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1.
Curr Probl Pediatr Adolesc Health Care ; 48(10): 250-264, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30262163

RESUMO

Autism spectrum disorder (ASD) is a heterogeneous neuropsychiatric condition that, based on recent CDC estimates affects an estimated 1 in 59 American children. Behavioral treatments remain the mainstay of treatment for the core symptoms of ASD including communication deficits, social interaction deficits and repetitive behavior. However, youth with ASD may also have severe behavioral challenges including irritability, aggression, and hyperactivity. Currently there are only two medications (risperidone and aripiprazole) approved by the FDA for the treatment of irritability associated with ASD in children. Psychiatric comorbidities are common in youth with ASD, affecting up to 70% of affected children and adolescents. Given the burden of co-occurring disorders, medications are often employed to target symptoms such as irritability, anxiety, and hyperactivity. Other common co-occurring conditions including gastrointestinal disorders and sleep disorders may be improved with pharmacologic management. Evidence for the efficacy of many commonly used psychotropic medications in ASD is limited by the lack of large placebo-controlled trials in youth with ASD. This paper reviews the current literature regarding use of medications to address co-occurring conditions in children and adolescents with ASD as well as areas of emerging research.


Assuntos
Aripiprazol/uso terapêutico , Transtorno do Espectro Autista/tratamento farmacológico , Transtornos Mentais/tratamento farmacológico , Psicotrópicos/uso terapêutico , Risperidona/uso terapêutico , Adolescente , Transtorno do Espectro Autista/fisiopatologia , Criança , Comorbidade , Guias como Assunto , Humanos , Humor Irritável/efeitos dos fármacos , Transtornos Mentais/fisiopatologia , Ensaios Clínicos Controlados Aleatórios como Assunto
2.
Artigo em Inglês | MEDLINE | ID: mdl-29358037

RESUMO

The tolerability of antidepressants is poorly characterized in children and adolescents with depressive and anxiety disorders. Among adverse events that affect the tolerability of antidepressants in youth is activation, a cluster of symptoms that represent a hyperarousal event characterized by impulsivity, restlessness, and/or insomnia. This cluster of symptoms was first identified as a side effect of selective serotonin and selective serotonin norepinephrine inhibitors (SSRIs and SSNRIs) in the early 1990s; however, activation remains poorly characterized in terms of prevalence, risk factors, and pathophysiology. This article describes the pathophysiology of antidepressant-related activation, predictors of activation and its clinical management in youth with depressive and anxiety disorders who are treated with antidepressant medications.


Assuntos
Acatisia Induzida por Medicamentos/fisiopatologia , Antidepressivos/efeitos adversos , Transtornos Disruptivos, de Controle do Impulso e da Conduta/induzido quimicamente , Transtornos Disruptivos, de Controle do Impulso e da Conduta/fisiopatologia , Inibidores de Captação de Serotonina/efeitos adversos , Inibidores da Recaptação de Serotonina e Norepinefrina/efeitos adversos , Adolescente , Antidepressivos/uso terapêutico , Transtornos de Ansiedade/tratamento farmacológico , Transtorno do Deficit de Atenção com Hiperatividade/induzido quimicamente , Criança , Transtorno Depressivo/tratamento farmacológico , Humanos , Agitação Psicomotora , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Ideação Suicida
3.
Bipolar Disord ; 16(7): 703-12, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24990479

RESUMO

OBJECTIVES: Despite different treatments and courses of illness, depressive symptoms appear similar in major depressive disorder (MDD) and bipolar I disorder (BP-I). This similarity of depressive symptoms suggests significant overlap in brain pathways underlying neurovegetative, mood, and cognitive symptoms of depression. These shared brain regions might be expected to exhibit similar activation in individuals with MDD and BP-I during functional magnetic resonance imaging (fMRI). METHODS: fMRI was used to compare regional brain activation in participants with BP-I (n = 25) and MDD (n = 25) during a depressive episode as well as 25 healthy comparison (HC) participants. During the scans, participants performed an attentional task that incorporated emotional pictures. RESULTS: During the viewing of emotional images, subjects with BP-I showed decreased activation in the middle occipital gyrus, lingual gyrus, and middle temporal gyrus compared to both subjects with MDD and HC participants. During attentional processing, participants with MDD had increased activation in the parahippocampus, parietal lobe, and postcentral gyrus. However, among these regions, only the postcentral gyrus also showed differences between MDD and HC participants. CONCLUSIONS: No differences in cortico-limbic regions were found between participants with BP-I and MDD during depression. Instead, the major differences occurred in primary and secondary visual processing regions, with decreased activation in these regions in BP-I compared to major depression. These differences were driven by abnormal decreases in activation seen in the participants with BP-I. Posterior activation changes are a common finding in studies across mood states in participants with BP-I.


