Demographic characteristics and delayed neurological sequelae risk factors in carbon monoxide poisoning.

AIM: Carbon monoxide (CO) is a colorless, odorless gas and tasteless. CO poisoning (COP) is one of the most frequently encountered inhalation poisonings. The most common cause of morbidity in COP is delayed neurological sequelae (DNS). DNS is the occurrence of neuropsychiatric findings within 2-240 days after discharge of patients with COP and there are no definitive diagnostic criteria. The aim of our study is; to determine the risk factors and incidence of DNS. METHOD: Our study is a retrospective, observational study. Patients with the diagnosis of COP in the emergency department between 2015 and 2016 were included in the study. Patients age, gender, findings in the initial physical examination (PE) and neurological examination (NE), blood carboxyhemoglobin (COHb) level, relation between hyperbaric oxygen (HBO) treatment and DNS were assessed. RESULTS: Total of 72 patients were included in the study. Mean age was 33.43 ±â€¯20.89. It was determined that pathological findings in the initial NE are a significant predictive factor for DNS (Odds ratio 18.600, p:0.004). Significant relation between NE and HBO treatment was present (p:00.1). There was no statistically significant relationship between initial COHb level and receiving HBO treatment (p:0.9). Median COHb level of patients with DNS was 30 (min:10, max: 43), median COHb level of patients without DNS was 25 (min:10, max:44) and there was no statistically significant relationship between the two groups according to COHb levels (p:0.7). CONCLUSION: Pathological findings in the initial neurological examination had a predictive value for delayed neurological sequelae in patients with carbon monoxide poisoning.

The relationship between health related quality of life and sensory deficits among patients with diabetes mellitus.

PURPOSE: (1) To profile sensory deficits examined in the ability to process sensory information from daily environment and discriminate between tactile stimuli among patients with controlled and un-controlled diabetes mellitus. (2) Examine the relationship between the sensory deficits and patients' health-related quality of life. METHODS: This study included 115 participants aged 33-55 with uncontrolled (n = 22) or controlled (n = 24) glycemic levels together with healthy subjects (n = 69). All participants completed the brief World Health Organization Quality of Life Questionnaire, the Adolescent/Adult Sensory Profile and performed the tactile discrimination test. RESULTS: Sensory deficits were more emphasized among patients with uncontrolled glycemic levels as expressed in difficulties to register sensory input, lower sensation seeking in daily environments and difficulties to discriminate between tactile stimuli. They also reported the lowest physical and social quality of life as compared to the other two groups. Better sensory seeking and registration predicted better quality of life. Disease control and duration contributed to these predictions. CONCLUSIONS: Difficulties in processing sensory information from their daily environments are particularly prevalent among patients with uncontrolled glycemic levels, and significantly impacted their quality of life. Clinicians should screen for sensory processing difficulties among patients with diabetes mellitus and understand their impacts on patients' quality of life. Implications for Rehabilitation Patients with diabetes mellitus, and particularly those with uncontrolled glycemic levels, may have difficulties in processing sensory information from daily environment. A multidisciplinary intervention approach is recommended: clinicians should screen for sensory processing deficits among patients with diabetes mellitus and understand their impacts on patients' daily life. By providing the patients with environmental adaptations and coping strategies, clinicians may assist in optimizing sensory experiences in real life context and elevate patients' quality of life. Relating to quality of life and emphasizing a multidisciplinary approach is of major importance in broadening our understanding of health conditions and providing holistic treatment for patients.

Distrust of the senses and its association with obsessive-compulsive symptoms.

