Brain activity changes with emotional words in different stages of psychosis.

BACKGROUND: To date, a large number of functional magnetic resonance imaging (fMRI) studies have been conducted on psychosis. However, little is known about changes in brain functioning in psychotic patients using an emotional auditory paradigm at different stages of the disease. Such knowledge is important for advancing our understanding of the disorder and thus creating more targeted interventions. This study aimed to investigate whether individuals with first-episode psychosis (FEP) and chronic schizophrenia show abnormal brain responses to emotional auditory processing and to compare the responses between FEP and chronic schizophrenia. METHODS: Patients with FEP (n = 31) or chronic schizophrenia (n = 23) and healthy controls (HCs, n = 31) underwent an fMRI scan while presented with both emotional and nonemotional words. RESULTS: Using HC as a reference, patients with FEP showed decreased right temporal activation, while patients with chronic schizophrenia showed increased bilateral temporal activation. When comparing the patient groups, individuals with FEP showed lower frontal lobe activation. CONCLUSION: To the best of our knowledge, this is the first study with an emotional auditory paradigm used in psychotic patients at different stages of the disease. Our results suggested that the temporal lobe might be a key issue in the physiopathology of psychosis, although abnormal activation could also be derived from a connectivity problem. There is lower activation in the early stage and evolution to greater activation when patients become chronic. This study highlights the relevance of using emotional paradigms to better understand brain activation at different stages of psychosis.

Variables associated with the success of group cognitive behavioral therapy for insomnia: preliminary results.

Insomnia Disorder (ID) is defined as the predominant dissatisfaction with the quantity or quality of sleep associated with difficulty in initiating or maintaining sleep or early-morning awakenings with the inability to go back to sleep.

Variables asociadas al éxito dela terapia cognitivo conductualgrupal para el insomnio: resultadospreliminares / Variables associated with the success of group cognitive behavioral therapy for insomnia: preliminary results

Introducción: El trastorno de insomnio (TI) se define comola predominante insatisfacción con la cantidad o la calidad delsueño asociada a dificultad para iniciar el sueño, mantenerlo odespertares precoces con incapacidad para volver a dormir. Laterapia cognitivo conductual (TCC) ha demostrado su eficaciapara el TI, consolidándose como tratamiento de elección.Objetivo. Identificar las variables asociadas al éxito de laTCC para el insomnio.Método. La muestra estuvo formada por 28 pacientesque acudieron a la Unidad del Sueño del HCUV y cumplíancriterios diagnósticos de TI. Todos los pacientes realizaron unprograma de TCC en formato grupal. Se evaluaron diversascaracterísticas sociodemográficas y clínicas (psicopatologíageneral, ansiedad, depresión, ira, regulación emocional,y personalidad) con el objetivo de determinar cuálesdiscriminaban entre los pacientes que mejoran y los que nomejoran tras la TCC, empleando como variable criterio elÍndice de Gravedad del Insomnio (ISI).Resultados. Tras el programa mejoró casi el 60% de lamuestra. Se hallaron diferencias significativas en el nivelde gravedad del insomnio tras la TCC en función del sexo(p=0,027), mejorando más las mujeres. Así mismo, menoresniveles de psicopatología se relacionaron con una mejorrespuesta a la intervención (p=0,007). Igualmente fueronsignificativas dos dimensiones de personalidad: bajaEvitación del riesgo (p=0,006) y alta Autodirección (p=0,026)apareciendo asociadas a la mejoría. (AU)

Introduction: Insomnia Disorder (ID) is defined as thepredominant dissatisfaction with the quantity or quality ofsleep associated with difficulty in initiating or maintainingsleep or early-morning awakenings with the inability to goback to sleep. Cognitive Behavioral Therapy (CBT) has proven itseffectiveness for ID, being established as a frontline treatment.Objective. To identify the variables associated with thesuccess of CBT for insomnia.Method. The sample consisted of 28 patients whoattended the HCUV Sleep Unit and met ID diagnostic criteria.All patients underwent a CBT program in group format.Several sociodemographic and clinical characteristics(general psychopathology, anxiety, depression, anger,emotional regulation, and personality) were evaluated inorder to determine which discriminated between patients who improve and those who do not improve after CBT,using the Index Insomnia Severity (ISI) as a criterionvariable. Results: After the program, almost 60% of thesample improved. Significant differences were found inthe level of severity of insomnia after CBT according to sex(p = 0.027), with women improving more. Likewise, lowerlevels of psychopathology were related to a better responseto the intervention (p = 0.007). Moreover, two personalitydimensions were significant: low Harm avoidance (p = 0.006)and high Self-directe. (AU)

Neuroimaging correlates of insight in non-affective psychosis: A systematic review and meta-analysis.