Assuntos
Transtorno Bipolar/complicações , Encéfalo/fisiopatologia , Depressão/etiologia , Depressão/patologia , Transtorno Depressivo Maior/complicações , Adulto , Atenção/fisiologia , Encéfalo/irrigação sanguínea , Mapeamento Encefálico , Cognição/fisiologia , Emoções/fisiologia , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Imagem por Ressonância Magnética , Masculino , Oxigênio/sangue , Adulto Jovem
4.
Brain Imaging Behav ; 8(3): 359-69, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22203524

RESUMO

Changes in diffusion tensor imaging (DTI) values co-occur with neurological and functional changes after stroke. However, quantitative DTI metrics have not been examined in response to participation in targeted rehabilitative interventions in chronic stroke. The primary purpose of this pilot study was to examine whether changes in DTI metrics co-occur with paretic arm movement changes among chronic stroke patients participating in a regimen of electrical stimulation targeting the paretic arm. Three subjects exhibiting stable arm hemiparesis were administered 30-minute (n = 1) or 120-minute (n = 2) therapy sessions emphasizing paretic arm use during valued, functional tasks and incorporating an electrical stimulation device. These sessions occurred every weekday for 8 weeks. A fourth subject served as a treatment control, participating in a 30-minute home exercise regimen without electrical stimulation every weekday for 8 weeks. DTI and behavioral outcome measures were acquired at baseline and after intervention. DTI data were analyzed using a region of interest (ROI) approach, with ROIs chosen based on tract involvement in sensorimotor function or as control regions. Behavioral outcome measures were the Fugl-Meyer Scale (FM) and the Action Research Arm Test (ARAT). The treatment control subject exhibited gains in pinch and grasp, as shown by a 5-point increase on the ARAT. The subject who participated in 30-minute therapy sessions exhibited no behavioral gains. Subjects participating in 120-minute therapy sessions displayed consistent impairment reductions and distal movement changes. DTI changes were largest in subjects two and three, with mean diffusivity (MD) decreases in the middle cerebellar peduncle and posterior limb of the internal capsule following treatment. No changes in fractional anisotropy (FA) were observed for sensorimotor tracts. Our preliminary results suggest that active rehabilitative therapies augmented by electrical stimulation may induce positive behavioral changes which are underscored by DTI changes indicative of increased white matter tract integrity in regions specific to sensory-motor function.


Assuntos
Encéfalo/patologia , Imagem de Tensor de Difusão/métodos , Terapia por Estimulação Elétrica/métodos , Manipulações Musculoesqueléticas/métodos , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral/patologia , Idoso , Feminino , Seguimentos , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Paresia/etiologia , Paresia/patologia , Paresia/reabilitação , Projetos Piloto , Índice de Gravidade de Doença , Acidente Vascular Cerebral/complicações , Resultado do Tratamento , Extremidade Superior
5.
Brain Res ; 1458: 56-66, 2012 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-22560503

RESUMO

Discrete jumps in knowledge, as exemplified by single-trial learning, are critical to survival. Despite its importance, however, one-trial learning remains understudied. We sought to better understand the brain activity adaptations that track punctuated changes in associative knowledge by studying visual-motor associative learning with functional magnetic resonance imaging. Human and primate neurophysiological studies of feedback-based learning indicate that performance feedback elicits high activity at first that diminishes rapidly with repeated success. Based on these findings we hypothesized a network of brain regions would track the importance of feedback, which is large early in learning and diminishes thereafter. Specifically, based on neurophysiological findings, we predicted that frontal and striatal regions would show a large activation to first trial feedback and a subsequent reduction selective to performance feedback but not stimulus cue presentation. We observed that the striatum and frontal cortex as well as several other cortical and subcortical sites exhibited this pattern. These findings match our prediction for activity in frontal and striatal regions. Furthermore, these observations support the more general hypothesis that a large network of regions participates in the associative process once the behavioral goal is definitively identified by first trial performance feedback. Activity in this network declines upon further rehearsal but only for feedback presentation. We suggest that, based on the timing of this process, these regions participate in binding together stimulus cue, motor response, and performance feedback information into an association that is used to accurately perform the task on after the first trial.


