Self-reported Sexual Response in Transgender Women to Audiovisual Stimulation Protocol / Autoinforme de Respuesta Sexual en Mujeres Transgénero ante un Protocolo de Estimulación Audiovisual

Abstract Sexuality changes associated with the medical transition in transgender women are not well known; the few studies present discrepancies in labeling their sexual orientation and controlling surgery conditions. This study aimed to evaluate the self-reported sexual response to audiovisual sexual stimulation protocol in androsexual transgender women on hormone replacement therapy. This study also evaluated their sexual functioning to support the empirical protocol. Participated androsexual transgender women with (n = 16) and without hormone therapy (n = 15) in a non-sex reassignment surgery condition. Androsexual cisgender men (n = 25) and women (n = 24) also were included as contrast groups. All participants were assessed with the Short Form of the Changes in Sexual Functioning Questionnaire; then watched video clips with neutral and sexual content and informed their sexual responses through two self-report scales adapted from the Film Scale. The results showed trans women with hormone therapy, compared to trans women without treatment, experienced a less selective sexual response to sexual stimuli. Also, they registered the lowest scores for every sexual functioning except for pleasure. In conclusion, transgender women on hormone therapy without sex reassignment surgery showed fluidity in their self-reported sexual response and reduced sexual functioning.

Resumen Poco se conoce de los cambios en la sexualidad de las mujeres transgénero que se encuentran bajo un proceso de transición médica. El objetivo de este estudio fue evaluar el autoinforme de la respuesta sexual de las mujeres transgénero bajo terapia hormonal y sin cirugía de reasignación de sexo ante un protocolo de estimulación sexual audiovisual, así como el funcionamiento sexual general para robustecer los resultados del protocolo. Participaron mujeres transgénero sin cirugía de reasignación de sexo con (n = 16) y sin terapia hormonal (n = 15), así como hombres (n = 25) y mujeres (n = 24) cisgénero como grupos de contraste. Todas las personas que participaron reportaron una atracción androsexual. Se evaluaron con la Versión Abreviada del Cuestionario de Cambios en el Funcionamiento Sexual, posteriormente observaron videos con contenido neutro y actividad sexual entre dos mujeres, dos hombres y entre mujer y hombre, y reportaron su respuesta sexual a través de dos escalas de autoinforme adaptadas de la Film Scale. Los resultados mostraron que las mujeres trans bajo terapia hormonal, a comparación de las mujeres trans sin tratamiento, tuvieron una respuesta sexual menos selectiva, aunque esta fue similar a la de las mujeres cisgénero, además puntuaron más bajo para todos los rubros del cuestionario de funcionamiento sexual, excepto para el placer. En conclusión, las mujeres transgénero en terapia hormonal muestran fluidez en su respuesta sexual autoinformada, así como una disminución en el funcionamiento sexual. Estos datos pueden ofrecer un entendimiento más amplio del tratamiento médico y psicológico, con la finalidad de mejorar la atención a la población trans.

Relevance of the voice in the process of gender affirmation in transsexual women: A cross-sectional study / Importancia de la voz en el proceso de afirmación de género en mujeres transexuales: Estudio transversal

Abstract Introduction Voice is a gender marker and can therefore be a source of gender dysphoria. There is a relationship between symptoms of anxiety and depression and voice-related difficulties in trans women (TW). Hormonal replacement treatment (HRT) in TW does not play a role in voice feminization. Access to voice feminization procedures is limited while the population demanding transgender healthcare is increasing. Objective To describe the degree of voice-related dysphoria experienced by TW that seek a voice feminization treatment. Method A descriptive, cross-sectional study, 26 TW completed quality of life (QoL) questionnaires and stated their reasons for seeking voice feminization. Fundamental frequency (f0) was measured. Results 77% of the participants were legally recognized as women, 96% were under HRT, and 27% had a history of gender affirmation surgery. Median f0 for TW was 131 Hz. f0 had a poor correlation with QoL measures. The mean score in the Trans Women Voice Questionnaire was 95 (SD = 14.3). Achieving a feminine voice that allows gender conformity was the main reason for seeking treatment. Discussion and conclusion Voice non-conformity affects QoL. None of the participants perceived their voice as feminine while 97% described their ideal voice as feminine. The inability to satisfy gender assurance needs has a detrimental effect on QoL. Improving access to affirmation procedures in public institutions without pathologization of transgender people is a pending agenda. Despite evidence that TW benefit from voice feminization treatments, it is difficult to define how to measure success.

