Increased medial prefrontal cortical thickness and resilience to traumatic experiences in North Korean refugees.

Little is known regarding structural brain changes in traumatized refugees and the association with psychopathology. In the present study, the cortical thickness in North Korean refugees and the association with psychological symptoms were explored. North Korean refugees with lifetime post-traumatic stress disorder (PTSD group, n = 27), trauma-exposed North Korean refugees without lifetime PTSD (trauma-exposed control (TEC) group, n = 23), and healthy South Korean controls without traumatic experiences (HC group, n = 51) completed questionnaires assessing depression, anxiety, somatization, and PTSD symptoms. The cortical thickness was measured by magnetic resonance imaging (MRI) using FreeSurfer. Age- and sex-adjusted cortical thickness of the right medial prefrontal cortex (mPFC) was greater in the TEC group than in the HC group. However, significant differences were not observed between the PTSD and HC groups. Increased right mPFC thickness was significantly correlated with less anxiety and somatization after controlling for age and sex in the TEC group, but not in the PTSD or HC groups. North Korean refugees who did not develop PTSD after trauma showed increased right mPFC thickness, which was associated with less severe psychiatric symptoms. These findings indicate that increased mPFC thickness might have helped to reduce PTSD and psychiatric symptoms after trauma, and likely reflects resilience achieved by potentially enhancing emotional regulation in the mPFC.

LVV-hemorphin-7 (LVV-H7) plays a role in antinociception in a rat model of alcohol-induced pain disorders.

Alcohol can increase the sensitivity to painful stimulation or convert insensibility to pain at different stages. We hypothesized that chronic alcohol consumption changes the level of LVV-hemorphin-7 (abbreviated as LVV-H7, an opioid-like peptide generated from hemoglobin ß-chain), thereby affecting pain sensation. We established a chronic alcohol-exposed rat model to investigate the effects of LVV-H7. Adult male Sprague-Dawley rats were subjected to daily intraperitoneal injection of 10 % ethanol (w/v) at 0.5 g/kg for 15 days and subsequent alcohol withdrawal for 5 days. Using different pharmacological strategies to affect the LVV-H7 level, we investigated the correlation between LVV-H7 and pain-related behavior. Tail-flick and hot plate tests were employed to investigate alcohol-induced pain-related behavioral changes. The serum level of LVV-H7 was determined by ELISA. Our results showed that alcohol first induced an analgesia followed by a hyperalgesia during alcohol withdrawal, which could be driven by the quantitative change of LVV-H7. A positive correlation between the level of LVV-H7 and Δtail-flick latency (measured latency minus basal latency) confirmed this finding. Moreover, we revealed that the LVV-H7 levels were determined by the activity of cathepsin D and red blood cell/hemoglobin counts, which could be affected by alcohol. These results suggest that the deterioration of anti-nociception induced by alcohol is correlated to the decreased level of LVV-H7, and this could be due to alcohol-induced anemia. This study may help to develop LVV-H7 structure-based novel analgesics for treating alcohol-induced pain disorders and thus ameliorate the complications in alcoholics.

Structural alterations in functional neurological disorder and related conditions: a software and hardware problem?

Functional neurological (conversion) disorder (FND) is a condition at the interface of neurology and psychiatry. A "software" vs. "hardware" analogy describes abnormal neurobiological mechanisms occurring in the context of intact macroscopic brain structure. While useful for explanatory and treatment models, this framework may require more nuanced considerations in the context of quantitative structural neuroimaging findings in FND. Moreover, high co-occurrence of FND and somatic symptom disorders (SSD) as defined in DSM-IV (somatization disorder, somatoform pain disorder, and undifferentiated somatoform disorder; referred to as SSD for brevity in this article) raises the possibility of a partially overlapping pathophysiology. In this systematic review, we use a transdiagnostic approach to review and appraise the structural neuroimaging literature in FND and SSD. While larger sample size studies are needed for definitive characterization, this article highlights that individuals with FND and SSD may exhibit sensorimotor, prefrontal, striatal-thalamic, paralimbic, and limbic structural alterations. The structural neuroimaging literature is contextualized within the neurobiology of stress-related neuroplasticity, gender differences, psychiatric comorbidities, and the greater spectrum of functional somatic disorders. Future directions that could accelerate the characterization of the pathophysiology of FND and DSM-5 SSD are outlined, including "disease staging" discussions to contextualize subgroups with or without structural changes. Emerging neuroimaging evidence suggests that some individuals with FND and SSD may have a "software" and "hardware" problem, although if structural alterations are present the neural mechanisms of functional disorders remain distinct from lesional neurological conditions. Furthermore, it remains unclear whether structural alterations relate to predisposing vulnerabilities or consequences of the disorder.

