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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
Nuclear Magnetic Resonance Imaging and PTSD
Title: Pseudo-Random Unitary Operators for Quantum Information Processing. Author(s): Emerson, Joseph, jemerson@perimeterinstitute.ca, Dept of Nuclear Engineering, Massachusetts Inst of Technology, Cambridge, MA, US; Weinstein, Yaakov S., Dept of Nuclear Engineering, Massachusetts Inst of Technology, Cambridge, MA, US; Saraceno, Marcos , Unidad de Actividad Fisica, Tandar, Comision Nacional de Energia Atomica, Buenes Aires, Argentina; Lloyd, Seth, Dept of Mechanical Engineering, Massachusetts Inst of Technology, Cambridge, MA, US; Cory, David G. , Dept of Nuclear Engineering, Massachusetts Inst of Technology, Cambridge, MA, US Address: Emerson, Joseph, Perimeter Inst for Theoretical Physics, 35 King Street N., Waterloo, ON, Canada, N2J 2W9, jemerson@perimeterinstitute.ca Source: Science, Vol 302(5653), Dec 2003. pp. 2098-2100. Publisher: US: American Assn for the Advancement of Science. Abstract: In close analogy to the fundamental role of random numbers in classical information theory, random operators are a basic component of quantum information theory. Unfortunately, the implementation of random unitary operators on a quantum processor is exponentially hard. Here we introduce a method for generating pseudo-random unitary operators that can reproduce those statistical properties of random unitary operators most relevant to quantum information tasks. This method requires exponentially fewer resources, and hence enables the practical application of random unitary operators in quantum communication and information processing protocols. Using a nuclear magnetic resonance quantum processor, we were able to realize pseudo-random unitary operators that reproduce the expected random distribution of matrix elements. _____
Title: Effects of chronic lithium and sodium valproate on concentrations of brain amino acids. Author(s): O'Donnell, T., U Alberta Hosp, Dept of Psychiatry, Edmonton, AB, Canada; Rotzinger, S., U Alberta Hosp, Dept of Psychiatry, Edmonton, AB, Canada; Ulrich, M., U Alberta Hosp, Dept of Psychiatry, Edmonton, AB, Canada Hanstock, C.C., U Alberta, Dept of Biomedical Engineering, Edmonton, AB, Canada; Nakashima, T.T., U Alberta, Dept of Chemistry, Edmonton, AB, Canada Silverstone, P.H. , peter.silverstone@ualberta.ca, U Alberta Hosp, Dept of Psychiatry, Edmonton, AB, Canada Address: Silverstone, P.H., Department of Psychiatry, University of Alberta Hospital, Edmonton, AB, Canada, T6G 2B7, peter.silverstone@ualberta.ca Source: European Neuropsychopharmacology, Vol 13(4), Aug 2003. pp. 220-227. Publisher: United Kingdom: Elsevier Science. Abstract: The present study was designed to determine if the mood stabilizers, lithium and valproate, have common effects on concentrations of amino acid neurotransmitters which may be related to their mechanisms of action. Two separate groups of rats were administered therapeutic doses of lithium, sodium valproate, or saline for 2 weeks. Whole brain extracts were then examined using either high-field -sup-1H nuclear magnetic resonance spectroscopy or high-performance liquid chromatography. Both drugs decreased whole brain concentrations of aspartate, glutamate, and taurine while brain concentrations of gamma-aminobutyric acid (GABA) and alanine decreased following chronic sodium valproate administration but not following chronic lithium administration. These findings indicate that lithium and sodium valproate share common effects on the concentrations of certain amino acid neurotransmitters in whole brain which may be related to their mechanisms of action in bipolar disorder. _____
Title: Neuronal pathology in the hippocampal area of patients with bipolar disorder: A study with proton magnetic resonance spectroscopic imaging. Author(s): Bertolino, Alessandro, National Insts of Health, National Inst of Mental Health, Intramural Research Program, Clinical Brain Disorders Branch, Bethesda, MD, US; Frye, Mark, National Insts of Health, National Inst of Mental Health, Biological Psychiatry Branch, Bethesda, MD, US; Callicott, Joseph H., National Insts of Health, National Inst of Mental Health, Intramural Research Program, Clinical Brain Disorders Branch, Bethesda, MD, US; Mattay, Venkata S., National Insts of Health, National Inst of Mental Health, Intramural Research Program, Clinical Brain Disorders Branch, Bethesda, MD, US; Rakow, Rebecca, National Insts of Health, National Inst of Mental Health, Intramural Research Program, Clinical Brain Disorders Branch, Bethesda, MD, US; Shelton-Repella, Jennifer, National Insts of Health, National Inst of Mental Health, Biological Psychiatry Branch, Bethesda, MD, US; Post, Robert, National Insts of Health, National Inst of Mental Health, Biological Psychiatry Branch, Bethesda, MD, US; Weinberger, Daniel R., National Insts of Health, National Inst of Mental Health, Intramural Research Program, Clinical Brain Disorders Branch, Bethesda, MD, US; Address: Weinberger, Daniel R., Clinical Brain Disorder Branch, Intramural Research Programs, National Inst of Mental Health, 10 Center Dr, Room 4S235 MSC 1379, Bethesda, MD, US, 20892 Source: Biological Psychiatry, Vol 53(10), May 2003. pp. 906-913. Publisher: United Kingdom: Elsevier Science. Abstract: The brain regions involved in the pathophysiology of bipolar disorder have not been definitively determined. Proton magnetic resonance spectroscopic imaging (-sup-1H-MRSI) allows measurement of N-acetylaspartate (NAA, marker of neuronal integrity), choline-containing compounds (CHO), and creatine+phosphocreatine (CRE) in multiple brain regions. The objective of this study was to assess possible NAA reductions in hippocampus and prefrontal regions in patients with bipolar disorder. We studied 17 patients with bipolar disorder and 17 age- and gender-matched healthy Ss on a 1.5-T nuclear magnetic resonance (NMR) machine. With -sup-1H-MRSI we measured ratios of areas under the metabolite peaks of the proton spectra (i.e., NAA/CRE, NAA/CHO, CHO/CRE) for multiple cortical and subcortical regions. Patients showed significant reductions of NAA/CRE bilaterally in the hippocampus. There were no significant changes in CHO/CCRE or in NAA ratios in any other area sampled. This study shows that patients with bipolar disorder have a regional reduction of NAA relative signals, suggesting neuronal damage or malfunction of the hippocampus. As suggested by other studies, neuronal pathology in the hippocampus may be involved in the pathophysiology of bipolar disorder and in susceptibility to psychosis. _____
Title: Chronic lithium and sodium valproate both decrease the concentration of myoinositol and increase the concentration of inositol monophosphates in rat brain. Author(s): O'Donnell, T., Department of Psychiatry, University of Alberta Hospital, Edmonton, AB, Canada; Rotzinger, S., Department of Psychiatry, University of Alberta Hospital, Edmonton, AB, Canada; Nakashima, T. T., Department of Chemistry, University of Alberta, Edmonton, AB, Canada; Hanstock, C. C. , Department of Biomedical Engineering, University of Alberta, Edmonton, AB, Canada; Ulrich, M., Department of Psychiatry, University of Alberta Hospital, Edmonton, AB, Canada; Silverstone, P.H., peter.silverstone@ualberta.ca, Department of Psychiatry, University of Alberta Hospital, Edmonton, AB, Canada Address: Silverstone, P.H., Department of Psychiatry, University of Alberta Hospital, Edmonton, AB, Canada, T6G 2B7, peter.silverstone@ualberta.ca Source: European Neuropsychopharmacology, Vol 13(3), May 2003. pp. 199-207. Publisher: United Kingdom: Elsevier Science. Abstract: One of the mechanisms underlying lithium's efficacy as a mood stabilizer in bipolar disorder has been proposed to be via its effects on the phosphoinositol cycle (PI cycle), where it is an inhibitor of the enzyme converting inositol monophosphates to myoinositol. In contrast, sodium valproate, another commonly used mood stabilizer, appears to have no direct effects on this enzyme and was thus believed to have a different mechanism of action. In the present study, high-resolution nuclear magnetic resonance (NMR) spectroscopy was used to study the chronic effects of both lithium and sodium valproate on the concentrations of myoinositol and inositol monophosphates in rat brain. As predicted, lithium-treated rats exhibited a significant increase in the concentration of inositol monophosphates and a significant decrease in myoinositol concentration compared to saline-treated controls. However, unexpectedly, sodium valproate administration produced exactly the same results as lithium administration. These novel findings suggest that both lithium and sodium valproate may share a common mechanism of action in the treatment of bipolar disorder via actions on the PI cycle. _____
