 17(1), Feb 1993. pp. 2-11. Publisher: US: Lippincott Williams & Wilkins. Abstract: Highlights pathological processes that underlie brain damage in alcoholism. Ethanol neurotoxicity, Wernicke's encephalopathy, hepatocerebral degeneration, head trauma, central pontine myelinolysis, Marchiafava-Bignami syndrome, pellagra, and premoribid pathological conditions, such as fetal alcohol syndrome, may all contribute to cognitive dysfunction in alcoholics. With the exception of ethanol neurotoxicity, all of these conditions are associated with specific neuropathological lesions. Distinguishing ethanol neurotoxicity from nutritional deficiency can be facilitated by magnetic resonance imaging (MRI). Computerized morphometric studies of alcoholic brains have revealed ventricular enlargement, selective loss of subcortical white matter, and alterations in neuronal size, number, architecture, and synaptic complexity. _____
Title: Magnetic resonance imaging of schizophrenia-like psychoses associated with cerebral trauma: Clinicopathological correlates. Author(s): Buckley, Peter, Case Western Reserve U, Cleveland, OH, US; Stack, John P.; Madigan, Cathy; O'Callaghan, Eadbhard; et al. Source: American Journal of Psychiatry, Vol 150(1), Jan 1993. pp. 146-148. Publisher: US: American Psychiatric Assn. Abstract: Three patients with schizophrenia-like psychosis (SZPP) and 2 with schizoaffective-like psychosis (SZFP), all aged 24-47 yrs, who experienced cerebral trauma before the onset of their illness underwent clinical and magnetic resonance imaging (MRI) evaluation. Comparisons were made with age-matched patients with Diagnostic and Statistical Manual of Mental Disorders-III (DSM-III) diagnosed schizophrenia, supplemented by 3 normal men (aged 26, 27, and 32 yrs), all of whom were examined using identical procedures. Each patient with an SZPP, but neither of those with an SZFP, showed abnormalities confined to or including the left temporal lobe. These observations complement recent findings in schizophrenia (e.g., K. Davison, 1990).
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Title: The Nature of Traumatic Memories: A 4-T fMRI Functional Connectivity Analysis. Author(s): Lanius, Ruth A. , ruth.lanius@lhsc.on.ca
Williamson, Peter C.
Densmore, Maria
Boksman, Kristine
Neufeld, R. W.
Gati, Joseph S.
Menon, Ravi S. Address: Lanius, Ruth A., Dept of Psychiatry, London Health Sciences Ctr, 339 Windermere Rd, P.O. Box 5339, London, ON, Canada, N6A 5A5, ruth.lanius@lhsc.on.ca Source: American Journal of Psychiatry , Vol 161(1), Jan 2004. pp. 36-44. Journal URL: http://ajp.psychiatryonline.org/ Publisher: US: American Psychiatric Assn. Publisher URL: ISSN: 0002-953X (Print) Digital Object Identifier: http://dx.doi.org/10.1176/appi.ajp.161.1.36 Language: English Key Concepts: interregional brain activity correlations; traumatic memory recall; posttraumatic stress disorder; traumatized adults Abstract: Used functional connectivity analyses (FCAs) to assess interregional brain activity correlations during the recall of traumatic memories in traumatized Ss with and without posttraumatic stress disorder (PTSD). Both 4-T functional magnetic resonance imaging (fMRI) and FCAs were used to assess interregional brain activity correlations during symptom provocation in 11 traumatized Ss with and 13 without PTSD. The use of FCAs in addition to subtraction analyses allowed assessment of specific brain regions involved in the recall of traumatic events and of the neuronal networks underlying the recall of such events. Significant between-group differences in functional connectivity were found: Non-PTSD Ss had greater correlation than the PTSD Ss in the left superior frontal gyrus, left anterior cingulate gyrus, left striatum, left parietal lobe, and left insula. In contrast, the PTSD Ss showed greater correlation than the non-PTSD Ss in the right posterior cingulate gyrus, right caudate, right parietal lobe, and right occipital lobe. The differences in brain connectivity between PTSD and comparison Ss may account for the nonverbal nature of traumatic memory recall in PTSD Ss, compared to a more verbal pattern of traumatic memory recall in comparison Ss. (PsycINFO Database Record (c) 2004 APA, all rights reserved) Subjects: *Brain; *Emotional Trauma; *Memory; *Posttraumatic Stress Disorder Classification: Neuroses & Anxiety Disorders (3215) Population: Human (10)