Evaluating Commonalities Across Medically Unexplained Symptoms.

This commentary presents commonalities in medically unexplained symptoms (MUS) across multiple organ systems, including symptoms, aetiological mechanisms, comorbidity with mental health disorders, symptom burden and impact on quality of life. Further, treatment outcomes and barriers in the clinician⁻patient relationship, and cross-cultural experiences are highlighted. This discussion is necessary in aiding an improved understanding and management of MUS due to the interconnectedness underlying MUS presentations across the spectrum of medical specialties.

The Neuroanatomy of Somatoform Disorders: A Magnetic Resonance Imaging Study.

BACKGROUND: Somatoform disorders (SDs) are a heterogeneous group of psychiatric syndromes characterized by common symptoms, which may mimic a physical condition but they are not explained by a medical condition. Although the biologic nature of this disorder has been widely accepted, the neuroanatomical correlates characterizing SDs are still inconclusive. OBJECTIVE: This study aims to explore gray matter (GM) volume alterations in SD patients compared to healthy controls and their possible association with clinical and cognitive measures. METHOD: We used voxel-based morphometry to examine regional GM volumes in 20 inpatients with SDs and 24-matched healthy controls. Only for SD patients, we employed multiple instruments to assess psychopathology and cognitive functioning, which were then used to explore their association with GM volume deficits. RESULTS: Compared to healthy controls, SD patients showed GM volume reductions in the hypothalamus, left fusiform gyrus, right cuneus, left inferior frontal gyrus, left posterior cingulate, and right amygdala (p < 0.05, cluster Family Wise Error corrected). Additionally, in SD, Symptom Checklist-90-Phobia and Hamilton Depressive Rating Scale scores negatively correlated with specific fronto-temporoparietal regions whereas Symptom Checklist-90-Sleep scores positively correlated with anterior cingulate cortex. Lastly, the Boston Naming Test negatively correlated with fronto-temporoparietal and striatal volumes whereas Free and Cued Selective Reminding Test and Stroop scores positively correlated with superior temporal gyrus and cuneus, respectively (all p < 0.05, cluster Family Wise Error corrected). CONCLUSION: Our results suggest that SDs might be characterized by selective impairments in specific cortico-limbic regions associated to two overlapping circuits, the neuromatrix of pain and the emotion regulation system.

Neuroimaging Applications in Functional Movement Disorders.

Functional (psychogenic) movement disorders are a subtype of functional neurological disorder, a common and disabling cause of neurological symptoms. Abnormal movement in people with functional movement disorders has specific characteristics (e.g., distractibility, variability, incongruence with deficits caused by neurological disease), allowing positive diagnosis and differentiation from other causes of movement disorder. Attempts to understand the pathophysiology of this disorder have previously focused mainly on the psychological level, emphasizing the importance of psychological trauma and adverse life events. However, the last two decades has seen a broadening of this approach to consider the neurobiological level, and brain imaging has formed a key part of this work. Here we review the available imaging evidence in functional movement disorders and explain how this evidence can help us understand more about the underlying pathophysiology of this common cause of abnormal movement control.

Regional white matter volume abnormalities in first-episode somatization disorder.

BACKGROUND: Alterations of white matter integrity have been implicated in patients with somatization disorder (SD). However, changes of white matter volume (WMV) remain unclear. This study is designed to examine regional WMV in patients with SD and to investigate the potential relationships between WMV abnormalities and personality traits, cognitive function, and symptom severity. METHODS: We recruited 25 first-episode, drug-naive patients with SD and 28 sex-, age-, and education-matched healthy controls for the study. Personality traits, cognitive function, and symptom severity were assessed for all participants. Data were analyzed with the computational anatomy toolbox (CAT12) methods. RESULTS: Patients with SD exhibited a significantly increased WMV in the right inferior frontal gyrus (IFG) (t = 4.4009) and a significantly decreased WMV in the left inferior longitudinal fasciculus (ILF) (t = -3.4292) relative to healthy controls. No correlation was found between abnormal WMV and clinical/cognitive variables in the patients. CONCLUSIONS: Our findings suggest the presence of significant regional WMV abnormalities in first-episode, drug-naive patients with SD, which might improve understanding the pathophysiology of SD.

Grey matter abnormalities in children and adolescents with functional neurological symptom disorder.

