Corollary discharge and anomalous self-experiences in schizophrenia and bipolar disorder: A specificity analysis.

OBJECTIVE: The Corollary Discharge (CD) mechanism inhibits self-generated speech sound perception, appearing disrupted in schizophrenia and potentially contributing to Anomalous Self-Experiences (ASEs). However, it remains unclear if this alteration and its correlation with ASEs extend to other psychotic disorders. METHODS: Electroencephalography was used to study the N1 Event-Related Potential (ERP) as an index of CD-mediated suppression in the auditory cortex across thirty-five participants with schizophrenia, twenty-six with bipolar disorder, and thirty healthy controls. Auditory N1 was elicited by two conditions: real-time listening to self-pronounced vowels while speaking through connected microphone and earphones (listen/talk -or talk condition in previous literature-) and passive listening to the same previously recorded self-uttered vowels (listen/no talk -or listen condition-). RESULTS: N1 ERP amplitude was lower in the listen/talk condition compared to listen/no talk across all groups. However, N1 suppression was significantly reduced in schizophrenia, with bipolar patients showing intermediate attenuation between both groups (i.e., non-significantly different from controls). Furthermore, N1 suppression inversely correlated with ASEs severity only in schizophrenia. CONCLUSIONS: Dysfunction of the CD mechanism may be a defining feature of schizophrenia, where it is connected to ASEs. SIGNIFICANCE: These results corroborate previous findings linking auditory N1 ERP suppression with disrupted CD mechanism in schizophrenia, but not in bipolar disorder.

Acute physiological and psychological responses during an incremental treadmill test wearing a new upper-body sports garment with elastomeric technology.

Background: The use of elastomeric technology in sports garments is increasing in popularity; however, its specific impact on physiological and psychological variables is not fully understood. Thus, we aimed to analyze the physiological (muscle activation of the pectoralis major, triceps brachii, anterior deltoid, and rectus abdominis, capillary blood lactate, systolic and diastolic blood pressure, and heart rate) and psychological (global and respiratory rating of perceived exertion [RPE]) responses during an incremental treadmill test wearing a new sports garment for the upper body that incorporates elastomeric technology or a placebo garment. Methods: Eighteen physically active young adults participated in two randomized sessions, one wearing the elastomeric garment and the other wearing a placebo. Participants performed in both sessions the same treadmill incremental test (i.e., starting at 8 km/h, an increase of 2 km/h each stage, stage duration of 3 min, and inclination of 1%; the test ended after completing the 18 km/h Stage or participant volitional exhaustion). The dependent variables were assessed before, during, and/or after the test. Nonparametric tests evaluated differences. Results: The elastomeric garment led to a greater muscle activation (p < 0.05) in the pectoralis major at 16 km/h (+33.35%, p = 0.01, d = 0.47) and 18 km/h (+32.09%, p = 0.02, d = 0.55) and in the triceps brachii at 10 km/h (+20.28%, p = 0.01, d = 0.41) and 12 km/h (+34.95%, p = 0.04, d = 0.28). Additionally, lower lactate was observed at the end of the test (-7.81%, p = 0.01, d = 0.68) and after 5 min of recovery (-13.71%, p < 0.001, d = 1.00) with the elastomeric garment. Nonsignificant differences between the garments were encountered in the time to exhaustion, cardiovascular responses, or ratings of perceived exertion. Conclusion: These findings suggest that elastomeric garments enhance physiological responses (muscle activation and blood lactate) during an incremental treadmill test without impairing physical performance or effort perception.

Relation between task-related activity modulation and cortical inhibitory function in schizophrenia and healthy controls: a TMS-EEG study.