Resumen Introducción La voz es un marcador de género y como tal puede ocasionar disforia de género. Existe una relación entre la ansiedad y la depresión y las dificultades relacionadas con la voz en mujeres trans (MT). La terapia de sustitución hormonal (TSH) en MT no feminiza la voz. El acceso a un tratamiento de feminización de voz es limitado, mientras que la población que demanda servicios de salud transgénero está aumentando. Objetivo Describir el grado de disforia relacionado con la voz de las MT que buscan un tratamiento de feminización de voz. Método Estudio descriptivo, transversal, 26 MT respondieron cuestionarios de calidad de vida (CV) y expresaron los motivos para buscar feminizar su voz. Se midió la frecuencia fundamental (f0). Resultados El 77% de las participantes eran reconocidas legalmente como mujeres, 96% tomaban TSH y 27% tenía antecedente de una cirugía de afirmación de género. La mediana de la f0 fue de 131 Hz. El puntaje medio en el Cuestionario de Voz para Mujeres Trans fue de 95 puntos (DE = 14.3) y tuvo una mala correlación con la f0. La expectativa principal fue lograr una voz femenina que permitiera una conformidad de género. Discusión y conclusión Una voz género-discordante afecta la CV. El 97% describió que su voz ideal sería femenina, pero ninguna percibió su voz como tal. La incapacidad para satisfacer las necesidades de afirmación de género tiene un efecto negativo sobre la CV. Mejorar el acceso a procedimientos de afirmación de género en instituciones públicas sin patologizar a las personas transgénero es una agenda pendiente. Existe evidencia de que los procedimientos de feminización de voz benefician a las MT, aunque se desconoce cuál es la mejor manera de medir el éxito.

Validation of the Comic Strip Test to evaluate empathy in a Mexican population sample.

INTRODUCTION: Empathy is the ability of an individual to understand it from another cognitive and emotional point of view. Empathy is a complex that represents a retouch in its evaluation, so, it is necessary to have instruments validated in the Mexican population. OBJECTIVE: Validation of the Comic Strip Test to evaluate empathy. METHOD: Sampling for convenience, based on internal consistency, convergent validity with the Empathy coefficient, construct validity in the factorial analysis, and the ability to discriminate between subjects with lack of empathy (psychopathology) and the control subjects through a curve ROC. RESULTS: The comic strips test was evaluated in 86 controls, 19 patients with schizophrenia (Cronbach's alpha = 0.894). The correlation with the empathy coefficient was 0.88, with sensitivity of 81.3% and specificity of 38%. CONCLUSIONS: The Comic Strip Test was validated with parametric psychometric parameters.

[Validación de la prueba de Tiras cómicas para evaluar la empatía en una muestra de población mexicana].

INTRODUCTION: Empathy is the ability of an individual to understand it from another cognitive and emotional point of view. Empathy is a complex that represents a retouch in its evaluation, so, it is necessary to have instruments validated in the Mexican population. OBJECTIVE: Validation of the Comic Strip Test to evaluate empathy. METHOD: Sampling for convenience, based on internal consistency, convergent validity with the Empathy coefficient, construct validity in the factorial analysis, and the ability to discriminate between subjects with lack of empathy (psychopathology) and the control subjects through a curve ROC. RESULTS: The comic strips test was evaluated in 86 controls, 19 patients with schizophrenia (Cronbach's alpha = 0.894). The correlation with the empathy coefficient was 0.88, with sensitivity of 81.3% and specificity of 38%. CONCLUSIONS: The Comic Strip Test was validated with parametric psychometric parameters.

ANTECEDENTES: La empatía es la capacidad de un individuo para entender al otro desde el punto de vista cognitivo y emocional. La empatía es un constructo complejo que representa un reto en su evaluación, por lo cual es necesario contar con instrumentos validados en población mexicana. OBJETIVO: Validación de la prueba de Tiras cómicas para evaluar empatía. MÉTODO: Muestreo por conveniencia, se midió la consistencia interna, la validez convergente con el coeficiente de empatía, la validez de constructo con análisis factorial y la capacidad de discriminar entre sujetos con déficit de empatía por psicopatología con controles por medio de una curva Receiver Operating Characteristic (ROC) por sus siglas en inglés. RESULTADOS: La escala de Tiras cómicas se evaluó en 86 controles, 19 pacientes con esquizofrenia, a de Cronbach = 0.894. La correlación con el coeficiente de empatía fue de 0.88, con una sensibilidad del 81.3% y la especificidad del 38%. CONCLUSIONES: Se validó la prueba de Tiras cómicas con adecuados parámetros psicométricos.

