Time-of-night variations in the story-like organization of dream experience developed during rapid eye movement sleep.

This study aimed to investigate the cycles (2nd/4th) and duration-related (5/10 min) variations in the story-like organization of dream experience elaborated during rapid eye movement (REM) sleep. Dream reports were analysed using story grammar rules. Reports were provided by those subjects (14 of 22) capable of reporting a dream after each of the four awakenings provoked in 2 consecutive nights during REM sleep of the 2nd and 4th cycles, after periods of either 5 or 10 min, counterbalanced across the nights. Two researchers who were blind as to the sleep condition scored the dream reports independently. The values of the indicators of report length (measured as value of total word count) and of story-like organization of dream reports were matched taking time-of-night (2nd and 4th cycles) and REM duration (5 versus 10 min) as factors. Two-way analyses of variance showed that report length increased significantly in 4th-cycle REM sleep and nearly significantly for longer REM duration, whereas the number of dream-stories per report did not vary. The indices of sequential (number of statements describing the event structure developed in the story) and hierarchical (number of episodes per story) organization increased significantly only in dream-stories reported after 10 min of 4th-cycle REM sleep. These findings indicate that the characteristics of structural organization of dream-stories vary along with time of night, and suggest that the elaboration of a long and complex dream-story requires a fairly long time and the availability of a great amount of cognitive resources to maintain its continuity and coherence.

Moderating effects of empathic concern and personal distress on the emotional reactions of disaster volunteers.

This study examines stress and mood outcomes in community volunteers who undertook one week's worth of post-disaster relief work in L'Aquila, Italy, which had been hit by an earthquake four months earlier. The study team obtained pre- and post-relief work data from 130 volunteers involved in activities such as preparing food for the displaced, cleaning the camps and distributing clean linen. The Perceived Stress Scale, the State-Trait Anxiety Inventory and the Profile of Mood States were administered at the start and at the end of the aid activities. Psychopathological symptoms and empathy were assessed in the beginning, using the Symptom Checklist 90 Revised and the Interpersonal Reactivity Index, respectively. The results show that, following the assistance work, volunteers displayed decreases in perceived stress, general distress, anxiety and anger, as well as increases in positive emotions. The empathy facets empathic concern and personal distress showed different patterns in modulating the post-disaster relief work adaptation for some of the mood outcomes.

Italian guidelines for primary headaches: 2012 revised version.

The first edition of the Italian diagnostic and therapeutic guidelines for primary headaches in adults was published in J Headache Pain 2(Suppl. 1):105-190 (2001). Ten years later, the guideline committee of the Italian Society for the Study of Headaches (SISC) decided it was time to update therapeutic guidelines. A literature search was carried out on Medline database, and all articles on primary headache treatments in English, German, French and Italian published from February 2001 to December 2011 were taken into account. Only randomized controlled trials (RCT) and meta-analyses were analysed for each drug. If RCT were lacking, open studies and case series were also examined. According to the previous edition, four levels of recommendation were defined on the basis of levels of evidence, scientific strength of evidence and clinical effectiveness. Recommendations for symptomatic and prophylactic treatment of migraine and cluster headache were therefore revised with respect to previous 2001 guidelines and a section was dedicated to non-pharmacological treatment. This article reports a summary of the revised version published in extenso in an Italian version.

Distinct neural systems involved in agency and animacy detection.

We designed an fMRI experiment comparing perception of human faces and robotic faces producing emotional expressions. The purpose of our experiment was to investigate engagement of different parts of the social brain by viewing these animate and inanimate agents. Both human and robotic face expressions evoked activity in face-responsive regions in the fusiform gyrus and STS and in the putative human mirror neuron system. These results suggest that these areas mediate perception of agency, independently of whether the agents are living or not. By contrast, the human faces evoked stronger activity than did robotic faces in the medial pFC and the anterior temporal cortex--areas associated with the representation of others' mental states (theory of mind), whereas robotic faces evoked stronger activity in areas associated with perception of objects and mechanical movements. Our data demonstrate that the representation of the distinction between animate and inanimate agents involves areas that participate in attribution of mental stance.

Do we really need vision? How blind people "see" the actions of others.

