Evidências Neurobiológicas de Viés Atencional no Transtorno Obsessivo-Compulsivo: Revisão Sistemática / Neurobiological Evidence of Attentional Bias in Obsessive-Compulsive Disorder: Systematic Review

Resumo O viés atencional corresponde à alocação de recursos de atenção a materiais irrelevantes à tarefa. Supõe-se que pacientes com transtorno obsessivo-compulsivo (TOC) apresentem viés atencional voltado à ameaça. Com o objetivo de descrever os achados neurobiológicos do viés atencional voltado à ameaça no TOC, foi realizada uma busca sistemática por estudos experimentais com investigação neurobiológica nas bases de dados: MEDLINE, Web of Science, Scopus e LILACS. Quatro estudos com grupo controle são descritos nos resultados, todos indicam diferenças estatisticamente significativas na atividade encefálica associada a atenção em pacientes. Os achados neurobiológicos dos estudos incluídos na revisão sugerem a alocação de recursos da atenção a estímulos irrelevantes, independente da valência emocional no TOC.

Abstract The attentional bias is the allocation of attentional resources to irrelevant stimuli during a task. It is assumed that patients with obsessive-compulsive disorder (OCD) presents attentional bias toward threatening stimuli. In order to describe OCD's neurobiological findings of attentional bias towards a threat, it was performed a systematic review of experimental studies with neurobiological assessment in the following databases: MEDLINE, Web of Science, Scopus and LILACS. Four studies with control group are described in this review, all presenting statistically significant differences in brain activity associated with attention in patients. The neurobiological findings of the studies included in the review suggest allocation of attentional resources to irrelevant stimuli, regardless of the emotional valence in OCD.

White Bear Suppression Inventory: translation and cross-cultural adaptation to Brazilian Portuguese.

Introduction Intrusive thoughts may cause a significant level of distress, since some individuals evaluate the content of those thoughts as aversive. Suppression of intrusive thoughts is one of the strategies adopted by these individuals, which increases the level of distress. Suppression of thoughts may be present as one of the factors that maintain different psychological disorders. Objective To describe the translation and adaptation into Brazilian Portuguese of the White Bear Suppression Inventory (WBSI), which measures thought suppression. Methods Three translations and back-translations were conducted by independent evaluators. Semantic equivalence was assessed and the three versions were evaluated to produce a synthesized version. Comments from participants on the preliminary version of the questionnaire were examined. Results We developed a preliminary Brazilian Portuguese version of the WBSI. It was found that most participants understood the descriptions of cognitions given in the translated questionnaire. Conclusion The use of three different versions of translations and back-translations, discussion of the synthetic version and interaction with the target population have conferred viability to the process of semantic equivalence of the Brazilian Portuguese final version of the WBSI.

White Bear Suppression Inventory: translation and cross-cultural adaptation to Brazilian Portuguese / White Bear Suppression Inventory: tradução e adaptação transcultural para a língua portuguesa do Brasil

Abstract Introduction Intrusive thoughts may cause a significant level of distress, since some individuals evaluate the content of those thoughts as aversive. Suppression of intrusive thoughts is one of the strategies adopted by these individuals, which increases the level of distress. Suppression of thoughts may be present as one of the factors that maintain different psychological disorders. Objective To describe the translation and adaptation into Brazilian Portuguese of the White Bear Suppression Inventory (WBSI), which measures thought suppression. Methods Three translations and back-translations were conducted by independent evaluators. Semantic equivalence was assessed and the three versions were evaluated to produce a synthesized version. Comments from participants on the preliminary version of the questionnaire were examined. Results We developed a preliminary Brazilian Portuguese version of the WBSI. It was found that most participants understood the descriptions of cognitions given in the translated questionnaire. Conclusion The use of three different versions of translations and back-translations, discussion of the synthetic version and interaction with the target population have conferred viability to the process of semantic equivalence of the Brazilian Portuguese final version of the WBSI.