Schizophrenia has been associated with a reduced task-related modulation of cortical activity assessed through electroencephalography (EEG). However, to the best of our knowledge, no study so far has assessed the underpinnings of this decreased EEG modulation in schizophrenia. A possible substrate of these findings could be a decreased inhibitory function, a replicated finding in the field. In this pilot study, our aim was to explore the association between EEG modulation during a cognitive task and the inhibitory system function in vivo in a sample including healthy controls and patients with schizophrenia. We hypothesized that the replicated decreased task-related activity modulation during a cognitive task in schizophrenia would be related to a hypofunction of the inhibitory system. For this purpose, 27 healthy controls and 22 patients with schizophrenia (including 13 first episodes) performed a 3-condition auditory oddball task from which the spectral entropy modulation was calculated. In addition, cortical reactivity-as an index of the inhibitory function-was assessed by the administration of 75 monophasic transcranial magnetic stimulation single pulses over the left dorsolateral prefrontal cortex. Our results replicated the task-related cortical activity modulation deficit in schizophrenia patients. Moreover, schizophrenia patients showed higher cortical reactivity following transcranial magnetic stimulation single pulses over the left dorsolateral prefrontal cortex compared to healthy controls. Cortical reactivity was inversely associated with EEG modulation, supporting the idea that a hypofunction of the inhibitory system could hamper the task-related modulation of EEG activity.

Corollary Discharge Dysfunction as a Possible Substrate of Anomalous Self-experiences in Schizophrenia.

BACKGROUND AND HYPOTHESIS: Corollary discharge mechanism suppresses the conscious auditory sensory perception of self-generated speech and attenuates electrophysiological markers such as the auditory N1 Event-Related Potential (ERP) during Electroencephalographic (EEG) recordings. This phenomenon contributes to self-identification and seems to be altered in people with schizophrenia. Therefore, its alteration could be related to the anomalous self-experiences (ASEs) frequently found in these patients. STUDY DESIGN: To analyze corollary discharge dysfunction as a possible substrate of ASEs, we recorded EEG ERP from 43 participants with schizophrenia and 43 healthy controls and scored ASEs with the 'Inventory of Psychotic-Like Anomalous Self-Experiences' (IPASE). Positive and negative symptoms were also scored with the 'Positive and Negative Syndrome Scale for Schizophrenia' (PANSS) and with the 'Brief Negative Symptom Scale' (BNSS) respectively. The N1 components were elicited by two task conditions: (1) concurrent listening to self-pronounced vowels (talk condition) and (2) subsequent non-concurrent listening to the same previously self-uttered vowels (listen condition). STUDY RESULTS: The amplitude of the N1 component elicited by the talk condition was lower compared to the listen condition in people with schizophrenia and healthy controls. However, the difference in N1 amplitude between both conditions was significantly higher in controls than in schizophrenia patients. The values of these differences in patients correlated significantly and negatively with the IPASE, PANSS, and BNSS scores. CONCLUSIONS: These results corroborate previous data relating auditory N1 ERP amplitude with altered corollary discharge mechanisms in schizophrenia and support corollary discharge dysfunction as a possible underpinning of ASEs in this illness.

Electroencephalography for the Study of the Auditory P300 Evoked Potential and Derived Measurements.

Electroencephalography (EEG) is a widely used tool in neuropsychiatry research. The most used measurements in EEG are the amplitude and latency of the cortical electrophysiological activity in response to stimulus, known as evoked potentials. Besides potentials, time/frequency analysis is also used to obtain information on global fluctuations of the recordings, which evoked potentials do not provide. Time/frequency analysis results in different values known as derived measures. In this work, a brief introduction to evoked potentials and time/frequency analyses in schizophrenia is given, focusing on P300, noise power, and spectral entropy. Finally, a detailed description is given on how to obtain EEG recordings, evoked potentials, and derived measures.

Default mode network components and its relationship with anomalous self-experiences in schizophrenia: A rs-fMRI exploratory study.