Male (30)
Female (40) Age Group: Adulthood (18 yrs & older) (300) Form/Content Type: Empirical Study (0800)
Quantitative Study (0890)
Journal Article (2400) Publication Type: Peer Reviewed Journal (270); Print; Electronic Release Date: 20040202 Accession Number: 2003-11167-007
Persistent link to this record: http://search.epnet.com/direct.asp?an=2003-11167-007&db=psyh
Cut and Paste: <A href="http://search.epnet.com/direct.asp?an=2003-11167-007&db=psyh">The Nature of Traumatic Memories: A 4-T fMRI Functional Connectivity Analysis.</A>
Database: PsycINFO _____
Record: 2
Title: Major Depression Following Traumatic Brain Injury. Author(s): Jorge, Ricardo E. , ricardo-jorge@uiowa.edu, Department of Psychiatry, University of Iowa, Iowa City, IA, US
Robinson, Robert G. , Department of Psychiatry, University of Iowa, Iowa City, IA, US
Moser, David , Department of Psychiatry, University of Iowa, Iowa City, IA, US
Tateno, Amane , Department of Psychiatry, University of Iowa, Iowa City, IA, US
Crespo-Facorro, Benedicto , Department of Psychiatry, University of Iowa, Iowa City, IA, US
Arndt, Stephan , Department of Psychiatry, University of Iowa, Iowa City, IA, US Address: Jorge, Ricardo E., MEB/Psychiatry Research, 500 Newton Rd, Iowa City, IA, US, 52242, ricardo-jorge@uiowa.edu Source: Archives of General Psychiatry , Vol 61(1), Jan 2004. pp. 42-50. Journal URL: http://archpsyc.ama-assn.org/ Publisher: US: American Medical Assn. Publisher URL: http://www.amapublications.com ISSN: 0003-990X (Print) Digital Object Identifier: http://dx.doi.org/10.1001/archpsyc.61.1.42 Language: English Key Concepts: major depression; traumatic brain injury; cognitive processes; social functioning Abstract: Determined the clinical, neuropsychological, and structural neuroimaging correlates of major depression occurring after traumatic brain injury (TBI). The study group consisted of 91 patients with TBI, and 27 patients with multiple traumas but without evidence of central nervous system injury constituted the control group. The patients' conditions were evaluated at baseline and at 3, 6, and 12 months after the traumatic episode. Neuropsychological testing and quantitative magnetic resonance imaging were performed at the 3-month follow-up visit. Major depressive disorder was observed in 30 of 91 patients during the first year after sustaining a TBI. Major depressive disorder was significantly more frequent among patients with TBI than among the controls. Patients with TBI who had major depression were more likely to have a personal history of mood and anxiety disorders than patients who did not have major depression. Patients with major depression exhibited comorbid anxiety (76.7%) and aggressive behavior (56.7%). Patients with major depression had significantly greater impairment in executive functions than their non-depressed counterparts. Major depression was associated with poorer social functioning at the 6- and 12- month follow-up. (PsycINFO Database Record (c) 2004 APA, all rights reserved) Subjects: *Cognitive Processes; *Major Depression; *Social Adjustment; *Traumatic Brain Injury Classification: Neurological Disorders & Brain Damage (3297) Population: Human (10) Location: US Form/Content Type: Empirical Study (0800)
Longitudinal Study (0850)
Quantitative Study (0890)
Journal Article (2400) Publication Type: Peer Reviewed Journal (270); Print; Electronic Release Date: 20040120 Accession Number: 2003-11223-005
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Cut and Paste: <A href="http://search.epnet.com/direct.asp?an=2003-11223-005&db=psyh">Majo r Depression Following Traumatic Brain Injury.</A>
Database: PsycINFO _____
Record: 3
Title: Decrements in volume of anterior ventromedial temporal lobe and olfactory dysfunction in schizophrenia. Author(s): Turetsky, Bruce I. , turetsky@bbl.med.upenn.edu, U Pennsylvania, Dept of Psychiatry, Schizophrenia Research Ctr, Philadelphia, PA, US
Moberg, Paul J. , U Pennsylvania, Dept of Psychiatry, Schizophrenia Research Ctr, Philadelphia, PA, US
Roalf, David R. , U Pennsylvania, Dept of Psychiatry, Schizophrenia Research Ctr, Philadelphia, PA, US