Resumo Introdução Pensamentos intrusivos podem causar um nível significativo de desconforto, uma vez que alguns indivíduos avaliam o conteúdo desses pensamentos como aversivos. A supressão dos pensamentos intrusivos é uma das estratégias adotadas por esses indivíduos, resultando no aumento do nível de desconforto. Supressão de pensamentos pode estar presente como um dos fatores de manutenção de diferentes transtornos psicológicos. Objetivos Descrever a tradução e adaptação para o português brasileiro do White Bear Suppression Inventory (WBSI), que avalia a supressão de pensamentos. Métodos Três traduções e retrotraduções foram conduzidas por avaliadores independentes. A equivalência semântica foi analisada e as três versões foram avaliadas para produzir uma versão preliminar. Os comentários dos participantes sobre a versão preliminar do questionário foram examinados. Resultados Foi desenvolvida uma versão final em português brasileiro do WBSI. Verificou-se que a maioria dos participantes entendeu as descrições das cognições apresentadas no questionário traduzido. Conclusão O uso de três versões diferentes de traduções e retrotraduções, discussão da versão preliminar e interação com a população-alvo conferiu viabilidade ao processo de equivalência semântica da versão final brasileira da WBSI.

How high level of anxiety in Panic Disorder can interfere in working memory? A computer simulation and electrophysiological investigation.

Panic disorder (PD) is characterized by repeated and unexpected attacks of intense anxiety, which are not restricted to a determined situation or circumstance. The coherence function has been used to investigate the communication among brain structures through the quantitative EEG (qEEG). The objective of this study is to analyze if there is a difference in frontoparietal gamma coherence (GC) between panic disorder patients (PDP) and healthy controls (HC) during the Visual oddball paradigm; and verify if high levels of anxiety (produced by a computer simulation) affect PDP's working memory. Nine PDP (9 female with average age of 48.8, SD: 11.16) and ten HC (1 male and 9 female with average age of 38.2, SD: 13.69) were enrolled in this study. The subjects performed the visual oddball paradigm simultaneously to the EEG record before and after the presentation of computer simulation (CS). A two-way ANOVA was applied to analyze the factors Group and the Moment for each pair of electrodes separately, and another one to analyze the reaction time variable. We verified a F3-P3 GC increased after the CS movie, demonstrating the left hemisphere participation during the anxiety processing. The greater GC in HC observed in the frontal and parietal areas (P3-Pz, F4-F8 and Fp2-F4) points to the participation of these areas with the expected behavior. The greater GC in PDP for F7-F3 and F4-P4 pairs of electrodes assumes that it produces a prejudicial "noise" during information processing, and can be associated to interference on the communication between frontal and parietal areas. This "noise" during information processing is related to PD symptoms, which should be better known in order to develop effective treatment strategies.

Virtual Reality as a Promising Strategy in the Assessment and Treatment of Bulimia Nervosa and Binge Eating Disorder: A Systematic Review.

Several lines of evidence suggest that Virtual Reality (VR) has a potential utility in eating disorders. The objective of this study is to review the literature on the use of VR in bulimia nervosa (BN) and binge eating disorder (BED). Using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement for reporting systematic reviews, we performed a PubMed, Web of Knowledge and SCOPUS search to identify studies employing VR in the assessment and treatment of BN and BED. The following search terms were used: "virtual reality", "eating disorders", "binge eating", and "bulimia nervosa". From the 420 articles identified, 19 were selected, nine investigated VR in assessment and 10 were treatment studies (one case-report, two non-controlled and six randomized controlled trials). The studies using VR in BN and BED are at an early stage. However, considering the available evidence, the use of VR in the assessment of those conditions showed some promise in identifying: (1) how those patients experienced their body image; and (2) environments or specific kinds of foods that may trigger binge-purging cycle. Some studies using VR-based environments associated to cognitive behavioral techniques showed their potential utility in improving motivation for change, self-esteem, body image disturbances and in reducing binge eating and purging behavior.