OBJECTIVE: Functional neurological symptom disorder refers to the presence of neurological symptoms not explained by neurological disease. Although this disorder is presumed to reflect abnormal function of the brain, recent studies in adults show neuroanatomical abnormalities in brain structure. These structural brain abnormalities have been presumed to reflect long-term adaptations to the disorder, and it is unknown whether child and adolescent patients, with illness that is typically of shorter duration, show similar deficits or have normal brain structure. METHOD: High-resolution, three-dimensional T1-weighted magnetic resonance images (MRIs) were acquired in 25 patients (aged 10-18 years) and 24 healthy controls. Structure was quantified in terms of grey matter volume using voxel-based morphometry. Post hoc, we examined whether regions of structural difference related to a measure of motor readiness to emotional signals and to clinical measures of illness duration, illness severity, and anxiety/depression. RESULTS: Patients showed greater volumes in the left supplementary motor area (SMA) and right superior temporal gyrus (STG) and dorsomedial prefrontal cortex (DMPFC) (corrected p < 0.05). Previous studies of adult patients have also reported alterations of the SMA. Greater SMA volumes correlated with faster reaction times in identifying emotions but not with clinical measures. CONCLUSIONS: The SMA, STG, and DMPFC are known to be involved in the perception of emotion and the modulation of motor responses. These larger volumes may reflect the early expression of an experience-dependent plasticity process associated with increased vigilance to others' emotional states and enhanced motor readiness to organize self-protectively in the context of the long-standing relational stress that is characteristic of this disorder.

Effects of subclinical depression, anxiety and somatization on brain structure in healthy subjects.

BACKGROUND: Dimensional approaches in highly prevalent psychiatric disorders like depression or anxiety could lead to a better understanding of pathogenesis and advantages in early detection and prevention. In an effort to better understand associations of brain structural variation across the depression/anxiety spectra, we investigated minor subclinical symptoms in a non-clinical healthy population. METHODS: We studied 177 healthy subjects from the community, who underwent high-resolution T1-weighted 3T MRI and completed the symptom-checklist-90 (SCL-90-R). Using voxel-based morphometry (VBM) analysis with CAT12 software, we correlated SCL-90-R-subscales for depression, anxiety, and somatization with gray matter across the brain. RESULTS: Significant positive gray matter correlations emerged across all three scales in different areas: the depression subscale correlated positively with gray matter in the Rolandic operculum, superior temporal gyrus (left) and postcentral gyrus (bilateral), the anxiety subscale correlated positively with middle temporal gyrus, Rolandic operculum, middle cingular gyrus and precuneus bilaterally, and the somatization subscale with left inferior prefrontal cortex. Somatization also showed negative correlations with cerebellar vermis and right supplementary motor area. LIMITATIONS: Our study is limited to VBM and does not include surface-based measures. It also only contains subjects with very small psychological distress by partly overlapping symptoms. CONCLUSION: Our findings are consistent with a non-linear relationship between symptom severity and cortical volume in several brain areas involved in both emotion regulation as well as altered in clinically manifest depressive/anxiety disorders.

Characteristics of patients contacting a center for undiagnosed and rare diseases.

BACKGROUND: Little is known about the characteristics of patients seeking help from dedicated centers for undiagnosed and rare diseases. However, information about their demographics, symptoms, prior diagnoses and medical specialty is crucial to optimize these centers' processes and infrastructure. METHODS: Using a questionnaire, structured information from 522 adult patients contacting a center for undiagnosed and rare diseases was obtained. The information included basic sociodemographic data (age, gender, insurance status), previous hospital admissions, primary symptoms of complaint and previously determined diagnosis. RESULTS: The majority of patients completing the questionnaire were female, 300 (57 %) vs. 222 men (43 %). The median age was 52 years (range 18-92). More than half, 309 (59 %), of our patients had never been admitted to a university hospital. Common diagnoses included other soft tissue disorders, not classified elsewhere (ICD M79, n = 63, 15.3 %), somatoform disorders (ICD F45, n = 51, 12.3 %) and other polyneuropathies (ICD G62, n=36, 8.7 %). The most frequent symptoms were general weakness (n = 180, 36.6 %) followed by arthralgia (n = 124, 25.2 %) and abdominal discomfort (n = 113, 23.0 %). The majority of patients had either internal medicine (81.3 %) and/or neurologic (37.6 %) health problems. CONCLUSIONS: Pain-associated diagnoses and the typical "unexplained" medical conditions (chronic fatigue syndrome, fibromyalgia, irritable bowel syndrome) are frequent among people contacting a center dedicated to undiagnosed diseases. The chief symptoms are mostly unspecific. An interdisciplinary organizational approach involving mainly internal medicine, neurology and psychiatry/psychosomatic care is needed.