Title: An NMR study of alterations in [l--sup-1-sup-3C]glucose metabolism in C6 glioma cells by gliotoxic amino acids. Author(s): Brennan, Lorraine, Department of Biochemistry, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland; Hewage, Chandralal, Department of Biochemistry, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland; Malthouse, J. Paul G., Department of Biochemistry, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland; McBean, Gethin J., gethin.mcbean@ucd.ie, Department of Biochemistry, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland Address: McBean, Gethin J., gethin.mcbean@ucd.ie Source: Neurochemistry International, Vol 42(6), May 2003. pp. 441-448. Publisher: United Kingdom: Elsevier Science. Abstract: Gliotoxins, are toxic to astrocytes in culture, and are inhibitors or substrates of high affinity sodium-dependent glutamate transporters. The mechanisms by which these gliotoxins cause toxicity are not fully understood. The effects of a series of gliotoxic amino acids (L-alpha--aminoadipate, L-serine- O -sulphate, D-aspartate and L-cysteate) on metabolism of [1--sup-1-sup-3C]glucose were examined in C6 glioma cells using -sup-1-sup-3C nuclear magnetic resonance (NMR) spectroscopy. The cells were preincubated in the presence of sub toxic concentrations of each gliotoxin (400 mu-mol/l) for 20 h. This was followed by incubation (4 h) with [1--sup-1-sup-3C]glucose (5.5 mmol/l) in the presence and absence of each gliotoxin. The incorporation of -sup-1-sup-3C label into the observed metabolites was analysed. Following preincubation with L-alpha--aminoadipate and L-serine- O-sulphate there was a significant decrease in the incorporation of -sup-1-sup-3C label into glutamate, alanine and lactate from [1--sup-1-sup-3C]glucose. In the presence of L-cysteate production of labeled glutamate was decreased, while there was no significant effect on the concentrations of labelled lactate and alanine. There was no change in the quality of LDH released into the medium after incubation of the cells with any of the gliotoxins. _____
Title: Integrated approaches to the action of general anesthetics and alcohol. Author(s): Homanics, Gregg E., U Pittsburgh, Dept of Anesthesiology, Pittsburgh, PA, US; Xu, Yan, U Pittsburgh, Dept of Anesthesiology, Pittsburgh, PA, US Tang, Pei, U Pittsburgh, Dept of Anesthesiology, Pittsburgh, PA, US Address: Homanics, Gregg E., homanicsge@anes.upmc.edu Source: Physiology & Behavior , Vol 77(4-5), Dec 2002. Special Issue: The Pittsburgh special issue. pp. 495-499. Publisher: US: Elsevier Science. Abstract: The use of inhalational anesthetics was first publicly demonstrated in 1846. Alcohol has been consumed for centuries and is now our most costly drug abuse problem. Despite widespread use, the molecular mechanism of action of these drugs has remained an enigma. The prevailing theory suggests that alcohol and anesthetics interact directly with neuronal membrane proteins to cause their effects. Our laboratories are using a variety of cutting edge approaches to gain insight into the mechanism of action of these drugs. Biophysical approaches such as high-resolution nuclear magnetic resonance (NMR) spectroscopy and genetic engineering approaches such as creation of designer mice are currently being used by our laboratories. These approaches are providing exciting insight into how these drugs exert their effects. This research could ultimately result in safer and better anesthetics, may lead to treatments for alcoholism, and may provide insight into basic biologic processes such as consciousness. _____
Title: The neural networks of music. Author(s): Baeck, E., Department of Neurology, ACZA campus Stuivenberg, Antwerp, Belgium Address: Baeck, E., Afdeling Neurologie, ACZA campus Stuivenberg, Lange Beeldekensstraat 267, 2060, Antwerpen, Belgium Source: European Journal of Neurology, Vol 9(5), Sep 2002. pp. 449-456. Publisher: United Kingdom: Blackwell Publishing. Abstract: Recent neuropsychological, transcranial Doppler sonographic, positron emission tomographic and functional nuclear magnetic resonance studies have indicated that musical perception is not dependent on the right hemisphere but on neural networks corresponding to the fundamental components of music in both hemispheres. In the brain there is no centre for music. Musicians have cerebral characteristics, anatomical as well as functional, which are correlated with the age at which they began their musical studies. This argues for cortical reorganization as a result of musical training. Whether these characteristics are to be ascribed to cortical plasticity alone, or to an innate structural property, or to both, remains an open question, however. Investigation of chromosomal defects, biochemical abnormalities and morphological features of congenital and degenerative brain diseases can provide further insight into the cerebral substrate of musicality. _____
Title: Magnetic resonance relaxometry in Parkinson's disease. Author(s): Mondino, F. , S. Croce Hosp, Dept of Neurology, Cuneo, Italy; Filippi, P., S. Luigi Hosp, Dept of Neurology, Turin, Italy; Magliola, U., S. Luigi Hosp, Dept of Neurology, Turin, Italy; Duca, S., Koelliker Hosp, Neuroradiology, Turin, Italy Address: Mondino, F., S. Croce Hosp, Dept of Neurology, Cuneo, Italy Source: Neurological Sciences, Vol 23(Suppl2), Sep 2002. Special Issue: Experimental models and clinical correlations in extrapyramidal diseases and dementia: Selected short paper. pp. S87-S88. Publisher: Germany: Springer Verlag. Abstract: Examined T2 relaxation time of the extrapyramidal nuclei in 25 39-76 yr old patients with Parkinson's disease. Nuclear magnetic resonance relaxation was used as an objective and noninvasive method of measuring regional iron concentrations. Results show there was no significant difference in T2 relaxation time both in the basal ganglia and substantia nigra of PD patients compared with controls. It is concluded that T2 shortening of the frontal cortex and signal intensity of extrapyramidal nuclei should not be used to support clinical PD diagnoses. _____
Title: Phospholipid abnormalities in postmortem schizophrenic brains detected by -sup-3-sup-1P nuclear magnetic resonance spectroscopy: A preliminary study. Author(s): Komoroski, Richard A., VA Boston Healthcare System, Boston, MA, US; Pearce, John M.; Griffin, W. Sue T.; Mrak, Robert E.; Omori, Masao; Karson, Craig N. Source: Psychiatry Research: Neuroimaging, Vol 106(3), May 2001. pp. 171-180. Publisher: Ireland: Elsevier Scientific Publishers Ireland. Abstract: Used -sup-3-sup-1P nuclear magnetic resonance (NMR) to characterize the phospholipids (PLs) in the left frontal cortex (gray matter) of postmortem brains from 4 Ss with schizophrenia (aged 42-82 yrs) and 5 controls (aged 49-74 yrs). High resolution -sup-3-sup-1P NMR spectra were obtained in an organic-solvent system to resolve PL classes (headgroups) and in a sodium-cholate, aqueous dispersion system to resolve phosphatidylcholine (PC) molecular species. A multivariate analysis of variance (MANOVA) which included the major PC molecular species and phosphatidylinositol (PI) showed a significant difference between schizophrenic (SZ) Ss and controls. Analysis showed that the PI was significantly higher in SZ Ss than controls. There were no differences between the 2 groups for other individual PL classes or for individual PL subclasses determined by the linkage type at the sn-1 position on glycerol. There was a trend for total PL content to be higher in SZ Ss than in controls. There was no evidence for elevated lysophosphatidylcholine or lysophosphatidylethanolamine in schizophrenia. The intensity of the PC peak representing molecular species with one saturated and one unsaturated (1 or 2 double bonds) acyl chain was higher for SZ Ss than for controls. Results suggest that PL abnormalities occur in the brain in schizophrenia. _____
