Comparing Methods of Seizure Response Monitoring During Electroconvulsive Therapy: Comparer les méthodes de surveillance des interventions en cas de crise durant la thérapie par électrochocs.

OBJECTIVE: Electroconvulsive therapy (ECT) is used to treat several mental illnesses. Seizure duration is used to determine if the administered stimulus was adequate. Duration is estimated by electroencephalogram (EEG) interpretation and/or observed motor response (OMR). Neither method is considered the gold standard. This study investigated the relationship between the 2 methods. The hypothesis was that both EEG and OMR would be significantly positively correlated. Previous researchers have suggested that the 2 methods resulted in different estimates. METHODS: A case series was conducted using recorded estimates obtained prospectively from 102 ECTs on adult psychiatric inpatients. RESULTS: A strong positive association was not observed in this study, correlation coefficient 0.510 (p < 0.001). CONCLUSIONS: This study suggests that the 2 methods differ, and further research is needed to determine the best indicator of adequate treatment.

Exploring resting frontal EEG and reflective functioning in maternal substance use.

Maternal substance use is associated with altered neural activity and poor offspring outcomes, which may be facilitated by suboptimal caregiving in the form of impaired parental reflective functioning (PRF). To investigate these associations, the resting-state frontal electroencephalography (EEG) power of 48 substance-using mothers and 37 non-substance-using mothers were examined, specifying seven frequency bands: delta, theta, alpha, alpha1, alpha2, beta, and gamma. Substance-using mothers exhibited enhanced beta and gamma spectral power compared to non-substance-using mothers, potentially reflecting higher arousal states in substance-using mothers. There were no between-group differences in any component of PRF (i.e., levels of pre-mentalizing, certainty, and interest and curiosity). Whole-sample analyses revealed significant positive correlations between pre-mentalizing and delta spectral power. Taken together, these findings suggest potential neural correlates of maternal substance use and PRF, providing an important next step into examining associations between maternal substance use and poor child outcomes.

Se asocia el uso materno de sustancias con la actividad neural alterada y el débil resultado en los hijos, lo cual pudiera ser favorecido por una prestación de cuidado subóptima en forma de un impedido funcionamiento con reflexión (PRF) en el progenitor. Para investigar estas asociaciones, se examinó la fuerza de la electroencefalografía frontal en estado de descanso de 48 madres que usaban sustancia y 37 madres que no usaban sustancias, especificando siete bandas de frecuencia: delta, theta, alpha, alpha 1, alpha 2, beta y gamma. Las madres que usaban sustancias mostraron una fuerza espectral aumentada en beta y gamma, tal como se les comparó con las madres que no usaban sustancias, lo que potencialmente refleja estados más altos de agitación en las madres que usaban sustancias. No se dieron diferencias entre grupos en ninguno de los componentes de PRF (v.g. niveles de pre-mentalización, opacidad e interés y curiosidad). Los análisis de todas las muestras revelaron correlaciones positivas significativas entre pre-mentalización y la fuerza espectral delta. Tomándolos en conjunto, estos resultados indican posibles correlaciones neurales entre del uso materno de sustancias y PRF, lo cual aporta un importante próximo paso para examinar las asociaciones entre el uso materno de sustancias y los débiles resultados en el niño.