Observing and learning actions and behaviors from others, a mechanism crucial for survival and social interaction, engages the mirror neuron system. To determine whether vision is a necessary prerequisite for the human mirror system to develop and function, we used functional magnetic resonance imaging to compare brain activity in congenitally blind individuals during the auditory presentation of hand-executed actions or environmental sounds, and the motor pantomime of manipulation tasks, with that in sighted volunteers, who additionally performed a visual action recognition task. Congenitally blind individuals activated a premotor-temporoparietal cortical network in response to aurally presented actions that overlapped both with mirror system areas found in sighted subjects in response to visually and aurally presented stimuli, and with the brain response elicited by motor pantomime of the same actions. Furthermore, the mirror system cortex showed a significantly greater response to motor familiar than to unfamiliar action sounds in both sighted and blind individuals. Thus, the mirror system in humans can develop in the absence of sight. The results in blind individuals demonstrate that the sound of an action engages the mirror system for action schemas that have not been learned through the visual modality and that this activity is not mediated by visual imagery. These findings indicate that the mirror system is based on supramodal sensory representations of actions and, furthermore, that these abstract representations allow individuals with no visual experience to interact effectively with others.

The effect of visual experience on the development of functional architecture in hMT+.

We investigated whether the visual hMT+ cortex plays a role in supramodal representation of sensory flow, not mediated by visual mental imagery. We used functional magnetic resonance imaging to measure neural activity in sighted and congenitally blind individuals during passive perception of optic and tactile flows. Visual motion-responsive cortex, including hMT+, was identified in the lateral occipital and inferior temporal cortices of the sighted subjects by response to optic flow. Tactile flow perception in sighted subjects activated the more anterior part of these cortical regions but deactivated the more posterior part. By contrast, perception of tactile flow in blind subjects activated the full extent, including the more posterior part. These results demonstrate that activation of hMT+ and surrounding cortex by tactile flow is not mediated by visual mental imagery and that the functional organization of hMT+ can develop to subserve tactile flow perception in the absence of any visual experience. Moreover, visual experience leads to a segregation of the motion-responsive occipitotemporal cortex into an anterior subregion involved in the representation of both optic and tactile flows and a posterior subregion that processes optic flow only.

Mental activity after early afternoon nap awakenings in healthy subjects.

Despite the common misconception that rapid eye movement (REM) sleep is a unique correlate of dreaming, reports of mental activity can be elicited after awakenings from any stage of nocturnal sleep. We extended the investigation to naps and tried to explore the relationship between recall length and level of sleep stage and depth preceding the awakening. We hypothesized that dream report length would be related to arousal level. In 10 healthy young adults, sleep EEG and EOG were recorded for four non-consecutive early afternoon naps. Dream recalls were recorded following 10 s, 1 min, and 6 min of NREM Stage 2 and after 5 min of first REM period. We measured mental recall with total word count (TWC) method, sleep stages by using EEG visual scoring and Delta and Beta activity by period amplitude (PAA) and power spectral (PSA) analyses. All awakening conditions were followed by a dream report. TWC was significantly greater after REM than after 10 s and 1 min of NREM, and TWC did not differ among the NREM awakenings. Delta activity after REM was significantly lower compared to the NREM 6 and 1 min while Beta activity did not differ across the conditions. Assuming that arousal level decreased with increased NREM duration and increasing Delta EEG activity, the constant TWC across the three NREM awakenings indicates that arousal level cannot be the only factor affecting dream report length. Some other factor such as memory processing may explain the longer dream reports following REM sleep, or it may be that the EEG is an imperfect indicator of arousal level.

How the brain heals emotional wounds: the functional neuroanatomy of forgiveness.

IN LIFE, EVERYONE GOES THROUGH HURTFUL EVENTS CAUSED BY SIGNIFICANT OTHERS: a deceiving friend, a betraying partner, or an unjustly blaming parent. In response to painful emotions, individuals may react with anger, hostility, and the desire for revenge. As an alternative, they may decide to forgive the wrongdoer and relinquish resentment. In the present study, we examined the brain correlates of forgiveness using functional Magnetic Resonance Imaging (fMRI). Healthy participants were induced to imagine social scenarios that described emotionally hurtful events followed by the indication to either forgive the imagined offenders, or harbor a grudge toward them. Subjects rated their imaginative skills, levels of anger, frustration, and/or relief when imagining negative events as well as following forgiveness. Forgiveness was associated with positive emotional states as compared to unforgiveness. Granting forgiveness was associated with activations in a brain network involved in theory of mind, empathy, and the regulation of affect through cognition, which comprised the precuneus, right inferior parietal regions, and the dorsolateral prefrontal cortex. Our results uncovered the neuronal basis of reappraisal-driven forgiveness, and extend extant data on emotional regulation to the resolution of anger and resentment following negative interpersonal events.