Assuntos
Aprendizagem por Associação/fisiologia , Corpo Estriado/fisiologia , Retroalimentação Fisiológica/fisiologia , Córtex Pré-Frontal/fisiologia , Adulto , Mapeamento Encefálico/métodos , Feminino , Humanos , Masculino , Estimulação Luminosa/métodos , Desempenho Psicomotor/fisiologia , Tempo de Reação/fisiologia , Adulto Jovem
6.
Ann Allergy Asthma Immunol ; 106(6): 527-32, 2011 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-21624753

RESUMO

BACKGROUND: Although nonallergic rhinitis (NAR) patients tend to be more sensitive to chemical/olfactory stimuli, a suprathreshold olfactory response or the presence of specific olfactory receptor genes do not explain why their symptoms are triggered by such exposures. OBJECTIVE: To investigate differential neurogenic responses to azelastine in NAR patients, using functional magnetic resonance imaging (fMRI) in response to specific olfactory triggers. METHODS: A longitudinal study design on 12 subjects with a physician diagnosis of NAR previously demonstrated to be clinically responsive to intranasal azelastine (Astelin) was performed. Subjects underwent fMRI during exposure to unpleasant (hickory smoke) and pleasant (vanilla) odorants while off and then on azelastine for 2 weeks. The olfactory fMRI paradigm consisted of a visually triggered sniff every 21 seconds with synchronized delivery of a 4 second pulse of odorant. Each odorant was presented 18 times over 4-6-minute fMRI runs. Continuous fresh air was presented to wash out each odorant after presentation. RESULTS: Nonallergic rhinitis patients exhibited increased blood flow to several regions of the brain in response to both pleasant and unpleasant odorants, specifically in odor-sensitive regions, while off intranasal azelastine. Treatment with intranasal azelastine significantly attenuated blood flow to regions of the brain relevant to either olfactory sensation or sensory processing in response to these odorants compared with fresh air. CONCLUSION: The general reduction compared with increase in brain activation in NAR patients on versus off azelastine suggests that a possible effect of this medication may be reduction of brain responses to odorants.


Assuntos
Encéfalo/fisiopatologia , Odorantes , Ftalazinas/uso terapêutico , Rinite/tratamento farmacológico , Rinite/fisiopatologia , Administração Intranasal , Adulto , Encéfalo/irrigação sanguínea , Encéfalo/efeitos dos fármacos , Feminino , Humanos , Estudos Longitudinais , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Percepção Olfatória , Ftalazinas/administração & dosagem , Ftalazinas/efeitos adversos , Fumaça , Resultado do Tratamento , Vanilla , Adulto Jovem
7.
J Affect Disord ; 133(1-2): 333-9, 2011 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-21546091

RESUMO

BACKGROUND: Of all mood states, patients in mixed episodes of bipolar disorder are at the greatest risk for impulsive behaviors including attempted suicide. The aim of this study was to examine whether the neural correlates of motor impulsivity are distinct in patients with mixed mania. METHODS: Ten patients with bipolar disorder in a mixed episode (BP-M), 10 bipolar comparison participants in a depressed episode (BP-D), and 10 healthy comparison (HC) participants underwent functional MRI while performing a Go/No-Go task of motor impulsivity. RESULTS: Both patient groups had elevated, self-rated motor impulsiveness scores. The BP-M group also had a trend-level increase in commission errors relative to the HC group on the Go/No-Go task. While the full sample strongly activated a ventrolateral prefrontal-subcortical brain network, the BP-M group activated the amygdala and frontal cortex more strongly than the HC group, and the thalamus, cerebellum, and frontal cortex more strongly than the BP-D group. LIMITATIONS: This study is primarily limited by a relatively small sample size. CONCLUSIONS: Higher commission error rates on the Go/No-Go task suggest increased vulnerability to impulsive responding during mixed episodes of bipolar disorder. Moreover, the distinct pattern of increased brain activation during mixed mania may indicate a connection between behavioral impulsivity and a failure of neurophysiological "inhibition", especially in the amygdala.


