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1.
Epidemiol Psychiatr Sci ; 29: e144, 2020 Jul 20.
Artículo en Inglés | MEDLINE | ID: mdl-32684190

RESUMEN

AIMS: Establishing the minimum clinically important difference (MCID) in functioning and cognition is essential to the interpretation of the research and clinical work conducted in bipolar disorders (BD). The present study aimed to estimate the MCID for the Functioning Assessment Short Test (FAST) and a battery of neuropsychological tests in BD. METHODS: Anchor-based and distributive methods were used to estimate the MCID for the FAST and cognition using data from a large, multicentre, observational cohort of individuals with BD. The FAST and cognition were linked with the Clinical Global Impressions Scale-Severity (CGI-S) and Global Assessment of Functioning (GAF) using an equipercentile method. The magnitude of the standard error measurement (s.e.m.) provided another estimate of the MCID. RESULTS: In total, 570 participants were followed for 2 years. Cross-sectional CGI-S and GAF scores were linked to a threshold ⩽7 on the FAST for functional remission. The MCID for the FAST equalled 8- or 9-points change from baseline using the CGI-S and GAF. One s.e.m. on the FAST corresponded to 7.6-points change from baseline. Cognitive variables insufficiently correlated with anchor variables (all ρ <0.3). One s.e.m. for cognitive variables corresponded to a range of 0.45 to 0.93-s.d. change from baseline. CONCLUSIONS: These findings support the value of the estimated MCID for the FAST and cognition and may be a useful tool to evaluate cognitive and functional remediation effects and improve patient functional outcomes in BD. The CGI-S and GAF were inappropriate anchors for cognition. Further studies may use performance-based measures of functioning instead.


Asunto(s)
Trastorno Bipolar/diagnóstico , Trastornos del Conocimiento/diagnóstico , Cognición/fisiología , Pruebas Neuropsicológicas/estadística & datos numéricos , Trastorno Bipolar/psicología , Trastornos del Conocimiento/psicología , Estudios Transversales , Función Ejecutiva , Femenino , Humanos , Masculino , Memoria a Corto Plazo , Evaluación de Resultado en la Atención de Salud , Tiempo de Reacción , Conducta Social
2.
Eur Neuropsychopharmacol ; 29(4): 471-481, 2019 04.
Artículo en Inglés | MEDLINE | ID: mdl-30846287

RESUMEN

According to the DSM-5, "reduction in the need for sleep" is the only sleep-related criteria for mixed features in depressive episodes. We aimed at studying the prevalence, clinical correlates and the role of hypersomnia in a sample of acutely depressed patients. Secondarily, we factors significantly increasing the odds of hypersomnia were studied. We conducted a post-hoc analysis of the BRIDGE-II-Mix study. Variables were compared between patients with hypersomnia (SLEEP+) and with insomnia (SLEEP-) with standard bivariate tests. A stepwise backward logistic regression model was performed with SLEEP+ as dependent variable. A total of 2514 subjects were dichotomized into SLEEP+ (n = 423, 16.8%) and SLEEP- (n = 2091, 83.2%). SLEEP+ had significant higher rates of obese BMI (p < 0.001), BD diagnosis (p = 0.027), severe BD (p < 0.001), lifetime suicide attempts (p < 0.001), lower age at first depression (p = 0.004) than SLEEP-. Also, SLEEP+ had significantly poorer response to antidepressants (AD) such as (hypo)manic switches, AD resistance, affective lability, or irritability (all 0<0.005). Moreover, SLEEP+ had significantly higher rates of mixed-state specifiers than SLEEP- (all 0 < 0.006). A significant contribution to hypersomnia in our regression model was driven by metabolic-related features, such as "current bulimia" (OR = 4.21) and "overweight/obese BMI (OR = 1.42)". Globally, hypersomnia is associated with poor outcome in acute depression. Hypersomnia is strongly associated with mixed features and bipolarity. Metabolic aspects could influence the expression of hypersomnia, worsening the overall clinical outcome. Along with commonly used screening tools, detection of hypersomnia has potential, costless discriminative validity in the differential diagnosis unipolar and bipolar depression.


