Neurology Psychiatry and Brain Research最新文献

Background

It has long been recognized that sustained or repeated child maltreatment has lasting psychological and emotional effects on the victims. This has helped to inform the criminal and civil justice systems how best to deal with perpetrators of abuse, as well social and health services when treating the victims. However, what is generally less well recognized is that physical and emotional abuse has a lasting and potentially non-reversible effect on brain function.

Methods

We conducted a literature review on the forensic, mental, psychological, and pathophysiological impact of child maltreatment and discuss the implications of child maltreatment as a potential mitigating factor in criminal court in cases where victims of abuse become perpetrators themselves.

Findings

Repeated exposure to traumatic experiences changes the responsiveness in the hypothalamus-pituitary-adrenal axis with lasting consequences in the developing brain for structures, such as the hippocampus and amygdala. These physiological changes are thought to cause a range of mental disorders, which are associated with poor affect regulation, anxiety, depression, and substance abuse.

Conclusions

The importance of developing our understanding of the long-term effects of child abuse and neglect cannot be overestimated as the result of child maltreatment will perpetrate criminal acts since offenders have higher rates of mental illness than the general community.

There is major evidence for the involvement of immunological processes in the pathophysiology of schizophrenia. Especially alterations of T-cell function and activation of the inflammatory response system appear to be linked to schizophrenia. A mild chronic inflammation process has been proposed and repeated findings of altered serum cytokine levels led to the hypothesis of a TH2 shift or cytokine imbalance in schizophrenia. We investigated serum levels of TH1 and TH2 related cytokines and immune markers in 25 patients suffering an acute schizophrenic episode (all unmedicated, 22 neuroleptica-naïve) at different stages of disorder (18 first episode, FEP; 7 recurrent episode, REP) compared to 25 age and sex matched healthy controls.

In patients, we found an increase of the TH2 system cytokine IL-13 (p = 0.039) and a decrease of the TH1 system markers sICAM-1 (p = 0.011) and sIL-2R (p = 0.063, n. s.). Elevation of the pro-inflammatory cytokine IL-6 was not significant (p = 0.052). The effect of sIL-2R decrease was greater in the FEP subgroup (p = 0.01) of patients. We found no group differences in the other investigated immune markers: IL-4, IL-8, TNF-alpha, and Interferon-gamma, in which most readings were below the lower detection limit of the respective assay.

Our findings support the notion of a TH1/TH2 imbalance particularly in the acute manifestation phase of schizophrenia. In the long run, this may lead to the identification of cytokine patterns that are applicable as trait or state markers, may be helpful in making or ensuring diagnosis or in monitoring therapy.

Background

Perceived internal and external control have long been theorized to relate to development and maintenance of anxiety (Barlow, 2002) and depression (Seligman, 1975). Experimental research studies investigating perceived control have largely focused on anxiety within cross-sectional samples and have shown that low levels of perceived internal and external control are associated with higher levels of anxiety (Gallagher et al., 2014) and depression (Brown & Siegel, 1988; Wardle et al., 2004). The majority of previous research has looked at the combined effects of perceived internal and external control and has not investigated these constructs as potential treatment targets in intensive, short-term clinical settings.

Methods

The current study examined the associations of perceived internal and external control as they relate to anxiety and depression symptom change in a partial hospital sample.

Results

Both perceived internal and external control increased significantly over brief, intensive treatment. Further, greater gains in internal perceived control were related to greater reductions in anxiety and depression symptoms.

Discussion

Our study was limited in that it did not include a control group or follow-up data. This study provides evidence that perceived internal control is related to change in symptoms in a diagnostically diverse and severe population, after very brief intensive treatment. Future studies should investigate if perceived internal control is a mechanism of change in treatment and explore how to maximize the development of perceived internal control in treatment, to maximize reduction in symptoms.

Objective

Studies show promise for the treatment of substance abuse through mindfulness practice. However, the neural mechanisms of mindfulness practice for treating substance use disorders are still unclear. Evidence suggests that major deficits in executive functions such as inhibitory control, risky behavior and decision-making, psychological flexibility, and working memory are associated with a craving to use. The current study aims to investigate the efficacy of mindfulness practice on improving executive functions, assessed by neuroscientific tools, in a group of adolescents with methamphetamine use disorders.

