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Major depression is associated with altered neural function in frontal and limbic areas.
The findings have been inconsistent, especially those derived from cerebral blood flow (CBF) measures.
To identify differences in regional CBF between patients and controls using arterial spin labeling (ASL) at rest.
20 patients with major depression and 20 matched healthy controls were scanned in the morning with a pCASL-sequence at a 3 T Siemens scanner. Mean Hamilton Depression Score (21 item version) was 26.2 ± 5.7 for patients, mean Beck Depression Inventory scores were 28.9 ± 8.9. Mean age did not differ between groups (39.6 vs. 44.4 years). Whole brain voxelwise T-Tests were correct for multiple comparisons using a False Discovery Rate of q < 0.05.
Mean global resting CBF was not different between groups (66.1 vs. 63.0 ml/100 mg/min, T = 0.95, p = 0.35). FDR correction at q < 0.05 led to a T-value threshold of 3.71 (p < 0.001) for group comparison. Hypoperfusion in patients was detected in left middle temporal gyrus, left middle frontal gyrus, right precentral gyrus. Hyperperfusion in patients was seen in the right superior temporal gyrus.
ASL revealed frontotemporal hypoperfusion in patients with major depression. This is in line with previous work and the current concept of depression. However, we were unable to replicate hyperperfusion in limibic areas.
Affective symptomatology has repeatedly been suggested to confer susceptibility to tardive dyskinesia (TD). In our sample of 174 schizophrenic patients a history of depressive symptoms was not associated with the occurrence of TD, whereas manic symptomatology was significantly associated with the absence of TD. Thus, our data suggest that affective symptomatology cannot unambiguously be considered to predispose to TD.
Preclinical and first clinical studies suggested that the selective γ-aminobutyric acid (GABA)-B receptor agonist baclofen might be effective in the treatment of alcohol dependence. However, previous randomized controlled trials have reported inconsistent results, possibly related to the low to medium dosages of baclofen used in these studies.
To assess the efficacy and safety of individually titrated high-dose baclofen (30-270 mg/d) for the treatment of alcohol dependence.
Fifty-six alcohol-dependent patients were randomized to a double-blind treatment with individually titrated baclofen or placebo. Multiple primary outcome measures were total abstinence and cumulative abstinence duration during a 12-week high-dose phase.
Preliminary results of this clinical trial will be presented.
Brain-derived neurotrophic factor (BDNF) plays important roles in neurotransmitter release and synaptic plasticity and has been hypothesized to be involved in the development and maintenance of addictive disorders. Also, alterations in secretion of stress hormones within the <a name="_Hlk388856744">hypothalamic–pituitary–adrenal </a>(HPA) axis have repeatedly been found in substance-related addictive disorders. It has been suggested that glucocorticoids might modulate behavioural responses to substances of abuse. Therefore, we investigated alterations of BDNF expression and HPA axis activity in non-substance-related addictive disorders, i.e. pathological gambling (PG) and Internet use disorder (IUD).
We measured serum BDNF levels, plasma levels of copeptin, a vasopressin (AVP) surrogate marker, adrenocorticotropic hormone (ACTH) and cortisol in male patients with PG (n=14), IUD (n=11) and carefully matched healthy controls for PG (n=13) and IUD (n=10).
BDNF serum levels were significantly increased in patients with PG in comparison to healthy control subjects (p = 0.016). Furthermore, cortisol plasma levels correlated negatively with the PG-YBOCS total severity score (r<sup>2</sup> = -.626, p = .039) in patients with PG. There was no significant difference in BDNF serum levels of patients with IUD in comparison to control subjects. Plasma levels of copeptin, ACTH and cortisol in patients with PG and IUD did not differ among groups.
These preliminary results might suggest that the pathophysiology of PG shares some characteristics with substance-related addictive disorders on a neuroendocrinological level, whereas those similarities could not be observed in IUD.
Transcranial direct current stimulation (tDCS) is currently discussed as a therapeutic intervention in various psychiatric disorders. Based on the report about the effectiveness of tDCS in a patient with catatonic schizophrenia, we applied bilateral prefrontal tDCS in a patient with corpus callosum aplasia (CCA) and severe catatonia instead of maintenance electroconvulsive therapy (ECT).
To investigate whether tDCS can replace ECT in a largely treatment-resistant patient.