Electroencephalographic findings in patients with major depressive disorder during cognitive or emotional tasks: a systematic review

Objective: Major depressive disorder (MDD) is a prevalent psychiatric condition characterized by multiple symptoms that cause great distress. Uncovering the brain areas involved in MDD is essential for improving therapeutic strategies and predicting response to interventions. This systematic review discusses recent findings regarding cortical alterations in depressed patients during emotional or cognitive tasks, as measured by electroencephalography (EEG). Methods: A search of the MEDLINE/PubMed and Cochrane databases was carried out using the keywords EEG and depression, confined to article title. Results: The studies identified reveal the frontal cortex as an important brain structure involved in the complex neural processes associated with MDD. Findings point to disorganization of right-hemisphere activity and deficient cognitive processing in MDD. Depressed individuals tend to ruminate on negative information and respond with a pattern of relatively higher right frontal activity to emotional stimuli associated with withdrawal and isolation. Conclusion: Patients with MDD may have altered dynamic patterns of activity in several neuroanatomical structures, especially in prefrontal and limbic areas involved in affective regulation. Identification of these alterations might help predict the response of patients to different interventions more effectively and thus maximize the effects both of pharmacotherapeutic and of psychotherapeutic strategies.

Electroencephalographic findings in patients with major depressive disorder during cognitive or emotional tasks: a systematic review.

OBJECTIVE:: Major depressive disorder (MDD) is a prevalent psychiatric condition characterized by multiple symptoms that cause great distress. Uncovering the brain areas involved in MDD is essential for improving therapeutic strategies and predicting response to interventions. This systematic review discusses recent findings regarding cortical alterations in depressed patients during emotional or cognitive tasks, as measured by electroencephalography (EEG). METHODS:: A search of the MEDLINE/PubMed and Cochrane databases was carried out using the keywords EEG and depression, confined to article title. RESULTS:: The studies identified reveal the frontal cortex as an important brain structure involved in the complex neural processes associated with MDD. Findings point to disorganization of right-hemisphere activity and deficient cognitive processing in MDD. Depressed individuals tend to ruminate on negative information and respond with a pattern of relatively higher right frontal activity to emotional stimuli associated with withdrawal and isolation. CONCLUSION:: Patients with MDD may have altered dynamic patterns of activity in several neuroanatomical structures, especially in prefrontal and limbic areas involved in affective regulation. Identification of these alterations might help predict the response of patients to different interventions more effectively and thus maximize the effects both of pharmacotherapeutic and of psychotherapeutic strategies.

Alterações Neurobiológicas Verificadas a partir do Tratamento com Terapia Cognitivo-comportamental no Transtorno Obsessivo-Compulsivo / Neurobiological Changes after Cognitive-Behavioral Therapy of Obsessive-Compulsive Disorder

RESUMO Hipóteses neurobiológicas sobre o Transtorno Obsessivo-Compulsivo (TOC) sugerem alterações funcionais e anatômicas em determinadas áreas cerebrais relacionadas aos sintomas. Evidências indicam que a Terapia Cognitivo-Comportamental (TCC) é eficaz para o tratamento do TOC e capaz de modular padrões neurais disfuncionais. O presente estudo objetivou descrever as alterações neurobiológicas promovidas pela TCC para o TOC. Realizou-se uma revisão sistemática, cuja amostra final correspondeu a cinco estudos. Em todos, houve melhora significativa do TOC e alterações neurobiológicas após a TCC, tais como redução da atividade e volume no córtex orbitofrontal, aumento da atividade no córtex cingulado anterior, tálamo e núcleo caudado. A TCC mostrou-se capaz de modular neurocircuitos envolvidos no TOC.

ABSTRACT Neurobiological theories about Obsessive-Compulsive Disorder (OCD) signalize functional and anatomical changes in specific areas of the brain related to its symptoms. Evidence indicates that Cognitive-Behavioral Therapy (CBT) is effective in the treatment of OCD as well as capable of modulating dysfunctional neural patterns. This study aimed at describing neurobiological changes derived from the treatment of OCD with the CBT. A systematic review was carried out and its final sample consisted of five studies. In all of them, there was significant improvement of OCD as well as neurobiological changes, after CBT. The main findings were reduced activity and volume in the orbitofrontal cortex and increased activity in the anterior cingulate cortex, thalamus and caudate nucleus. CBT has shown to be able to modulate the neural circuits involved in OCD.