La toxicomanie maternelle est liée à une activité neuronale altérée et de mauvais résultats sur les enfants de la personne, ce qui peut être facilité par un mode de soin suboptimal sous la forme d'un fonctionnement de réflexion parentale (PRF en anglais) altéré. Pour enquêter sur ces liens, l'électroencéphalographie frontale au repos (EEG) de 48 mères toxicomanes et de 37 mères non-toxicomanes a été examiné, plus spécifiquement sur quatre bandes de fréquences : delta, thêta, alpha, alpha1, alpha2, béta, et gamma. Les mères toxicomanes ont fait preuve d'une puissance spectrale de béta et gamma importante comparées aux mères non-toxicomanes, ce qui reflète peut-être de plus d' états d'excitation chez les mères toxicomanes. Nous n'avons observé aucune différence entre les groupes pour ce qui concerne les composantes de la PRF (soit, niveaux de pré-mentalisation, d'opacité, d'intérêt et de curiosité). Des analyses sur tout l'échantillon ont révélé des corrélations positives importantes entre la puissance spectrale de pré-mentalisation et la puissance spectrale delta. Considérés dans l'ensemble, ces résultats suggèrent un corrélat neural potentiel de la toxicomanie maternelle et de la PRF, ce qui présente une nouvelle étape importante dans l'examen des liens entre la toxicomanie maternelle et les mauvais résultats sur l'enfant.

[Social psychiatry and neurobiology : A long overdue convergence exemplified by schizophrenia]. / Sozialpsychiatrie und Neurobiologie : Eine längst fällige Annäherung am Beispiel der Schizophrenie.

BACKGROUND: The proliferation of biological psychiatry has greatly increased over the last two decades. With the possibility to carry out brain research using modern technical methods, it seemed that social influencing factors would lose importance in the development of mental diseases; however, in actual fact this does not seem to be justified. It is necessary to overcome this separation, in that social factors are incorporated into a conceptual framework in the development of mental diseases, which simultaneously also takes the results of current neurobiological research into consideration. OBJECTIVES AND METHODS: The aims of this review article are to summarize the current state of sociopsychiatric research and to emphasize the perspectives of the biological principles and their validity with respect to the social dimensions of psychiatry, as exemplified by schizophrenic disorders. The article presents the options for a biosocial approach in social psychiatry and gives an overview of the currently available literature. RESULTS AND CONCLUSION: There is an abundance of neurobiological research approaches, which are closely associated with sociopsychiatric topics, such as social cognition. Social psychiatry and biological psychiatry should no longer be considered as diametrically opposed subdisciplines. On the contrary, the options which could emerge from a synthesis must be used in research and clinical practice.

Neurofeedback: One of today's techniques in psychiatry?

OBJECTIVES: Neurofeedback is a technique that aims to teach a subject to regulate a brain parameter measured by a technical interface to modulate his/her related brain and cognitive activities. However, the use of neurofeedback as a therapeutic tool for psychiatric disorders remains controversial. The aim of this review is to summarize and to comment the level of evidence of electroencephalogram (EEG) neurofeedback and real-time functional magnetic resonance imaging (fMRI) neurofeedback for therapeutic application in psychiatry. METHOD: Literature on neurofeedback and mental disorders but also on brain computer interfaces (BCI) used in the field of neurocognitive science has been considered by the group of expert of the Neurofeedback evaluation & training (NExT) section of the French Association of biological psychiatry and neuropsychopharmacology (AFPBN). RESULTS: Results show a potential efficacy of EEG-neurofeedback in the treatment of attentional-deficit/hyperactivity disorder (ADHD) in children, even if this is still debated. For other mental disorders, there is too limited research to warrant the use of EEG-neurofeedback in clinical practice. Regarding fMRI neurofeedback, the level of evidence remains too weak, for now, to justify clinical use. The literature review highlights various unclear points, such as indications (psychiatric disorders, pathophysiologic rationale), protocols (brain signals targeted, learning characteristics) and techniques (EEG, fMRI, signal processing). CONCLUSION: The field of neurofeedback involves psychiatrists, neurophysiologists and researchers in the field of brain computer interfaces. Future studies should determine the criteria for optimizing neurofeedback sessions. A better understanding of the learning processes underpinning neurofeedback could be a key element to develop the use of this technique in clinical practice.

[EEG technician-nurse collaboration during stereo-electroencephalography]. / Les collaborations infirmière-technicien EEG lors de la stéréo-électroencéphalographie.

Drug-resistant epilepsy has significant repercussions on the daily life of children. Surgery may represent a hope. The nurse and the electroencephalogram technician carry out important teamwork during pre-surgical assessment tests and notably the stereo-electroencephalography.