Assuntos
Transtorno Bipolar/fisiopatologia , Encéfalo/fisiopatologia , Comportamento Impulsivo/fisiopatologia , Adulto , Afeto , Tonsila do Cerebelo/patologia , Tonsila do Cerebelo/fisiopatologia , Transtorno Bipolar/psicologia , Encéfalo/patologia , Depressão , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Agitação Psicomotora , Fatores de Risco , Tentativa de Suicídio , Análise e Desempenho de Tarefas
8.
Biol Psychiatry ; 69(4): 381-8, 2011 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-21051038

RESUMO

BACKGROUND: Bipolar I disorder is defined by the occurrence of mania. The presence of mania, coupled with a course of illness characterized by waxing and waning of affective symptoms, suggests that bipolar disorder arises from dysfunction of neural systems that maintain emotional arousal and homeostasis. We used functional magnetic resonance imaging (fMRI) to study manic bipolar subjects as they performed a cognitive task designed to examine the ventrolateral prefrontal emotional arousal network. METHODS: We used fMRI to study regional brain activation in 40 DSM-IV manic bipolar I patients and 36 healthy subjects while they performed a continuous performance task with emotional and neutral distracters. Event-related region-of-interest analyses were performed to test the primary hypothesis. Voxelwise analyses were also completed. RESULTS: Compared with healthy subjects, the manic subjects exhibited blunted activation to emotional and neutral images, but not targets, across most of the predefined regions of interest. Several additional brain regions identified in the voxelwise analysis also exhibited similar differences between groups, including right parahippocampus, right lingual gyrus, and medial thalamus. In addition to these primary findings, the manic subjects also exhibited increased activation in response to targets in a number of brain regions that were primarily associated with managing affective stimuli. Group differences did not appear to be secondary to medication exposure or other confounds. CONCLUSIONS: Bipolar manic subjects exhibit blunted brain fMRI response to emotional cues throughout the ventrolateral prefrontal emotional arousal network. Disruption of this emotional network may contribute to the mood dysregulation of bipolar disorder.


Assuntos
Tonsila do Cerebelo/fisiopatologia , Transtorno Bipolar/fisiopatologia , Córtex Pré-Frontal/fisiopatologia , Adulto , Nível de Alerta/fisiologia , Mapeamento Encefálico , Emoções/fisiologia , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Imagem por Ressonância Magnética , Masculino , Rede Nervosa/fisiopatologia , Vias Neurais/fisiopatologia , Testes Neuropsicológicos
9.
J Commun Disord ; 43(5): 438-52, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20493496

RESUMO

UNLABELLED: There are many distinct forms of dementia whose pharmacological and behavioral management differ. Differential diagnosis among the dementia variants currently relies upon a weighted combination of genetic and protein biomarkers, neuroanatomical integrity, and behavior. Diagnostic specificity is complicated by a high degree of overlap in the initial presenting symptoms across dementia subtypes. For this reason, reliable markers are of considerable diagnostic value. Communication disorders have proven to be among the strongest predictors for discriminating among dementia subtypes. As such, speech-language pathologists may be poised to make an increasingly visible contribution to dementia diagnosis and its ongoing management. The value and durability of this potential contribution, however, demands an improved discipline-wide knowledge base about the unique features associated with different dementia variants. To this end we provide an overview of cognition, language, and clinical pathological features of four of the most common non-Alzheimer's dementias: frontotemporal dementia, vascular dementia, Lewy body disease dementia, and Parkinson's disease dementia. LEARNING OUTCOMES: Readers will learn characteristics and distinguishing features of several non-Alzheimer's dementias, including Parkinson's disease dementia, frontotemporal dementia, vascular dementia, and Lewy body dementia. Readers will also learn to distinguish between several variants of frontotemporal dementia. Finally, readers will gain knowledge of the term primary progressive aphasia as it relates to the aforementioned dementia etiologies.