OBJECTIVE: Neurological correlates of impaired insight in non-affective psychosis remain unclear. This study aimed to review and meta-analyze the studies assessing the grey matter volumetric correlates of impaired insight in non-affective psychosis. METHODS: This study consisted of a systematic review of 23 studies, and a meta-analysis with SDM-PSI of the 11 studies that were whole-brain and reported maps or peaks of correlation of studies investigating the grey matter volumetric correlates of insight assessments of non-affective psychosis, PubMed and OVID datasets were independently reviewed for articles reporting neuroimaging correlates of insight in non-affective psychosis. Quality assessment was realized following previous methodological approaches for the ABC quality assessment test of imaging studies, based on two main criteria: the statistical power and the multidimensional assessment of insight. Study peaks of correlation between grey matter volume and insight were used to recreate brain correlation maps. RESULTS: A total of 418 records were identified through database searching. Of these records, twenty-three magnetic resonance imaging (MRI) studies that used different insight scales were included. The quality of the evidence was high in 11 studies, moderate in nine, and low in three. Patients with reduced insight showed decreases in the frontal, temporal (specifically in superior temporal gyrus), precuneus, cingulate, insula, and occipital lobes cortical grey matter volume. The meta-analysis indicated a positive correlation between grey matter volume and insight in the right insula (i.e., the smaller the grey matter, the lower the insight). CONCLUSION: Several brain areas might be involved in impaired insight in patients with non-affective psychoses. The methodologies employed, such as the applied insight scales, may have contributed to the considerable discrepancies in the findings.

Neuroimaging correlates of insight in non-affective psychosis: A systematic review and meta-analysis / Revisión sistemática y metaanálisis en neuroimagen y conciencia de enfermedad en psicosis no afectivas

Objective: Neurological correlates of impaired insight in non-affective psychosis remain unclear. This study aimed to review and meta-analyze the studies assessing the grey matter volumetric correlates of impaired insight in non-affective psychosis.Methods: This study consisted of a systematic review of 23 studies, and a meta-analysis with SDM-PSI of the 11 studies that were whole-brain and reported maps or peaks of correlation of studies investigating the grey matter volumetric correlates of insight assessments of non-affective psychosis, PubMed and OVID datasets were independently reviewed for articles reporting neuroimaging correlates of insight in non-affective psychosis. Quality assessment was realized following previous methodological approaches for the ABC quality assessment test of imaging studies, based on two main criteria: the statistical power and the multidimensional assessment of insight. Study peaks of correlation between grey matter volume and insight were used to recreate brain correlation maps.Results: A total of 418 records were identified through database searching. Of these records, twenty-three magnetic resonance imaging (MRI) studies that used different insight scales were included. The quality of the evidence was high in 11 studies, moderate in nine, and low in three. Patients with reduced insight showed decreases in the frontal, temporal (specifically in superior temporal gyrus), precuneus, cingulate, insula, and occipital lobes cortical grey matter volume. The meta-analysis indicated a positive correlation between grey matter volume and insight in the right insula (i.e., the smaller the grey matter, the lower the insight). (AU)