Neurobiological origin of psychogenic nonepileptic seizures: A review of imaging studies.

Psychogenic nonepileptic seizures (PNES) are relatively common occurrences in epilepsy centers. Pathophysiology of PNES is still poorly understood. In this paper, the evidence for a neurobiological origin of PNES will be reviewed. Recent evidence suggests altered functional and structural brain connectivity as an underlying pathophysiological mechanism in patients with PNES. Pursuing the concept of connectome in patients with PNES and comparing the findings with healthy individuals may result in a breakthrough in identifying the exact neurobiological origin of PNES. Finding the neurobiological bases and identification of biomarkers of PNES will potentially have important clinical implications in formulating better diagnostic and therapeutic approaches for affected patients.

Abnormal regional homogeneity and its correlations with personality in first-episode, treatment-naive somatization disorder.

BACKGROUND: Structural and functional abnormalities of the default mode network (DMN) and their correlations with personality have been found in somatization disorder (SD). However, no study is conducted to identify regional neural activity and its correlations with personality in SD. In this study, regional homogeneity (ReHo) was applied to explore whether abnormal regional neural activity is present in patients with SD and its correlations with personality measured by Eysenck Personality Questionnaire (EPQ). METHODS: Twenty-five first-episode, treatment-naive patients with SD and 28 sex-, age-, and education-matched healthy controls participated in the whole study. During the scanning, all subjects were instructed to lie still with their eyes closed and remain awake. A ReHo approach was employed to analyze the data. RESULTS: The SD group had a significantly increased ReHo in the left angular gyrus (AG) compared to healthy controls. The increased ReHo positively correlated to the neuroticism scores of EPQ (EPQ-N). No other correlations were detected between the ReHo values and other related factors, such as symptom severity and education level. CONCLUSIONS: Our results suggest that abnormal regional neural activity of the DMN may play a key role in SD with clinical implications and emphasize the importance of the DMN in the pathophysiological process of SD.

Alterations in white matter integrity in first-episode, treatment-naive patients with somatization disorder.

White matter (WM) abnormality in somatization disorder (SD) has not been reported yet. This study was designed to elucidate the alterations in WM integrity in SD. A total of 25 patients with SD and 28 healthy controls were enrolled in the study. WM integrity was analyzed using tract-based spatial statistics. No differences were found between the patients and the controls for fractional anisotropy (FA) values, mean diffusivity (MD), axial diffusivity, and radial diffusivity values at the corrected p<0.05 level. Patients with SD had significantly decreased FA values in the cingulum and inferior fronto-occipital fasciculus, and significantly increased MD values in the anterior thalamic radiation and corticospinal tract compared with the controls at the uncorrected p<0.005 level. Somatization severity was correlated with the FA values of the cingulum and inferior fronto-occipital fasciculus in the patients. The patients exhibit suggestive alterations in WM integrity in the cingulum, inferior fronto-occipital fasciculus, anterior thalamic radiation, and corticospinal tract.

A neural circuit framework for somatosensory amplification in somatoform disorders.

Although somatosensory amplification is theorized to serve a critical role in somatization, it remains poorly understood neurobiologically. In this perspective article, convergent visceral-somatic processing is highlighted, and neuroimaging studies in somatoform disorders are reviewed. Neural correlates of cognitive-affective amplifiers are integrated into a neurocircuit framework for somatosensory amplification. The anterior cingulate cortex, insula, amygdala, hippocampal formation, and striatum are some of the identified regions. Clinical symptomatology in a given patient or group may represent dysfunction in one or more of these neurobehavioral nodes. Somatosensory amplification may, in part, develop through stress-mediated aberrant neuroplastic changes and the neuromodulatory effects of inflammation.

Regional gray matter volume and anxiety-related traits interact to predict somatic complaints in a non-clinical sample.

Somatic complaints can be important features of an individual's expression of anxiety. Anxiety-related traits are also risk factors for somatic symptoms. However, it is not known which neuroanatomical mechanisms may be responsible for this relationship. In this study, our first step was to use voxel-based morphometry (VBM) approaches to investigate the neuroanatomical basis underlying somatic complaints in a large sample of healthy subjects. We found a significant positive correlation between somatic complaints and parahippocampal gyrus (PHG) volume adjacent to the entorhinal cortex. Further analysis revealed that the interaction between PHG volume/entorhinal cortex and neuroticism-anxiety (N-Anx) predicted somatic complaints. Specifically, somatic complaints were associated with higher N-Anx for individuals with increased PHG volume. These findings suggest that increased PHG volume and higher trait anxiety can predict vulnerability to somatic complaints in the general population.