BACKGROUND AND OBJECTIVES: Leading cognitive theories of OCD suggests that despite prevalent and persistent doubt, individuals with OCD do not have perceptual deficits. An alternate cognitive theory, the Seeking Proxies for Internal States hypothesis (SPIS), proposes that sensory distrust in OCD stems from actual deficits in accessing internal states. Consistent with the SPIS, previous research has found that high-OC individuals were less accurate than low-OC individuals in producing target levels of muscle tension in a biofeedback task and that OC symptoms were positively associated with reliance on an external proxy. METHODS: The current study aimed to replicate and extend the SPIS hypothesis in two experiments using a modified version of the biofeedback-aided muscle tensing task using grip strength as the sensory input and a distance perception task. We contrasted the performance of undergraduate students self-reporting high- and low-OC symptoms. RESULTS: Overall, our findings failed to substantially support the SPIS hypothesis such that OC symptoms were not associated with deficient access to internal states of grip strength and distance perception or increased reliance on feedback. LIMITATIONS: As this study was conducted in a non-clinical sample, we were unable to generalise our findings to a clinical population. CONCLUSIONS: Findings are commensurate with the wider OCD literature suggesting the absence of cognitive and perceptual deficits in OCD individuals.

Comparing the executive attention of adult females with ADHD to that of females with sensory modulation disorder (SMD) under aversive and non-aversive auditory conditions.

Certain behavioral expressions of sensory modulation disorder (SMD) such as distractibility, hyperactivity, and impulsivity are often similar to those of attention deficit/hyperactivity disorder (ADHD) in pediatric and adult populations. There is also a high comorbidity rate between these two diagnoses and absence of research regarding the objective neuropsychological differentiation between them. In the present study we employed a factorial design which enabled us to: (a) systematically examine the effects of SMD and ADHD on executive attention in a sample of adult females using a Stroop-like task, and (b) measure the effect of aversive conditions (sounds) on executive attention. The experimental measures used were the Stroop-like Location-Direction Task (SLDT) to assess executive attention and the battery of aversiveness to sounds (BAS), a standardized measure of aversive sounds that was developed for this study and enabled individual customization of aversive auditory sounds. Results revealed, as expected, a specific core deficit in executive attention for the ADHD factor. In addition to that, the present study provides an important, pioneering finding of SMD impairment in a unique combination of a cognitively demanding task with aversive sounds, providing preliminary objective evidence differentiating SMD from ADHD.

Wii-habilitation as balance therapy for children with acquired brain injury.

PURPOSE: To evaluate the effectiveness of the Nintendo Wii compared to traditional balance therapy in improving balance, motivation, and functional ability in children undergoing acute rehabilitation after brain injury. METHODS: A non-concurrent, randomized multiple baseline single-subject research design was used with three participants. Data were analyzed by visual inspection of trend lines. RESULTS: Daily Wii balance training was equally motivating to traditional balance therapy for two participants and more motivating for one participant. While improvements in dynamic balance were observed, the results for static balance remain inconclusive. All participants demonstrated improvements in functional ability. CONCLUSION: Wii balance therapy is a safe, feasible, and motivating intervention for children undergoing acute rehabilitation after an acquired brain injury. Further research to examine the effectiveness of Wii balance therapy in this population is warranted.

Sensory hypersensitivity in children with high-functioning pervasive developmental disorder.

BACKGROUND: Studies have shown that children with pervasive developmental disorder (PDD) have high rates of sensory hypersensitivity. In addition, a few recent studies suggested that sensory hypersensitivity was related to anxiety or depression. However, most studies had methodological limitations because they included children with mental retardation and did not examine broadband psychopathology. Therefore, the purpose of this study was to examine the prevalence of sensory hypersensitivity in children with high-functioning PDD (HFPDD) and the correlation among sensory hypersensitivity, various characteristics, and broadband psychopathology. METHODS: We assessed 132 children with HFPDD (aged 6-15 years, 75% male) that were divided into sensory hypersensitivity (HS) and sensory non-hypersensitivity (non-HS) groups. A logistic regression model was used to examine correlations among sensory hypersensitivity, age, gender, PDD subtypes, socioeconomic status, and broadband psychopathology, including symptoms of anxiety and depression. RESULTS: Of the 132 children with HFPDD, 65.9% (n = 87) were categorized as HS and 34.1% (n = 45) as non-HS. The most common sensory hypersensitivity was auditory. Logistic regression analyses revealed that sensory hypersensitivity in HFPDD was significantly associated with autistic disorder and symptoms of anxiety and depression. CONCLUSIONS: Majority of children with HFPDD exhibited sensory hypersensitivity. Our findings suggested that sensory hypersensitivity may be a core feature of HFPDD and is possibly correlated to symptoms of anxiety and depression. We propose that sensory hypersensitivity in children with PDD should be aggressively assessed.

