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Ego-boundary disturbance (EBD) in schizophrenia is a unique psychopathological cluster characterized by passivity experiences (involving thoughts, actions, emotions and sensations) attributed by patients to some external agency. Aberrant mirror neuron activation may explain impaired self-monitoring and agency attribution underlying these ‘first rank’ symptoms.
We aim to study mirror neuron activity (MNA) in schizophrenia patients with and without EBD using transcranial magnetic stimulation (TMS).
50 right-handed schizophrenia patients (DSM IV) were evaluated using the Mini-International Neuropsychiatric Interview and the Positive & Negative Syndrome Scale. They completed a TMS experiment to assess putative premotor MNA. Motor evoked potential (MEP) was recorded in the right first dorsal interosseous muscle (FDI) with (a) 120% of resting motor threshold (RMT) and (b) stimulus intensity set to evoke MEP of 1 millivolt amplitude (MT1). These were done in 3 states: actual observation of an action using the FDI, virtual-observation (video) of this action and resting state. The difference of MEP between resting to action-observation states formed the measure of MNA.
MNA measured using MT1 and 120% RMT paradigms for real-observation was significantly lower in the 18 patients with EBD (thought-broadcast/withdrawal/insertion, made-act/impulse/affect and somatic passivity) than the 32 patients without EBD (t=2.75, p = 0.009; t = 2.41, p = 0.02 respectively for the two paradigms). The two groups did not differ on age, gender, education and total symptom scores.
Schizophrenia patients with EBD have lower premotor MNA. This highlights the role of MNA dysfunction in the pathophysiology of this unique and intriguing symptom cluster in schizophrenia.
Cortical inhibition (CI) is a neurophysiological outcome of the interaction between GABA inhibitory interneurons and other excitatory neurons. Transcranial magnetic stimulation (TMS) measures of CI deficits have been documented in both symptomatic and remitted bipolar disorder (BD) suggesting it could be a trait marker. The effects of medications and duration of illness may contribute to these findings.
To study CI in BD.
To compare CI across early-course medication-naive BD-mania, remitted first episode mania (FEM) and healthy subjects (HS).
Symptomatic BD subjects having < 3 episodes, currently in mania and medication-naive (n = 27), remitted FEM (n = 27; YMRS < 12 and HDRS < 8) and 45 HS, matched for age and gender, were investigated. Resting motor threshold (RMT) and 1-millivolt motor threshold (MT1) were estimated from the right first dorsal interosseous muscle. Paired-pulse TMS measures of short (SICI; 3ms) and long interval intracortical inhibition (LICI; 100ms) were acquired. Group differences in measures of CI were examined using ANOVA.
Symptomatic mania patients had the highest motor thresholds and the maximum LICI indicating a state of an excessive GABA-B neurotransmitter tone. Remitted mania patients had deficits in SICI indicating reduced GABA-A neurotransmitter tone. Putative changes in GABA-A neurotransmitter system activity with treatment may be investigated in future studies. CI has received less attention in BD as compared to schizophrenia and is a potential avenue for future research in this area.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Terror struck Pune on 13 Feb. 2010 as a powerful bomb ripped apart a popular restaurant, killing nine people and injuring more than 45. A retrospective analysis of the injury patterns was done.
Materials and Methods
The CDC template, viz. “Bomb Surveillance Form” was used for the data collection, that was analyzed by SPSS version 15 software.
Of the 50 survivors transferred to the four nearby hospitals, 11 (22%) of them had severe life threatening injuries, with 19 patients (38%) having primary blast injuries, Secondary type of injury was seen in, and 22% had tertiary injuries. Orthopedic (24%) and burn injuries (36%) were prominent. The mortality rate was 16%.
The occurrence of MCI in an unexpected scenario overwhelms the medical resources and challenges the emergency medical facilities. Analysis of the injuries revealed that fatal outcome was related to presence of shock, severe lung, bowel injury, presence of more than four types of injury and greater than 50% burns.
Highlights the importance of being able to recognize the blast injury patterns and their management.
Inability to compare with other blast injuries due to several missing data.
Blast injury sustained in a small, enclosed space is one of the most serious and complicated forms of multiple trauma. Hospitals and civic authorities must be prepared to counter this menace of modem times. Not everything that is faced can be changed, but nothing can be changed until it is faced.
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