Frontal cortex absolute beta power measurement in Panic Disorder with Agoraphobia patients.

UNLABELLED: Panic disorder patients are hypervigilant to danger cues and highly sensitive to unpredictable aversive events, what leads to anticipatory anxiety, that is one key component of the disorder maintenance. Prefrontal cortex seems to be involved in these processes and beta band activity may be related to the involvement of top-down processing, whose function is supposed to be disrupted in pathological anxiety. The objective of this study was to measure frontal absolute beta-power (ABP) with qEEG in panic disorder and agoraphobia (PDA) patients compared to healthy controls. METHODS: qEEG data were acquired while participants (24 PDA patients and 21 controls) watched a computer simulation (CS), consisting of moments classified as "high anxiety" (HAM) and "low anxiety" (LAM). qEEG data were also acquired during two rest conditions, before and after the computer simulation display. The statistical analysis was performed by means of a repeated measure analysis of variance (two-way ANOVA) and ABP was the dependent variable of interest. The main hypothesis was that a higher ABP in PDA patients would be found related to controls. Moreover, in HAM the ABP would be different than in LAM. RESULTS: the main finding was an interaction between the moment and group for the electrodes F7, F8, Fp1 and Fp2. We observed a higher ABP in PDA patients when compared to controls while watching the CS. The higher beta-power in the frontal cortex for the PDA group may reflect a state of high excitability, together with anticipatory anxiety and maintenance of hypervigilant cognitive state. CONCLUSIONS: our results suggest a possible deficiency in top-down processing reflected by a higher ABP in the PDA group while watching the CS and they highlight the recruitment of prefrontal regions during the exposure to anxiogenic stimuli. LIMITATIONS: the small sample, the wide age range of participants and the use of psychotropic medications by most of the PDA patients.

Psychometric evidence of the Brazilian version of Driving Cognitions Questionnaire (DCQ).

This paper examined the psychometric data obtained by the Brazilian version DCQ (Driving Cognitions Questionnaire) and its convergence with DBS (Driving Behavior Survey). The research included 187 participants of both genders, aged between 19 and 79years (mean 34years), with driving license in category 'B' (cars). The internal consistency obtained by research (Cronbach's alpha) was α=0.96 for full DCQ; α=0.89 for the subscale panic in the direction, α=0.91 for the subscale of concern in causing accidents and α=0.92 for the subscale of social concern. Psychometrically the results are positive and confirm the relevance of using the instrument. The survey also found positive convergence (although less pronounced) with the DBS, which is another instrument that comes to difficulties when driving or dealing with traffic or driving a car. Thus, this article demonstrates psychometric results that point to the profitable use of the Brazilian version of DCQ as an adjunct in the diagnosis of difficulty in driving.

Evoked Potential in Panic Disorder Patients: A Systematic Review.

Researchers have been using the electroencephalogram to better understand the cognitive and neurobiological bases of panic disorder (PD) through the P300 component; this is an electric potential of the cerebral cortex that is generated in response to external sensorial stimuli and which involves more complex neurophysiological processes related to stimulus interpretation; it is then used to investigate possible alterations in the information processing and attention of patients suffering from this disorder. Aiming to verify the results found by experimental articles already published about P300 in PD patients and the information processing differences between PD patients and healthy controls, a systematic review of the PubMed and Institute for Scientific Information databases was conducted. The selection criterion involved those articles, written in English, which referred to an experimental research that focused on the P300 component, with a sample composed of PD (or panic attacks) patients. Seven articles were found that fit the selected criteria. Most of the articles show that these patients suffer from: impaired information processing and attention, an inability to automatically respond to new stimuli, and impaired interpretation of internal and external stimuli related to the disorder. Such impairment may be related to an unspecified dysfunction in the limbic-reticular structures, which would affect: active, focused and short-term attention, working and short-term memory, recognition and decision making. Some limitations were highlighted, such as the use of small samples and possible comorbidity with other disorders, which did not allow clearer results. This research can contribute to understand the neurobiological differences of PD patients and develop treatments based on such evidence.