Validación de la prueba de Tiras cómicas para evaluar la empatía en una muestra de población mexicana / Validation of the Comic strip test to assess empathy in a Mexican population sample

Resumen Antecedentes: La empatía es la capacidad de un individuo para entender al otro desde el punto de vista cognitivo y emocional. La empatía es un constructo complejo que representa un reto en su evaluación, por lo cual es necesario contar con instrumentos validados en población mexicana. Objetivo: Validación de la prueba de Tiras cómicas para evaluar empatía. Método: Muestreo por conveniencia, se midió la consistencia interna, la validez convergente con el coeficiente de empatía, la validez de constructo con análisis factorial y la capacidad de discriminar entre sujetos con déficit de empatía por psicopatología con controles por medio de una curva Receiver Operating Characteristic (ROC) por sus siglas en inglés. Resultados: La escala de Tiras cómicas se evaluó en 86 controles, 19 pacientes con esquizofrenia, a de Cronbach = 0.894. La correlación con el coeficiente de empatía fue de 0.88, con una sensibilidad del 81.3% y la especificidad del 38%. Conclusiones: Se validó la prueba de Tiras cómicas con adecuados parámetros psicométricos.

Abstract Introduction: Empathy is the ability of an individual to understand it from another cognitive and emotional point of view. Empathy is a complex that represents a retouch in its evaluation, so, it is necessary to have instruments validated in the Mexican population. Objective: Validation of the Comic Strip Test to evaluate empathy. Method: Sampling for convenience, based on internal consistency, convergent validity with the Empathy coefficient, construct validity in the factorial analysis, and the ability to discriminate between subjects with lack of empathy (psychopathology) and the control subjects through a curve ROC. Results: The comic strips test was evaluated in 86 controls, 19 patients with schizophrenia (Cronbach's alpha = 0.894). The correlation with the empathy coefficient was 0.88, with sensitivity of 81.3% and specificity of 38%. Conclusions: The Comic Strip Test was validated with parametric psychometric parameters.

Síndrome de jet lag o cambio de zonas de tiempo / The jet lag syndrome or time-zone changes

Resumen Nuestro planeta, así como la vida que en él se desarrolla, se encuentra en constante movimiento. Los ritmos geofísicos influyen en la actividad de los organismos, de tal manera que los seres vivos han desarrollado mecanismos adaptativos para poder responder a las variaciones diarias del medio ambiente. El sistema circadiano es el responsable de responder a estas variaciones cíclicas ambientales. Cuando se modifican las señales ambientales, como en un viaje que implica atravesar varias zonas horarias, se ocasionan cambios fisiológicos que han llevado a buscar estrategias para contrarrestar los síntomas que se presentan; estas estrategias incluyen el ejercicio programado, la exposición a la luz brillante, la melatonina y la alimentación programada.

Abstract Our planet and the life that develops in it are in constant movement, therefore, the geophysical rhythms influence the activity of organisms, in such a way that living beings have developed adaptative mechanims in order to respond to the daily variations of the environment. The circadian system is responsible for responding to these cyclical environmental variations. When the environmental signals are modified, like for instance, on a trip that involves crossing several time zones, physiological changes occur. This results in searching for possible strategies to counteract the symptomatology. These strategies include scheduled exercise, exposure to a bright light, melatonin and scheduled meals.

Influence of Culture in Obsessive-compulsive Disorder and Its Treatment.

BACKGROUND: The aspects of cultural identity and its impact on obsessive-compulsive disorder (OCD) have been un-derstudied. There are different opinions, ranging from the idea that culture does not affect the symptoms of this condition to the idea that cultures with high religiosity may have more severity of OCD. Also, the concept of OCD has considerably var-ied across history and cultures, from being considered an issue related to lack of control of blasphemous ideas, and a part of anxious issues, to the description of complex neurobiological systems in its causation. OBJECTIVE: The aim of this review was to address OCD as a well-characterized disorder with a proposed neurobiological ba-sis which may or may not have variations depending on cultural diversity. The question that was asked in this review is whether or not there are cultural differences in the manifestations of the OCD symptomatology and which factors of cultural diversity have a major influence on such manifestations along with the differences among some cultures regarding OCD is-sues, where the difference among countries has also been highlighted. METHODS: A review of the literature was conducted that includes the following words: obsessive-compulsive disorder, cul-ture, cultural identity and religion in a period of 10 years. CONCLUSION: Cultural variations do not seem to differ from symptomatic clusters of OCD, which may be indicating that a se-ries of adaptive behaviors is evolutionarily evolving to be constantly altered, perhaps by well-determined pathophysiological mechanisms. Some aspects that have been related to some dimensions of OCD symptomatology are religion and religiosity, affecting the content of obsessions and the severity of manifestations. Properly evaluating the education background, access to health services, food, and the genetic structure of populations, using investigational instruments sensitive to these cultural elements, will increase our understanding of the importance of culture on OCD and its treatment.