Arnold, Steven E. , U Pennsylvania, Dept of Psychiatry, Schizophrenia Research Ctr, Philadelphia, PA, US
Gur, Raquel E. , U Pennsylvania, Dept of Psychiatry, Schizophrenia Research Ctr, Philadelphia, PA, US Address: Turetsky, Bruce I., Neuropsychiatry Program, Department of Psychiatry, University of Pennsylvania, 10th Floor, Gates Bldg., Philadelphia, PA, US, 19104, turetsky@bbl.med.upenn.edu Source: Archives of General Psychiatry , Vol 60(12), Dec 2003. pp. 1193-1200. Journal URL: http://archpsyc.ama-assn.org/ Publisher: US: American Medical Assn. Publisher URL: http://www.amapublications.com ISSN: 0003-990X (Print) Digital Object Identifier: http://dx.doi.org/10.1001/archpsyc.60.12.1193 Language: English Key Concepts: anterior ventromedial temporal lobe; olfactory dysfunction; schizophrenia; structural brain abnormalities Abstract: Determined whether patients with schizophrenia exhibit volumetric deficits in the anterior ventromedial temporal lobe, the target for neuronal inputs from the olfactory bulb, and whether these are related to olfactory performance deficits. Design was a cohort study of patients and healthy control subjects who underwent both 1-mm spoiled-gradient echo magnetic resonance imaging and behavioral tests of olfaction and memory. Fifty-two patients with a DSM-IV diagnosis of schizophrenia and 38 healthy control subjects participated. Individuals were excluded for history of head trauma, significant substance abuse, and medical conditions affecting brain function or olfactory capacity. Patients with schizophrenia have reduced cortical volumes in brain regions that receive afferents directly from the olfactory bulb. Behavioral olfactory deficits are related to structural brain abnormalities in these regions. (PsycINFO Database Record (c) 2004 APA, all rights reserved) Subjects: *Anosmia; *Schizophrenia; *Temporal Lobe; Olfactory Bulb
Classification: Schizophrenia & Psychotic States (3213) Population: Human (10) Location: US Age Group: Adulthood (18 yrs & older) (300) Form/Content Type: Empirical Study (0800)
Journal Article (2400) Publication Type: Peer Reviewed Journal (270); Print; Electronic Release Date: 20040112 Accession Number: 2003-10532-003
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Cut and Paste: <A href="http://search.epnet.com/direct.asp?an=2003-10532-003&db=psyh">Decr ements in volume of anterior ventromedial temporal lobe and olfactory dysfunction in schizophrenia.</A>
Database: PsycINFO _____
Record: 4
Title: Resting Regional Cerebral Perfusion in Recent Posttraumatic Stress Disorder. Author(s): Bonne, Omer , Department of Psychiatry, Hadassah University Hospital, Jerusalem, Israel
Gilboa, Asaf , Department of Psychiatry, Hadassah University Hospital, Jerusalem, Israel
Louzoun, Yoram , Department of Nuclear Medicine, Hadassah University Hospital, Jerusalem, Israel
Brandes, Dalia , Department of Psychiatry, Hadassah University Hospital, Jerusalem, Israel
Yona, Ilan , Department of Psychiatry, Hadassah University Hospital, Jerusalem, Israel
Lester, Hava , Department of Nuclear Medicine, Hadassah University Hospital, Jerusalem, Israel
Barkai, Gavriel , Department of Psychiatry, Hadassah University Hospital, Jerusalem, Israel
Freedman, Nanette , Department of Nuclear Medicine, Hadassah University Hospital, Jerusalem, Israel
Chisin, Roland , Department of Nuclear Medicine, Hadassah University Hospital, Jerusalem, Israel
Shalev, Arieh Y. , Department of Psychiatry, Hadassah University Hospital, Jerusalem, Israel Address: Bonne, Omer, Mood and Anxiety Disorders Program, National Institute of Mental Health, 15K North Drive, Room 200, Bethesda, MD, US, 20892-2670 Source: Biological Psychiatry , Vol 54(10), Nov 2003. pp. 1077-1086. Journal URL: http://www.elsevier.com/inca/publications/store/5/0/5/7/5/0/ Publisher: United Kingdom: Elsevier Science. Publisher URL: ISSN: 0006-3223 (Print) Digital Object Identifier: http://dx.doi.org/10.1016/S0006-3223(03)00525-0 Language: English Key Concepts: posttraumatic stress disorder; temporal lobe; cerebellum; cortisol; cerebral blood flow Abstract: Brain imaging research in posttraumatic stress disorder has been largely performed on patients with chronic disease, often heavily medicated, with current or past alcohol and substance abuse. Additionally, virtually only activation brain imaging