The 41 year-old male patient showed severe catatonic symptoms since adolescence and was treated by weekly ECT for almost 6 years. Due to cardiac complications and increasing cognitive deficits caused by long-term ECT and weekly anesthesia, tDCS was suggested. The anode was positioned over the left dorsolateral prefrontal cortex (DLPFC), the cathode over the right DLPFC. 2mA tDCS was delivered for 2x 20 minutes (90 minutes break in between), three times a week for the first two weeks, thereafter once to twice weekly. Concomitant medication (clozapine 600 mg/d, aripiprazole 10 mg/d, pirenzepine 50 mg/d, lorazepam 3 mg/d) was continued.
So far, more than 20 double sessions of tDCS were applied. ECT was needed once after a period of hospitalisation for 10 days due to pneumonia. Since then the patient has solely received tDCS for more than 13 weeks. Catatonic symptoms resolved further under tDCS compared to ECT (Bush-Francis Catatonia Rating Scale: 27/69 points during ECT, 5/69 during tDCS).
tDCS in combination with neuroleptic treatment could be an alternative to ECT in organic catatonia. Further studies are needed to support our hypothesis.
Joint hypermobility syndrome (JHS) has repeatedly been associated with anxiety and anxiety disorders, fibromyalgia, irritable bowel syndrome and temporomandibular joint disorder. However, the neural underpinnings of these associations still remain unclear. This study explored brain responses to facial visual stimuli with emotional cues using fMRI techniques in general population with different ranges of hypermobility.
Fifty-one non-clinical volunteers (33 women) completed state and trait anxiety questionnaire measures, were assessed with a clinical examination for hypermobility (Beighton system) and performed an emotional face processing paradigm during functional neuroimaging.
Trait anxiety scores did significantly correlate with both state anxiety and hypermobility scores. BOLD signals of the hippocampus did positively correlate with hypermobility scores for the crying faces versus neutral faces contrast in ROI analyses. No results were found for any of the other studied ROIs. Additionally, hypermobility scores were also associated with other key affective processing areas (i.e. the middle and anterior cingulate gyrus, fusiform gyrus, parahippocampal region, orbitofrontal cortex and cerebellum) in the whole brain analysis.
Hypermobility scores are associated with trait anxiety and higher brain responses to emotional faces in emotion processing brain areas (including hippocampus) described to be linked to anxiety and somatic symptoms. These findings increase our understanding of emotion processing in people bearing this heritable variant of collagen and the mechanisms through which vulnerability to anxiety and somatic symptoms arises in this population.
Depression has sleep disturbances as a key symptom and recently sleep has been suggested as a new area to optimize treatment in depression. Orexin is produced in the hypothalamus and projected throughout the brain innervating a number of structures important in depression. It controls a number of physiological processes including sleep, arousal, cognitive processes and stress, which are affected during depression.
The study examines the possible implications for abnormalities in the orexinergic system in depression. We aim to determine whether treatment targeting this system relieves depressive symptoms.
Using real-time qPCR and Western blotting optimal sampling time is determined by an assessment of the diurnal variation of orexin expression. Expression of orexin and its receptors are investigated in the hypothalamus, the hippocampus, and the prefrontal cortex of the Flinders Sensitive Line (FSL) and the Chronic Mild Stress model of depression. Behavioral and molecular response to treatment with a conventional antidepressant and an orexin receptor antagonist will be addressed in FSL rats. In addition, we will include exercise as a noninvasive treatment, which has shown positive effects on both sleep and depression in humans.
Real-time qPCR analysis showed increased expression of the orexin-1 receptor (40%) and the orexin-2 receptor (39%) in the prefrontal cortex of FSL rats compared to the control rats, the Flinders Resistant Line rats.
This study may provide a platform for screening of drugs with effects on both sleep and depressive symptoms with perspectives for the development of novel strategies for treatment of depression.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Sex differences in cognitive functioning have long been recognized in schizophrenia patients and healthy controls (HC). However, few studies have focused on patients with an at-risk mental state (ARMS) for psychosis. Thus, the aim of the present study was to investigate sex differences in neurocognitive performance in ARMS patients compared with HC.
The data analyzed in this study were collected within the multicenter European Gene–Environment Interactions study (11 centers). A total of 343 ARMS patients (158 women) and 67 HC subjects (33 women) were included. All participants completed a comprehensive neurocognitive battery. Linear mixed effects models were used to explore whether sex differences in cognitive functioning were present in the total group (main effect of sex) and whether sex differences were different for HC and ARMS (interaction between sex and group).