Asunto(s)
Trastorno Bipolar/epidemiología , Trastorno Depresivo Mayor/epidemiología , Trastornos de Somnolencia Excesiva/epidemiología , Trastornos del Inicio y del Mantenimiento del Sueño/epidemiología , Adulto , Comorbilidad , Femenino , Humanos , Internacionalidad , Masculino
3.
Med Mal Infect ; 49(2): 150-156, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30736992

RESUMEN

Approximately 10% of patients presenting with Lyme disease experience fatigue, musculoskeletal pain, concentration disorders, or short-term memory deficits in the six months following treatment. This entity has been defined as post-Lyme disease syndrome or post-treatment Lyme disease syndrome. The pathophysiology of this syndrome is unknown, but neither persistence of the bacterium nor effectiveness of antibiotics are currently reported in the literature. The French High Council for Public Health (French acronym HCSP) has recently defined a new entity called "persistent polymorphic symptoms after a tick bite" allowing for designing studies to better understand these subjective presentations, for which objective biomarkers are currently lacking. This entity encompasses patients experiencing fatigue and generalized pain in the months following a tick bite and can be associated with several subjective symptoms with major impact on the quality of life. In the field of somatoform disorders, this article reviews functional neuroimaging studies in patients presenting with subjective complaints and discusses potential clinical implications for persisting symptoms after tick bites and post-treatment Lyme disease syndrome.


Asunto(s)
Neuroimagen Funcional , Síndrome de la Enfermedad Post-Lyme/diagnóstico , Trastornos Somatomorfos/diagnóstico por imagen , Mordeduras de Garrapatas/diagnóstico , Humanos , Síndrome de la Enfermedad Post-Lyme/psicología , Mordeduras de Garrapatas/psicología
4.
J Affect Disord ; 246: 346-354, 2019 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-30597295

RESUMEN

OBJECTIVE: This study primarily focused on the relationship between comorbid attention deficit-hyperactivity disorder (ADHD), mixed features and bipolarity in major depressive patients. METHODS: The sample comprised 2777 patients with Major Depressive Episode (MDE) enrolled in a multicentre, multinational study originally designed to assess different definitions of mixed depression. Socio-demographic, familial and clinical characteristics were compared in patients with (ADHD + ) and without (ADHD-) comorbid ADHD. RESULTS: Sixty-one patients (2.2%) met criteria for ADHD. ADHD was associated with a higher number of (hypo)manic symptoms during depression. Mixed depression was more represented in ADHD + patients than in ADHD- using both DSM-5 and experimental criteria. Differences were maintained after removing overlapping symptoms between (hypo)mania and ADHD. ADHD in MDE was also associated with a variety of clinical and course features such as onset before the age of 20, first-degree family history of (hypo)mania, past history of antidepressant-induced (hypo)manic switches, higher number of depressive and affective episodes, atypical depressive features, higher rates of bipolarity specifier, psychiatric comorbidities with eating, anxiety and borderline personality disorders. LIMITATIONS: The study was primarily designed to address mixed features in ADHD, with slightly reduced sensitivity to the diagnosis of ADHD. Other possible diagnostic biases due to heterogeneity of participating clinicians. CONCLUSIONS: In a sample of major depressive patients, the comorbid diagnosis of current ADHD is associated with bipolar diathesis, mixed features, multiple psychiatric comorbidity and a more unstable course. Further prospective studies are necessary to confirm the possible mediating role of temperamental mood instability and emotional dysregulation in such a complex clinical presentation.


Asunto(s)
Trastorno por Déficit de Atención con Hiperactividad/complicaciones , Trastorno Depresivo Mayor/complicaciones , Adulto , Síntomas Afectivos , Antidepresivos/uso terapéutico , Trastornos de Ansiedad/complicaciones , Trastorno por Déficit de Atención con Hiperactividad/psicología , Trastorno Bipolar/complicaciones , Trastorno Bipolar/psicología , Trastorno de Personalidad Limítrofe/complicaciones , Estudios Transversales , Trastorno Depresivo Mayor/tratamiento farmacológico , Trastorno Depresivo Mayor/psicología , Composición Familiar , Trastornos de Alimentación y de la Ingestión de Alimentos/complicaciones , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos
5.
Annu Int Conf IEEE Eng Med Biol Soc ; 2019: 429-432, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31945930