Title: -sup-3-sup-1P Nuclear magnetic resonance spectroscopy findings in bipolar illness: A meta-analysis. Author(s): Yildiz, Aysegul, Dokuz Eylul Medical School, Dept of Psychiatry, Izmir, Turkey; Sachs, Gary S.; Dorer, David J.; Renshaw, Perry F. Source: Psychiatry Research: Neuroimaging, Vol 106(3), May 2001. pp. 181-191. Publisher: Ireland: Elsevier Scientific Publishers Ireland. Abstract: Reviewed studies comparing phosphomonoester (PME) and/or phosphodiester (PDE) values of bipolar Ss to values observed in healthy control. Data from the studies meeting inclusion criteria (8 reports involving 139 bipolar Ss and 189 comparison Ss) were grouped according to the mood state of the Ss. Meta-analyses of data were performed to compare PME and PDE levels of euthymic bipolar patients to healthy controls, as well as comparing PME levels during euthymia in bipolar Ss to values observed during manic and depressed states. The PME values of euthymic bipolar patients were significantly lower than the PME values of healthy controls. Depressed bipolar patients had significantly higher PME values compared with euthymic bipolar Ss. No significant difference could be detected between the PDE values of bipolars and controls. This meta-analysis found support for trait- and possibly state-dependent abnormalities of membrane phospholipid metabolism, which may reflect a dysregulation in brain-signal transduction systems of relevance in bipolar illness. _____
Title: Functional magnetic resonance imaging. Author(s): Bullmore, E. T., U Cambridge, Dept of Psychiatry, Cambridge, England; Suckling, J. Source: International Review of Psychiatry, Vol 13(1), Feb 2001. pp. 24-33. Publisher: United Kingdom: Carfax Publishing. Abstract: (This reprinted article originally appeared in the New Oxford Textbook of Psychiatry, 2000). Functional magnetic resonance imaging (fMRI) is a technique for imaging changes in brain haemodynamics linked to local neuronal activity. It is likely that fMRI will become an increasingly important and widely used technique for psychiatric research in the next 5 yrs; applications to clinical practice are also conceivable. In this article, the authors review the technical foundations of fMRI. They begin with a brief summary of the basic physical principles of magnetization and nuclear magnetic resonance. This is followed by a description of some commonly used procedures for magnetic resonance imaging in general; an introduction to exogenous and endogenous contrast agents; and a section on gradient echo echoplanar imaging for fMRI specifically. Common artefacts and essential hardware requirements are described. Then issues of experimental design and data analysis are discussed in conclusion. References to some supplementary textbooks and specialist journals are provided as guides to further reading. _____
Title: Functional imaging studies: Linking mind and basic neuroscience. Author(s): Shulman, Robert G., Yale U, School of Medicine, Dept of Molecular Biophysics & Biochemistry, New Haven, CT, US Source: American Journal of Psychiatry, Vol 158(1), Jan 2001. pp. 11-20. Publisher: US: American Psychiatric Assn. Abstract: Discusses the imaging of brain activity with positron emission tomography (PET) and functional magnetic resonance imaging (MRI), which has assumed a central position in psychiatry. Functional imaging signals arise from changes in the neurophysiological parameters of glucose and oxygen consumption mediated by blood flow. Recent in vivo -sup-1-sup-3C nuclear magnetic resonance (NMR) neurochemical studies have established a quantitative coupling between the rates of glucose oxidation and glutamate neurotransmitter flux in rats and humans, thereby linking measured neurophysiological parameters to brain function. These results show that in the awake, resting, and unstimulated states, 70%-80% of brain energy consumption is devoted to the same glutamate/glutamine neurotransmitter signaling as are the small percentages stimulated by tasks. Furthermore, in anesthetized animals, in which unstimulated activity is reduced, the total signal rather than a particular increment is required for a response. On this basis, the total signal, as well as the difference in the signal, measures cortical neurotransmitter flux. The total signal in a region therefore contains valuable information about required brain activity. _____
Title: Brain pharmacokinetics and tissue distribution in vivo of fluvoxamine and fluoxetine by fluorine magnetic resonance spectroscopy. Author(s): Bolo, Nicolas R., FORENAP Ctr for Research in Neuroscience, Magnetic Resonance Unit, Rouffach, France; Hode, Yann; Nedelec, Jean-Franccois; Laine, Eric; Wagner, Gabrielle; Macher, Jean-Paul Source: Neuropsychopharmacology, Vol 23(4), Oct 2000. pp. 428-438. Publisher: US: Elsevier Science. Abstract: This investigation of fluvoxamine and fluoxetine-norfluoxetine distributions in vivo at steady-state and of quantitative kinetics in brain and plasma after drug therapy interruption was performed by fluorine nuclear magnetic resonance spectroscopy (-sup-1-sup-9F MRS), spectroscopic imaging (MRSI), andplasma HPLC on 12 Ss (aged 36-67 yrs) treated for depression. MRSI suggests a homogeneous distribution of -sup-1-sup-9F MRS visible fluvoxamine mainly in brain. Fluvoxamine steady-state brain concentrations and brain-to-plasma concentration ratios were similar to those of combined fluoxetine-norfluoxetine (CF-norfluoxetine). Fluvoxamine brain elimination half-life was significantly shorter than that of CF-norfluoxetine. Fluvoxamine brain-to-plasma was 2.2 +- 0.3, contrarily to CF-norfluoxetine (1.0 +- 0.3). This study shows that quantitative pharmacokinetics in target organs by -sup-1-sup-9F MRS in vivo should prove useful for understanding and investigating outcomes of treatment modifications and side effects. _____
Title: Neuroimaging: Applications in disorders of early brain development. Author(s): Hoon, Alexander H., Kennedy Krieger Inst, Baltimore, MD, US; Melhem, Elisa R. Source: Journal of Developmental & Behavioral Pediatrics, Vol 21(4), Aug 2000. pp. 291-302. Publisher: US: Lippincott Williams & Wilkins. Abstract: Neuroimaging techniques have established new connections between etiological factors and disorders of early brain development. Neuroimaging has also strengthened the link between patterns of selective vulnerability in the developing brain and clinical syndromes, especially cerebral palsy. Both computed tomography (CT) and magnetic resonance imaging (MRI) identify early developmental malformations, including neural tube defects, callosal dysgenesis, neuronal migration disorders, posterior fossa malformations, and hydrocephalus. Periventricular white matter damage, most commonly seen in premature infants, is best visualized by cranial ultrasonography in the neonatal period and on MRI later in childhood. In term infants and children with genetic metabolic diseases, various applications of nuclear magnetic resonance, including MRI, have important diagnostic roles. The utility of diffusion-weighted imaging, MR spectroscopy, and functional MRI to further understanding of brain injury, biochemistry, and function is under active investigation. In summary, selecting the appropriate neuroimaging technique can improve diagnosis and management of childhood neurodevelopmental disorders. _____
Title: Neuroprotective effects of creatine in a transgenic mouse model of Huntington's disease. Author(s): Ferrante, Robert J., Bedford Veteran's Administration Medical Ctr, Geriatric Research Education & Clinical Ctr, Bedford, MA, US; Andreassen, Ole A.; Jenkins, Bruce G.; Dedeoglu, Alpaslan; Kuemmerle, Stefan; Kubilus, James K.; Kaddurah-Daouk, Rima; Hersch, Steven M.; Beal, M. Flint Source: Journal of Neuroscience, Vol 20(12), Jun 2000. pp. 4389-4397. Publisher: US: Society for Neuroscience. Abstract: Huntington's disease (HD) is a progressive neurodegenerative illness for which there is no effective therapy. The authors examined whether creatine, which may exert neuroprotective effects by increasing phosphocreatine levels or by stabilizing the mitochondrial permeability transition, has beneficial effects in a transgenic mouse model of HD (line 6/2). Dietary creatine supplementation striatal neurons and the formation of huntingtin-positive aggregates in R6/2 mice. Body weight and motor performance on the rotarod test were significantly improved in creatine-supplemented R6/2 mice, whereas the onset of diabetes was markedly delayed. Nuclear magnetic resonance spectroscopy showed that creatine supplementation significantly increased brain creatine concentrations and delayed decreases in N-acetylaspartate concentrations. These results support a role of metabolic dysfunction in a transgenic mouse model of HD and suggest a novel therapeutic strategy to slow the pathological process. _____