Treino assertivo para a depressão: uma revisão bibliográfica / Assertive training for depression: a literature review

A depressão apresenta alta prevalência e provoca um impacto negativo significativo na qualidade de vida das pessoas. Dentre os aspectos comprometidos, estão as habilidades sociais e, mais especificamente, a assertividade, que vem sendo apontada como deficitária nesses pacientes, sendo o treinamento assertivo bastante recomendado nesses casos. O entendimento dos padrões inadequados de comportamento social é fundamental para que se possa atuar na prevenção e no tratamento desses sintomas em pacientes deprimidos. Neste artigo, é realizada uma revisão narrativa da literatura sobre assertividade, treinamento assertivo e depressão. São apresentadas as estratégias utilizadas para o treinamento da assertividade e descritos estudos que se propuseram a avaliar a eficácia do treinamento assertivo em pacientes deprimidos. Verificou-se que programas de treinamento em assertividade têm se mostrado eficazes em pacientes deprimidos e podem facilitar e potencializar as interações sociais, o que representa um importante ganho para esses pacientes. Estudos orientados para essa temática são importantes tanto para o contexto das relações interpessoais como dos transtornos psicológicos e seu tratamento(AU)

Depression is highly prevalent and causes a significant negative impact on quality of life. Among the committed aspects are social skills and more specifically assertiveness, which has been identified as deficient in these patients. Therefore, assertive training is highly recommended in these cases. Understanding the inadequate standards of social behavior is essential so that we can act in the prevention and treatment of these symptoms in depressed patients. This paper presents a narrative review of the literature on assertiveness, assertive training and depression. The strategies used for the training of assertiveness are presented and studies that assessed the effectiveness of assertiveness training in depressed patients are described. It was found that assertiveness training programs have proven effective in depressed patients and can facilitate and enhance social interactions, which is an important gain for these patients. Studies in this theme are important for not only for the context of interpersonal relationships, but also for psychological disorders and their treatment(AU)

O uso do teatro do oprimido no tratamento em grupo para transtorno de ansiedade social / Using theater of the oppressed in group treatment for social anxiety disorder

O Teatro do Oprimido (TO), criado por Augusto Boal na década de 1960, é um conjunto de técnicas, exercícios e jogos teatrais que tem como objetivo principal colocar o teatro a serviço da transformação social. O transtorno de ansiedade social (TAS) é considerado um transtorno grave, de curso crônico, que pode chegar a ser incapacitante, e, atualmente, o tratamento considerado mais efetivo para esses casos é a terapia cognitivo-comportamental (TCC). Objetivou-se desenvolver um programa de tratamento psicológico estruturado para TAS, aliando a TCC em grupo às técnicas do TO, e avaliar sua eficácia em comparação a um grupo-controle em lista de espera. Foram avaliados 35 sujeitos que participaram do tratamento, e 21 em lista de espera. As avaliações ocorreram antes do início, ao final e um mês após a terapia. Foram realizadas 18 sessões, duas vezes por semana, com duração de duas horas cada. Os instrumentos utilizados foram os Inventários Beck de Depressão e Ansiedade, o Inventário de Ansiedade e Fobia Social (SPAI), a Escala de Medo da Avaliação Negativa (FNE) e a Escala de Autoestima. O grupo experimental apresentou resultados significativos em comparação ao grupo-controle em todos os instrumentos aplicados. O grupo experimental melhorou, mas o grupo-controle, não. Os resultados encontrados indicam que o modelo proposto foi uma intervenção com resultado superior à passagem do tempo(AU)