RESUMEN

Lower-limb exoskeletons have been used in gait rehabilitation to facilitate the restoration of motor skills. These robotics systems could be complemented by Brain-Computer Interfaces (BCIs) to assist or rehabilitate people with walking disabilities. In this preliminary study, electroencephalography-based brain functional connectivity is analyzed during exoskeleton-assisted gait motor imagery (MI) training. Partial Directed Coherence (PDC) analysis was employed to assess the exchange of information flow between EEG signals during gait MI in four healthy subjects, two using an exoskeleton and two without using it. Besides, in order to explore the functional connectivity, an outflow index based on the number of significant directed connectivities revealed by the PDC analysis is proposed. We found that the outflow index increases in the central zone (C2, C3, C4) while decreases in the central-parietal (CP1, CP2) and fronto-central (FC1) zones when the training was assisted by an exoskeleton. The results obtained can be useful to obtain informative features for BCI applications as well as in motor rehabilitation.


Asunto(s)
Interfaces Cerebro-Computador , Marcha , Encéfalo , Electroencefalografía , Humanos , Imágenes en Psicoterapia
6.
Annu Int Conf IEEE Eng Med Biol Soc ; 2018: 203-206, 2018 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-30440373

RESUMEN

The use of motion assistance devices improves the rehabilitation process of patients that have motor disabilities. In the case these devices are controlled by brain-machine interfaces, the rehabilitation process can be improved due to neuroplasticity. However, in the case of lower limb rehabilitation, the limited accuracy of the control algorithms is a serious difficulty to overcome. In this research, different EEG signal's processing techniques, based on motor imagery, are tested for a brain-computer interface in an offline scenario, in order to detect the limitations of the models previous to its realtime implementation. The results reveal that motor imagery is very dependent on the subject and that Stockwell Transform provides the best accuracy among the models tested.


Asunto(s)
Interfaces Cerebro-Computador , Electroencefalografía , Procesamiento de Señales Asistido por Computador , Algoritmos , Electroencefalografía/métodos , Humanos , Imágenes en Psicoterapia , Imaginación , Extremidad Inferior , Plasticidad Neuronal
7.
Annu Int Conf IEEE Eng Med Biol Soc ; 2018: 2170-2173, 2018 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-30440834

RESUMEN

This work studies a novel transcranial direct current stimulation (tDCS) montage to improve a brain-machine interface (BMI) lower limb motor imagery detection. The tDCS montage is composed by two anodes and one cathode. One anode is located over the motor cortex and the other one over the cerebellum. Ten healthy subjects participated in this experiment. They were randomly separated into two groups: sham, which received a fake stimulation, and active tDCS, which received a real stimulation. Each subject was experimented on five consecutive days. Results pointed out that there was a significant difference $(p < 0 .05)$ in the classification accuracy between the sham and the active tDCS group. On each of the five days of the experiment the active tDCS group achieved better accuracy results than the sham group: 4%, 10%, 10%, 9% and 7% higher respectively.


Asunto(s)
Interfaces Cerebro-Computador , Corteza Motora , Estimulación Transcraneal de Corriente Directa , Imágenes en Psicoterapia , Extremidad Inferior
8.
Annu Int Conf IEEE Eng Med Biol Soc ; 2018: 2398-2401, 2018 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-30440890

RESUMEN

In this work, hip and knee angles were decoded from low frequency EEG components recorded during the execution of two tasks. In order to compare their performance, three decoders based on multiple linear regression (MLR) models were applied under different conditions; which consisted in considering the processed data as a whole or divided into segments. Results suggest that, when the segments are related to specific tasks, the segmentation provides a better performance than applying the decoding method to unsegmented data.


Asunto(s)
Electroencefalografía , Articulación de la Cadera/fisiología , Articulación de la Rodilla/fisiología , Extremidad Inferior , Fenómenos Biomecánicos , Femenino , Humanos , Modelos Lineales , Masculino , Análisis de Regresión
9.
Encephale ; 44(6): 558-564, 2018 Dec.
Artículo en Francés | MEDLINE | ID: mdl-30466778

RESUMEN

Aripiprazole may be viewed as the prototype of third-generation antipsychotics. This concept is based on the notion of D2 partial agonism, whereas all molecules of first-and second generation were D2 antagonists. After reviewing the basic pharmacological notions linked to such concepts, the mechanisms of action of these molecules are addressed, with a particular focus on functional selectivity and biased ligand. One of the essential pharmacological properties of D2 agonists, and particularity aripiprazole, is their ability to not induce D2 supersensitivity as well as to reverse this supersensitivity when it has been induced by D2 antagonists. In clinical practice, this impacts the choice of treatment in first episode psychosis as well as in refractory schizophrenia. Animal research shows that D2 supersensitivity could contribute to worsen addictive trends. The pharmacokinetic incidence of D2 supersensitivity tends to favour the long-acting forms of partial agonists. The notion of partial agonism could finally lead to design fourth-generation antipsychotics, on the basis on research focusing on functional selectivity.