La diversidad sexo-genérica: Un punto de vista evolutivo / Sexual-gender diversity: An evolutionary point of view

Introducción Hay un grupo de gente con una incoherencia entre el género y su sexo biológico (fenotipo) con el género de autopercepción. Las diferencias entre esta condición y la orientación sexual nos dan una serie de subtipos de género y de diversidad sexual: transexuales, travestis y transgéneros, homosexuales, heterosexuales, bisexuales y asexuales. Objetivo Revisar las evidencias que puedan apoyar si la diversidad de género y la orientación sexual son estrategias evolutivas. Método Se consultaron documentos históricos, médicos y políticos sobre el nacimiento de los conceptos de género y orientación sexual en The National Library of Medicine. Estos se actualizaron en una revisión de la literatura científica de los últimos cincuenta años en los sistemas SCOPUS, PubMed y Science Direct. Se utilizaron las palabras: homosexuality, transsexuality, gender y evolution. Resultados Debido a que la reproducción sexual es tan indispensable y celosamente seleccionada, para continuar la combinación genética, la existencia de la homosexualidad y la transexualidad son una paradoja evolutiva. Hay una gama de este tipo de conductas en los animales de reproducción sexual, en mamíferos, aves, reptiles y peces. Hasta el momento sólo hemos utilizado el comportamiento animal para ilustrar la naturalidad de la homosexualidad. En esencia: hay animales homosexuales en la naturaleza. Por lo tanto, la homosexualidad es natural, y en este artículo se presentan las explicaciones evolutivas al respecto. La transexualidad es una cuestión de género, y en la psiquiatría contemporánea sigue siendo calificada como una enfermedad mental, llamada "disforia de género". Discusión y conclusión Hay bases biológicas para esta alternativa particular en los seres humanos, en los que el papel de los niveles de hormonas elevados, los anticuerpos contra los receptores de testosterona, el orden del nacimiento y el uso de algunas drogas se discuten en el presente artículo. Comprender que los seres humanos no son una especie dicotómica es el objetivo principal de este trabajo, ya que en el homo sapiens, las diferencias en muchos aspectos de nuestras funciones es la norma que nos hace tan diferentes, pero al mismo tiempo iguales en derechos básicos como seres humanos.

Introduction There are people with a gender incoherence between their biological gender (phenotype) and the self-perception gender. Differences among such condition and sexual orientation give us more subtypes of gender and sexual diversity: transsexual, travesties and transgender, homosexual, heterosexual, bisexual and asexual. Objective To review if there are well supported evidences about sexual and gender diversity as part of evolutionary strategies. Method Medical and political historical documents about the birth of the concepts of gender and sexual orientation were consulted at The National Library of Medicine. These were updated, in a review of the scientific literature of the last fifty years in SCOPUS, PubMed and Science Direct systems. The following words were used: homosexuality, transsexuality, gender and evolution. Results Because sexual reproduction is so indispensable and so zealously selected, the existence of homosexuality and transsexuality is a kind of paradox. One must wonder: why would not evolution quickly select against behavior, which diverts an animal from sexual reproduction? Yet despite this apparently unlikelihood homosexuality does exist. Homosexuality is also the innate sexual preference for one's own gender or the biological urge for same-sex coitus. So despite popular non-recognition of the phenomenon, natural history observations have revealed a wide range of homosexuality throughout the animal kingdom. To account for homosexuality -or any phenomenon- using evolution, it is necessary that it be natural, i.e. it must occur naturally without human influence. Thus, animal behavior is used to illustrate the naturalness of homosexuality. In essence: there are homosexual animals in nature; therefore homosexuality is natural. Transsexuality is a gender issue, and in psychiatry remains as a mental disease named "gender dysphoria". Discussion and conclusion There is some biological basis for these particular human beings, in whom the role of high levels of hormones, antibodies against testosterone receptors, order or birth is also discussed in the present article. To understand that humans are not a dichotomist species is the main goal of this work, as homo sapiens differences in many aspects of our functions are the norm.