Method

Forty adolescents (18–21 years old) with methamphetamine use disorders were selected and randomly assigned to experimental (n = 20) and control groups (n = 20). Subjects were assessed three times: before the intervention, immediately after and one month after treatment. Mindfulness-based substance abuse treatment (MBSAT) was administered for 12 sessions, two 50–60 minutes sessions per week.

Results

Results Mixed model ANOVAs analysis showed that mindfulness-based intervention improved executive functions in the experimental group compared to controls.

Conclusions

This study is the first to support the benefits of mindfulness-based practice in improving executive functions of adolescents with methamphetamine use disorders.

The regulation of muscarinic acetylcholine receptors (mAChR) critically influences emotional outcomes. Previous researches indicate that a single systemic injection of pilocarpine – a mAChR agonist – displays long-term defensive behaviors in rats evaluated in distinct unconditioned tests up to 3 months following treatment. However, it is not clear whether these effects share underlying behavioral phenotypes involved in conditioned responses. With this in mind, we examined whether mAChR activation modulates contextual fear conditioning (CFC) and/or hippocampal synaptic plasticity. Adult male Wistar rats were injected with pilocarpine (150 mg/kg) and behaviorally evaluated in the CFC test or followed by synaptic plasticity (LTP/LTD) investigation in CA1 stratum radiatum of hippocampal slices. There was no difference between groups in the quantification of freezing behavior during the test period (24 h after treatment) besides a decrease of freezing 1 month later. Similarly, no changes were observed in rats conditioned 24 h later and tested 1 month after. Synaptic plasticity investigation following short- or long-term treatment revealed no differences between control and treated subjects. In summary, our results show that hippocampus-dependent fear behavior and memory consolidation mediated by hippocampal cholinergic inputs are not sensitive to activation of mAChR by a systemic nonconvulsant dose of pilocarpine. Therefore, we suggest that the long-term defensive behaviors and anxiogenic-like features displayed by pilocarpine observed in rats are mediated by different underlying mechanisms and or set of synapses.

Background

Postpartum affective disorders may be associated with dysregulation of gonadal steroids. We investigated peripheral levels of allopregnanolone and progesterone in a combined group of women with postpartum onset of severe depression and/or psychosis who, as previously reported, responded with rapid symptom remission during sublingual estradiol treatment. The aim was to assess differences in allopregnanolone and progesterone between patients and healthy controls at baseline, and hormonal changes during estradiol treatment and symptom remission in patients.

Methods

Allopregnanolone and progesterone in serum were analyzed with radioimmunoassay before and four weeks after initiation of sublingual estradiol treatment in ten women with postpartum depression and four women with postpartum psychosis (ICD-10). Twenty-eight healthy postpartum controls were included for baseline comparison.

Results

Allopregnanolone declined significantly during estradiol treatment while there was a trend for lower baseline allopregnanolone levels in patients compared with healthy postpartum controls. The ratio between allopregnanolone and progesterone was significantly lower in patients compared with controls and it remained unchanged after clinical recovery.

Limitations

This study is a secondary analysis of two estradiol treatment studies based on availability of samples for the analysis of allopregnanolone. Healthy controls were assessed earlier after delivery. Data on potential confounders (somatic health, breastfeeding, other medication) were not available.

Conclusions

These preliminary findings suggest that clinical recovery of severe postpartum depression and psychosis during estradiol treatment does not seem to depend on increasing levels of allopregnanolone. Differences in progesterone metabolism may constitute a risk factor for severe postnatal affective dysregulation.

Background

Paraphilias can be seen in the context of schizophrenia. Among the paraphilias, zoophilia is less commonly reported. Paraphilias are often associated with hypersexuality and psychiatric comorbidities. Paraphilias like zoophilia may result in development of sexually transmitted diseases.

Method

After obtaining informed consent, details of history were obtained. Mental status of the patient was done at regular intervals. General physical examination, appropriate blood investigations and neuroimaging were done.