Is Social Phobia a "Mis-Communication" Disorder? Brain Functional Connectivity during Face Perception Differs between Patients with Social Phobia and Healthy Control Subjects.

Recently, a differential recruitment of brain areas throughout the distributed neural system for face perception has been found in social phobic patients as compared to healthy control subjects. These functional abnormalities in social phobic patients extend beyond emotion-related brain areas, such as the amygdala, to include cortical networks that modulate attention and process other facial features, and they are also associated with an alteration of the task-related activation/deactivation trade-off. Functional connectivity is becoming a powerful tool to examine how components of large-scale distributed neural systems are coupled together while performing a specific function. This study was designed to determine whether functional connectivity networks among brain regions within the distributed system for face perception also would differ between social phobic patients and healthy controls. Data were obtained from eight social phobic patients and seven healthy controls by using functional magnetic resonance imaging. Our findings indicated that social phobic patients and healthy controls have different patterns of functional connectivity across brain regions within both the core and the extended systems for face perception and the default mode network. To our knowledge, this is the first study that shows that functional connectivity during brain response to socially relevant stimuli differs between social phobic patients and healthy controls. These results expand our previous findings and indicate that brain functional changes in social phobic patients are not restricted to a single specific brain structure, but rather involve a mis-communication among different sensory and emotional processing brain areas.

Beyond amygdala: Default Mode Network activity differs between patients with social phobia and healthy controls.

The Default Mode Network (DMN) is a constellation of brain areas that decrease their activity during a wide number of different goal-oriented tasks as compared to passive "rest" tasks. DMN can be modulated by different factors such as emotional states, cognitive load of the task and psychopathology, including anxiety. Moreover, DMN seems to play a pivotal role in social cognition. For example, the ability to predict another person's behaviour taking his or her perspective modulates the activity of the DMN. Recent data from autistic patients support a role of DMN in social cognition as well. Social Phobia (SP) is an anxiety disorder characterized by an abnormal distress in situations that require social interaction. To date, no study has assessed DMN in Social Phobia. To determine potential differences in DMN activity between Social Phobia patients (SPP) and healthy control (HC) subjects we examined functional magnetic resonance imaging (fMRI) data obtained during a face perception study with emotional and neutral stimuli. As compared to HC, SPP showed a lower deactivation in the precuneus and posterior cingulate regions (PCun/PCC) during task conditions. These regions are part of the so-called "Theory of Mind" circuit and in particular they are involved in the evaluation of one's own emotional state. Because of the role of the PCun/PCC in self-state perception and attribution and, more in general, the role of the DMN in social cognition, we suggest that its impairment in the DMN network in SPP might be relevant in the development of the feeling of wariness of others' judgment and may be related to the so-called self-focused attention. Self-focused attention is the awareness of self-referent information, and is present in many emotional disorders and may additionally prevent individuals from observing external information that could disconfirm their own fears. Moreover, the abnormal modulation of activity in the DMN may reflect persistent rumination or anxiety-related thoughts that are not modulated by the switch from rest to task.

Differential modulation of neural activity throughout the distributed neural system for face perception in patients with Social Phobia and healthy subjects.

Social Phobia (SP) is a marked and persistent fear of social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. Faces of others are perceived as threatening by social phobic patients (SPP). To investigate how face processing is altered in the distributed neural system for face perception in Social Phobia, we designed an event-related fMRI study in which Healthy Controls (HC) and SPP were presented with angry, fearful, disgusted, happy and neutral faces and scrambled pictures (visual baseline). As compared to HC, SPP showed increased neural activity not only in regions involved in emotional processing including left amygdala and insula, as expected from previous reports, but also in the bilateral superior temporal sulcus (STS), a part of the core system for face perception that is involved in the evaluation of expression and personal traits. In addition SPP showed a significantly weaker activation in the left fusiform gyrus, left dorsolateral prefrontal cortex, and bilateral intraparietal sulcus as compared to HC. These effects were found not only in response to emotional faces but also to neutral faces as compared to scrambled pictures. Thus, SPP showed enhanced activity in brain areas related to processing of information about emotional expression and personality traits. In contrast, brain activity was decreased in areas for attention and for processing other information from the face, perhaps as a result of a feeling of wariness. These results indicate a differential modulation of neural activity throughout the different parts of the distributed neural system for face perception in SPP as compared to HC.

A follow up study on the efficacy of metadoxine in the treatment of alcohol dependence.

