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1.
Nat Med ; 30(2): 373-381, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38182784

RESUMO

Traumatic brain injury (TBI) is a leading cause of disability. Sequelae can include functional impairments and psychiatric syndromes such as post-traumatic stress disorder (PTSD), depression and anxiety. Special Operations Forces (SOF) veterans (SOVs) may be at an elevated risk for these complications, leading some to seek underexplored treatment alternatives such as the oneirogen ibogaine, a plant-derived compound known to interact with multiple neurotransmitter systems that has been studied primarily as a treatment for substance use disorders. Ibogaine has been associated with instances of fatal cardiac arrhythmia, but coadministration of magnesium may mitigate this concern. In the present study, we report a prospective observational study of the Magnesium-Ibogaine: the Stanford Traumatic Injury to the CNS protocol (MISTIC), provided together with complementary treatment modalities, in 30 male SOVs with predominantly mild TBI. We assessed changes in the World Health Organization Disability Assessment Schedule from baseline to immediately (primary outcome) and 1 month (secondary outcome) after treatment. Additional secondary outcomes included changes in PTSD (Clinician-Administered PTSD Scale for DSM-5), depression (Montgomery-Åsberg Depression Rating Scale) and anxiety (Hamilton Anxiety Rating Scale). MISTIC resulted in significant improvements in functioning both immediately (Pcorrected < 0.001, Cohen's d = 0.74) and 1 month (Pcorrected < 0.001, d = 2.20) after treatment and in PTSD (Pcorrected < 0.001, d = 2.54), depression (Pcorrected < 0.001, d = 2.80) and anxiety (Pcorrected < 0.001, d = 2.13) at 1 month after treatment. There were no unexpected or serious adverse events. Controlled clinical trials to assess safety and efficacy are needed to validate these initial open-label findings. ClinicalTrials.gov registration: NCT04313712 .


Assuntos
Lesões Encefálicas Traumáticas , Ibogaína , Veteranos , Humanos , Veteranos/psicologia , Magnésio/uso terapêutico , Resultado do Tratamento , Lesões Encefálicas Traumáticas/tratamento farmacológico
2.
Neuropsychopharmacology ; 40(4): 849-60, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25292261

RESUMO

Hypothalamus communication with the rest of the brain and peripheral target tissues is critically important for many physiological and psychological functions. These functions include maintaining neuroendocrine circadian rhythms and managing affective processes. The hypothalamus maintains both direct neural connections within the brain and it also controls a variety of neuroendocrine processes that can influence target tissues throughout the body. Dysregulation of the hypothalamic pituitary adrenal axis and hyperactivity of the subgenual cortex are both frequently observed in depression. However, many details of how the hypothalamus, the hypothalamic pituitary adrenal (HPA) axis, and the subgenual cingulate interact with each other are unknown. We hypothesized that resting-state functional connectivity between the hypothalamus and the subgenual cortex would be associated with altered circadian rhythm in patients with depression and depressive symptoms. We also hypothesized that this would be most apparent in patients that have major depression with psychotic symptoms, who typically have the most robust HPA-axis dysregulation. Resting-state functional magnetic resonance imaging (fMRI) scans were collected to observe low-frequency resting-state functional connectivity patterns of the hypothalamus in 39 healthy participants, 39 patients with major depression, and 22 patients with major depression with psychotic symptoms. Hourly overnight measures of cortisol secretion and multiple measures of psychiatric symptom severity were also collected on all. Strong hypothalamic functional connectivity with the subgenual cortex was observed in healthy participants. This connectivity was significantly reduced in patients with psychotic major depression. Increased cortisol secretion during the circadian nadir and reduced connectivity were both associated with symptom severity. Reduced connectivity and high cortisol secretion during the circadian nadir are both useful for explaining a significant amount of variance in symptom severity that occurs between healthy participants and depressed patients. However, only cortisol secretion was useful for explaining the severity of symptoms within the depressed groups. This study suggests that the communication between the hypothalamus and the subgenual cortex is disrupted in patients with major depression with psychotic features. It also suggests that these disruptions are associated with increased symptom severity and may be a cause or a consequence of cortisol dysregulation.


Assuntos
Córtex Cerebral/fisiopatologia , Transtorno Depressivo Maior/patologia , Hipotálamo/fisiopatologia , Vias Neurais/fisiopatologia , Adolescente , Adulto , Idoso , Antidepressivos/uso terapêutico , Mapeamento Encefálico , Córtex Cerebral/irrigação sanguínea , Transtorno Depressivo Maior/sangue , Transtorno Depressivo Maior/tratamento farmacológico , Feminino , Seguimentos , Humanos , Hidrocortisona/sangue , Hipotálamo/irrigação sanguínea , Processamento de Imagem Assistida por Computador , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Vias Neurais/irrigação sanguínea , Oxigênio/sangue , Descanso , Adulto Jovem
3.
J Psychiatr Res ; 47(10): 1319-28, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23791396