Result

We have described here the case of an adult male suffering from schizophrenia with co-morbid alcohol and cannabis use disorder with hypersexuality, who had zoophilia and developed hepatitis B infection.

Conclusion

Paraphilias like zoophilia can lead to development of sexually transmitted disease in patients with schizophrenia.

Objective

Processing of positive emotions in depressed individuals is different from healthy ones but its physiological correlates especially during different levels of consciousness is not yet well-understood. This study investigated physiological correlates of emotional processing of positive emotions during hypnosis and consciousness in depressed individuals compared to healthy control with the electroencephalogram (EEG).

Method

Forty individuals classified in two groups of depression (N = 20, 10 females) and healthy control (N = 20, 10 females) participated in this study. Participants in each group underwent a positive emotional experience during hypnotic state and conscious state while their EEG pattern was recorded. The EEG power was analyzed for both groups during hypnosis and conscious state.

Results

Results showed that experience of happiness significantly changed EEG pattern compared to the resting state in both groups with a significant increase in the Beta band in the right hemisphere. However, the increase in the right temporal beta activity was significantly higher in healthy subjects compared to depressed ones. Furthermore, the experience of happiness was not significantly different during hypnotic and conscious states in both groups. A significant increase in the Alpha band was also observed in both groups during hypnotic experience but not conscious state.

Conclusions

Electrophysiological processing of happiness is not different during hypnosis and consciousness but is associated with an increase of Beta band in the right temporal hemisphere in both depression and healthy subjects.

Background

Major Depressive Disorder (MDD) is one of the most common mental disorders. Converging evidence suggests that the insula plays an important role in the pathophysiology of MDD. Little is known regarding in which insula subregion volume alterations occur in patients with MDD.

Methods

We analyzed voxel-based morphometry in T1-weighted MRI scans of unmedicated DSM-IV MDD patients (n = 26) and in age, education, and sex matched healthy controls (HC, n = 26). Furthermore, we performed a quantitative meta-analysis across 14 structural MRI MDD studies by applying the anatomical likelihood estimation technique to identify concordant volume reductions in MDD in the insula cortex.

Results

We found significantly reduced grey matter volumes (GMV) in patients with MDD compared to HCs in the left mid-insula and in the right and left caudate nucleus. The left mid-insular volume reduction in our sample was consistent with the coordinate-based meta-analysis results.

Conclusions

The findings highlight the role of the mid-insula in the psychopathology of MDD. The mid-insula subregion might be associated with reduced interoceptive abilities in patients with MDD that is the ability to process information of “how the body feels”. In addition, the caudate nucleus has been described as being part of a network that mediates emotional and motivational processes which seems to be affected in MDD.

Background

Socioeconomic factors have been linked to suicide, but little research has explored the effects of these determinants on suicide risk in US populations. This population-based study assessed socioeconomic determinants of suicide risk to inform suicide assessment and intervention.

Method

Secondary analysis of the Monroe County Florida 2016 Behavioral Risk Factor Surveillance Survey suicide behavior questions among adult residents (n = 528). Univariate analysis and logistic regression assessed associations of self-reported socioeconomic status (education, employment, income, housing), health care access, quality of life, substance use, mental illness and suicide risk.

Result(s)

Among respondents, 7.34% (n = 49, CI = 4.27–10.41) were at risk for suicide. Persons at risk reported more depression (χ² [1, n = 417] = 105.5, p =  .001), poorer mental health (χ² [2, n = 411] = 36.6, p =  .001), and more activity limitation due to health (χ² [1, n = 408] = 34.3, p =  .001) than those not at risk. Persons at risk were more likely to be renting homes (63.5%, n = 19, CI = 43.53–80.52) than persons not at risk (36.9%, n = 86, CI = 28.53–43.29).

Limitations

32% missing data supports replication of study findings using larger data sets. Maximum likelihood estimation handled missing data in regression analyses. Low prevalence of suicide risk required collapsing some conceptually different categories.

Conclusion(s)

Housing was a stronger socioeconomic predictor of suicide risk than income, employment, or education. This finding supports exploring housing status in suicide assessment and research.