Asunto(s)
Antipsicóticos/farmacología , Antipsicóticos/uso terapéutico , Aripiprazol/farmacología , Aripiprazol/uso terapéutico , Agonistas de Dopamina/farmacología , Agonistas de Dopamina/uso terapéutico , Trastornos Psicóticos/tratamiento farmacológico , Esquizofrenia/tratamiento farmacológico , Animales , Humanos
10.
J Appl Physiol (1985) ; 125(5): 1404-1410, 2018 11 01.
Artículo en Inglés | MEDLINE | ID: mdl-29975604

RESUMEN

Force is generated by muscle units according to the neural activation sent by motor neurons. The motor unit is therefore the interface between the neural coding of movement and the musculotendinous system. Here we propose a method to accurately measure the latency between an estimate of the neural drive to muscle and force. Furthermore, we systematically investigate this latency, which we refer to as the neuromechanical delay (NMD), as a function of the rate of force generation. In two experimental sessions, eight men performed isometric finger abduction and ankle dorsiflexion sinusoidal contractions at three frequencies and peak-to-peak amplitudes {0.5, 1, and 1.5 Hz; 1, 5, and 10 of maximal force [%maximal voluntary contraction (MVC)]}, with a mean force of 10% MVC. The discharge timings of motor units of the first dorsal interosseous (FDI) and tibialis anterior (TA) muscle were identified by high-density surface EMG decomposition. The neural drive was estimated as the cumulative discharge timings of the identified motor units. The neural drive predicted 80 ± 0.4% of the force fluctuations and consistently anticipated force by 194.6 ± 55 ms (average across conditions and muscles). The NMD decreased nonlinearly with the rate of force generation ( R2 = 0.82 ± 0.07; exponential fitting) with a broad range of values (from 70 to 385 ms) and was 66 ± 0.01 ms shorter for the FDI than TA ( P < 0.001). In conclusion, we provided a method to estimate the delay between the neural control and force generation, and we showed that this delay is muscle-dependent and is modulated within a wide range by the central nervous system. NEW & NOTEWORTHY The motor unit is a neuromechanical interface that converts neural signals into mechanical force with a delay determined by neural and peripheral properties. Classically, this delay has been assessed from the muscle resting level or during electrically elicited contractions. In the present study, we introduce the neuromechanical delay as the latency between the neural drive to muscle and force during variable-force contractions, and we show that it is broadly modulated by the central nervous system.


Asunto(s)
Sistema Nervioso Central/fisiología , Neuronas Motoras/fisiología , Contracción Muscular , Adulto , Electromiografía , Humanos , Masculino
11.
Acta Psychiatr Scand ; 138(4): 348-359, 2018 10.
Artículo en Inglés | MEDLINE | ID: mdl-29766490

RESUMEN

OBJECTIVE: Remitted bipolar disorder (BD) patients frequently present with chronic mood instability and emotional hyper-reactivity, associated with poor psychosocial functioning and low-grade inflammation. We investigated emotional hyper-reactivity as a dimension for characterization of remitted BD patients, and clinical and biological factors for identifying those with and without emotional hyper-reactivity. METHOD: A total of 635 adult remitted BD patients, evaluated in the French Network of Bipolar Expert Centers from 2010-2015, were assessed for emotional reactivity using the Multidimensional Assessment of Thymic States. Machine learning algorithms were used on clinical and biological variables to enhance characterization of patients. RESULTS: After adjustment, patients with emotional hyper-reactivity (n = 306) had significantly higher levels of systolic and diastolic blood pressure (P < 1.0 × 10-8 ), high-sensitivity C-reactive protein (P < 1.0 × 10-8 ), fasting glucose (P < 2.23 × 10-6 ), glycated hemoglobin (P = 0.0008) and suicide attempts (P = 1.4 × 10-8 ). Using models of combined clinical and biological factors for distinguishing BD patients with and without emotional hyper-reactivity, the strongest predictors were: systolic and diastolic blood pressure, fasting glucose, C-reactive protein and number of suicide attempts. This predictive model identified patients with emotional hyper-reactivity with 84.9% accuracy. CONCLUSION: The assessment of emotional hyper-reactivity in remitted BD patients is clinically relevant, particularly for identifying those at higher risk of cardiometabolic dysfunction, chronic inflammation, and suicide.