Auditory and visual cortical activity during selective attention in fragile X syndrome: a cascade of processing deficiencies.

OBJECTIVE: This study examined whether attention deficits in fragile X syndrome (FXS) can be traced back to abnormalities in basic information processing. METHOD: Sixteen males with FXS and 22 age-matched control participants (mean age 29 years) performed a standard oddball task to examine selective attention in both auditory and visual modalities. Five FXS males were excluded from analysis because they performed below chance level on the auditory task. ERPs were recorded to investigate the N1, P2, N2b, and P3b components. RESULTS: N1 and N2b components were significantly enhanced in FXS males to both auditory and visual stimuli. Interestingly, in FXS males, the P3b to auditory stimuli was significantly reduced relative to visual stimuli. These modality differences in information processing corresponded to behavioral results, showing more errors on the auditory than on the visual task. CONCLUSIONS: The current findings suggest that attentional impairments in FXS at the behavioral level can be traced back to abnormalities in event-related cortical activity. These information processing abnormalities in FXS may hinder the allocation of attentional resources needed for optimal processing at higher-levels. SIGNIFICANCE: These findings demonstrate that auditory information processing in FXS males is critically impaired relative to visual information processing.

Prospective trial of equine-assisted activities in autism spectrum disorder.

BACKGROUND: Anecdotal reports and some studies suggest that equine-assisted activities may be beneficial in autism spectrum disorders (ASD). OBJECTIVE: To examine the effects ofequine-assisted activities on overall severity of autism symptoms using the Childhood Autism Rating Scale (CARS) and the quality ofparent-child interactions using the Timberlawn Parent-Child Interaction Scale. In addition, this study examined changes in sensory processing, quality of life, and parental treatment satisfaction. DESIGN AND PARTICIPANTS: Children with ASD were evaluated at four time points: (1) before beginning a 3-to-6 month waiting period, (2) before starting the riding treatment, and (3) after 3 months and (4) 6 months of riding. Twenty-four participants completed the waiting list period and began the riding program, and 20 participants completed the entire 6 months of riding. Pretreatment was compared to posttreatment with each child acting as his or her own control. RESULTS: A reduction in the severity of autism symptoms occurred with the therapeutic riding treatment. There was no change in CARS scores during the pretreatment baseline period; however, there was a significant decrease after treatment at 3 months and 6 months of riding. The Timberlawn Parent-Child Interaction Scale showed a significant improvement in Mood and Tone at 3 months and 6 months of riding and a marginal improvement in the reduction of Negative Regard at 6 months of riding. The parent-rated quality of life measure showed improvement, including the pretreatment waiting period. All of the ratings in the Treatment Satisfaction Survey were between good and very good. CONCLUSION: These results suggest that children with ASD benefit from equine-assisted activities.

Relationship between touch impairment and brain activation after lesions of subcortical and cortical somatosensory regions.

BACKGROUND: The neural basis underlying somatosensory impairment and recovery poststroke is virtually unexplored. OBJECTIVE: To investigate the relationship between touch discrimination impairment and task-related brain activation in stroke survivors with somatosensory impairment following subcortical or cortical lesions. METHODS: A total of 19 stroke survivors with touch impairment were investigated using fMRI and a touch discrimination paradigm 1-month poststroke; 11 had subcortical and 8 cortical sensory lesions; 12 age-matched healthy controls were also studied. Mean task-related contrast images were regressed with sensory impairment using random effects analysis for each subgroup and the total group. RESULTS: There was no significant difference in touch impairment between stroke subgroups. Touch discrimination of the affected hand correlated negatively with task-related activation in the ipsilesional primary somatosensory cortex (SI; adjacent to the SI hand area activated in healthy controls); ipsilesional secondary somatosensory cortex (SII); contralesional thalamus; and attention-related frontal and occipital regions in the subcortical group. In contrast, the cortical group did not show significant correlated activity. Yet there was no significant between-group difference in a priori somatosensory regions: only in the superior medial frontal gyrus. A negative correlation was observed in the contralesional thalamus for the total group, irrespective of lesion type. CONCLUSION: The findings provide novel evidence of neural correlates of poststroke touch impairment involving a distributed network of ipsilesional SI and SII, the contralesional thalamus, and frontal attention regions, particularly following subcortical lesions. Further systematic investigation of a modulatory role for ipsilesional SI, the thalamus, and frontal attention regions in sensory processing and recovery is warranted, particularly given implications for rehabilitation.