paradigms have been done in posttraumatic stress disorder, whereas in other mental disorders both resting and activation studies have been performed. Twenty-eight (11 posttraumatic stress disorder) trauma survivors underwent resting state hexamethylpropyleneamineoxime single photon emission computed tomography and magnetic resonance imaging 6 months after trauma. Eleven nontraumatized subjects served as healthy controls. Regional cerebral blood flow in the cerebellum was higher in posttraumatic stress disorder than in both control groups. Regional cerebral blood flow in right precentral, superior temporal, and fusiform gyri in posttraumatic stress disorder was higher than in healthy controls. Cerebellar and extrastriate regional cerebral blood flow were positively correlated with continuous measures of depression and posttraumatic stress disorder. Cortisol level in posttraumatic stress disorder was negatively correlated with medial temporal lobe perfusion. Anterior cingulate perfusion and cortisol level were positively correlated in... (PsycINFO Database Record (c) 2003 APA, all rights reserved) Subjects: *Brain; *Cerebellum; *Cerebral Blood Flow; *Posttraumatic Stress Disorder; *Temporal Lobe; Hydrocortisone Classification: Neuroses & Anxiety Disorders (3215) Population: Human (10)
Male (30)
Female (40) Location: Israel Form/Content Type: Empirical Study (0800)
Quantitative Study (0890)
Journal Article (2400) Publication Type: Peer Reviewed Journal (270); Print; Electronic Release Date: 20031201 Accession Number: 2003-09950-014
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Cut and Paste: <A href="http://search.epnet.com/direct.asp?an=2003-09950-014&db=psyh">Rest ing Regional Cerebral Perfusion in Recent Posttraumatic Stress Disorder.</A>
Database: PsycINFO _____
Record: 5
Title: Researchers probe depression in children. Author(s): Voelker, Rebecca Source: JAMA: Journal of the American Medical Association , Vol 289(23), Jun 2003. pp. 3078-3079. Journal URL: http://jama.ama-assn.org/
Publisher: US: American Medical Assn. Publisher URL: http://www.amapublications.com ISSN: 0098-7484 (Print) Digital Object Identifier: http://dx.doi.org/10.1001/jama.289.23.3078 Language: English Key Concepts: research; depression; children; adolescents; etiology; treatment; prevention; antidepressant medications; early trauma; genetic vulnerability; brain development; symptoms; magnetic resonance imaging Abstract: Researchers have attempted to determine whether depression in children really is the same disorder as in adolescents and adults, or if there are important differences. What they are finding is a mixed picture. One element that some experts say distinguishes depression in very young children is abuse, neglect, and a variety of psychiatric illnesses in parents. Some researchers suggest that genetic vulnerability coupled with early trauma during a critical period of development can lead to changes in the brain that set the stage for depression. A list of depressive symptoms that may be more common in children and adolescents is presented. It is noted that the use of antidepressant medications in children and adolescents has emerged as one of the most prominent treatment issues in the last decade. Even though research has shown the efficacy of some antidepressant medications as well as cognitive-behavioral therapy in children, a wide range of unanswered questions in etiology, treatment, and prevention remain. The use of magnetic resonance imaging to examine brain structure abnormalities that may be associated with early onset depression is also discussed. (PsycINFO Database Record (c) 2003 APA, all rights reserved) Subjects: *Childhood Development; *Early Experience; *Etiology; *Major Depression; *Treatment; Antidepressant Drugs; Drug Therapy; Experimentation; Genetics; Magnetic Resonance Imaging; Neural Development; Symptoms Classification: Affective Disorders (3211)
Health & Mental Health Treatment & Prevention (3300) Population: Human (10) Age Group: Childhood (birth-12 yrs) (100)
Adolescence (13-17 yrs) (200) Form/Content Type: Journal Article (2400) Publication Type: Peer Reviewed Journal (270); Print; Electronic Release Date: 20030811 Accession Number: 2003-05625-002