Asunto(s)
Síntomas Afectivos , Trastorno Bipolar , Enfermedades Cardiovasculares , Trastornos del Metabolismo de la Glucosa , Aprendizaje Automático , Intento de Suicidio/estadística & datos numéricos , Adulto , Síntomas Afectivos/sangre , Síntomas Afectivos/epidemiología , Síntomas Afectivos/etiología , Síntomas Afectivos/fisiopatología , Trastorno Bipolar/sangre , Trastorno Bipolar/complicaciones , Trastorno Bipolar/epidemiología , Trastorno Bipolar/fisiopatología , Glucemia , Presión Sanguínea/fisiología , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/fisiopatología , Femenino , Francia/epidemiología , Trastornos del Metabolismo de la Glucosa/sangre , Trastornos del Metabolismo de la Glucosa/epidemiología , Hemoglobina A Glucada , Humanos , Masculino , Persona de Mediana Edad , Inducción de Remisión , Riesgo
12.
Eur Psychiatry ; 52: 61-67, 2018 08.
Artículo en Inglés | MEDLINE | ID: mdl-29734127

RESUMEN

OBJECTIVE: To examine any association of birth decade, sex and exposure to alcohol and/or substance use disorders (ASUD) with age at onset (AAO) of bipolar I disorder (BD-I). METHODS: Using data from a representative clinical sample of 3896 BD-I cases recruited from 14 European countries, we examined AAO distributions in individuals born in consecutive birth decades. Cumulative probabilities with Mantel-Cox log-rank tests, pairwise comparisons and Odds Ratios (OR) with 95% confidence intervals (95% CI) were employed to analyze AAO according to birth decade, sex, and presence or absence of an ASUD. RESULTS: In the total sample, median AAO of BD-I decreased from about 41 years for those born in the 1930s to about 26 years for those born in the 1960s. In a sub-sample of 1247 individuals (selected to minimize confounding), AAO significantly decreased for males and females born in each consecutive decade between 1930 and 50 (OR: 0.65; 95% CI: 0.51, 0.81), and for cases with an ASUD as compared to without (OR: 0.77, 95% CI: 0.69, 0.87). The best fitting regression model identified an independent effect for each birth decade and an interaction between ASUD status and sex, with a consistently earlier AAO in males with an ASUD (OR: 0.79: 95% CI: 0.70, 0.91). CONCLUSIONS: In BD-I cases diagnosed according to internationally recognized criteria and recruited to pan-European clinical observational studies, the AAO distributions are compatible with a birth cohort effect. A potentially modifiable risk factor, namely ASUD status, was associated with the observed reduction in AAO, especially in males.


Asunto(s)
Edad de Inicio , Alcoholismo/epidemiología , Trastorno Bipolar/epidemiología , Comparación Transcultural , Adulto , Factores de Edad , Alcoholismo/diagnóstico , Trastorno Bipolar/diagnóstico , Efecto de Cohortes , Europa (Continente) , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Multicéntricos como Asunto , Estudios Observacionales como Asunto , Oportunidad Relativa , Modelos de Riesgos Proporcionales , Factores de Riesgo , Factores Sexuales
13.
Encephale ; 44(6S): S34-S38, 2018 Dec.
Artículo en Francés | MEDLINE | ID: mdl-30935485

RESUMEN

Despite the lack of progress in the curative treatment of mental illness, especially schizophrenia, the accumulation of neuroscience data over the past decade suggests the re-conceptualization of schizophrenia. With the advent of new biomarkers and cognitive tools, new neuroscience technologies such as functional dynamic connectivity and the identification of subtle clinical features; it is now possible to detect early stages at risk or prodromes of a first psychotic episode. Current concepts reconceptualizes schizophrenia as a neurodevelopmental disorder at early onset, with polygenic risk and only symptomatic treatment for positive symptoms at this time. The use of such technologies in the future suggests new diagnostic and therapeutic options. Next steps include new pharmacological perspectives and potential contributions of new technologies such as quantitative system pharmacology brain computational modeling approach.