[Electroconvulsive therapy and level of evidence: From causality to dose-effect relationship]. / Électroconvulsivothérapie et niveau de preuve : de la causalité à la relation dose-effet.

OBJECTIVES: The first objective of this article is to summarize the history of electroconvulsive therapy (ECT) in psychiatry in order to highlight the transition from clinical level of evidence based on phenomenological descriptions to controlled trial establishing causal relationship. The second objective is to apply the criteria of causation for ECT, to focus on the dose-effect relationship criteria, and thus to analyze the conditions of application of these criteria for ECT. METHODS: A literature review exploring the use of electricity, ECT and electroencephalography (EEG) in psychiatry was conducted. The publications were identified from the Pubmed and GoogleScholar electronic databases. The scientific literature search of international articles was performed in July 2016. RESULTS: In 1784, a Royal commission established in France by King Louis XVI tested Mesmer's claims concerning animal magnetism. By doing that, the commission, including such prominent scientists as the chemist Anton Lavoisier and the scientist and researcher on electricity and therapeutics Benjamin Franklin, played a central role in establishing the criteria needed to assess the level of evidence of electrical therapeutics in psychiatry. Surprisingly, it is possible to identify the classical Bradford Hill criteria of causation in the report of the commission, except the dose-effect relationship criteria. Since then, it has been conducted blinded randomized controlled trials that confirmed the effectiveness of ECT against ECT placebos for the treatment of psychiatric disorders. At present, the dose-effect relationship criteria can be analyzed through an EEG quality assessment of ECT-induced seizures. CONCLUSIONS: EEG quality assessment includes several indices: TSLOW (time to onset of seizure activity ≤5Hz, seconds), peak mid-ictal amplitude (mm), regularity (intensity or morphology of the seizure (0-6)), stereotypy (global seizure patterning, 0-3) and post-ictal suppression (0-3). A manual rating sheet is needed to score theses indices. Such manual rating with example of EEG segments recording is proposed in this article. Additional studies are needed to validate this manual, to better establish the dose-response relationship for the ECT, and thus strengthen the position of the EEG as a central element for clinical good practice for ECT.

[Negative symptoms of schizophrenia: from electrophysiology to electrotherapy]. / Symptômes négatifs de la schizophrénie: de l'électrophysiologie à l'électrothérapie.

The aim of this review of the literature is to summarize the state of the knowledge concerning the relationship between negative symptoms in schizophrenia, electrophysiology and electrotherapy. The scientific literature search of international articles was performed during August and September 2015 using the PubMed electronic database. We used the following MeSH terms: "Negative symptoms", "Schizophrenia", "Electrophysiology", "Neurophysiology", "EEG power", "Alpha rhythm", "Transcranial magnetic stimulation", "Transcranial direct current stimulation", "Electroconvulsive therapy", "Neurofeedback", "Vagus Nerve Stimulation", "Deep Brain Stimulation", and "State dependent". Negative symptoms in schizophrenia are associated with altered activity in prefrontal cortex in functional neuroimaging studies. This is in line with electrophysiological measurements that found a change in EEG spectral power in the alpha frequency band over prefrontal brain regions. The notion of functional hypofrontality has led to hypotheses that electrotherapy applied to the prefrontal cortex may be an effective treatment of negative symptoms in schizophrenia. Repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) were used to increase cortical activity in schizophrenia and achieve a clinical effect on negative symptoms. Three meta-analyses confirmed, with a moderate effect size, that rTMS is an effective treatment option for negative symptoms in schizophrenia. The two subsequently published prospective multicenter studies, however, found opposite results from each other. Two randomized controlled studies suggested that tDCS is an effective treatment option for negative symptoms. There is no study on the efficacy of neurofeedback, vagal nerve stimulation or deep brain stimulation on negative symptoms in schizophrenia. Additional studies are needed to confirm the efficacy of rTMS and tDCS on negative symptoms in schizophrenia. Influencing factors, related to clinical and stimulation parameters, of rTMS and tDCS on negative symptoms should be better investigated. Effects related to electrophysiological brain activity of the patient, especially in the alpha band, during the stimulation should also be better investigated. The action of electrotherapy may be state dependent, and a better understanding of electrophysiological effects of electrotherapy techniques could enable their optimization.