Objetivo: Los correlatos neurológicos de la conciencia de enfermedad en psicosis no afectivas siguen sin estar claros. Este estudio tiene como objetivo revisar y metaanalizar los estudios que evalúan los correlatos volumétricos de la materia gris de la conciencia de enfermedad deficiente en la psicosis no afectiva.Métodos: Este estudio consistió en una revisión sistemática de 23 estudios y un metaanálisis con SDM-PSI de los 11 estudios que examinaron todo el cerebro y reportaron mapas o picos de correlación de estudios que investigan los correlatos volumétricos de materia gris de evaluaciones de insight de psicosis no afectiva. Los conjuntos de datos de PubMed y OVID se revisaron de forma independiente para los artículos que informaban sobre correlaciones de neuroimagen de insight en psicosis no afectiva. La evaluación de la calidad de los estudios de imagen se realizó siguiendo enfoques metodológicos previos usando la prueba de evaluación de la calidad ABC basados en dos criterios principales: el poder estadístico y la evaluación multidimensional del insight. Los picos de correlación del estudio entre el volumen de materia gris y la conciencia de enfermedad fueron utilizados para recrear mapas de correlación cerebral.Resultados: Se incluyeron veintitrés estudios de imágenes por resonancia magnética (IRM) que utilizaron diferentes escalas de conciencia de enfermedad. La calidad de los estudios revisados fue clasificada como alta en 11 estudios, moderada en 9 estudios y baja en 3 estudios. Los pacientes con insight reducido mostraron disminuciones en el volumen de materia gris cortical de los lóbulos frontal, temporal (específicamente en la circunvolución temporal superior), precúneo, cingulado, ínsula y lóbulo occipital. El metaanálisis mostró una correlación positiva entre el volumen de materia gris y la conciencia de enfermedad en la ínsula derecha (es decir, cuanto más pequeña es la materia gris, menor es el insight). (AU)

Neuroimaging correlates of insight in non-affective psychosis: A systematic review and meta-analysis.

OBJECTIVE: Neurological correlates of impaired insight in non-affective psychosis remain unclear. This study aimed to review and meta-analyze the studies assessing the grey matter volumetric correlates of impaired insight in non-affective psychosis. METHODS: This study consisted of a systematic review of 23 studies, and a meta-analysis with SDM-PSI of the 11 studies that were whole-brain and reported maps or peaks of correlation of studies investigating the grey matter volumetric correlates of insight assessments of non-affective psychosis, PubMed and OVID datasets were independently reviewed for articles reporting neuroimaging correlates of insight in non-affective psychosis. Quality assessment was realized following previous methodological approaches for the ABC quality assessment test of imaging studies, based on two main criteria: the statistical power and the multidimensional assessment of insight. Study peaks of correlation between grey matter volume and insight were used to recreate brain correlation maps. RESULTS: A total of 418 records were identified through database searching. Of these records, twenty-three magnetic resonance imaging (MRI) studies that used different insight scales were included. The quality of the evidence was high in 11 studies, moderate in nine, and low in three. Patients with reduced insight showed decreases in the frontal, temporal (specifically in superior temporal gyrus), precuneus, cingulate, insula, and occipital lobes cortical grey matter volume. The meta-analysis indicated a positive correlation between grey matter volume and insight in the right insula (i.e., the smaller the grey matter, the lower the insight). CONCLUSION: Several brain areas might be involved in impaired insight in patients with non-affective psychoses. The methodologies employed, such as the applied insight scales, may have contributed to the considerable discrepancies in the findings.

Terapia grupal cognitivo-conductual para el insomnio: evaluación de resultados tras su introducción en un departamento de salud / Cognitive-behavioural group therapy for insomnia: evaluation of the results after its implementation in a health department

INTRODUCCIÓN: La terapia cognitivo-conductual (TCC) es el tratamiento de elección en el trastorno de insomnio crónico en adultos. PACIENTES Y MÉTODOS: Estudio pragmático abierto de 32 pacientes tras ocho sesiones de TCC grupal para el insomnio. RESULTADOS: La remisión (índice de gravedad del insomnio: 0-7 puntos) y la respuesta (caída del índice de gravedad del insomnio > 8) fue del 31,3% y 46,9% al mes (n = 32) y del 42,8% y 52,4% al año (n = 21), respectivamente, con un tamaño del efecto de 1,9 al mes y 2,3 al año. Al mes, el 40,6% cumplía criterios de caso de insomnio (según el cuestionario de síntomas de insomnio), y al año, el 19%, con una mejoría significativa de síntomas nocturnos y consecuencias diurnas. También mejoraron las preguntas del índice de calidad de sueño de Pittsburgh sobre el insomnio y la eficiencia del sueño. La escala de activación previa al sueño (n = 7) mostró un trasvase desde activación significativa somática y cognitiva a ausencia de activación al mes. En los diarios de sueño, el tiempo total de sueño aumentó 53 minutos de media al mes (n = 14) y 76 al año (n = 10), con un aumento superior al 10% en el 71,4% de los pacientes al mes y al año, y una eficiencia del sueño media superior al 85%. El tamaño del efecto para el tiempo total de sueño y la eficiencia del sueño estuvo entre 0,7 y 1. CONCLUSIONES: La TCC grupal para el insomnio parece una opción terapéutica eficaz en un entorno clínico