Asunto(s)
Antipsicóticos , Intervención Médica Temprana/métodos , Farmacología Clínica/métodos , Esquizofrenia/tratamiento farmacológico , Adolescente , Adulto , Factores de Edad , Edad de Inicio , Antipsicóticos/clasificación , Antipsicóticos/uso terapéutico , Encéfalo , Niño , Preescolar , Continuidad de la Atención al Paciente , Diagnóstico Precoz , Femenino , Humanos , Lactante , Recién Nacido , Persona de Mediana Edad , Embarazo , Esquizofrenia/diagnóstico , Esquizofrenia/epidemiología , Esquizofrenia/patología , Psicología del Esquizofrénico , Integración de Sistemas , Adulto Joven
14.
Eur Psychiatry ; 45: 190-197, 2017 09.
Artículo en Inglés | MEDLINE | ID: mdl-28957786

RESUMEN

OBJECTIVE: Bipolar disorders (BD) are characterized by sleep disturbances and emotional dysregulation both during acute episodes and remission periods. We hypothesized that sleep quality (SQ) and emotional reactivity (ER) defined clusters of patients with no or abnormal SQ and ER and we studied the association with functioning. METHOD: We performed a bi-dimensional cluster analysis using SQ and ER measures in a sample of 533 outpatients patients with BD (in remission or with subsyndromal mood symptoms). Clusters were compared for mood symptoms, sleep profile and functioning. RESULTS: We identified three clusters of patients: C1 (normal ER and SQ, 54%), C2 (hypo-ER and low SQ, 22%) and C3 (hyper-ER and low SQ, 24%). C1 was characterized by minimal mood symptoms, better sleep profile and higher functioning than other clusters. Although highly different for ER, C2 and C3 had similar levels of subsyndromal mood symptoms as assessed using classical mood scales. When exploring sleep domains, C2 showed poor sleep efficiency and a trend for longer sleep latency as compared to C3. Interestingly, alterations in functioning were similar in C2 and C3, with no difference in any of the sub-domains. CONCLUSION: Abnormalities in ER and SQ delineated three clusters of patients with BD and significantly impacted on functioning.


Asunto(s)
Afecto , Trastorno Bipolar/complicaciones , Trastornos del Sueño-Vigilia/complicaciones , Estrés Psicológico/complicaciones , Adulto , Nivel de Alerta , Trastorno Bipolar/psicología , Análisis por Conglomerados , Femenino , Francia , Humanos , Conducta Impulsiva , Masculino , Persona de Mediana Edad , Trastornos del Inicio y del Mantenimiento del Sueño/complicaciones , Trastornos del Sueño-Vigilia/psicología , Estrés Psicológico/psicología
15.
IEEE Int Conf Rehabil Robot ; 2017: 68-71, 2017 07.
Artículo en Inglés | MEDLINE | ID: mdl-28813795

RESUMEN

We evaluated the electromechanical delay (EMD) for the tibialis anterior (TA) muscle during the performance of time-varying ankle dorsiflexions. Subjects were asked to track a sinusoidal trajectory, for a range of amplitudes and frequencies. Motor unit (MU) action potential trains were identified from surface electromyography (EMG) decomposition and summed to generate the cumulative spike train (CST). CST and the exerted force were cross-correlated to identify the delay between the CST and force, which was considered as an estimate of the EMD. The results showed that the EMD decreased logarithmically with the increase in the slope of the force produced.