Women performed better in social cognition, speed of processing, and verbal learning than men regardless of whether they were ARMS or HC. However, only differences in speed of processing and verbal learning remained significant after correction for multiple testing. Additionally, ARMS patients displayed alterations in attention, current IQ, speed of processing, verbal learning, and working memory compared with HC.
Findings indicate that sex differences in cognitive functioning in ARMS are similar to those seen between healthy men and women. Thus, it appears that sex differences in cognitive performance may not be specific for ARMS, a finding resembling that in patients with schizophrenic psychoses.
Postoperative cognitive impairment is among the most common medical complications associated with surgical interventions – particularly in elderly patients. In our aging society, it is an urgent medical need to determine preoperative individual risk prediction to allow more accurate cost–benefit decisions prior to elective surgeries. So far, risk prediction is mainly based on clinical parameters. However, these parameters only give a rough estimate of the individual risk. At present, there are no molecular or neuroimaging biomarkers available to improve risk prediction and little is known about the etiology and pathophysiology of this clinical condition. In this short review, we summarize the current state of knowledge and briefly present the recently started BioCog project (Biomarker Development for Postoperative Cognitive Impairment in the Elderly), which is funded by the European Union. It is the goal of this research and development (R&D) project, which involves academic and industry partners throughout Europe, to deliver a multivariate algorithm based on clinical assessments as well as molecular and neuroimaging biomarkers to overcome the currently unsatisfying situation.
Gender differences in symptomatology in chronic schizophrenia and first episode psychosis patients have often been reported. However, little is known about gender differences in those at risk of psychotic disorders. This study investigated gender differences in symptomatology, drug use, comorbidity (i.e. substance use, affective and anxiety disorders) and global functioning in patients with an at-risk mental state (ARMS) for psychosis.
The sample consisted of 336 ARMS patients (159 women) from the prodromal work package of the EUropean network of national schizophrenia networks studying Gene-Environment Interactions (EU-GEI; 11 centers). Clinical symptoms, drug use, comorbidity and functioning were assessed at first presentation to an early detection center using structured interviews.
In unadjusted analyses, men were found to have significantly higher rates of negative symptoms and current cannabis use while women showed higher rates of general psychopathology and more often displayed comorbid affective and anxiety disorders. No gender differences were found for global functioning. The results generally did not change when corrected for possible cofounders (e.g. cannabis use). However, most differences did not withstand correction for multiple testing.
Findings indicate that gender differences in symptomatology and comorbidity in ARMS are similar to those seen in overt psychosis and in healthy controls. However, observed differences are small and would only be reliably detected in studies with high statistical power. Moreover, such small effects would likely not be clinically meaningful.
The phenomenon of buying-shopping disorder (BSD) was described over 100 years ago. Definitions of BSD refer to extreme preoccupation with shopping and buying, to impulses to purchase that are experienced as irresistible, and to recurrent maladaptive buying excesses that lead to distress and impairments. Efforts to stop BSD episodes are unsuccessful, despite the awareness of repeated break-downs in self-regulation, experiences of post-purchase guilt and regret, comorbid psychiatric disorders, reduced quality of life, familial discord, work impairment, financial problems, and other negative consequences. A recent meta-analysis indicated an estimated point prevalence of BSD of 5%. In this narrative review, the authors offer a perspective to consider BSD as a mental health condition and to classify this disorder as a behavioral addiction, based on both research data and on long-standing clinical experience.
We report on a new type of polymer electrolyte fuel cell based on a hydroxide ion conductive polymer combined with a non-noble chromium–nickel (Cr–Ni) catalyst for the oxygen reduction reaction (ORR). We study variable fractions of Cr in Ni by density functional theory simulating the thermodynamic potentials characterizing the ORR. We found increased ORR catalytic activity employing the rotating disk electrode technique. The polarization curve and power densities measured for the constructed fuel cell indicate considerable performance improvement with the Cr–Ni catalyst. Thus we expect that this kind of fuel cell may open up alternative routes in fuel cell research using non-noble catalysts.