Assuntos
Transtornos Cognitivos/etiologia , Demência/complicações , Transtornos da Linguagem/etiologia , Distúrbios da Fala/etiologia , Afasia/diagnóstico , Demência/diagnóstico , Progressão da Doença , Humanos , Doença de Parkinson/complicações , Semântica
10.
Neurorehabil Neural Repair ; 24(2): 195-203, 2010 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-20107135

RESUMO

BACKGROUND AND PURPOSE: Conventional electrical stimulation modalities are limited by their lack of opportunities for motor learning and, consequently, their impact on function. Other rehabilitative regimens necessitate affected hand and wrist movement for patients to be included, making them implausible for most patients. In light of these challenges, the current study examined the efficacy of a repetitive task-specific training (RTP) regimen using an electrical stimulation neuroprosthesis in stroke patients exhibiting no affected wrist or hand movement. METHOD: Eight chronic stroke patients (mean = 46.5 months) with moderately affected arm motor deficits participated in 30-minute therapy sessions occurring every weekday for 8 weeks. During the sessions, they wore the neuroprosthesis to enable performance of valued activities identified largely by the patients. To ensure transfer to their real-world environments, most sessions were home based, with the patients coming to the clinic for "tune-up" sessions (eg, adjusting the stimulation parameters, exercises, and/or fit of the device) twice every other week (a total of 8 clinical visits). Outcomes were evaluated using the Action Research Arm Test (ARAT) and the upper extremity section of the Fugl-Meyer Assessment (FM), the amount of use scale of the Motor Activity Log (MAL), and high-field functional magnetic resonance imaging (fMRI). RESULTS: Before the intervention, patients exhibited stable motor deficits. After the intervention, they exhibited ARAT and FM score increases (+2.85 and +2.2, respectively). Postintervention fMRI revealed significant increases in cortical activation, possibly brought about by markedly increased affected arm use patterns on the MAL (+0.97). CONCLUSIONS: An affected arm RTP program incorporating NEURSTIM appears to increase affected arm use and elicit neural changes in more impaired patients. These factors may conspire to produce motor changes, although motor changes are smaller in this population than with less impaired patients. The program may act as a "bridge" to other promising regimens.


Assuntos
Mãos/fisiopatologia , Córtex Motor/fisiopatologia , Movimento/fisiologia , Acidente Vascular Cerebral , Idoso , Mapeamento Encefálico , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Córtex Motor/irrigação sanguínea , Oxigênio/sangue , Método Simples-Cego , Acidente Vascular Cerebral/patologia , Acidente Vascular Cerebral/fisiopatologia , Reabilitação do Acidente Vascular Cerebral , Resultado do Tratamento
11.
Early Interv Psychiatry ; 3(3): 189-97, 2009 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-22640382

RESUMO

AIM: To identify differential patterns of brain activation between adolescents with bipolar disorder and adolescents with attention-deficit hyperactivity disorder (ADHD) to better understand the neurophysiology of both disorders. We hypothesized that subjects with ADHD would show altered activation in brain regions involved in executive and sustained attention. In contrast, we hypothesized that bipolar subjects would show altered brain activation in regions responsible for emotionally homeostasis, including the striatum and amygdala. METHODS: Functional magnetic resonance imaging was performed during a continuous performance task with a response inhibition component in 11 adolescents with bipolar disorder during a manic episode, 10 adolescents with ADHD, and 13 healthy adolescents. RESULTS: There were no differences in behavioural performance among the three groups. Compared with bipolar subjects, subjects with ADHD showed increased activation in the superior temporal lobe during successful response inhibition. Although bipolar subjects did not show activation differences in the striatum or amygdala compared with ADHD subjects, increased left parahippocampal activation in the bipolar group was associated with increased manic symptoms. CONCLUSIONS: The patterns of brain activation observed in the current study support divergent patterns of neurophysiological dysfunction in individuals with bipolar disorder as compared with those with ADHD. Therefore, the impulsive behaviour seen in both disorders may be the consequence of dysfunction in different brain regions, and further research may help identify neurobiological markers that are specific to each condition.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/fisiopatologia , Transtorno Bipolar/fisiopatologia , Mapeamento Encefálico/psicologia , Encéfalo/fisiopatologia , Adolescente , Mapeamento Encefálico/métodos , Estudos de Casos e Controles , Criança , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Imagem por Ressonância Magnética/psicologia , Masculino , Desempenho Psicomotor/fisiologia
12.
Top Stroke Rehabil ; 15(5): 468-83, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-19008206