Perfil neuropsicológico en transexuales: efecto del tratamiento de reasignación de sexo / Neuropsychological profile in transsexuals: effect of sex reassignment treatment

Las funciones cognitivas, como el aprendizaje, la memoria y las funciones ejecutivas, son afectadas por las hormonas esteroides sexuales. El objetivo fue evaluar el perfil cognoscitivo en personas transexuales hombre a mujer (TH-M) en presencia y ausencia de tratamiento hormonal con estrógenos. Participaron un total de 54 sujetos. El grupo experimental fue de 22 pacientes TH-M, dividido en dos grupos: con tratamiento hormonal (n=9) y sin tratamiento hormonal (n=13). El grupo control fue conformado por hombres (n=16) y mujeres (n=16), pareados en edad y escolaridad. Evaluados con la batería NEUROPSI: Atención y Memoria (Ostrosky-Solís, Gómez, Matute, Roselli, Ardila & Pineda, 2003). Los grupos transexuales tuvieron mejores puntajes que los controles en atención inmediata y en formación de categorías, pero mostraron menores puntajes que los controles en codificación de material visoespacial y de caras, en memoria verbal inmediata y evocada. Se encontraron correlaciones negativas entre meses de tratamiento y la codificación visoespacial, memoria para caras y memoria verbal. Los resultados sugieren que las hormonas sexuales tienen efectos organizadores y activadores sobre la cognición.

Mental functions, including learning, executive functions and memory, are susceptible to be affected by sexual steroids hormones. The objective was to evaluate the cognitive profile of transsexual’s male to female (TM-F) in presence and absence of hormonal treatment with estrogens. A total of 54 subjects participated. The experimental group was conformed by 22 patients in condition transsexual male to female, divided in two groups: with hormonal treatment (n=9) and without hormonal treatment (n=13). The control group was conformed by heterosexual men (n=16) and women (n=16) paired in age and schooling to the experimental group. Subjects were evaluated by a comprehensive neuropsychological battery, NEUROPSI: Attention and Memory (Ostrosky-Solís, Gómez, Matute, Roselli, Ardila & Pineda, 2003). Transsexual’s groups performed better than controls in immediate attention, category formation, but worse than controls in visuospatial codification, faces, recall and immediate verbal memory. Negative correlations were founded between treatment months in visuospatial codification, faces, and verbal memory.

Preliminary study in patients with obsessive-compulsive disorder treated with electrical stimulation in the inferior thalamic peduncle.

OBJECTIVE: Deep brain stimulation has been used in the treatment of refractory obsessive-compulsive disorder (OCD). Our principal objective was to determine the safety and effectiveness of deep brain stimulation of the inferior thalamic peduncle in the treatment of refractory OCD. METHODS: An open protocol was performed from March 2003 to April 2007 in 5 patients with OCD refractory to conventional treatments. Bilateral stereotactic implantation of tetrapolar electrodes was aimed at the inferior thalamic peduncle and corroborated by electrophysiological responses and magnetic resonance imaging. All patients were off stimulation for 1 month after implantation. In the on-stimulation period, parameters were set at 5 V, 450 microseconds, 130 Hz in bipolar and continuous mode. Clinical changes were evaluated every 3 months for 12 months by means of the Yale-Brown Obsessive Compulsive Scale and the Global Assessment of Functioning scale. Statistical significance was assessed by the Friedman and Wilcoxon tests. RESULTS: The mean Yale-Brown Obsessive Compulsive Scale score decreased from 35 to 17.8 (P < 0.001), and the mean Global Assessment of Functioning scale score improved from 20% to 70% (P < 0.0001). The neuropsychological battery did not show significant changes, and there were no side effects related to electrical stimulation in the chronic period. CONCLUSION: We conclude that inferior thalamic peduncle stimulation is a safe procedure and may be an effective alternative in the treatment of those OCD cases refractory to conventional treatments.

Adenosine and sleep homeostasis in the Basal forebrain.

It is currently hypothesized that the drive to sleep is determined by the activity of the basal forebrain (BF) cholinergic neurons, which release adenosine (AD), perhaps because of increased metabolic activity associated with the neuronal discharge during waking, and the accumulating AD begins to inhibit these neurons so that sleep-active neurons can become active. This hypothesis grew from the observation that AD induces sleep and AD levels increase with wake in the basal forebrain, but surprisingly it still remains untested. Here we directly test whether the basal forebrain cholinergic neurons are central to the AD regulation of sleep drive by administering 192-IgG-saporin to lesion the BF cholinergic neurons and then measuring AD levels in the BF. In rats with 95% lesion of the BF cholinergic neurons, AD levels in the BF did not increase with 6 h of prolonged waking. However, the lesioned rats had intact sleep drive after 6 and 12 h of prolonged waking, indicating that the AD accumulation in the BF is not necessary for sleep drive. Next we determined that, in the absence of the BF cholinergic neurons, the selective adenosine A1 receptor agonist N6-cyclohexyladenosine, administered to the BF, continued to be effective in inducing sleep, indicating that the BF cholinergic neurons are not essential to sleep induction. Thus, neither the activity of the BF cholinergic neurons nor the accumulation of AD in the BF during wake is necessary for sleep drive.

Caffeine challenge in insomniac patients after total sleep deprivation.