The Theatre of the Oppressed (TO) was created by Augusto Boal in the 1960's. It is a set of techniques, theater games, and exercises, that aims to put theater at the service of social transformation. Social Anxiety Disorder (SAD) is considered to be a serious disorder, of chronic course, that can lead to incapacity. Cognitive-Behavioral Therapy (CBT) is considered to be the most effective treatment for SAD. The objective of this research was to develop a structured psychological treatment for SAD, combining group CBT with techniques of TO and having those results compared with a stand-by list control group. Thirty-five patients that participated in the treatment, and twenty-one individuals from the stand-by list, were evaluated. The evaluations occurred one month prior to the beginning of the therapy, at the end of the therapy, one month after the therapy. The protocol had eighteen sessions of two hours each. The sessions happened twice a week and the instruments used in the research were the Beck Depression Inventory, the Beck Anxiety Inventory, the Social Phobia Anxiety Inventory (SPAI), the Fear of Negative Evaluation (FNE), and Self-Esteem Scale. The results found showed a significant statistical difference between the control group and the experimental group, all instruments considered. The experimental group improved in a significant way while the control group did not. The results indicate that the proposed protocol was more effective than the passage of time(AU)

Terapia cognitivo-comportamental e coaching cognitivo-comportamental: como as duas práticas se integram e se diferenciam / Cognitive-behavioural therapy and cognitive-behavioural coaching: differences and similarities between the two approaches

O coaching cognitivo-comportamental (CCC) é um processo estruturado de estabelecimento e alcance de metas que se fundamenta sobre o princípio cognitivo-comportamental, que pressupõe que não são os eventos em si que deflagram respostas emocionais e comportamentais, mas a interpretação que os indivíduos apresentam sobre eles. Nesse sentido, o CCC é um processo de identificação e desbloqueio de padrões cognitivos que dificultam a realização e o alcance de objetivos vinculado a planos de ação para a mudança comportamental, tendo sido descrito como método eficaz para o alcance de resultados na vida profissional e pessoal. No entanto, a interface dessa prática com a terapia cognitivo-comportamental (TCC) tem sido pouco investigada no Brasil. Assim, este artigo tem como objetivo discutir algumas das principais semelhanças e diferenças entre essas duas práticas. Pretende-se, com essa discussão, contribuir para o fortalecimento da prática profissional fundamentada sobre a abordagem cognitivo-comportamental para além do contexto clínico no nosso país, tendo em vista que o CCC visa atuar com clientes que não preencham critérios diagnósticos para transtornos mentais ou que simplesmente almejam alcançar uma experiência de viver mais plena e dotada de significado(AU)

Cognitive-behavioral coaching (CBC) is a structured process of goal establishment and attainment that is grounded on the cognitive-behavioral principle that emotional and behavioral responses are not triggered by events per se but by the individual's interpretation of them. In this respect, the CBC is a process of identifying and unblocking cognitive patterns that difficult goal achievement, tagged to action plans targeting behavioral change. CBC has been described as an effective method for achieving results in both professional and personal dimensions of life. However, the interface of this practice with CBT has been little investigated in Brazil. Thus, the present article aims at attempting to bridge this gap by presenting and discussing some of the main similarities and differences between these two practices. It is intended that this discussion will contribute towards the strengthening of cognitive-behavioral-grounded practices beyond the clinical context in our country, with patients who do not fulfill diagnostic criteria for mental disorders or with those who simply aim at developing a more purposeful experience of living(AU)

Demographics, clinical characteristics and quality of life of Brazilian women with driving phobia.