Asunto(s)
Tobillo/fisiología , Electromiografía/métodos , Contracción Muscular/fisiología , Músculo Esquelético/fisiología , Adulto , Humanos , Masculino , Procesamiento de Señales Asistido por Computador
16.
IEEE Int Conf Rehabil Robot ; 2017: 818-822, 2017 07.
Artículo en Inglés | MEDLINE | ID: mdl-28813921

RESUMEN

Transcranial direct stimulation (tDCS) is a technique for modulating brain excitability that has potential to be used in motor neurorehabilitation by enhancing motor activity, such as motor imagery (MI). tDCS effects depend on different factors, like current density and the position of the stimulating electrodes. This study presents preliminary results of the evaluation of the effect of current density on MI performance by measuring right-hand/feet MI accuracy of classification from electroencephalographic (EEG) measurements after anodal tDCS is applied with a 4×1 ring montage over the right-hand or feet motor cortex. Results suggest that there might be an enhancement of feet MI when tDCS is applied over the right-hand motor cortex, but further evaluation is required. If results are confirmed with a larger sample, the montage could be used to optimize feet MI performance and improve the outcome of MI-based brain-computer interfaces, which are used during motor neurorehabilitation.


Asunto(s)
Electroencefalografía/clasificación , Imaginación/clasificación , Corteza Motora/fisiología , Estimulación Transcraneal de Corriente Directa , Pie/fisiología , Mano/fisiología , Humanos , Imaginación/fisiología
17.
J Psychiatr Res ; 95: 37-45, 2017 12.
Artículo en Inglés | MEDLINE | ID: mdl-28777981

RESUMEN

BACKGROUND: This study aims at testing for paths from childhood abuse to clinical indicators of complexity in bipolar disorder (BD), through dimensions of affective dysregulation, impulsivity and hostility. METHOD: 485 euthymic patients with BD from the FACE-BD cohort were included from 2009 to 2014. We collect clinical indicators of complexity/severity: age and polarity at onset, suicide attempt, rapid cycling and substance misuse. Patients completed questionnaires to assess childhood emotional, sexual and physical abuses, affective lability, affect intensity, impulsivity, motor and attitudinal hostility. RESULTS: The path-analysis demonstrated significant associations between emotional abuse and all the affective/impulsive dimensions (p < 0.001). Sexual abuse was moderately associated with emotion-related dimensions but not with impulsivity nor motor hostility. In turn, affect intensity and attitudinal hostility were associated with high risk for lifetime presence of suicide attempts (p < 0.001), whereas impulsivity was associated with a higher risk of lifetime presence of substance misuse (p < 0.001). No major additional paths were identified when including Emotional and Physical Neglect in the model. CONCLUSIONS: This study provides refinement of the links between early adversity, dimensions of psychopathology and the complexity/severity of BD. Mainly, dimensions of affective dysregulation, impulsivity/hostility partially mediate the links between childhood emotional to suicide attempts and substance misuse in BD.


Asunto(s)
Adultos Sobrevivientes de Eventos Adversos Infantiles , Síntomas Afectivos , Trastorno Bipolar , Hostilidad , Conducta Impulsiva , Delitos Sexuales , Trastornos Relacionados con Sustancias , Intento de Suicidio , Adulto , Adultos Sobrevivientes de Eventos Adversos Infantiles/estadística & datos numéricos , Síntomas Afectivos/epidemiología , Trastorno Bipolar/epidemiología , Trastorno Bipolar/etiología , Trastorno Bipolar/fisiopatología , Estudios de Cohortes , Comorbilidad , Femenino , Francia/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Delitos Sexuales/estadística & datos numéricos , Intento de Suicidio/estadística & datos numéricos , Adulto Joven
18.
Acta Psychiatr Scand ; 136(4): 362-372, 2017 10.
Artículo en Inglés | MEDLINE | ID: mdl-28741646

RESUMEN

OBJECTIVE: To evaluate aggressiveness during a major depressive episode (MDE) and its relationship with bipolar disorder (BD) in a post hoc analysis of the BRIDGE-II-MIX study. METHOD: A total of 2811 individuals were enrolled in this multicenter cross-sectional study. MDE patients with (MDE-A, n = 399) and without aggressiveness (MDE-N, n = 2412) were compared through chi-square test or Student's t-test. A stepwise backward logistic regression model was performed. RESULTS: MDE-A group was more frequently associated with BD (P < 0.001), while aggressiveness was negatively correlated with unipolar depression (P < 0.001). At the logistic regression, aggressiveness was associated with the age at first depressive episode (P < 0.001); the severity of mania (P = 0.03); the diagnosis of BD (P = 0.001); comorbid borderline personality disorder (BPD) (P < 0.001) but not substance abuse (P = 0.63); no current psychiatric treatment (P < 0.001); psychotic symptoms (P = 0.007); the marked social/occupational impairment (P = 0.002). The variable most significantly associated with aggressiveness was the presence of DSM-5 mixed features (P < 0.001, OR = 3.815). After the exclusion of BPD, the variable of lifetime suicide attempts became significant (P = 0.013, OR = 1.405). CONCLUSION: Aggressiveness seems to be significantly associated with bipolar spectrum disorders, independently from BPD and substance abuse. Aggressiveness should be considered as a diagnostic criterion for the mixed features specifier and a target of tailored treatment strategy.