To achieve their conservation goals individuals, communities and organizations need to acquire a diversity of skills, knowledge and information (i.e. capacity). Despite current efforts to build and maintain appropriate levels of conservation capacity, it has been recognized that there will need to be a significant scaling-up of these activities in sub-Saharan Africa. This is because of the rapid increase in the number and extent of environmental problems in the region. We present a range of socio-economic contexts relevant to four key areas of African conservation capacity building: protected area management, community engagement, effective leadership, and professional e-learning. Under these core themes, 39 specific recommendations are presented. These were derived from multi-stakeholder workshop discussions at an international conference held in Nairobi, Kenya, in 2015. At the meeting 185 delegates (practitioners, scientists, community groups and government agencies) represented 105 organizations from 24 African nations and eight non-African nations. The 39 recommendations constituted six broad types of suggested action: (1) the development of new methods, (2) the provision of capacity building resources (e.g. information or data), (3) the communication of ideas or examples of successful initiatives, (4) the implementation of new research or gap analyses, (5) the establishment of new structures within and between organizations, and (6) the development of new partnerships. A number of cross-cutting issues also emerged from the discussions: the need for a greater sense of urgency in developing capacity building activities; the need to develop novel capacity building methodologies; and the need to move away from one-size-fits-all approaches.
On Perspectives. Mathematical logic arose from a concern with the nature and the limits of rational or mathematical thought, and from a desire to systematise the modes of its expression. The pioneering investigations were diverse and largely autonomous. As time passed, and more particularly in the last two decades, interconnections between different lines of research and links with other branches of mathematics proliferated. The subject is now both rich and varied. It is the aim of the series to provide, as it were, maps or guides to this complex terrain. We shall not aim at encyclopaedic coverage; nor do we wish to prescribe, like Euclid, a definitive version of the elements of the subject. We are not committed to any particular philosophical programme. Nevertheless we have tried by critical discussion to ensure that each book represents a coherent line of thought; and that, by developing certain themes, it will be of greater interest than a mere assemblage of results and techniques.
The books in the series differ in level: some are introductory some highly specialised. They also differ in scope: some offer a wide view of an area, others present a single line of thought. Each book is, at its own level, reasonably self contained. Although no book depends on another as prerequisite, we have encouraged authors to fit their book in with other planned volumes, sometimes deliberately seeking coverage of the same material from different points of view. We have tried to attain a reasonable degree of uniformity of notation and arrangement. However, the books in the series are written by individual authors, not by the group. Plans for books are discussed and argued about at length. Later, encouragement is given and revisions suggested. But it is the authors who do the work; if as we hope, the series proves of value, the credit will be theirs.
History of the Ω-Group. During 1968 the idea of an integrated series of monographs on mathematical logic was first mooted. Various discussions led to a meeting at Oberwolfach in the spring of 1969. Here the founding members of the group (R. O. Gandy, A. Levy, G. H. Muller, G. E. Sacks, D. S. Scott) discussed the project in earnest and decided to go ahead with it. Professor F. K. Schmidt and Professor Hans Hermes gave us encouragement and support.
A combined theoretical and experimental investigation was carried out with the objective of evaluating theoretical predictions relating to a two-dimensional airfoil subjected to high amplitude harmonic oscillation of the free stream at constant angle of attack. Current theoretical approaches were reviewed and extended for the purposes of quantifying the bound, unsteady vortex sheet strength along the airfoil chord. This resulted in a closed form solution that is valid for arbitrary reduced frequencies and amplitudes. In the experiments, the bound, unsteady vortex strength of a symmetric 18 % thick airfoil at low angles of attack was measured in a dedicated unsteady wind tunnel at maximum reduced frequencies of 0.1 and at velocity oscillations less than or equal to 50 %. With the boundary layer tripped near the leading edge and mid-chord, the phase and amplitude variations of the lift coefficient corresponded reasonably well with the theory. Near the maximum lift coefficient overshoot, the data exhibited an additional high-frequency oscillation. Comparisons of the measured and predicted vortex sheet indicated the existence of a recirculation bubble upstream of the trailing edge which sheds into the wake and modifies the Kutta condition. Without boundary layer tripping, a mid-chord bubble is present that strengthens during flow deceleration and its shedding produces a dramatically different effect. Instead of a lift coefficient overshoot, as per the theory, the data exhibit a significant undershoot. This undershoot is also accompanied by high-frequency oscillations that are characterized by the bubble shedding. In summary, the location of bubble and its subsequent shedding play decisive roles in the resulting temporal aerodynamic loads.