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Cut and Paste: <A href="http://search.epnet.com/direct.asp?an=2003-05625-002&db=psyh">Rese archers probe depression in children.</A>
Database: PsycINFO _____
Record: 6
Title: Unsuspected Atypical Hemispheric Dominance for Language as Determined by fMRI: Comment. Author(s): Derakhshan, Iraj Source: Epilepsia , Vol 44(5), May 2003. pp. 734-734. Publisher: United Kingdom: Blackwell Publishing. Publisher URL: http://www.blackwellpublishing.com ISSN: 0013-9580 (Print) Language: English Key Concepts: atypical hemispheric dominance for language; functional magnetic resonance; presurgical diagnostic procedures; patient with left frontal focal epilepsy Abstract: Letter to editor by the current author commenting on an article "Unsuspected atypical hemispheric dominance for language as determined by fMRI" by Spreer J, Quiske A, Altenmuller DM, et al. (see record 2002-04637-020). The article by Spreer et al. on unsuspected atypical dominance for language in a right-handed patient is of interest for two main reasons, their reliance on Wada test to tell them something solid on laterality of movement control, and their emphasis on family history of sinistrality in their patient. Their patient is an example of those who are incongruent in behavioral and neural handedness. These "fake-handers" for a variety of reasons have decided to operate against their natural mandate.The so-called pathological handedness is not among these reasons because the latter entity does not exist. The patient of Spreers et al. was an incongruous righthander. These are the same group who are named crossed aphasic with a right-sided cortical lesion and left-sided paralysis, rare among the right-handers and common among the left-handers. This new understanding, with overwhelming support from the literature, obviates the respected authors' need to resort to highly dubious speculations about their patient who sustained a head trauma at age 10 years. (PsycINFO Database Record (c) 2004 APA, all rights reserved) Subjects: *Epilepsy; *Lateral Dominance; *Magnetic Resonance Imaging; Neurosurgery Classification: Neurological Disorders & Brain Damage (3297)
Medical Treatment of Physical Illness (3363) Population: Human (10) Form/Content Type: Journal Article (2400)
Journal Letter (5500) Publication Type: Peer Reviewed Journal (270); Print; Electronic Release Date: 20040308 Accession Number: 2003-00711-007
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Cut and Paste: <A href="http://search.epnet.com/direct.asp?an=2003-00711-007&db=psyh">Unsu spected Atypical Hemispheric Dominance for Language as Determined by fMRI: Comment.</A>
Database: PsycINFO _____
Record: 7
Title: Selectively reduced regional cortical volumes in post-traumatic stress disorder. Author(s): Rauch, Scott L. , rauch@psych.mgh.harvard.edu, Psychiatric Neuroimaging Research Group, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, US
Shin, Lisa M. , Psychiatric Neuroimaging Research Group, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, US
Segal, Ethan , Psychiatric Neuroimaging Research Group, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, US
Pitman, Roger K. , Psychiatric Neuroimaging Research Group, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, US
Carson, Margaret A. , VA Research Service and St. Anselm College, Manchester, NH, US
McMullin, Katherine , Psychiatric Neuroimaging Research Group, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, US
Whalen, Paul J. , Departments of Psychiatry and Psychology, University of Wisconsin, Madison, WI, US
Makris, Nikos , Center for Morphometric Analysis, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, US Address: Rauch, Scott L., Psychiatric Neuroimaging Research Group, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, 13th St., Bldg 149, CNY-9, Charlestown, MA, US, 02129, rauch@psych.mgh.harvard.edu Source: Neuroreport: For Rapid Communication of Neuroscience Research , Vol 14(7), May 2003. pp. 913-916. Journal URL: Publisher: US: Lippincott Williams & Wilkins. Publisher URL: ISSN: 0959-4965 (Print) Digital Object Identifier: http://dx.doi.org/10.1097/00001756-200305230-00002 Language: English Key Concepts: post-traumatic stress disorder; pregenual anterior cingulate cortex; ventromedial frontal cortex; subcallosal