RESUMO

Anhedonia is the inability to experience pleasure from normally pleasant stimuli. Although anhedonia is a prominent feature of many psychiatric disorders, trait anhedonia is also observed dimensionally in healthy individuals. Currently, the neurobiological basis of anhedonia is poorly understood because it has been mainly investigated in patients with psychiatric disorders. Thus, previous studies have not been able to adequately disentangle the neural correlates of anhedonia from other clinical symptoms. In this study, trait anhedonia was assessed in well-characterized healthy participants with no history of Axis I psychiatric illness. Functional magnetic resonance imaging with musical stimuli was used to examine brain responses and effective connectivity in relation to individual differences in anhedonia. We found that trait anhedonia was negatively correlated with pleasantness ratings of music stimuli and with activation of key brain structures involved in reward processing, including nucleus accumbens (NAc), basal forebrain and hypothalamus which are linked by the medial forebrain bundle to the ventral tegmental area (VTA). Brain regions important for processing salient emotional stimuli, including anterior insula and orbitofrontal cortex were also negatively correlated with trait anhedonia. Furthermore, effective connectivity between NAc, VTA and paralimbic areas, that regulate emotional reactivity to hedonic stimuli, was negatively correlated with trait anhedonia. Our results indicate that trait anhedonia is associated with reduced reactivity and connectivity of mesolimbic and related limbic and paralimbic systems involved in reward processing. Critically, this association can be detected even in individuals without psychiatric illness. Our findings have important implications both for understanding the neurobiological basis of anhedonia and for the treatment of anhedonia in psychiatric disorders.


Assuntos
Anedonia , Mapeamento Encefálico , Encéfalo/fisiologia , Vias Neurais/fisiologia , Recompensa , Estimulação Acústica , Adolescente , Adulto , Encéfalo/irrigação sanguínea , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Música , Vias Neurais/irrigação sanguínea , Oxigênio/sangue , Escalas de Graduação Psiquiátrica , Desempenho Psicomotor , Tempo de Reação/fisiologia , Inquéritos e Questionários , Adulto Jovem
4.
Prev Med ; 54(6): 408-14, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22498022

RESUMO

OBJECTIVE: Faith Moves Mountains assessed the effectiveness of a faith-placed lay health advisor (LHA) intervention to increase Papanicolaou (Pap) test use among middle-aged and older women in a region disproportionately affected by cervical cancer and low screening rates (regionally, only 68% screened in prior 3 years). METHOD: This community-based RCT was conducted in four Appalachian Kentucky counties (December 2005-June 2008). Women aged 40-64 and overdue for screening were recruited from churches and individually randomized to treatment (n=176) or wait-list control (n=169). The intervention provided LHA home visits and newsletters addressing barriers to screening. Self-reported Pap test receipt was the primary outcome. RESULTS: Intention-to-treat analyses revealed that treatment group participants (17.6% screened) had over twice the odds of wait-list controls (11.2% screened) of reporting Pap test receipt post-intervention, OR=2.56, 95% CI: 1.03-6.38, p=0.04. Independent of group, recently screened participants (last Pap >1 but <5 years ago) had significantly higher odds of obtaining screening during the study than rarely or never screened participants (last Pap ≥5 years ago), OR=2.50, 95% CI: 1.48-4.25, p=0.001. CONCLUSIONS: The intervention was associated with increased cervical cancer screening. The faith-placed LHA addressing barriers comprises a novel approach to reducing cervical cancer disparities among Appalachian women.


Assuntos
Pesquisa Participativa Baseada na Comunidade , Efeitos Psicossociais da Doença , Cura pela Fé/métodos , Conhecimentos, Atitudes e Prática em Saúde , Teste de Papanicolaou , Infecções por Papillomavirus/diagnóstico , Neoplasias do Colo do Útero/diagnóstico , Esfregaço Vaginal/estatística & dados numéricos , Adulto , Região dos Apalaches , Agentes Comunitários de Saúde/estatística & dados numéricos , Feminino , Seguimentos , Humanos , Kentucky , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde/métodos , Proteínas Associadas a Pancreatite , Infecções por Papillomavirus/prevenção & controle , Infecções por Papillomavirus/psicologia , Educação de Pacientes como Assunto , Seleção de Pacientes , Classe Social , Inquéritos e Questionários , Neoplasias do Colo do Útero/prevenção & controle , Neoplasias do Colo do Útero/psicologia , Esfregaço Vaginal/psicologia , Listas de Espera
5.
J Am Diet Assoc ; 102(11): 1669-71, 2002 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-12449293

RESUMO

Nutritional authorities encourage consumers to include calcium-rich foods in their daily diets. However, consumer purchases are driven not only by health considerations and dietary preferences, but also by cost. This study assessed the cost of calcium from a wide variety of food sources, as well as supplements, based on retail prices in Seattle, San Francisco, Raleigh, NewYork City, and Washington, D.C., while controlling for seasonal variation. Costs were adjusted based on calcium absorption fractions. Calcium carbonate supplements emerged as the least expensive source of calcium, at roughly one-third the cost of the least expensive food source of calcium. The least expensive food sources of calcium were Total cereal, skim milk, and calcium-fortified orange juice from frozen concentrate. This information is useful for dietitians, health professionals, and consumers in meeting calcium requirements on a budget.


Assuntos
Cálcio da Dieta/economia , Suplementos Nutricionais/economia , Absorção , Disponibilidade Biológica , Cálcio da Dieta/administração & dosagem , Cálcio da Dieta/farmacocinética , Custos e Análise de Custo , Laticínios/economia , Humanos , Lactase , Necessidades Nutricionais , Estações do Ano , Estados Unidos , beta-Galactosidase/administração & dosagem , beta-Galactosidase/economia
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