BACKGROUND AND PURPOSE: This study compared the effects of caffeine in patients with primary insomnia and normal volunteers. The main goal was to determine the differences in sensitivity to caffeine between the groups. We investigated the effects on daytime sleep of placebo or caffeine after a night of total sleep deprivation (SD). We hypothesized that insomniacs would be more affected by caffeine, which would suggest a change in adenosine receptor (number or sensitivity) in primary insomniacs. PATIENTS AND METHODS: Six primary insomnia patients (Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)) and six normal volunteers with no sleep complaints participated in a double-blind study with caffeine or placebo administered under a cross-over design with each subject serving as his or her own control. The participants did not have a history of drinking coffee or caffeinated beverages. Data from all-night polysomnography and multiple sleep latency test (MSLT) were collected in the sleep research laboratory of National Institute of Medical Sciences and Nutrition Salvador Zubirán. RESULTS: During the baseline night, patients with insomnia had significantly less delta sleep and less total sleep time than the normal volunteers. Mean sleep latency under basal MSLT did not differ between the groups. However, insomnia patients had significantly less total sleep during each nap compared to normal volunteers. After one night of total SD and under caffeine administration, the insomniacs had significantly longer sleep latency and less total sleep time in MSLT compared to normal volunteers. After SD, healthy volunteers reduced sleep latencies in MSLT with or without caffeine. CONCLUSIONS: Patients with insomnia had a higher sensitivity to the diurnal awakening effect of caffeine even after one night of SD. This suggests that changes in the adenosine receptors could, in part, be responsible for the hyperarousal state that has been reported in primary insomnia.

Electrocortical and behavioral responses elicited by acute electrical stimulation of inferior thalamic peduncle and nucleus reticularis thalami in a patient with major depression disorder.

OBJECTIVE: Our aim was to study electrocortical and behavioral responses elicited by 6, 60 and 3/s stimulation of the inferior thalamic peduncle (ITP) and nucleus reticularis thalami (Re) in a patient with of major depression disorder resistant to psychotherapy, pharmacotherapy and electroconvulsive therapy and candidate to be treated by electrical stimulation of the ITP. METHODS: In this patient, two multicontact electrodes were implanted bilaterally through frontal coronal parasagittal burr-holes with oblique trajectories aiming ITP and Re. Stimulation was performed through externalized systems. Referential scalp electroencephalographic (EEG) recordings were performed and subjective sensations and clinical symptoms reported by patient and changes in responsiveness in single response tasks during stimulation trials were systematically recorded. RESULTS: Unilateral, low (6/s) and high (60/s) frequency stimulation of either ITP or Re produced identical recruiting-like responses or desynchronization-DC shift changes predominant at frontopolar region, bilaterally. Billateral, high intensity 3/s stimulation or either ITP or Re produced electrocortical responses that consisted in generalized 3/s spike-wave complexes predominant at frontopolar, frontocentral and frontotemporal regions. However, while ITP responses were accompanied by all symptoms described for a spontaneous absence attack, Re responses were behaviorly accompanied only by delayed reaction time. CONCLUSION: These data suggests that in humans as in cats, ITP and Re are both part of a non-specific thalamo-orbitofrontal system normally engaged in cortical synchronization, selective attention and sleep. SIGNIFICANCE: Under abnormal conditions, ITP and RE may play a role in the physiopathology of typical absence attacks and depression disorders.

Neurobiological background for performing surgical intervention in the inferior thalamic peduncle for treatment of major depression disorders.

OBJECTIVE: To present a review of evidence for an inhibitory thalamo-orbitofrontal system related to physiopathology of major depression disorders (MDDs) and to postulate that interfering with hyperactivity of the thalamo-orbitofrontal system by means of chronic high-frequency electrical stimulation of its main fiber connection, the inferior thalamic peduncle (ITP), may result in an improvement in patients with MDD. METHODS: Experimentally, the thalamo-orbitofrontal system has been proposed as part of the nonspecific thalamic system. Under normal conditions, the nonspecific thalamic system induces characteristic electrocortical synchronization in the form of recruiting responses that mimic some sleep stages. It also inhibits input of irrelevant sensory stimuli, thus facilitating the process of selective attention. Permanent disruption of the system, via lesioning or temporary inactivation through cooling of the ITP with cryoprobes, results in a state of hyperkinesia, increased attention, and cortical desynchronization. RESULTS: Surgical lesioning of the medial part of orbitofrontal cortex and white matter overlying area 13, which includes the ITP, may result in significant improvement in MDD. Imaging studies (functional magnetic resonance imaging and positron emission tomography) consistently demonstrate hyperactivity in the orbitofrontal cortex and midline thalamic regions during episodes of MDD. This hyperactivity decreases with efficient control of MDD by medical treatment, indicating that orbitofrontal cortex and midline thalamic overactivity are related to the depressive condition. Conversely, noradrenergic and serotoninergic systems in the frontal lobes have been implicated in the pathophysiology of MDD. Although noradrenergic receptor density in the frontal lobe is consistently increased in depressed patients who commit suicide, 5-hydroxytryptamine reuptake blockers, which are potent antidepressive drugs, decrease hypermetabolism in the orbital frontal cortex in MDD. Therefore, the serotonin hypothesis for depression postulates that norepinephrine and serotonin in the frontal lobes are required to maintain antidepressive responsiveness. Dysregulation of the secretion of both neurotransmitters initiates overactivity of orbitofrontal cortex, resulting in depression. It is possible that surgical interventions in this region, including electrical stimulation of ITP, disrupt adrenergic and serotoninergic dysregulation in patients with MDD. CONCLUSION: Circumscribed lesions or electrical stimulation of the ITP, a discrete target easily identified by electrophysiological studies, may improve MDD. Electrical stimulation may have the advantage of being less invasive and more adjustable to patient needs.