Anomalous self-experiences (ASEs) in schizophrenia have been under research for the last 20 years. However, no neuroimage studies have provided insight of the possible biological underpinning of ASEs. In this novel approach, the connectivity within the default mode network, calculated through a ROI-based analysis of functional magnetic resonance imaging data, was correlated to the ASEs scores assessed by the Inventory of Psychotic-Like Anomalous Self-Experiences (IPASE) in a sample of 22 schizophrenia patients. The Pearson's correlation coefficients between IPASE scores and intrahemispheric connectivity of the parahippocampal gyrus with the isthmus cingulate cortex in both hemispheres, and right parahippocampal gyrus with the right rostral anterior cingulate cortex were positive and significant suggesting a relation between hyperactive functional connectivity and anomalous self-experiences intensity. Prior literature reported these areas to have a role in self-processing and consciousness as well as being anatomically connected. Further research with larger sample size and comparison with controls are needed to confirm the relationship of this connectivity with anomalous self-experiences.

Dermal substitutes: an alternative for the reconstruction of large full-thickness defects in the plantar surface

Abstract Large defects in plantar surface secondary to acral melanoma excision can be difficult to repair with local flaps, and skin grafts in weight-bearing surfaces often suffer necrosis causing prolonged disability. Acellular dermal matrices represent an easy alternative to cover deep wounds or those with bone or tendon exposure. Despite their high cost and the requirement of two surgical procedures, this alternative may offer excellent functional and aesthetic results in acral defects.

Search for schizophrenia and bipolar biotypes using functional network properties.

INTRODUCTION: Recent studies support the identification of valid subtypes within schizophrenia and bipolar disorder using cluster analysis. Our aim was to identify meaningful biotypes of psychosis based on network properties of the electroencephalogram. We hypothesized that these parameters would be more altered in a subgroup of patients also characterized by more severe deficits in other clinical, cognitive, and biological measurements. METHODS: A clustering analysis was performed using the electroencephalogram-based network parameters derived from graph-theory obtained during a P300 task of 137 schizophrenia (of them, 35 first episodes) and 46 bipolar patients. Both prestimulus and modulation of the electroencephalogram were included in the analysis. Demographic, clinical, cognitive, structural cerebral data, and the modulation of the spectral entropy of the electroencephalogram were compared between clusters. Data from 158 healthy controls were included for further comparisons. RESULTS: We identified two clusters of patients. One cluster presented higher prestimulus connectivity strength, clustering coefficient, path-length, and lower small-world index compared to controls. The modulation of clustering coefficient and path-length parameters was smaller in the former cluster, which also showed an altered structural connectivity network and a widespread cortical thinning. The other cluster of patients did not show significant differences with controls in the functional network properties. No significant differences were found between patients´ clusters in first episodes and bipolar proportions, symptoms scores, cognitive performance, or spectral entropy modulation. CONCLUSION: These data support the existence of a subgroup within psychosis with altered global properties of functional and structural connectivity.

Dermal substitutes: an alternative for the reconstruction of large full-thickness defects in the plantar surface.

Large defects in plantar surface secondary to acral melanoma excision can be difficult to repair with local flaps, and skin grafts in weight-bearing surfaces often suffer necrosis causing prolonged disability. Acellular dermal matrices represent an easy alternative to cover deep wounds or those with bone or tendon exposure. Despite their high cost and the requirement of two surgical procedures, this alternative may offer excellent functional and aesthetic results in acral defects.

Cutaneous infiltration by T-cell prolymphocytic leukemia in two adult patients. / Infiltración cutánea por leucemia prolinfocítica T en dos pacientes adultos.