Disruption of synaesthesia by posthypnotic suggestion: an ERP study.

This study examined whether the behavioral and electrophysiological correlates of synaesthetic response conflict could be disrupted by posthypnotic suggestion. We recorded event-related brain potentials while a highly suggestible face-color synaesthete and matched controls viewed congruently and incongruently colored faces in a color-naming task. The synaesthete, but not the controls, displayed slower response times, and greater P1 and sustained N400 ERP components over frontal-midline electrodes for incongruent than congruent faces. The behavioral and N400 markers of response conflict, but not the P1, were abolished following a posthypnotic suggestion for the termination of the participant's synaesthesia and reinstated following the cancellation of the suggestion. These findings demonstrate that the conscious experience of synaesthesia can be temporarily abolished by cognitive control.

El proceso de la sensorialidad a la simbolización / The process from sensoriality to symbolization

El trabajo pretende hacer un breve recorrido por el proceso que lleva de la sensorialidad a la simbolización a través de la relación terapéutica. El objetivo general es intentar mostrar a partir de un caso clínico – niña de cinco años, gemela de otra niña y prematura- como las ansiedades primitivas, fijadas en unos enclavamientos sensoriales, no mentalizados y expresadas en una masturbación compulsiva y otras conductas autosensoriales, se pueden ir elaborando en un marco terapéutico relacional que permite una regresión a nivel sensorial. A través de ir viviendo y verbalizando todo esto se puede facilitar la evolución desde una fase de carácter confusional a una reestructuración emocional que permite el acceso a la simbolización a través del juego, la palabra y posteriormente, la letra (AU)

This paper describes the process that takes place in a therapeutic relation and leads from sensoriality to the capacity to symbolize. A clinical case is presented to show how primitive anxieties, fixated to unmentalized sensorial enclaves and expressed through compulsive masturbation and other autosesory behaviours, can be worked through in a relational and therapeutic frame work allowing for regression to a sensorial level. Through experiencing and expressing these aspects, and evolution in the patient form a phase of confusional character to an emotional restructuring which enables an access to the capacity to symbolize through play, word and letter can be facilitated (AU)

Comorbidity between balance and anxiety disorders: verification in a normal population.

Comorbidity between balance and anxiety disorders has been documented in clinical psychiatric and neurological samples. The authors aimed to determine whether the comorbidity of balance and anxiety disorders has an analogous representation in the normal population. Participants were 20 undergraduate students ages 22-29 years. The authors assigned them to high or low trait anxiety groups and performed a balance task in 3 experimental stages: baseline, training, and test. The baseline and test stages consisted of 4 wobbly and 4 stable trials each. The authors measured state anxiety in the form of auditory startle responses (ASRs) during the stable trials. In the baseline stage, the ASR amplitudes were higher in the high trait anxiety participants. In the test stage, the low trait anxiety participants performed the balance task better than the high trait anxiety participants did. These data suggest that the clinical entity designated as a comorbidity of balance and anxiety disorders has an analogous representation in the normal population.

[Sensory syndrome and aphasia after left insular infarct]. / L'insula, une île oubliée? Troubles sensitifs et troubles du langage après infarctus insulaire gauche.