Driving phobia is associated with serious consequences such as restriction of freedom, career impairments and social embarrassment. The main objective of this paper is to compare clinical characteristics and quality of life between women with driving phobia and women without this phobia. These factors were assessed using structured interviews, semi-structured questionnaires, scales and inventories. We accessed diagnoses, depressive symptoms, anxiety symptoms, anxiety traits, driving cognitions and quality of life. There was no difference between groups with regard to demographic data and driving history. Both groups were also equivalent in the number of traumatic events and accidents experienced while driving or riding. The fear of driving group showed higher state and trait anxiety scores. A high frequency of cognitive distortions can explain why people with driving phobia often engage in maladaptive safety behaviors in an attempt to protect themselves from unpredicted dangers when driving. Regarding quality of life, the control group had slightly higher scores on all subscales, but significant differences were observed for only three scales: "functional capacity", "social aspects", and "mental health". More studies with larger samples more instruments and other contexts are needed to further investigate the clinical characteristics and personality traits of people who have a fear of driving.

Electroencephalographic findings in panic disorder / Achados eletroencefalográficos no transtorno do pânico

Some studies have reported the importance of electroencephalography (EEG) as a method for investigating abnormal parameters in psychiatric disorders. Different findings in time and frequency domain analysis with regard to central nervous system arousal during acute panic states have already been obtained. This study aimed to systematically review the EEG findings in panic disorder (PD), discuss them having a currently accepted neuroanatomical hypothesis for this pathology as a basis, and identify limitations in the selected studies. Literature search was conducted in the databases PubMed and ISI Web of Knowledge, using the keywords electroencephalography and panic disorder; 16 articles were selected. Despite the inconsistency of EEG findings in PD, the major conclusions about the absolute power of alpha and beta bands point to a decreased alpha power, while beta power tends to increase. Different asymmetry patterns were found between studies. Coherence studies pointed to a lower degree of inter-hemispheric functional connectivity at the frontal region and intra-hemispheric at the bilateral temporal region. Studies on possible related events showed changes in memory processing in PD patients when exposed to aversive stimuli. It was noticed that most findings reflect the current neurobiological hypothesis of PD, where inhibitory deficits of the prefrontal cortex related to the modulation of amygdala activity, and the subsequent activation of subcortical regions, may be responsible to trigger anxiety responses. We approached some important issues that need to be considered in further researches, especially the use of different methods for analyzing EEG signals (AU)

Alguns estudos relataram a importância da eletroencefalografia (EEG) como método de investigação de parâmetros anormais em transtornos psiquiátricos. Achados diferentes na análise do domínio do tempo e da frequência em relação à excitabilidade do sistema nervoso central durante estados agudos de pânico já foram obtidos. O objetivo deste estudo foi revisar sistematicamente os achados de EEG no transtorno do pânico (TP), discuti-los com base em uma hipótese neuroanatômica atualmente aceita para essa patologia e identificar limitações nos estudos selecionados. A pesquisa bibliográfica foi realizada nas bases de dados PubMed e ISI Web of Knowledge, utilizando as palavras-chave eletroencefalografia e transtorno do pânico; 16 artigos foram selecionados. Apesar da inconsistência dos achados de EEG no TP, as principais conclusões sobre a potência absoluta das bandas alfa e beta apontam para uma diminuição da potência em alfa, enquanto em beta a potência tende a aumentar. Diferentes padrões de assimetria foram encontrados entre estudos. Os estudos de coerência apontaram para um menor grau de conectividade funcional inter-hemisférica na região frontal e intra-hemisférica na região temporal bilateral. Estudos de potenciais eventos relacionados demonstraram mudanças no processamento da memória em pacientes com TP quando expostos a estímulos aversivos. Notou-se que a maioria dos resultados reflete a atual hipótese neurobiológica do TP, nos quais déficits inibitórios do córtex pré-frontal em relação à modulação da atividade da amígdala, e a subsequente ativação de regiões subcorticais, podem ser responsáveis por desencadear respostas de ansiedade. Foram abordadas algumas questões importantes que precisam ser consideradas em futuras pesquisas, especialmente o uso de diferentes métodos de análise de sinais de EEG (AU)

Alpha absolute power measurement in panic disorder with agoraphobia patients.