INTRODUCTION: Cognitive-behavioural therapy (CBT) is the preferred treatment in cases of chronic insomnia disorder in adults. PATIENTS AND METHODS: Open pragmatic study of 32 patients after eight sessions of group CBT for insomnia. RESULTS: Remission (insomnia severity index: 0-7 points) and response (insomnia severity index drops to > 8) were 31.3% and 46.9% at one month (n = 32) and 42.8% and 52.4% at one year (n = 21), respectively, with an effect size of 1.9 at one month and 2.3 at one year. At one month, 40.6% met the criteria for a case of insomnia (according to the insomnia symptoms questionnaire), and at one year, 19%, with a significant improvement in the symptoms at night and the consequences during the day. The questions of the Pittsburgh Sleep Quality Index on insomnia and sleep efficiency also improved. The pre-sleep arousal scale (n = 7) showed a shift from significant somatic and cognitive arousal to no arousal at one month. In the sleep diaries, total sleep time increased by an average of 53 minutes at one month (n = 14) and 76 minutes at one year (n = 10), with an increase of more than 10% in 71.4% of patients at one month and at one year, and an average sleep efficiency of more than 85%. The effect size for total sleep time and sleep efficiency was between 0.7 and 1. CONCLUSIONS: Group CBT for insomnia appears to be an effective treatment option in a clinical setting

First-Episode Psychotic Patients Showed Longitudinal Brain Changes Using fMRI With an Emotional Auditory Paradigm.

Most previous longitudinal studies of functional magnetic resonance imaging (fMRI) in first-episode psychosis (FEP) using cognitive paradigm task found an increased activation after antipsychotic medications. We designed an emotional auditory paradigm to explore brain activation during emotional and nonemotional word processing. This study aimed to analyze if longitudinal changes in brain fMRI BOLD activation is present in patients vs. healthy controls. A group of FEP patients (n = 34) received clinical assessment and had a fMRI scan at baseline and follow-up (average, 25-month interval). During the fMRI scan, both emotional and nonemotional words were presented as a block design. Results were compared with a pair of healthy control group (n = 13). Patients showed a decreased activation at follow-up fMRI in amygdala (F = 4.69; p = 0.04) and hippocampus (F = 5.03; p = 0.03) compared with controls. Middle frontal gyrus was the only area that showed a substantial increased activation in patients (F = 4.53; p = 0.04). A great heterogeneity in individual activation patterns was also found. These results support the relevance of the type of paradigm in neuroimaging for psychosis. This is, as far as we know, the first longitudinal study with an emotional auditory paradigm in FEP. Our results suggested that the amygdala and hippocampus play a key role in psychotic disease. More studies are needed to understand the heterogeneity of response at individual level.

Longitudinal studies of functional magnetic resonance imaging in first-episode psychosis: A systematic review.

BACKGROUND: Little is known about changes in brain functioning after first-episode psychosis (FEP). Such knowledge is important for predicting the course of disease and adapting interventions. Functional magnetic resonance imaging has become a promising tool for exploring brain function at the time of symptom onset and at follow-up. METHOD: A systematic review of longitudinal fMRI studies with FEP patients according to PRISMA guidelines. Resting-state and task-activated studies were considered together. RESULTS: Eleven studies were included. These reported on a total of 236 FEP patients were evaluated by two fMRI scans and clinical assessments. Five studies found hypoactivation at baseline in prefrontal cortex areas, two studies found hypoactivation in the amygdala and hippocampus, and three others found hypoactivation in the basal ganglia. Other hypoactivated areas were the anterior cingulate cortex, thalamus and posterior cingulate cortex. Ten out of eleven studies reported (partial) normalization by increased activation after antipsychotic treatment. A minority of studies observed hyperactivation at baseline. CONCLUSIONS: This review of longitudinal FEP samples studies reveals a pattern of predominantly hypoactivation in several brain areas at baseline that may normalize to a certain extent after treatment. The results should be interpreted with caution given the small number of studies and their methodological and clinical heterogeneity.