INTRODUCTION: Sensorial impairment without hemiplegia is usually caused by a thalamic lesion. CASE REPORT: A 28-year-old woman presented with hemianesthesia associated with aphasia following a left insular lesion, subsequent to subarachnoid hemorrhage. Brain MRI Flair sequence revealed a high intensity signal in the left insular and frontal subcortical regions. Insular infarct was diagnosed, associated with hemorrhagic sequelae. DISCUSSION/CONCLUSION: Study of the normal and pathologic insular cortex suggest several implications of the region in somatosensory and language functions. However, the insular cortex has been mainly associated with central pain. Lasting objective hypoesthesia has been very rarely documented. The left insular cortex has also been implicated in speech apraxia but our patient presented with fluent aphasia mostly affecting the rhythm of speech, as it has been observed in thalamic aphasia.

A psychophysical study of auditory and pressure sensitivity in patients with fibromyalgia and healthy controls.

UNLABELLED: Fibromyalgia (FM) is characterized by widespread tenderness. Studies have also reported that persons with FM are sensitive to other stimuli, such as auditory tones. We hypothesized that subjects with FM would display greater sensitivity to both pressure and auditory tones and report greater sensitivity to sounds encountered in daily activities. FM subjects (n = 30) and healthy control subjects (n = 28) were administered auditory tones and pressure using the same psychophysical methods to deliver the stimuli and a common way of scaling responses. Subjects were also administered a self-report questionnaire regarding sensitivity to everyday sounds. Participants with FM displayed significantly greater sensitivity to all levels of auditory stimulation (Ps < .05). The magnitude of difference between FM patients' lowered auditory sensitivity (relative to control subjects) was similar to that seen with pressure, and pressure and auditory ratings were significantly correlated in both control subjects and subjects with FM. FM patients also were more sensitive to everyday sounds (t = 8.65, P < .001). These findings support that FM is associated with a global central nervous system augmentation in sensory processing. Further research is needed to examine the neural substrates associated with this abnormality and its role in the etiology and maintenance of FM. PERSPECTIVE: Muscle tenderness is the hallmark of FM, but the findings of this study and others suggest that persons with FM display sensitivity to a number of sensory stimuli. These findings suggest that FM is associated with a global central nervous system augmentation of sensory information. These findings may also help to explain why persons with FM display a number of comorbid physical symptoms other than pain.

Cannabis in painful HIV-associated sensory neuropathy: a randomized placebo-controlled trial.

OBJECTIVE: To determine the effect of smoked cannabis on the neuropathic pain of HIV-associated sensory neuropathy and an experimental pain model. METHODS: Prospective randomized placebo-controlled trial conducted in the inpatient General Clinical Research Center between May 2003 and May 2005 involving adults with painful HIV-associated sensory neuropathy. Patients were randomly assigned to smoke either cannabis (3.56% tetrahydrocannabinol) or identical placebo cigarettes with the cannabinoids extracted three times daily for 5 days. Primary outcome measures included ratings of chronic pain and the percentage achieving >30% reduction in pain intensity. Acute analgesic and anti-hyperalgesic effects of smoked cannabis were assessed using a cutaneous heat stimulation procedure and the heat/capsaicin sensitization model. RESULTS: Fifty patients completed the entire trial. Smoked cannabis reduced daily pain by 34% (median reduction; IQR = -71, -16) vs 17% (IQR = -29, 8) with placebo (p = 0.03). Greater than 30% reduction in pain was reported by 52% in the cannabis group and by 24% in the placebo group (p = 0.04). The first cannabis cigarette reduced chronic pain by a median of 72% vs 15% with placebo (p < 0.001). Cannabis reduced experimentally induced hyperalgesia to both brush and von Frey hair stimuli (p < or = 0.05) but appeared to have little effect on the painfulness of noxious heat stimulation. No serious adverse events were reported. CONCLUSION: Smoked cannabis was well tolerated and effectively relieved chronic neuropathic pain from HIV-associated sensory neuropathy. The findings are comparable to oral drugs used for chronic neuropathic pain.