A patient with a resistant major depression disorder treated with deep brain stimulation in the inferior thalamic peduncle.

OBJECTIVE AND IMPORTANCE: The present report explored the effect of electrical stimulation on the inferior thalamic peduncle in a patient with resistant major depression disorder (MDD). CLINICAL PRESENTATION: This report refers to a 49-year-old woman with a history of recurrent episodes of major depression for 20 years (12 episodes and 2 hospitalizations), fulfilling Diagnostic and Statistical Manual of Mental Disorders, 4th edition, revised, criteria for MDD; in addition, the patient met criteria for borderline personality disorder and bulimia. Her longest episode of depression with suicidal ideation began 5 years before surgery. The patient's symptom array responded poorly to different combinations of antidepressants, cognitive therapy, and electroconvulsive therapy, which induced improvement only for short periods of time. Immediately before surgery, her Global Assessment of Functioning score was 20 and her Hamilton Depression Scale score ranged from 33 to 42. The patient was proposed for surgery for MDD. INTERVENTION: The patient had bilateral eight-contact electrodes stereotactically implanted for stimulation of areas at and around the inferior thalamic peduncle. Electrode position was corroborated by unilateral electrical stimulation searching for recruiting responses and regional direct current shifts in the electroencephalogram. Recording electrodes were replaced by tetrapolar electrodes for deep brain stimulation and connected to an internalized stimulation system for continuous bipolar stimulation at 130 Hz, 0.45 milliseconds, 2.5 V. Bimonthly follow-up included psychiatric and neuropsychological evaluations performed over the course of 24 months. After 8 months of ON stimulation, the patient entered a double-blind protocol with stimulators turned OFF. Improvement of depression measured by the Hamilton Depression Scale score was evident after initial placement of electrodes without electrical stimulation. Depression relapsed partially at the end of the first week. Electrical stimulation further improved depression, normalizing depression scores and neuropsychological performance. Patient depression scores ranked between 2 and 8 during 8 months of ON stimulation without antidepressant medication. After stimulation was turned OFF, spontaneous fluctuations in patient symptoms reflected by Hamilton Depression Scale and Global Assessment of Functioning scores were documented; these fluctuations disappeared after stimulation was turned on by Month 20. CONCLUSION: Complicated patients with comorbid conditions are common referrals to psychosurgery services. In this report, we present promising results of electrical stimulation of the inferior thalamic peduncle to treat recurrent unipolar depression in a patient with MDD and borderline personality disorder who responded poorly to treatment.

Low delta sleep predicted a good clinical response to olanzapine administration in schizophrenic patients.

INTRODUCTION: Schizophrenic patients show sleep abnormalities, consisting mainly of decreased delta sleep time, short rapid eye movement (REM) sleep latency, and a reduction in sleep continuity variables. Olanzapine is a novel antipsychotic drug with an atypical profile. The goals of the present study were to determine if pre-treatment sleep variables and the initial response to olanzapine administration on the sleep variables can predict the clinical improvement after eight weeks of treatment. MATERIAL AND METHODS: Twenty-one schizophrenic (DSM-IV) patients were studied. They were clinically evaluated using the positive and negative syndrome scale (PANSS), and the Calgary Depression Scale for Schizophrenia. Sleep recordings were as follows: one acclimatization nigh, one night of baseline recordings, and two nights in which the patients receives olanzapine 10 mg, one hour before bedtime. For sleep-comparison purposes, a group of normal volunteers were also studied with acclimatization and baseline nights. After the sleep recordings ended patients continued with the administration of 10 mg/d of olanzapine, that was titrated as needed up to 20 mg/d or down to 5 mg/d. Evaluations were conducted weekly. RESULTS: Awakening and sleep latency variables were significantly higher in schizophrenic patients compared to normal volunteers. Delta sleep was lower in patients than in normal subjects, with no detectable values in some of the schizophrenics. There was not correlation at baseline, between psychopathological scores and delta sleep or other sleep variables. The acute administration of olanzapine 10 mg produced an improvement in continuity sleep variables as well as increase in deltas sleep percentage. Having less than 10% of delta sleep at baseline predicted a good clinical outcome. Eleven of 18 patients showed good clinical improvement after eight weeks of treatment with olanzapine, those were the subjects that had an augmentation of delta sleep above 10% with the first two doses of olanzapine, with minimal side effects. CONCLUSIONS: To have low delta sleep at baseline and the effect of the augmentation of this variable in schizophrenic patients seems to predict a good response to olanzapine. Olanzapine was therapeutically useful, well-tolerated medication, with a favorable safety profile.