BACKGROUND: We carried out a three months follow-up study on the efficacy of metadoxine in a cohort of alcoholics admitted to the Alcohol misuse Long-term Treatment (ALT) Unit-University of Pisa (Italy). We analyzed the clinical data, psychometric tests and blood tests of 160 alcoholics on admission and after 3 months of treatment. We compared 58 pts treated with metadoxine (MET) with 102 pts who did not receive (NULL) any drug as an adjunct to the psycho-educational interventions provided by the ALT Unit. RESULTS: At follow-up, the patients in treatment with metadoxine showed a significant improvement in the rate of complete abstinence (44.8% vs. 21.6%; chi square: 8.45, df = 1, p < 0.0037). Furthermore, the number of drop-outs at three months of treatment was also significantly lower in the MET than in the NULL group (17% vs. 57%; chi square of 23.22, df = 1, p < 0.001). CONCLUSION: Our findings support the use of metadoxine in the management of alcohol dependence. However, randomized clinical trials are necessary to confirm and replicate them. This study raises the importance of identifying new pharmacological compounds effective on the outcome of alcoholism in order to help patients to best adhere to treatment programs and to prevent the development of mental and physical complications due to chronic and heavy use of alcohol.

Combination of event-related potentials and functional magnetic resonance imaging during single-letter reading.

This work proposes a mathematical approach for combining event-related potentials (ERPs) and functional magnetic resonance images (fMRI). Data were separately recorded during the same event-related experimental design, consisting of visually presented single letters and non-alphabetic symbols, that had to be either simply observed (passive condition) or read aloud (active condition). This protocol was useful for exploring the neural correlates of reading processes. Healthy adults participated in the experiment. Averaged ERPs were decomposed by independent component analysis; low resolution electromagnetic tomography (LORETA) was applied to estimate the current density distribution maps of each independent component. fMRI images time series were analyzed by multiple linear regression. ERP-fMRI correspondence was quantified by computing the Euclidean distance between LORETA local maxima and clusters of significantly activated fMRI voxels. During reading aloud of letters, that is clearly the task most similar to natural reading conditions, significant electrical and hemodynamic response was observed in the left medial frontal gyrus (BA 6) and left middle temporal gyrus (BA 22/39) just before articulation and in the bilateral middle superior temporal gyrus (BA 22/37) during and after verbal-motor production. These results indicate that the middle-superior temporal gyrus plays a crucial and multifunctional role in grapheme-phoneme matching.

Psychiatric comorbidity and chronicisation in primary headache.

The frequent association between primary headaches and psychiatric disorders is consistently reported in the literature. There is increasing evidence that a bi-directional relationship links these somatic conditions to psychopathological events. Prospective studies show that several psychiatric disorders are severe risk factors for both the onset and chronicisation of primary headache, and for a long time it has been suspected that headache triggers psychiatric disorders, mostly of affective nature, and affects both their course and outcome. Researchers are actively involved in investigating the biological basis of such a relationship while clinicians still need to strengthen their interest in psychiatric comorbidity of their primary headache patients to improve clinical outcome and to prevent chronic evolutions.

Tertiary treatment for psychiatric comorbidity in headache patients.

The presence of significant and confounding psychiatric comorbidity is greater in patients attending headache clinics than in headache patients from the general population. The frequent comorbidity of headache with generalized anxiety disorder can take advantage of the administration of benzodiazepines. With regard to depression-related headache, it's wellknown that the antidepressive drugs can improve migraine as well as tension-type headache. Antiepileptic drugs give one more good opportunity. The recognition of a psychiatric comorbidity is mandatory for an accurate management of the patient because prevents the clinicians from using any drug that might be dangerous for a mysdiagnosed psychiatric disturbance and often permits to administer medications that can efficaciously control both headache and psychiatric disorders.

Beyond sensory images: Object-based representation in the human ventral pathway.

We investigated whether the topographically organized, category-related patterns of neural response in the ventral visual pathway are a representation of sensory images or a more abstract representation of object form that is not dependent on sensory modality. We used functional MRI to measure patterns of response evoked during visual and tactile recognition of faces and manmade objects in sighted subjects and during tactile recognition in blind subjects. Results showed that visual and tactile recognition evoked category-related patterns of response in a ventral extrastriate visual area in the inferior temporal gyrus that were correlated across modality for manmade objects. Blind subjects also demonstrated category-related patterns of response in this "visual" area, and in more ventral cortical regions in the fusiform gyrus, indicating that these patterns are not due to visual imagery and, furthermore, that visual experience is not necessary for category-related representations to develop in these cortices. These results demonstrate that the representation of objects in the ventral visual pathway is not simply a representation of visual images but, rather, is a representation of more abstract features of object form.