Teoría de hypnosis / No disponible

Durante aproximadamente los últimos 50 años, el estudio y la práctica de la hipnosis se han enmarcado dentro del campo de la Psicología. Este artículo revisa las conclusiones que constituyen un acuerdo emergente entre los científicos sobre los fenómenos fundamentales de la hipnosis, y describe la influencia de las teorías de hipnosis que han tenido una repercusión determinante en el campo, y que no descansan en la idea de que la hipnosis se puede explicar por un "estado de trance" específico de la hipnosis. Estas teorías incluyen la teoría socio-psicológica del rol (ejemplo: Sarbin, Coe), la teoría cognitivo-comportamental (ejemplo: Barber), la teoría neodisociativa (ejemplo: Hilgard), la teoría socio-psicológica de Spanos, la teoría de la expectativa de respuesta (ejemplo: Kirsch), el modelo integrador de Lynn, y la teoría del set de respuesta (ejemplo: Kirsch, Lynn) (AU)

In the past 50 years or so, the study and practice of hypnosis has moved into the mainstream of psychology. This article reviews findings that constitute an emerging consensus among scientists about the basic phenomena of hypnosis and describes influential theories of hypnosis have had a shaping influence on the field and do not rely on the idea that hypnosis can be explained by a "trance state" specific to hypnosis. These theories include social psychological role theory (e.g., Sarbin, Coe), cognitive behavioral theory (e.g., Barber), neodissociation theory (e.g., Hilgard), Spanos’s social psychological theory, response expectancy theory (e.g., Kirsch), Lynn’s integrative model, and response set theory (e.g., Kirsch, Lynn) (AU)

Hallucinations in schizophrenia, sensory impairment, and brain disease: a unifying model.

Based on recent insight into the thalamocortical system and its role in perception and conscious experience, a unified pathophysiological framework for hallucinations in neurological and psychiatric conditions is proposed, which integrates previously unrelated neurobiological and psychological findings. Gamma-frequency rhythms of discharge activity from thalamic and cortical neurons are facilitated by cholinergic arousal and resonate in networks of thalamocortical circuits, thereby transiently forming assemblies of coherent gamma oscillations under constraints of afferent sensory input and prefrontal attentional mechanisms. If perception is based on synchronisation of intrinsic gamma activity in the thalamocortical system, then sensory input to specific thalamic nuclei may merely play a constraining role. Hallucinations can be regarded as underconstrained perceptions that arise when the impact of sensory input on activation of thalamocortical circuits and synchronisation of thalamocortical gamma activity is reduced. In conditions that are accompanied by hallucinations, factors such as cortical hyperexcitability, cortical attentional mechanisms, hyperarousal, increased noise in specific thalamic nuclei, and random sensory input to specific thalamic nuclei may, to a varying degree, contribute to underconstrained activation of thalamocortical circuits. The reticular thalamic nucleus plays an important role in suppressing random activity of relay cells in specific thalamic nuclei, and its dysfunction may be implicated in the biological vulnerability to hallucinations in schizophrenia. Combined with general activation during cholinergic arousal, this leads to excessive disinhibition in specific thalamic nuclei, which may allow cortical attentional mechanisms to recruit thalamic relay cells into resonant assemblies of gamma oscillations, regardless of their actual sensory input, thereby producing an underconstrained perceptual experience.

Nonpharmacologic interventions for psychotic symptoms in dementia.

This article proposes an initial nomenclature and systematic approach for the nonpharmacologic understanding and treatment of psychotic symptoms in dementia. An analysis of delusions and hallucinations must examine alternative etiologies, including misdiagnosis and misunderstanding, the misinterpretation of reality because of cognitive losses, sensory deprivation and vision loss, ambiguous sensations, and delirium and medical causes. Nonpharmacologic treatments frequently follow directly from etiology, such as improving sensory function via hearing aids or eyeglasses, providing stimulation, changing antecedents prone to misinterpretation (eg, reflections in windows), or circumventing misinterpretations (eg, ensuring that an equivalent object is available so there is no sense of loss or theft). Given the differences between psychotic symptoms in Alzheimer's disease and those in other diseases, the term psychosis should be abandoned for most dementia patients, and assessments of etiology should be developed. Future research should clarify what proportion of symptoms currently identified as psychotic are attributable to related etiologies.