Title: Astrocytes and the HIV-associated dementia complex. Author(s): Patton, Holly Krull, U Alabama At Birmingham, US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering, Vol 60(9-B), Apr 2000. pp. 4448. Publisher: US: Univ Microfilms International. Abstract: One-half to two-thirds of individual develop the HIV-Associated Dementia Complex (ADC). Manifestations of ADC can occur anytime post-infection and are primarily associated with systemic AIDS; most individuals with ADC show signs of immunosuppression. Clinical features are somewhat variable, but characteristics include cognitive, motor, and behavioral abnormalities. Patients experience a slowing and loss of cognition and motor control. Previously, the rat astrocyte has been implicated for its participation in the pathogenesis of ADC. Rat astrocytes respond to gp120, a viral glycoprotein, by activating Na+/H+ exchange, increasing glutamate efflux, and increasing K+ conductance. In this study, we show that the human astrocyte displays decreased glutamate influx and increased glutamate efflux in response to gp120. Gp120 also increased outward ion conductances in the cell-attached patch clamp mode. Further at the whole-cell patch clamp level, we show that this gp120-induced K+ channel activity is dependent on extracellular Na+, can be blocked, at least partially by dimethylamiloride, and is insensitive to apamin. Upon further investigation, we found a novel Na+/H+ exchange protein. To test our working hypothesis in vivo, we utilized nuclear magnetic resonance (NMR) techniques to measure brain pH in asymptomatic, HIV-infected individuals. Most of the previous magnetic resonance spectroscopy and imaging (MRSI) work done toward understanding ADC in the brain has been done on 1.5 and 2 Tesla (T) systems. We have done our experiments on a 4.1 T whole-body system to increase spatial resolution, to get better-defined peaks, and, thus, to get higher quality data. The cerebellum may be candidate in participation of ADC in that, during normal functioning, the cerebellum is responsible for eye movements as well as stance and gait. Further, the cerebellum also has few microglia and macrophages. Patients with cerebellar lesion present with abnormal movements of eyes and extremities, hypotonia, and ataxia. In this study, we show that there is an increase in the pH i of HIV-infected but asymptomatic individuals. This change in pH i is most obvious when we compare the number of voxels above two standard deviations of the control mean. In volunteer subjects, 3% of voxels are two standard deviations above the mean; however, in HIV-infected individuals, this percentage increases to 26%. _____
Title:In vivo imaging of the pharmacodynamics and pharmacokinetics of lithium. Author(s): Kilts, Clinton D. , Emory U, School of Medicine, Dept of Psychiatry & Behavioral Sciences, Atlanta, GA, US Source: Journal of Clinical Psychiatry. Vol 61(Suppl9), 2000. pp. 41-46. Publisher: US: Physicians Postgraduate Press. Abstract: The therapeutic efficacy of lithium for the long-term management of bipolar disorder is well recognized, along with the risk of lithium-induced toxicity. The author describes the current findings of in vivo functional neuroimaging techniques with respect to the pharmacokinetics and pharmacodynamics of lithium and their future potential to elucidate the drug distribution and neural mechanisms that produce its therapeutic effects. Brain -sup-7Li nuclear magnetic resonance spectroscopy findings have disassociated postdose brain and blood lithium concentrations and suggest a pharmacokinetic basis for lithium response and nonresponse. The application of in vivo synaptic activity and neurochemical imaging is providing new knowledge related to the distributed neural activity associated with lithium response and is contributing to the critical human testing of neuroprotective and signal transduction models of lithium's therapeutic effects. _____
Title: Neurochemical brain imaging investigations of schizophrenia. Author(s): Soares, Jair C., U Pittsburgh Medical Ctr, Western Psychiatric Inst & Clinic, Pittsburgh, PA, US; Innis, Robert B. Source: Biological Psychiatry, Vol 46(5), Sep 1999. pp. 600-615. Publisher: US: Elsevier Science. Abstract: Neurochemical brain imaging methods developed over the past 20 years offer significant promise for elucidating the biochemical underpinnings of schizophrenia. The two general methodologies used for these studies have been (1) radiotracer imaging like positron emission tomography and single photon emission computerized tomography (SPECT) and (2) nuclear magnetic resonance imaging (MRI) , functional MRI, and magnetic resonance spectroscopy (MRS). Despite conflicting findings, striatal D-sub-2 receptor density may be elevated in some, but not all, patients. Elevated synthesis, and increased release of dopamine after amphetamine challenge, have also been reported. Imaging of cortical 5-hydroxytryptamine (5-HT) type 2A receptors suggests that this system is unaffected, in conflict with findings of postmortem studies. Although prior postmortem studies suggested an increase in cortical gamma-aminobutyric acid (GABA) type A receptors, three SPECT studies have found no significant changes. MRS studies have shown decreased levels of N-acetyl-aspartate moieties in hippocampus and frontal cortex of schizophrenic patients, which is consistent with the reported loss of neurons and neuropil in postmortem brains. In conclusion, developments in radiotracer and nuclear MRI have provided promising leads to the biochemical abnormalities associated with schizophrenia. _____
Title: I gangi della base in pazienti con Disturbo Ossessivo-Compulsivo: uno studio quantitativo don Risonanza Magnetica Nucleare. Translated Title: Basal ganglia in patients with obsessive-compulsive disorder: A quantitative Magnetic Resonance Imaging study. Author(s): Iannitelli, Angela, U Roma La Sapienza, III Clinica Psichiatrica, Rome, Italy; Landucci, Simona; Pacitti, Francesca; Di Biasi, Claudio; Trasimeni, Guido; Gualdi, Gian Franco; Bersani, Giuseppe Source: Rivista di Psichiatria , Vol 34(1), Jan-Feb 1999. pp. 22-31. Publisher: Italy: Pensiero Scientifico Editore srl. Abstract: Studied the nuclear magnetic resonance (NMR) images of basal ganglia in patients with obsessive-compulsive disorder (OCD) and healthy controls. Human Ss: Nine male Italian adults (aged 20-51 yrs) (OCD) (right-handed). Nine normal male Italian adults (matched controls). Data on sociodemographic variables and clinical and psychological symptoms were obtained by semistructured interview. NMR images of the basal ganglia were evaluated according to linear and proportional measurements. The results were evaluated according to diagnosis of OCD, age, age at diagnosis of OCD, duration of OCD, educational level, prior and current pharmacological treatment, obsessive and compulsive symptoms, size of right and left caudate and putamen nuclei, the bicaudate ratio, the bifrontal ratio, the biputamen ratio, and the atrophy index for frontal, caudate, and putamen nuclei. Tests used: The Hamilton Rating Scale for Anxiety, the Hamilton Rating Scale for Depression, The Scale for the Assessment of Positive Symptoms, the Scale for the Assessment of Negative Symptoms, and the Yale-Brown Obsessive Compulsive Scale (W. K. Goodman et al, 1989). An ANOVA and other statistical tests were used. (English abstract) _____
Title: Common pattern of cortical pathology in childhood-onset and adult-onset schizophrenia as identified by proton magnetic resonance spectroscopic imaging. Author(s): Bertolino, Alessandro; Kumra, Sanjiv; Callicott, Joseph H.; Mattay, Venkata S.; Lestz, Rachel M.; Jacobsen, Leslie; Barnett, Ian S.; Duyn, Jeff H.; Frank, Joseph A.; Rapoport, Judith L.; Weinberger, Daniel R. Source: American Journal of Psychiatry, Vol 155(10), Oct 1998. pp. 1376-1383. Publisher: US: American Psychiatric Assn. Abstract: As part of a program to address the pathophysiological continuity between childhood-onset and adult-onset schizophrenia, the authors performed multislice proton magnetic resonance spectroscopic imaging on patients with childhood-onset schizophrenia to specifically test whether the hippocampal area and dorsolateral prefrontal cortex show the same abnormalities as seen in adult-onset schizophrenia. A 1.5-T nuclear magnetic resonance machine was used to test 14 patients (mean age 16.4 yrs) with childhood-onset schizophrenia and 14 sex- and age-matched comparison Ss. Ratios of areas under the metabolite peaks of the proton spectra were determined (i.e., NAA/CRE, NAA/CHO, CHO/CRE) for multiple cortical and subcortical regions. Patients showed significantly lower NAA/CRE ratios bilaterally in the hippocampal area and the dorsolateral prefrontal cortex than the comparison Ss. _____