BACKGROUND: Panic attacks are thought to be a result from a dysfunctional coordination of cortical and brainstem sensory information leading to heightened amygdala activity with subsequent neuroendocrine, autonomic and behavioral activation. Prefrontal areas may be responsible for inhibitory top-down control processes and alpha synchronization seems to reflect this modulation. The objective of this study was to measure frontal absolute alpha-power with qEEG in 24 subjects with panic disorder and agoraphobia (PDA) compared to 21 healthy controls. METHODS: qEEG data were acquired while participants watched a computer simulation, consisting of moments classified as "high anxiety"(HAM) and "low anxiety" (LAM). qEEG data were also acquired during two rest conditions, before and after the computer simulation display. RESULTS: We observed a higher absolute alpha-power in controls when compared to the PDA patients while watching the computer simulation. The main finding was an interaction between the moment and group factors on frontal cortex. Our findings suggest that the decreased alpha-power in the frontal cortex for the PDA group may reflect a state of high excitability. CONCLUSIONS: Our results suggest a possible deficiency in top-down control processes of anxiety reflected by a low absolute alpha-power in the PDA group while watching the computer simulation and they highlight that prefrontal regions and frontal region nearby the temporal area are recruited during the exposure to anxiogenic stimuli.

Does immobilization of dependent hand promote adaptative changes in cerebral cortex? An analysis through qEEG asymmetry.

This study aimed to elucidate electrophysiological and cortical mechanisms involved when 15 healthy right-handed subjects executed an index finger flexion and extension task before and after hand immobilization, using qEEG beta band (13-30Hz) asymmetry. This beta band is involved in motor activity and sensorial factors. Our hypothesis is that an increase in beta band asymmetry in pre-frontal, motor and parietal areas will occur in post-hand immobilization, because these areas need to reorganize for new planning, preparation and voluntary motor control. We found increase in beta band asymmetry during post-treatment task. We concluded that beta band asymmetry plays an important role in the analysis of cortical changes in several brain areas when associated to motor task. Furthermore, we assume that 48h of hand immobilization change cortical functioning.

Electroencephalographic findings in panic disorder.

Some studies have reported the importance of electroencephalography (EEG) as a method for investigating abnormal parameters in psychiatric disorders. Different findings in time and frequency domain analysis with regard to central nervous system arousal during acute panic states have already been obtained. This study aimed to systematically review the EEG findings in panic disorder (PD), discuss them having a currently accepted neuroanatomical hypothesis for this pathology as a basis, and identify limitations in the selected studies. Literature search was conducted in the databases PubMed and ISI Web of Knowledge, using the keywords electroencephalography and panic disorder; 16 articles were selected. Despite the inconsistency of EEG findings in PD, the major conclusions about the absolute power of alpha and beta bands point to a decreased alpha power, while beta power tends to increase. Different asymmetry patterns were found between studies. Coherence studies pointed to a lower degree of inter-hemispheric functional connectivity at the frontal region and intra-hemispheric at the bilateral temporal region. Studies on possible related events showed changes in memory processing in PD patients when exposed to aversive stimuli. It was noticed that most findings reflect the current neurobiological hypothesis of PD, where inhibitory deficits of the prefrontal cortex related to the modulation of amygdala activity, and the subsequent activation of subcortical regions, may be responsible to trigger anxiety responses. We approached some important issues that need to be considered in further researches, especially the use of different methods for analyzing EEG signals.

Current methodological designs of fMRI studies of panic disorder: can data be compared?

Panic disorder (PD) is a pluridimensional condition that leads to psychological suffering. Due to advances in neuroimaging techniques, important contributions have been made in the understanding of the neurobiological basis of PD. However, because of diverging research designs and protocols, more conclusive data concerning the neurocircuitry of PD remain difficult to achieve. To address this issue, a bibliographical search was performed using the Institute for Scientific Information Web of Science and Medline/PubMed databases. Fifteen articles were found, and their research methodology including sample, comorbidity, gender, and pharmacological criteria were explored. Although current functional magnetic resonance imaging studies of PD constitute fundamental tools for health sciences, more uniform research protocols must be implemented to provide more consistent and conclusive data concerning the neural substrates of PD.(AU)