Effects of hypocretin2-saporin and antidopamine-beta-hydroxylase-saporin neurotoxic lesions of the dorsolateral pons on sleep and muscle tone.

The hypocretin neurons have been implicated in regulating sleep-wake states as they are lost in patients with the sleep disorder narcolepsy. Hypocretin (HCRT) neurons are located only in the perifornical region of the posterior hypothalamus and heavily innervate pontine brainstem neurons, such as the locus coeruleus (LC), which have traditionally been implicated in promoting arousal. It is not known how the hypocretin innervation of the pons regulates sleep-wake states as pontine lesions have never been shown to increase sleep. It is likely that in previous studies specific neurons were not lesioned. Therefore, in this study, we applied saporin-based neurotoxins to the dorsolateral pons and monitored sleep in rats. Anti-dopamine-beta-hydroxylase-saporin killed the LC neurons but sleep was affected only during a two hour light-dark transition period. Application of hypocretin2-saporin killed fewer LC neurons relative to other adjacent neurons. This occurred because the LC neurons possess the hypocretin receptor 1 but the ligand hypocretin 2 binds to this receptor with less affinity relative to the hypocretin receptor 2. The hypocretin2-saporin lesioned rats compared to controls had increased sleep during the dark period and displayed increased limb movements during REM sleep. None of the lesioned rats had sleep onset REM sleep periods or cataplexy. We conclude that the hypocretin innervation to the pons functions to awaken the animal when the lights turn off (via its innervation of the LC), sustains arousal and represses sleep during the rest of the night (via a wider innervation of other pontine neurons), and modulates muscle tone.

[Prevalence of psychiatric disorders in patients with severe obesity waiting for bariatric surgery]. / Prevalencia de trastornos psiquiátricos en pacientes con obesidad extrema candidatos a cirugía bariátrica.

INTRODUCTION: Obesity is a chronic condition, in which different systems of the body are affected. There are some previous studies in which the prevalence of psychiatric disorders in extreme obese patients has been reported, but there are some methodological problems. As far as we know this is the first report of the prevalence of psychiatric disorders in obese patients that need to have a surgical treatment for this disorder in Mexico. The main goal of this study was to determine the prevalence and risk factors of psychiatric disorders in extreme obese patients candidates to bariatric surgery. MATERIAL AND METHODS: The Structured Clinical Interview for DSM-IV (SCID) axis I disorders, were performed in 70 obese patients that will undergo for bariatric surgery. Also the medical files were reviewed in order to obtain the main medical conditions related to obesity. RESULTS: There were 25 men and 35 women in this study (average age +/- s.d = 39.0 +/- 10.4). The Body Mass Index (BMI) was 53.8 +/- 11.9. Sixty percent of the patients had some psychiatric disorder in the axis I of DSM-IV. The most frequent psychiatric problem that was observed was anxiety disorders. The main medical problems observed were: arterial hypertension (59%), diabetes mellitus type 2 (29%) and obstructive sleep apnea syndrome (29%). The BMI and diabetes mellitus were associated with a lower risk for presenting a psychiatric disorder (for a BMI of 65.5 +/- 10.3 kg/m2: OR 0.26, CI 0.05-1.15, p = 0.04; for diabetes mellitus: OR 0.20, CI 0.03-1.05, p = 0.02). CONCLUSIONS: More than half of the patients had at least one psychiatric disorder in axis 1 of DSM-IV, related mostly to anxiety and mood disorders. Our findings point out the importance of psychiatric and psychological intervention in this group of patients, in which a follow up and adherence of medical, nutritional and psychological problems could be the difference, between a good or bad prognosis. Follow-up studies with obese patients after bariatric surgery, will be important to support our findings.