Cognitive impairment in obstructive sleep apnea.

Obstructive sleep apnea (OSA) is characterised by repetitive cessation or reduction of airflow due to upper airway obstructions. These respiratory events lead to chronic sleep fragmentation and intermittent hypoxemia. Several studies have shown that OSA is associated with daytime sleepiness and cognitive dysfunctions, characterized by impairments of attention, episodic memory, working memory, and executive functions. This paper reviews the cognitive profile of adults with OSA and discusses the relative role of altered sleep and hypoxemia in the aetiology of these cognitive deficits. Markers of cognitive dysfunctions such as those measured with waking electroencephalography and neuroimaging are also presented. The effects of continuous positive airway pressure (CPAP) on cognitive functioning and the possibility of permanent brain damage associated with OSA are also discussed. Finally, this paper reviews the evidence suggesting that OSA is a risk factor for developing mild cognitive impairment and dementia in the aging population and stresses the importance of its early diagnosis and treatment.

[Mixed depressions: clinical and neurophysiological biomarkers]. / Épisodes dépressifs mixtes : clinique et biomarqueurs neurophysiologiques.

Epidemiological studies of major depressive episodes (MDE) highlighted the frequent association of symptoms or signs of mania or hypomania with depressive syndrome. Beyond the strict definition of DSM-IV, epidemiological recognition of a subset of MDE characterized by the presence of symptoms or signs of the opposite polarity is clinically important because it is associated with pejorative prognosis and therapeutic response compared to the subgroup of "typical MDE". The development of DSM-5 took into account the epidemiological data. DSM-5 opted for a more dimensional perspective in implementing the concept of "mixed features" from an "episode" to a "specification" of mood disorder. As outlined in the DSM-5: "Mixed features associated with a major depressive episode have been found to be a significant risk factor for the development of bipolar I and II disorder. As a result, it is clinically useful to note the presence of this specifier for treatment planning and monitoring of response to therapeutic". However, the mixed features are sometimes difficult to identify, and neurophysiological biomarkers would be useful to make a more specific diagnosis. Two neurophysiological models make it possible to better understand MDE with mixed features : i) the emotional regulation model that highlights a tendency to hyper-reactive and unstable emotion response, and ii) the vigilance regulation model that highlights, through EEG recording, a tendency to unstable vigilance. Further research is required to better understand relationships between these two models. These models provide the opportunity of a neurophysiological framework to better understand the mixed features associated with MDE and to identify potential neurophysiological biomarkers to guide therapeutic strategies.

The Irreducibility of Vision: Gestalt, Crowding and the Fundamentals of Vision.

What is fundamental in vision has been discussed for millennia. For philosophical realists and the physiological approach to vision, the objects of the outer world are truly given, and failures to perceive objects properly, such as in illusions, are just sporadic misperceptions. The goal is to replace the subjectivity of the mind by careful physiological analyses. Continental philosophy and the Gestaltists are rather skeptical or ignorant about external objects. The percepts themselves are their starting point, because it is hard to deny the truth of one own's percepts. I will show that, whereas both approaches can well explain many visual phenomena with classic visual stimuli, they both have trouble when stimuli become slightly more complex. I suggest that these failures have a deeper conceptual reason, namely that their foundations (objects, percepts) do not hold true. I propose that only physical states exist in a mind independent manner and that everyday objects, such as bottles and trees, are perceived in a mind-dependent way. The fundamental processing units to process objects are extended windows of unconscious processing, followed by short, discrete conscious percepts.