Title: In vivo neurochemistry of the brain in schizophrenia as revealed by magnetic resonance spectroscopy. Author(s): Kegeles, Lawrence S., New York State Psychiatric Inst, Dept of Neuroscience, New York, NY, US; Humaran, Teresa J.; Mann, J. John Source: Biological Psychiatry, Vol 44(6), Sep 1998. pp. 382-398. Publisher: US: Elsevier Science. Abstract: A brief review of the history and methodology of nuclear magnetic resonance (NMR) and magnetic resonance spectroscopy (MRS) is presented. A comparison is made of MRS capabilities with other functional imaging modalities. Aspects of the neurochemistry of schizophrenia relevant to MRS studies are reviewed, as are the reported MRS studies involving patients with schizophrenia. Areas of consistent findings include decreased phosphomonoesters and increased phosphodiesters in frontal lobes, and decreases in the putative neuronal cell marker, N-acetylaspartate, in temporal lobes. Studies of neurotransmitters such as glutamate, gamma-aminobutyric acid, and glutamine have generated inconsistent results. The authors suggest that studies of neurotransmitters have future potential with improvements in field strength and in spectral editing techniques. It is concluded thatMRS has the potential to measure brain medication levels and simultaneous effects on neurochemistry and that MRS may assist in characterizing high-risk populations, and ultimately guide medication use. _____
Title: Continuous osmotic minipump infusion of alcohol into brain decreases brain [Mg-super(2+)] and brain bioenergetics and enhances susceptibility to hemorrhagic stroke: An in vivo -sup-3-sup-1P-NMR study. Author(s): Altura, Burton M., State U New York, Health Science Ctr, Dept of Physiology, Brooklyn, NY, US; Weaver, Charles; Gebrewold, Asefa; Altura, Bella T.; Gupta, Raj K. Source: Alcohol, Vol 15(2), Feb 1998. pp. 113-117. Publisher: US: Elsevier Science. Abstract: Evaluated whether chronic, continuous infusion of 30% ethanol (EtOH) via a catheter in the 3rd cerebral ventricle of the rat brain progressively reduces, [Mg-super(2+)]-sub(i), brain bioenergetics, and cytosolic phosphorylation potential as determined by in vivo -sup-3-sup-1P-nuclear magnetic resonance spectroscopy. It was hypothesized that Ss receiving EtOH infusions would be very susceptible to acute alcohol-induced hemorrhagic stroke. Male rats were surgically fitted with mini-osmotic pumps that injected 4 g/kg EtOH into their brain for 7 or 14 days. Findings show 9- and 12-fold increases in hemorrhagic stroke mortality compared to naive, control Ss. Eating habits, grooming, gait and arterial blood pressure were not affected by the chronic brain implantation of EtOH. Correlations were found between [Mg-super(2+)] -sub(i and phosphocreat and between [Mg-super(2+)]-sub(i and cytosolic phosphorylation potential. Peripheral blood alcohol concentration rose to between 16.5-30.5 mg/dl. _____
Title: Programa intensivo de exposicion en vivo para el tratamiento del rechazo a la exploracion con resonancia magnetica nuclear. Estudio de casos. Translated Title: An intensive program of in vivo exposure to treat patients who refused to undergo nuclear magnetic resonance studies: A study of 9 cases. Author(s): Soto Torres, Isabel, U Nacional de Educacion a Distancia, Psicologa-Practica en Psicologia Clinica, Madrid, Spain Source: Analisis y Modificacion de Conducta , Vol 24(93), 1998. pp. 107-126. Publisher: Spain: Promolibro. Abstract: Studied the effectiveness of an intensive program of in vivo exposure to reduce the fear of undergoing nuclear magnetic resonance studies (NMR) in patients who objected to general anesthesia.. Human Ss: Nine male and female Spanish adults (aged 20-66 yrs) (3 Ss with depression). A 3-phase intervention was used: (1) initial contact and assessment, (2) training in gradual in vivo exposure to NMR, supported by respiratory control exercises and self-instruction, and (3) completion of NMR. Anxiety levels before the intervention and during each phase were compared. (English abstract) _____
Title: -sup-1H Magnetic resonance spectroscopy of the right striatum in obsessive-compulsive disorder: The role of the basal ganglia. Author(s): Koenig, Almuth, U Freiburg, Dept of Psychiatry, Freiburg, Germany; Thiel, Thorsten, U Freiburg, Dept of Neuroradiology, Freiburg, Germany; Ebert, Dieter, U Freiburg, Dept of Psychiatry, Freiburg, Germany Overmeier, Stefan, U Freiburg, Dept of Psychiatry, Freiburg, Germany; Henke, Michaela, U Freiburg, Dept of Psychiatry, Freiburg, Germany; Berger, Mathias, U Freiburg, Dept of Psychiatry, Freiburg, Germany; Hennig, Juergen, U Freiburg, Dept of Psychiatry, Freiburg, Germany; Hohagen, Fritz, U Freiburg, Dept of Psychiatry, Freiburg, Germany Address: Ebert, Dieter, Dept of Psychiatry, U Freiburg, Hauptstr. 5, 79104, Freiburg, Germany Source: German Journal of Psychiatry, Vol 1(2), 1998. pp. 53-61. Publisher: Germany: German Journal of Psychiatry. Abstract: Posted date: 1998. single photon emission computerized tomography (SPECT) and PET studies have provided evidence suggesting that the orbitofrontal gyrus, the cingulate gyrus and the striatum are part of the functional neuroanatomy of obsessive compulsive disorder (OCD). Structural deficits may account for abnormal brain activation, but cranial computed tomography and nuclear magnetic resonance studies have produced contradictory results to date. Lower N-acetyl aspartate (NAA) was described in the right striatum of OCD patients in a -sup-1H proton magnetic resonance spectroscopy study. The authors therefore compared the right striatum of 10 drug-naive patients suffering from OCD with 10 controls, matched for sex, age, and education, using -sup-1H magnetic resonance spectroscopy. The relative NAA levels in the right striatum of OCD patients were 7% lower, but there was no significant difference to the controls. The authors conclude that basal ganglia pathology may define only a subgroup of OCD patients. _____
Title: Language deficits in a child with omolateral (left) temporo-basal and cerebellar lesions. Author(s): Riva, Daria, Ist. Naz. Neurologico "C. Besta", Developmental Neurology Div, Milan, Italy Source: Neuropsychologia, Vol 36(1), Jan 1998. pp. 71-75. Publisher: US: Elsevier Science. Abstract: Reports the case of an 8-yr-old boy with 2 distinct brain lesions, probably hamartomas or low grade gliomas: one in the left basal temporal region, with involvement of the fusiform gyrus, the other in the white matter of the left cerebellar hemisphere. Both lesions were diagnosed at 7, when nuclear magnetic resonance was performed because of partial complex seizure. A mild delay in the 1st language acquisition and a long-lasting difficulty in word retrieval were reported. On neuropsychological testing, language was impaired more in production tasks than in comprehension ones, with severe deficit in word finding. The etiological role of the 2 different lesions is discussed in relation to experimental evidence of the existence of a distinct language area in the basal temporal region (fusiform gyrus). _____
Title: Effects of brain membranes on -sup-1H nuclear magnetic resonance signal intensity of ethanol in vitro. Author(s): Govindaraju, Varanavasi, Veterans Affairs Medical Ctr, Magnetic Resonance Unit, San Francisco, CA, US; Meyerhoff, Dieter J.; Maudsley, Andrew A.; Vermathen, Martina; Weiner, Michael W. Source: Alcohol & Alcoholism, Vol 32(6), Nov-Dec 1997. pp. 671-681. Publisher: United Kingdom: Oxford Univ Press. Abstract: Determined whether the interaction of ethanol (EtOH) with brain membranes in vitro diminishes EtOH visibility and evaluated whether a magnetization transfer (MT) effect can be observed for the interaction of EtOH with brain membranes in vitro. Furthermore, studies were performed to determine if the brain membranes from rats chronically exposed to EtOH had a different effect on EtOH nuclear magnetic resonance (NMR) visibility and spin-spin relaxation time (T2) than brain membranes obtained from controls. 18 male Ss were given 5% EtOH in water the 1st wk, 10% the 2nd wk, and 15% the 3rd wk. Control Ss were given plain water. Ss were decapitated and brain membranes examined. Results show that the NMR visibility of EtOH is lower in brain membrane suspensions in vitro as compared to EtOH in saline solutions. The factors decreasing EtOH NMR visibility are T2 relaxation, water presaturation time, and off-resonance saturation by a frequency-dependent MT pulse. One-pulse NMR measurements without water presaturation showed that EtOH visibility was significantly increased by 15% in brain membrane suspensions of EtOH-fed Ss. Furthermore EtOH in brain membrane suspensions from EtOH-fed Ss showed smaller MT effects than from controls. _____