BACKGROUND: T-cell prolymphocytic leukemia (T-PLL) is a T-cell lymphoproliferative disorder that frequently involves the skin. The objective was to describe two cases of T-PLL with cutaneous involvement and to present a review of the literature concerning the clinical characteristics, differential diagnosis and treatment of these patients. CASE REPORTS: 1) 79 year-old man, with a previous diagnosis of T-PLL based on a laboratory incidental finding. He had been treated with alemtuzumab, but it had to be interrupted due to recurrent infections. After interrupting the treatment, the patient developed a symmetrical rash on his extremities. The skin biopsy demonstrated TPLL infiltration. 2) 28 year-old man that presented with asthenia and lymphocytosis. He also showed a purpuric rash on his trunk and facial erythema. Histopathology of the skin and bone marrow confirmed the diagnosis of T-PLL with cutaneous involvement. CONCLUSIONS: T-cell prolymphocytic leukemia accounts for 2% of mature leukemias in adults. Skin involvement is reported in 20-50% of the patients. The characteristic features are facial involvement, purpuric lesions and symmetry of the rash, although there are atypical manifestations as well. Differential diagnosis includes other T-cell lymphoproliferative disorders with hematologic and skin involvement, such as Sézary syndrome. Patients with T-PLL may show cutaneous infiltration at the moment of debut or relapse of the disease. The skin is an accessible organ for taking samples to study and diagnose these patients.

INTRODUCCIÓN: La leucemia prolinfocítica T (LPL-T) es una neoplasia hematológica del grupo de síndromes linfoproliferativos T que con frecuencia produce infiltración cutánea. Se presentan dos casos de LPL-T con afectación cutánea y se revisa la literatura en cuanto a características clínicas, diagnóstico diferencial y tratamiento de estos pacientes. CASOS CLÍNICOS: 1) Varón de 79 años diagnosticado de LPL-T tras un hallazgo analítico incidental. Tras suspender el tratamiento con alemtuzumab por infecciones recurrentes, comenzó con lesiones cutáneas maculopapulosas eritematopurpúricas que afectaban la raíz de las extremidades. La biopsia cutánea confirmó la infiltración por su enfermedad de base. 2) Varón de 28 años que debutó con astenia y hallazgos analíticos de leucocitosis. Había comenzado además con lesiones purpúricas en el tronco y eritema malar bilateral. El estudio de médula ósea y la biopsia cutánea confirmaron el diagnóstico de LPL-T con infiltración cutánea. CONCLUSIONES: La LPL-T corresponde al 2% de las leucemias linfocíticas maduras en los adultos. Entre el 20% y el 50% de los pacientes presentan afectación cutánea, con predominio en la región facial, y son característicos el eritema, la púrpura y la simetría, aunque existen manifestaciones atípicas. El diagnóstico diferencial incluye otros síndromes linfoproliferativos T con afectación cutánea y en sangre periférica, entre los que destaca el síndrome de Sézary. Los pacientes con LPL-T pueden presentar afectación cutánea en el debut o en una recidiva de la enfermedad. La piel representa un órgano accesible para la toma de muestras y para el diagnóstico y el estudio de estos pacientes.

Dermoscopy of cutaneous melanoma metastases: A color-based pattern classification.

Dermoscopic studies about cutaneous metastases of malignant melanoma (CMMM) are few. Our objective was to analyze the dermoscopic features of CMMM and propose a new dermoscopic pattern classification based on color pigmentation and some specific dermoscopic features. A retrospective evaluation of 150 dermoscopic images of CMMM taken from 40 patients was performed. One hundred CMMM images were individually evaluated by six dermatologists in order to classify them according to four dermoscopic patterns: (i) blue pattern; (ii) pink pattern; (iii) brown pattern; and (iv) mixed pattern. One hundred and fifty dermoscopic images including 50 CMMM and 100 benign lesions were evaluated by five dermatologists to calculate the accuracy of these patterns in the recognition of CMMM. An intra- and interobserver reproducibility agreement study between all different dermoscopic pattern classifications was performed. Seventy-five percent of our cases of CMMM showed a monochromatic pattern. Light brown pigmented halo, peripheral gray spots and polymorphic atypical vessels were the most significant focal dermoscopic structures. The reproducibility of the color-based dermoscopic pattern classification was superior to previous dermoscopic pattern classification. In summary, a dermoscopic pattern classification based on color pigmentation and some specific dermoscopic features may be useful in recognizing early cutaneous melanoma metastasis. Multicentric studies are recommended in order to lower the impact of interobserver variability.