cortex; amygdala; hippocampus; volumetric differences Abstract: Different subterritories of anterior cingulate cortex (ACC) and adjacent ventromedial frontal cortex have been shown to serve distinct functions. This scheme has influenced contemporary pathophysiologic models of psychiatric disorders. Prevailing neuro-circuitry models of post-traumatic stress disorder (PTSD) implicate dysfunction within pregenual ACC and subcallosal cortex(SC), as well as amygdala and hippocampus. In the current study, cortical parcellation of magnetic resonance imaging data was performed to test for volumetric differences in pregenual ACC and SC, between women with PTSD and trauma-exposed women without PTSD. The PTSD group exhibited selectively decreased pregenual ACC and SC volumes. These results are consistent with contemporary schemes regarding functional and structural dissection of frontal cortex, and suggest specific regional cortical pathology in PTSD. (PsycINFO Database Record (c) 2003 APA, all rights reserved) Subjects: *Amygdala; *Cerebral Cortex; *Hippocampus; *Human Females; *Posttraumatic Stress Disorder Classification: Neuroses & Anxiety Disorders (3215)
Neuropsychology & Neurology (2520) Population: Human (10)
Female (40) Age Group: Adulthood (18 yrs & older) (300)
Middle Age (40-64 yrs) (360) Form/Content Type: Empirical Study (0800)
Qualitative Study (0880)
Journal Article (2400) Publication Type: Journal (250); Print; Electronic Release Date: 20031215 Accession Number: 2003-99421-002
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Cut and Paste: <A href="http://search.epnet.com/direct.asp?an=2003-99421-002&db=psyh">Sele ctively reduced regional cortical volumes in post-traumatic stress disorder.</A>
Database: PsycINFO _____
Record: 8
Title: Individual differences in a husband and wife who developed PTSD after a motor vehicle accident: A functional MRI case study. Author(s): Lanius, Ruth A. , ruth.lanius@lhsc.on.ca
Hopper, James W.
Menon, Ravi S. Address: Lanius, Ruth A., Dept of Psychiatry, London Health Sciences Ctr, 339 Windermere Rd, PO Box 5339, London, ON, Canada, N6A 5A5, ruth.lanius@lhsc.on.ca Source: American Journal of Psychiatry , Vol 160(4), Apr 2003. pp. 667-669. Journal URL: http://ajp.psychiatryonline.org/ Publisher: US: American Psychiatric Assn. Publisher URL: ISSN: 0002-953X (Print) Digital Object Identifier: http://dx.doi.org/10.1176/appi.ajp.160.4.667 Language: English Key Concepts: neuropathology; PTSD; posttraumatic stress disorder; sex differences; motor vehicle accident Abstract: This report describes a husband and wife with acute posttraumatic stress disorder (PTSD) who exhibited different subjective, psychophysiological, and neurobiological responses to traumatic script-drive imagery that caused them to reexperience their traumas. The couple, who had been trapped in their car during a serious motor vehicle accident, was assessed for responses with heart-rate monitor and functional magnetic resonance imaging. It is concluded that PTSD patients can have very different responses, both subjectively and biologically, while reexperiencing traumatic events. (PsycINFO Database Record (c) 2003 APA, all rights reserved) Subjects: *Individual Differences; *Motor Traffic Accidents; *Neuropathology; *Posttraumatic Stress Disorder; Motor Vehicles Classification: Neuroses & Anxiety Disorders (3215) Population: Human (10)
Male (30)
Female (40) Age Group: Adulthood (18 yrs & older) (300)
Middle Age (40-64 yrs) (360) Form/Content Type: Empirical Study (0800) Special Feature: References (300)
Peer Reviewed (600) Publication Type: Journal Article (250); Print(Paper) Release Date: 20030505 Accession Number: 2003-03280-011
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Cut and Paste: <A href="http://search.epnet.com/direct.asp?an=2003-03280-011&db=psyh">Indi vidual differences in a husband and wife who developed PTSD after a motor vehicle accident: A functional MRI case study.</A>
Database: PsycINFO _____
Record: 9
Title: Posttraumatic epilepsy: Neuroradiologic and neuropsychological assessment of long-term outcome. Author(s): Mazzini, Letizia , mazzini.1@libero.it, "San Giovanni Bosco" Hosp, Dept of Neurology, Torino, Italy
Cossa, Federico Maria , Scientific Inst of Veruno (No), Inst of Care & Research (IRCCS), "Fonda |