Title: NMR spectroscopy in mental health and neuro sciences. Author(s): Joshi, Nanda B., National Inst of Mental Health & Neuro Sciences, Dept of Biophysics, Bangalore, India Source: NIMHANS Journal , Vol 15(4), Oct 1997. pp. 353-360. Publisher: India: National Inst of Mental Health & Neurosciences. Abstract: Nuclear magnetic resonance (NMR) spectroscopy has emerged as a powerful noninvasive technique to study the biochemical processes in intact cells, organs and humans. The main feature of NMR spectroscopy is that the biochemical events can be followed as they take place within a living system under physiological conditions. NMR spectroscopy, due to its specificity, can provide the quantitative determination of various chemicals in the living systems. It is possible to study the cellular metabolism, reaction rates and the fluxes of enzymes and cations using multinuclear high resolution NMR spectroscopy. In view of its noninvasive nature, this technique is ideally suited for investigating the bioenergetics and metabolism of brain in normal and pathological conditions and interdependence between neural cells. NMR spectroscopy is also playing an important role in the elucidation of hitherto unrecognized cause of various cerebral disorders. _____
Title: In vivo hippocampal -sup-3-sup-1P NMR metabolites in Alzheimer's disease and ageing. Author(s): Mecheri, G., Claude Bernard U, Lyon RTH Laennec Medical School, Bron, France; Marie-Cardine, M.; Sappey-Marinier, D.; Bonmartin, H.; Albrand, G.; Ferry, G.; Coppard-Meyer, N.; Courpron, P. Source: European Psychiatry , Vol 12(3), 1997. pp. 140-148. Publisher: France: Editions Scientifiques Elsevier. Abstract: Studied both inter-group (patients vs controls) and intra-group (right vs left hippocampus) differences in the lateral predominance of abnormalities in the measurement of phosphorus 31 (-sup-3-sup-1P) Nuclear Magnetic Resonance (NMR) spectroscopy metabolites. Ss were 7 patients (mean age 77 yrs) meeting the Diagnostic and Statistical Manual of Mental Disorders-III-Revised (DSM-III-R) criteria of senile dementia and the National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association criteria of probable Alzheimer's disease (AD), and 11 aged controls. There were significant differences in phosphorus metabolites for both intra-group comparison (pH shifted toward relative alkalosis in the left hippocampus of patients) and inter-group consideration (reduced phosphodiesters and elevated gamma adenosine triphosphate in the right hippocampus, higher inorganic phosphate in the left hippocampus) for patients as compared to controls. _____
Title: Stabilization of secondary structure of synthetic Alzheimer beta-amyloid protein analogs in the presence of aluminum. Author(s): Vyas, Sandip Bipin, U Alaska Fairbanks, US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering , Vol 56(11-B), May 1996. pp. 6099. Publisher: US: Univ Microfilms International. Abstract: The gradual accretion of fibrillar protein deposits in a tissue or organ is a hallmark of all amyloidogenic diseases. These deposits accumulate as senile plaques and cerebrovascular deposits in the brain and are characteristics of Alzheimer's disease. A majority of the brain amyloid deposits consist of a 40 amino acid protein, the Alzheimer beta-protein, Abeta P, which in a soluble form is ubiquitous in biological tissues. In order to provide a more detailed understanding of the structural transformations of soluble Abeta P, sequence analogs derived from beta1-40, and having His to Arg, and scL-Asp- to scD-Asp substitutions were synthesized. The kinetic variations of beta1-40 and beta6-25 were studied using amide circular dichroism spectroscopy by monitoring ellipticity changes of the peptide backbone. In both peptides, the gradual loss of secondary structure was a multiphasic process which was also dependent on concentration. The circular dichroism titrations with metal ions revealed the involvement of at least two ions in the conformational transitions of beta1-40 and beta6-25. The association of Al(III) with scL-Asp to scD-Asp derived analogs caused surprising conformational changes in beta6-25, which were distinct from beta1-40. Microheterogeneous products corresponding to Al(III)-bound peptide species were resolvable on the reversed-phase surface. The association of aluminum was investigated by low field 27 Al nuclear magnetic resonance spectroscopy. The signal corresponding to Al(III)-bound peptide species revealed that at least four Al(III) ions were bound to beta1-40 and beta6-25 between pH 5 and 6. Moreover, beta1-40 effectively competed with EDTA to bind with Al(III). This study also describes a strategy which resolved the band broadening in reversed-phase high-performance liquid chromatography of beta1-40 and derived analogs. Chromatographic parameters related to interactive contact area of beta1- _____
Title: Nuclear magnetic resonance spectroscopic studies of cortical development. Author(s): Minshew, Nancy J., U Pittsburgh, School of Medicine, Dept of Psychiatry, Pittsburgh, PA, US; Pettegrew, Jay W. Source: Thatcher, Robert W. (Ed); Lyon, G. Reid (Ed); et al; 1996. Developmental neuroimaging: Mapping the development of brain and behavior. San Diego, CA, US: Academic Press, Inc. pp. 107-125 Abstract: [None] _____
Title: Nuclear magnetic resonance spectroscopy: A review of neuropsychiatric applications. Author(s): Passe, Theodore J., Duke U, School of Medicine, Durham, NC, US; Charles, H. Cecil; Rajagopalan, Pradeep; Krishnan, K. Ranga Source: Progress in Neuro-Psychopharmacology & Biological Psychiatry, Vol 19(4), Jul 1995. pp. 541-563. Publisher: US: Elsevier Science. Abstract: Reviews the research on the applications of magnetic resonance spectroscopy (MRS), a powerful neuropsychiatric research tool for the noninvasive investigation of in vivo brain biochemistry. The history of MRS as it has progressed from an in vitro method of biochemical analysis to its current in vivo research uses is presented, and an overview of the physical priniciples of MRS, including methods for spectral localization, are discussed. Applications of the different MRS modalities to various neuropsychiatric disorders, such as Alzheimer's disease (AD), schizophrenia, affective disorders, and AIDS, are reviewed. The study of both fluorinated neuroleptics and the antidepressant fluoxetine using -1-9F MRS are discussed in detail. _____
Title: Sodium binding as measured by sodium-23 nuclear magnetic resonance spectroscopy and its influence on saltiness perception as determined by sensory analysis. Author(s): Rosett, Terri Robertson, U Illinois at Urbana-Champaign, US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering , Vol 55(9-B), Mar 1995. pp. 3657. Publisher: US: Univ Microfilms International. Abstract: Interactions of the sodium ion (Na+) with other food components and the effects on saltiness perception must be considered when modifying food formulations to produce reduced sodium products. This research focuses on the binding of Na+ in aqueous gum systems as determined by 23 Na nuclear magnetic resonance (NMR) spectroscopy and its relations to perceived saltiness. Additionally, multidimensional scaling (MDS), a non-traditional sensory testing method, and Decision Boundary (DB) theory, a comparative judgement theory never before tested with chemosensory stimuli, were studied to determine their efficiencies and applications to sensory science. Two levels of NaCl (0.1% and 0.2%, w/v) were added to two concentrations (0.1% and 0.3%, w/v) of two ionic (xanthan and kappa carrageenan) and two nonionic (locust bean and guar) gum solutions. Aqueous nonionic locust bean (0.3%, w/v) and ionic xanthan (0.1% and 0.3%, w/v) gum systems containing NaCl, or equal weights of NaCl plus KCl, or NaCl plus CaCl2 were also examined. 23 Na NMR transverse relaxation rates (R2, sec-1) values indicated Na+ was less mobile, on average, in ionic than nonionic gum systems. Ionic gums correspondingly suppressed saltiness perception compared to nonionic gums. As Na+ increased in both ionic and nonionic systems, R2 values converged and perceived saltiness equalized. At equivalent molar concentrations of added ions, 23 Na NMR R2 (sec-1) values showed an increase in average Na+ mobility with the addition of K+ or Ca2+ to the ionic gum systems. Correspondingly, salt taste increased with the addition of KCl. Enhancement of salt taste of NaCl by KCl is due, in part, to competitive binding of Na+ and K+ in a system. Maximizing saltiness in food formulas may be helped by selecting nonionic thickeners such as locust bean as opposed to ionic xanthan gum; adding calcium in the form of non-fat dry milk or whey. _____
Title: Proton MRS of choline in brain and red blood cells: Effects of lithium therapy. Author(s): Domino, Edward F. , U Michigan, Ann Arbor, MI, US Source: Nasrallah, Henry A. (Ed); Pettegrew, Jay W. (Ed); 1995. NMR spectroscopy in psychiatric brain disorders. Progress in psychiatry, No. 47. Washington, DC, US: American Psychiatric Association. pp. 199-212 Abstract: Discusses the use of magnetic resonance spectroscopy in the measurement of red blood cell (RBC) and brain choline levels during lithium therapy. what does the N(CH[subscript 3])[superscript 3+] signal measure by current [superscript]1H nuclear magnetic resonance techniques / determining effects of lithium on choline levels in human RBCs with [superscript]1H-MRS and other biochemical assays _____