RESUMO

PURPOSE: The role of intensity of aphasia therapy was investigated using functional magnetic resonance imaging (fMRI) to document changes in neural activation patterns associated with massed versus distributed therapy in an individual with chronic conduction aphasia. METHOD: Language therapy targeted word-finding deficits and phonological processing. fMRI scans were acquired at baseline, after massed therapy, and after distributed therapy. RESULTS: Treatment was effective, as demonstrated by increases in performance on standardized measures, narrative analysis, and task performance in the fMRI scanner. Task improvement across fMRI testing sessions corresponded with increases in fMRI blood oxygenation level dependent (BOLD) signal. Greatest behavioral gains and BOLD signal increases occurred after massed therapy, with slight gains accompanying distributed therapy. Increases in fMRI BOLD signal occurred after therapy in left basal ganglia and right hemisphere frontotemporal cortex. CONCLUSIONS: Intensity of aphasia therapy impacts the recovery process and warrants additional research. Basal ganglia and right hemisphere structures may be important neural substrates for aphasia recovery.


Assuntos
Afasia/reabilitação , Afasia/terapia , Imagem por Ressonância Magnética , Recuperação de Função Fisiológica/fisiologia , Fonoterapia , Afasia/fisiopatologia , Gânglios da Base/fisiologia , Córtex Cerebral/fisiologia , Doença Crônica , Dominância Cerebral/fisiologia , Feminino , Humanos , Pessoa de Meia-Idade
13.
Top Stroke Rehabil ; 15(5): 427-50, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-19008203

RESUMO

Brain-mapping techniques have proven to be vital in understanding the molecular, cellular, and functional mechanisms of recovery after stroke. This article briefly summarizes the current molecular and functional concepts of stroke recovery and addresses how various neuroimaging techniques can be used to observe these changes. The authors provide an overview of various techniques including diffusion-tensor imaging (DTI), magnetic resonance spectroscopy (MRS), ligand-based positron emission tomography (PET), single-photon emission computed tomography (SPECT), regional cerebral blood flow (rCBF) and regional metabolic rate of glucose (rCMRglc) PET and SPECT, functional magnetic resonance imaging (fMRI), near infrared spectroscopy (NIRS), electroencephalography (EEG), magnetoencephalography (MEG), and transcranial magnetic stimulation (TMS). Discussion in the context of poststroke recovery research informs about the applications and limitations of the techniques in the area of rehabilitation research. The authors also provide suggestions on using these techniques in tandem to more thoroughly address the outstanding questions in the field.


Assuntos
Mapeamento Encefálico/métodos , Recuperação de Função Fisiológica , Acidente Vascular Cerebral , Eletroencefalografia , Humanos , Imagem por Ressonância Magnética , Magnetoencefalografia , Tomografia por Emissão de Pósitrons , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/patologia , Reabilitação do Acidente Vascular Cerebral , Tomografia Computadorizada de Emissão de Fóton Único , Estimulação Magnética Transcraniana
14.
Early Interv Psychiatry ; 2(4): 225-33, 2008 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-19190727

RESUMO

AIMS: Impulsivity is common in bipolar disorder, especially during mania. Understanding the functional neuroanatomy of response inhibition, one component of impulsivity, might clarify the neural substrate of bipolar disorder. METHODS: Sixteen DSM-IV first-episode, manic bipolar patients and 16 matched healthy subjects were examined during a first manic episode using functional magnetic resonance imaging while performing a response inhibition task. All subjects were studied using a 4.0 Tesla Varian Unity INOVA Whole Body MRI/MRS system. The response inhibition task was presented using non-ferromagnetic goggles, and task performance was recorded during scan acquisition. Imaging data were analysed using analysis of functional neuroimages. Group contrasts were made for the specific response inhibition measure. RESULTS: The groups performed the task similarly, although both demonstrated relatively poor rates of target response, but high rates of successful 'stops'. Despite similar behavioural results, the groups showed significantly different patterns of functional magnetic resonance imaging brain activation. Specifically, during response inhibition, the healthy subjects exhibited significantly greater activation in anterior and posterior cingulate, medial dorsal thalamus, middle temporal gyrus, and precuneus. The bipolar patients exhibited prefrontal activation (BA 10) that was not observed in healthy subjects. CONCLUSIONS: Bipolar and healthy subjects exhibit different patterns of brain activation to response inhibition; these differences may reflect different functional neuroanatomic approaches to response inhibition between the two groups.


Assuntos
Transtorno Bipolar/patologia , Encéfalo/fisiopatologia , Transtorno Bipolar/psicologia , Estudos de Casos e Controles , Cognição , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Desempenho Psicomotor , Adulto Jovem
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