Dismorfofobia: o olhar do outro / Dysmorphophobia: to be seen through someone else's eyes

O modus vivendi moderno tem produzido cada vez mais um crescente descontentamento em relação à anatomia corporal e a imaginação a respeito do corpo perfeito desperta um desejo no indivíduo nem sempre condizente com sua realidade. Sem limitação para as transfigurações, o corpo é modelado com base no sonho de uma estrutura corporal perfeita, na maioria das vezes, inalcançável, com os inúmeros procedimentos cirúrgicos propostos. Assim, é fundamental que os cirurgiões plásticos conheçam o Transtorno Dismórfico Corporal (TDC) ou dismorfofobia, desordem esta prevalente em ambos os sexos, em que a visão da aparência é deturpada, caracterizada pela inquietação excessiva de uma imperfeição física minúscula ou por imperfeições corporais ilusórias. O diagnóstico pode passar despercebido pelo não conhecimento, pelo subdiagnóstico ou pela preocupação apenas com a alteração corporal, o que pode trazer prejuízos pessoais, demandas jurídicas e até ajudar a manter o distúrbio.

The modern modus vivendi has promoted a growing discontentment in regard to self body image, and imagining a perfect body leads to a desire in an individual that is not always compatible with reality. With no limits in transfiguration, the body is modeled based on the dream of a perfect body structure, which is most times unattainable and requires numerous proposed surgical procedures. Therefore, it is of utmost importance for plastic surgeons to become aware of Body Dysmorphic Disorder (BDD), or dysmorphophobia. This is a disorder that is prevalent in both sexes, in which self visual appearance is distorted. It is also characterized by an excessive concern over a tiny physical imperfection or delusive physical imperfections. The diagnosis can remain unnoticed due to lack of knowledge, misdiagnosis, or concern only over body alterations, which may lead to personal damage, legal claims, and also risk of prolonging the disorder.

Psychogenic pseudosyncope: diagnosis and management.

Psychogenic pseudosyncope (PPS) is the appearance of transient loss of consciousness (TLOC) in the absence of true loss of consciousness. Psychiatrically, most cases are classified as conversion disorder, which is hypothesized to represent the physical manifestation of internal stressors. The incidence of PPS is likely under-recognized and the disorder is under investigated in the unexplained syncope population, yet it can be diagnosed accurately with a focused history and confirmed with investigations including head-up tilt testing (HUTT), electroencephalogram (EEG; sometimes combined with video) or, in some centers, transcranial Doppler (TCD). Patients are more likely to be young females with an increased number of episodes over the past 6months. They frequently experience symptoms prior to their episodes including light-headedness, shortness of breath and tingling. Conversion disorder is associated with symptomatic chronicity, increased psychiatric and physical impairment, and diminished quality of life. Understanding the epidemiology, biological underpinnings and approach to diagnosis of PPS is important to improve the recognition of this disorder so that patients may be managed appropriately. The general treatment approach involves limiting unnecessary interventions, providing the patient with needed structure, and encouraging functionality. While there are no treatment data available for patients with PPS, studies in related conversion disorder populations support the utility of psychotherapy. Psychotropic medications should be considered in patients with comorbid psychiatric disorders.

Distinctive spontaneous regional neural activity in patients with somatoform pain disorder: a preliminary resting-state fMRI study.

This resting-state functional magnetic resonance imaging study found that nine patients with somatoform pain disorder exhibited atypical precentral gyrus activation compared with 20 healthy controls. The role of the precentral gyrus in pain-related processing is discussed.

Management of burning mouth syndrome taking into consideration various etiologic factors.

The aim of the research was to detect the stomatologic, endocrine and psycho-neurologic status in patients with burning mouth syndrome, elaborate different diagnostic criteria and effective therapy for the patients with burning mouth syndrome. 92 patients with burning mouth syndrome were studied. Patients ranged in age from 28 to 72 years. The conducted studies gave the possibility to make conclusions, the most important of which are: burning mouth syndrome (BMS) is not only stomatologic problem; this psychosomatic syndrome belongs to gerontologic disease and tendency of its "rejuvenation" was revealed as well (in the current study --2 women (28 and 32 year old, and 38 year old man); degree of revelation of the symptoms of depression, anxiety, obsession and somatization is closely related with duration of the diseases. These symptoms are progressing together with aging and reach the peak at 60-70 years old. Individual scheme of therapy was developed on the background of clinico-paraclinical study.