Title: [superscript 19]F-MRS: A new tool for psychopharmacology. Author(s): Heimberg, Carolyn, U Arkansas for Medical Sciences, Little Rock, AR, US; Komoroski, Richard A.; Newton, Joseph E. O.; Karson, Craig Source: Nasrallah, Henry A. (Ed); Pettegrew, Jay W. (Ed); 1995. NMR spectroscopy in psychiatric brain disorders. Progress in psychiatry, No. 47. Washington, DC, US: American Psychiatric Association. pp. 213-234 Abstract: Evaluates the suitability of 19-flourine for use in nuclear magnetic resonance spectroscopy in the detection of psychotropic drugs [superscript 19]F: relevance to spectroscopy / quantitation issues / acquisition parameters / [superscript 19]F spectroscopic studies of antidepressants / [superscript 19]F spectroscopic studies of antipsychotics [animals, humans] _____
Title: Obsessive-compulsive symptomatology in normal pressure hydrocephalus: A case report. Author(s): Abbruzzese, Massimo, Istituto Scientifico H. S. Raffaele, Milan, Italy; Scarone, Silvio; Colombo, Cristina Source: Journal of Psychiatry & Neuroscience , Vol 19(5), Nov 1994. pp. 378-380. Publisher: Canada: Canadian Medical Assn. Abstract: Describes a 20-yr-old male patient with a Diagnostic and Statistical Manual of Mental Disorders-III-Revised (DSM-III-R) diagnosis of obsessive-compulsive disorder (OCD) and a nuclear magnetic resonance imaging (MRI) picture of a normal pressure hydrocephalus. After neurosurgery, the patient showed marked improvement in his compulsions, which previously had shown little response to pharmacological treatment. Data support the hypothesis that malfunctioning in the cortical-subcortical circuits involving the orbital-frontal cortex, basal ganglia, and thalamus underpins OCD psychopathological features. _____
Title: Relationship between lithium ion transport and phospholipid composition in erythrocytes from bipolar patients receiving lithium carbonate. Author(s): Mota de Freitas, D., Loyola U, Dept of Chemistry, Chicago, IL, US; Abraha, A.; Rong, Q.; Silberberg, J.; et al. Source: Lithium , Vol 5(1), Feb 1994. pp. 29-39. Publisher: United Kingdom: Churchill Livingstone. Abstract: Used blood samples from 10 lithium-treated (LT) bipolar patients and 10 matched normal controls to investigate the factors responsible for the slow rates of Na-super(+)-Li-super(+ ) exchange in red blood cells (RBCs) of LT patients with bipolar illness. Significant differences were found between the 2 groups for the affinity of Li-super(+ ) for the RBC membrane measured by -7Li nuclear magnetic resonance (NMR) relaxation methods, the amount of phosphatidyl serine in the RBC membrane determined by -3-2P NMR spectroscopy, and the rate of Na-super(+)-Li-super(+ ) exchange in Li-super(+)-loaded RBC suspensions measured by atomic absorption. The Li-super(+ ) binding constants were negatively correlated with the rates of RBC Na-super(+)-Li-super(+ ) exchange observed under standard assay conditions. Changes in lipid-protein interactions in the RBC membrane of LT patients may result in stronger Li-super(+ ) binding to the membrane and in slower rates of RBC Na-super(+)-Li-super(+ ) exchange. _____
Title: In vivo exploration of brain phosphorus metabolism in patients with senile dementia of Alzheimer type. Author(s): Mecheri, G., Ctr Hospitalier Specialise, Le Vinatier, Bron, France; Bissuel, Y.; Dalery, J.; Terra, J. L.; et al. Source: European Psychiatry , Vol 9(2), 1994. pp. 105-109. Publisher: France: Editions Scientifiques Elsevier. Abstract: Compared in vivo nuclear magnetic resonance (NMR) -3-1p spectroscopy data in 1 male and 4 female patients (aged 72-84 yrs) with senile dementia of the Alzheimer type (SDAT) with those of 4 healthy male controls (aged 70-75 yrs). In vivo NMR -3-1p spectroscopy is a noninvasive, nonionizing method of exploration of energy and phospholipid metabolism in the brain. Abnormal phosphomonoesters concentrations, either high or low, were found in the patients, but statistical analysis did not elicit any significant difference relative to controls. _____
Title: Cognitive and neuroradiological findings in congenital adrenal hyperplasia. Author(s): Sinforiani, E., IRCCS C. Mondino, Padua, Italy; Livieri, C.; Mauri, M.; Bisio, P. Source: Psychoneuroendocrinology, Vol 19(1), 1994. pp. 55-64. Publisher: US: Elsevier Science Ltd/Pergamon. Abstract: 19 patients (aged 16+ yrs) with congenital adrenal hyperplasia (CAH) and 19 individually matched normal controls were given a neuropsychological evaluation. No significant differences were detected among Ss. CAH Ss, however, revealed slightly higher IQs with respect to the expected distribution. No significant learning disabilities could be detected. 15 patients underwent nuclear magnetic resonance scans, 4 of whom showed small areas of increased signal intensity in the white matter, without prevalence of side. This finding did not correlate with clinical and cognitive characteristics. Possible hormonal influences are discussed. _____
Title: Molecular insights into schizophrenia. Author(s): Pettegrew, Jay W., U Pittsburgh, School of Medicine, Western Psychiatric Inst & Clinic, Dept of Psychiatry, Neurophysics Lab, Pittsburgh, PA, US; Minshew, Nancy J. Source: Andreasen, Nancy C. (Ed); 1994. Schizophrenia: From mind to molecule. American Psychopathological Association series. Washington, DC, US: American Psychiatric Association. pp. 221-243 Abstract: describe a method that integrates neuroradiology with the study of cell membrane function at the molecular level; specifically, the application of nuclear magnetic resonance spectroscopy to the study of cell membrane physiology in first-episode [adult] schizophrenic patients / findings [suggest] that schizophrenic patients may have abnormalities in phospholipid metabolism in the prefrontal cortex; the changes observed are consistent with either abnormal patterns of brain development or acceleration of processes in the brain that occur during aging _____
Title: The role of nuclear magnetic resonance imaging in psychiatric research. Author(s): Potts, Nicholas L. S. , Duke U Medical Ctr, Dept of Psychiatry, Durham, NC, US; Davidson, Jonathan R. T.; Krishnan, K. R. R. Source: Journal of Clinical Psychiatry, Vol 54(12, Suppl), Dec 1993. pp. 13-18. Publisher: US: Physicians Postgraduate Press. Abstract: Highlights the current data in living human Ss that demonstrates structural changes in psychiatric disorders using magnetic resonance imaging (MRI). The principles of MRI, and benefits and disadvantages of MRI compared with computerized tomography (CT) scanning are reviewed. The use of MRI in schizophrenia, depression, dementia, autism, anorexia and bulimia, and anxiety disorders (i.e., panic disorder, obsessive compulsive disorder, social phobia) is discussed. Magnetic resonance spectroscopy (MRS) is a more recent imaging technique for investigating psychiatric disorders. The theoretical aspects of MRS are described in addition to its use in schizophrenia and in social phobia. The use of MRS in the study of medications is also discussed. _____
Title: La resonancia magnetica nuclear en psiquiatria. Translated Title: Nuclear magnetic resonance in psychiatry. Author(s): Hamad, H. , Ctr de Salud Mental de Antequera, Malaga, Spain Source: Actas Luso-Espanolas de Neurologia, Psiquiatria y Ciencias Afines , Vol 21(6), Nov-Dec 1993. pp. 221-229. Publisher: Spain: Editorial Garsi SA. Abstract: Reviews studies that utilized magnetic resonance imaging (MRI) to study brain abnormalities in patients with schizophrenia, mood disorders, anxiety disorders, and obsessive-compulsive disorders. The conditions in which MRI should be utilized are described, and the limitations and disadvantages of applying MRI to psychological disorders are considered. (English abstract) _____
Title: La risonanza magnetica nucleare nei pazienti affetti da psicosi schizofreniche. Una rassegna critica della recente letteratura. Translated Title: Nuclear magnetic resonance in schizophrenic patients: A review of current research. Author(s): Caruso, Romana , U degli Studi Brescia, Istituto di Psichiatria, Italy; Turrina, Cesare; Ermentini, Augusto Source: Rivista di Psichiatria , Vol 28(6), Nov-Dec 1993. pp. 283-292. Publisher: Italy: Pensiero Scientifico Editore srl. Abstract: Reviews studies that employed magnetic resonance imaging to examine schizophrenic patients. The types of brain anomalies detected are reviewed. The methodology of different studies is described and compared. (English abstract) _____