Asunto(s)
Agresión/fisiología , Trastorno Bipolar/fisiopatología , Trastorno Depresivo Mayor/fisiopatología , Adulto , Trastorno Bipolar/epidemiología , Trastorno de Personalidad Limítrofe/epidemiología , Trastorno de Personalidad Limítrofe/fisiopatología , Comorbilidad , Estudios Transversales , Trastorno Depresivo Mayor/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad
19.
Acta Psychiatr Scand ; 135(5): 479-488, 2017 May.
Artículo en Inglés | MEDLINE | ID: mdl-28369709

RESUMEN

OBJECTIVE: To explore the prevalence and clinical profile of males and females who develop antidepressant treatment-emergent mania (ATEM). METHOD: From an original sample of 754 patients with BD, we identified ATEM+ cases (n = 75) and ATEM- controls (n = 135) that met stringent criteria. We specifically examined the combinations of clinical factors that best classified males and females as ATEM+ cases. RESULTS: Seventy-five individuals were classified as ATEM+; 87% of ATEM events occurred during antidepressant monotherapy. Regression analyses demonstrated that the presence of an alcohol and/or substance use disorder [Odds Ratio (OR) 6.37], a history of one or more suicide attempts (OR 4.19) and higher number of depressive episodes per year of illness (OR 1.71) correctly classified 73% of males. In contrast, 84% of females were correctly classified on the basis of a positive history of thyroid disorder (OR 3.23), a positive family history of BD I (OR 2.68) and depressive onset polarity (OR 2.01). CONCLUSION: Using stringent definitions of ATEM status to reduce the probability of inclusion of false-positive cases and false-negative controls, we identified for the first time that the risk profiles for the development of an ATEM differ significantly according to gender.


Asunto(s)
Antidepresivos/efectos adversos , Trastorno Bipolar/psicología , Adolescente , Adulto , Antidepresivos/uso terapéutico , Trastorno Bipolar/tratamiento farmacológico , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Femenino , Humanos , Masculino , Escalas de Valoración Psiquiátrica , Análisis de Regresión , Caracteres Sexuales , Adulto Joven
20.
Acta Psychiatr Scand ; 135(5): 460-469, 2017 May.
Artículo en Inglés | MEDLINE | ID: mdl-28260234

RESUMEN

OBJECTIVE: The aim of our study was to investigate, in bipolar patients, whether affect lability was associated with suicidal ideation incidence during 2-year follow-up, and which subtype of affect lability was associated with suicidal ideation. METHOD: A total of 319 euthymic or mildly depressed bipolar outpatients recruited in the French FondaMental Advanced Centres of Expertise for Bipolar Disorder were divided into two subgroups according to the occurrence of suicidal ideation during a 2-year follow-up. Affect lability was assessed by the French version of the Affect Lability Scale. RESULTS: Bipolar patients with high affect lability were more likely to report suicidal ideation during follow-up, even after adjustment for age, study level, rapid cycling, current depression level, anxiety disorder, and lifetime history SA (OR = 2.47; 95% CI [1.15-5.30], P = 0.01). The risk of suicidal ideation increased with the level of affect lability. More specifically, the propensity to switch from neutral to elation affect, from anxious to depressive affect (or inversely), and from neutral to anger affect predicted suicidal ideation. CONCLUSION: Reducing affective lability could become a new therapeutic target of suicidal prevention in bipolar disorder.


Asunto(s)
Trastorno Bipolar/psicología , Intento de Suicidio/estadística & datos numéricos , Adulto , Anciano , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Escalas de Valoración Psiquiátrica , Factores de Riesgo , Ideación Suicida , Intento de Suicidio/psicología
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