Title: Imagerie cerebrale et troubles thymiques. Translated Title: Brain imaging and affective disorders. Author(s): Martinot, Jean-Luc , INSERM Unite 334, Service Hospitalier Frederic Joliot, France Source: Revue de Neuropsychologie , Vol 3(3), Sep 1993. pp. 271-286. Publisher: France: ADRSC CNRS-CRNC. Abstract: Discusses applications of cerebral imaging techniques in clinical practice and research with affective disorders (ADs). The use of structural imaging methods (e.g., computerized tomography and magnetic resonance imagery) in the diagnosis of organic pathology underlying ADs is described, and the contribution of functional imaging techniques (e.g., positron emission tomography and nuclear magnetic resonance spectroscopy) to an understanding of cerebral activity during the course of various ADs is reviewed. Results are presented of neurophysiological, psychopharmacological, and clinical research using these imaging techniques. _____
Title: Functional magnetic resonance imaging of motor cortex: Hemispheric asymmetry and handedness. Author(s): Kim, Seong-gi, U Minnesota Medical School, Ctr for Magnetic Resonance Research, Minneapolis, US; Ashe, James; Hendrich, Kristy; Ellermann, Jutta M.; et al. Source: Science, Vol 261(5121), Jul 1993. pp. 615-617. Publisher: US: American Assn for the Advancement of Science. Abstract: A hemispheric asymmetry in the functional activation of the human motor cortex during contralateral (C) and ipsilateral (I) finger movements, especially in right-handed Ss, was documented with nuclear magnetic resonance imaging at high field strength. 10 right-handed and 5 left-handed human Ss participated in this study. Whereas the right motor cortex was activated mostly during contralateral finger movements in both right-handed (C/I mean area of activation = 36.8) and left-handed (C/I = 29.9) Ss, the left motor cortex was activated substantially during I movements in left-handed Ss (C/I = 5.4) and even more so in right-handed Ss (C/I = 1.3). _____
Title: A preliminary -3-1P MRS study of autism: Evidence for undersynthesis and increased degradation of brain membranes. Author(s): Minshew, Nancy J., U Pittsburgh School of Medicine, PA, US; Goldstein, Gerald; Dombrowski, Stephen M.; Panchalingam, Kanagasabai; et al. Source: Biological Psychiatry, Vol 33(11-12), Jun 1993. pp. 762-773. Publisher: US: Elsevier Science. Abstract: Investigated brain high energy phosphate and membrane phospholipid metabolism in the dorsal prefrontal cortex of 11 high-functioning autistic males (aged 12-36 yrs) and 11 matched normal controls, using in vivo -3-1P nuclear magnetic resonance spectroscopy (MRS). Autistic Ss had decreased levels of phosphocreatine and esterified ends compared with controls. A common pattern of correlations was observed between metabolite levels and neuropsychologic and language test scores among autistic Ss. As test performance declined in the autistic Ss, levels of the most labile high energy phosphate compound and of membrane building blocks decreased, and levels of membrane breakdown products increased. Findings are consistent with a hypermetabolic energy state and undersynthesis of brain membranes and may relate to the neurophysiologic and neuropathologic abnormalities in autism. _____
Title: In vivo -7Li nuclear magnetic resonance study of lithium pharmacokinetics and chemical shift imaging in psychiatric patients. Author(s): Komoroski, Richard A., U Arkansas for Medical Sciences, NMR Lab, Little Rock, US; Newton, Joseph E.; Sprigg, Jay R.; Cardwell, David; et al. Source: Psychiatry Research: Neuroimaging , Vol 50(2), Jun 1993. pp. 67-76. Publisher: Ireland: Elsevier Scientific Publishers Ireland. Abstract: Applied -7Li in vivo nuclear magnetic resonance spectroscopy to human studies. The technique was used to monitor the pharmacokinetics of Li elimination and the between-dose pharmacokinetics of Li in the brain for 3 patients on Li therapy for schizoaffective disorder or bipolar illness, manic type. Brain Li concentrations were at their highest from 0 to 2 hrs after the peak occurred in serum concentration. Elimination from brain tissue took longer than elimination from muscle, and no signal could be detected from brain at 10 days after termination of therapy. A birdcage radiofrequency coil for -7Li was constructed and used to measure the -7Li spin-lattice relaxation time of 4.6 sec in vivo in another patient with schizoaffective disorder and to acquire preliminary spectroscopic images of a phantom and human brain. _____
Title: Altered brain energy metabolism in demented patients with multiple subcortical ischemic lesions: Working hypotheses. Author(s): Brown, Gregory G., Henry Ford Hosp, Div of Neuropsychology, Detroit, MI, US; Garcia, Julio H.; Gdowski, James W.; Levine, Steven R.; et al. Source: Archives of Neurology, Vol 50(4), Apr 1993. pp. 384-388. Publisher: US: American Medical Assn. Abstract: Demented patients with clinical and radiological evidence of multiple subcortical ischemic lesions (MSILs) appear to have greater relative signal intensities of high-energy phosphate peaks than patients with Alzheimer's disease (AD) or nondemented controls. Phosphorus 31 nuclear magnetic resonance data for brain energy metabolism were collected for 18 Ss with MSILs, 21 nondemented controls, and 19 Ss with probable AD (all Ss aged 63.3-67.3 yrs). Results, obtained from brain regions superficial to the subcortical lesions identified on imaging studies, complement findings (D. Sappey-Marinier et al, 1992) of a reduction of adenosine triphosphate concentrations within subcortical regions displaying hyperintense white matter signals. Testable working hypotheses are offered to explain what pathological mechanism might cause the elevation of high-energy phosphate metabolites in brain regions superficial to the sites of subcortical ischemic damage. _____
Title: Interet de la spectroscopie RMN dans l'exploration du metabolisme cerebral de sujets atteints de maladie d'Alzheimer. Translated Title: Interest of cerebral 31P nuclear magnetic resonance (RMN) spectroscopy in senile dementia Alzheimer's type. Author(s): Bissuel, Y., Ctr Hospitalier Specialise du Vinatier, Bron, France; Mecher, G.; Mehier, H.; Dalery, J.; et al. Source: Encephale , Vol 19(1), Jan-Feb 1993. pp. 29-35. Publisher: France: Doin Editeurs. Abstract: Compared levels of phosphomonoesters in victims of Alzheimer's disease and in normal Ss of similar age and sex. Ss were 5 elderly adults (aged 72-84 yrs) with Alzheimer's disease and 5 elderly controls (aged 72-84 yrs). Ss underwent magnetic resonance spectroscopy to determine their levels of phosphomonoesters. (English abstract) _____
Title: -3-1P Nuclear magnetic resonance spectroscopy: Neurodevelopment and schizophrenia. Author(s): Pettegrew, Jay W., U Pittsburgh, Western Psychiatric Inst & Clinic, PA, US; Keshavan, Matcheri S.; Minshew, Nancy J. Source: Schizophrenia Bulletin , Vol 19(1), 1993. pp. 35-53. Publisher: US: Superintendent of Documents. Abstract: Discusses in vivo phosphorous-31 nuclear magnetic resonance studies of the dorsal prefrontal cortex in neuroleptic-naive, 1st episode, schizophrenic (SCZ) patients and matched controls. There seem to be alterations in membrane phospholipid and energy metabolism. The membrane alterations observed in SCZ Ss are compatible with premature aging or altered timing and exaggeration of regressive events occurring during normal brain development. These molecular changes may precede onset of clinical symptoms and brain structural changes in schizophrenia. New approaches are suggested to the pathogenesis and treatment of this illness. _____
Translated Title: NMR-tomography of the brain in parkinson's disease. Author(s): Artemyev, D. V., I. M. Sechenov Moscow Medical Academy, Russia; Damulin, I. V.; Ternovoy, S. K.; Belichenko, O. I.; et al. Source: Zhurnal Nevropatologii i Psikhiatrii imeni S.S. Korsakova, Vol 93(6), 1993. pp. 27-29. Publisher: Russia: Izdatel'stvo 'Medicina'. Abstract: Studied the following: (1) the effects of age, disease duration, disease severity, disease form, and presence of systemic atherosclerosis on the nature of cerebral atrophy and on changes in the white substance of the cerebral hemispheres, and (2) correlations between structural changes observed with nuclear magnetic resonance tomography and disturbances of higher mental functions. Ss were 20 adults (aged 38-72 yrs) with Parkinson's disease. Neurologic examination, neuropsychological testing, nuclear magnetic resonance (NMR) tomography, biochemical blood analysis, ophthalmoscopy, electrocardiography, Doppler ultrasound studies, and rheovasography were performed. (English abstract)
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