Structural connectivity modifications following deep brain stimulation of the subcallosal cingulate and nucleus accumbens in severe anorexia nervosa.

PURPOSE: Anorexia nervosa (AN) is a mental health disorder characterized by significant weight loss and associated medical and psychological comorbidities. Conventional treatments for severe AN have shown limited effectiveness, leading to the exploration of novel interventional strategies, including deep brain stimulation (DBS). However, the neural mechanisms driving DBS interventions, particularly in psychiatric conditions, remain uncertain. This study aims to address this knowledge gap by examining changes in structural connectivity in patients with severe AN before and after DBS. METHODS: Sixteen participants, including eight patients with AN and eight controls, underwent baseline T1-weigthed and diffusion tensor imaging (DTI) acquisitions. Patients received DBS targeting either the subcallosal cingulate (DBS-SCC, N = 4) or the nucleus accumbens (DBS-NAcc, N = 4) based on psychiatric comorbidities and AN subtype. Post-DBS neuroimaging evaluation was conducted in four patients. Data analyses were performed to compare structural connectivity between patients and controls and to assess connectivity changes after DBS intervention. RESULTS: Baseline findings revealed that structural connectivity is significantly reduced in patients with AN compared to controls, mainly regarding callosal and subcallosal white matter (WM) tracts. Furthermore, pre- vs. post-DBS analyses in AN identified a specific increase after the intervention in two WM tracts: the anterior thalamic radiation and the superior longitudinal fasciculus-parietal bundle. CONCLUSIONS: This study supports that structural connectivity is highly compromised in severe AN. Moreover, this investigation preliminarily reveals that after DBS of the SCC and NAcc in severe AN, there are WM modifications. These microstructural plasticity adaptations may signify a mechanistic underpinning of DBS in this psychiatric disorder.

Cognitive and quality-of-life related factors of body mass index (BMI) improvement after deep brain stimulation in the subcallosal cingulate and nucleus accumbens in treatment-refractory chronic anorexia nervosa.

BACKGROUND: Up to 20% of the cases of anorexia nervosa (AN) are chronic and treatment-resistant. Recently, the efficacy of deep brain stimulation (DBS) for severe cases of AN has been explored, with studies showing an improvement in body mass index and other psychiatric outcomes. While the effects of DBS on cognitive domains have been studied in patients with other neurological and psychiatric conditions so far, no evidence has been gathered in AN. METHODS: Eight patients with severe, chronic, treatment-resistant AN received DBS either to the nucleus accumbens (NAcc) or subcallosal cingulate (SCC; four subjects on each target). A comprehensive battery of neuropsychological and clinical outcomes was used before and 6-month after surgery. FINDINGS: Although Body Mass Index (BMI) did not normalise, statistically significant improvements in BMI, quality of life, and performance on cognitive flexibility were observed after 6 months of DBS. Changes in BMI were related to a decrease in depressive symptoms and an improvement in memory functioning. INTERPRETATION: These findings, although preliminary, support the use of DBS in AN, pointing to its safety, even for cognitive functioning; improvements of cognitive flexibility are reported. DBS seems to exert changes on cognition and mood that accompany BMI increments. Further studies are needed better to determine the impact of DBS on cognitive functions.

A Randomized Trial of Deep Brain Stimulation to the Subcallosal Cingulate and Nucleus Accumbens in Patients with Treatment-Refractory, Chronic, and Severe Anorexia Nervosa: Initial Results at 6 Months of Follow Up.

BACKGROUND: The main objective of this study was to assess the safety and efficacy of deep brain stimulation (DBS) in patients with severe anorexia nervosa (AN). METHODS: Eight participants received active DBS to the subcallosal cingulate (SCC) or nucleus accumbens (NAcc) depending on comorbidities (affective or anxiety disorders, respectively) and type of AN. The primary outcome measure was body mass index (BMI). RESULTS: Overall, we found no significant difference (p = 0.84) between mean preoperative and postoperative (month 6) BMI. A BMI reference value (BMI-RV) was calculated. In patients that received preoperative inpatient care to raise the BMI, the BMI-RV was defined as the mean BMI value in the 12 months prior to surgery. In patients that did not require inpatient care, the BMI-RV was defined as the mean BMI in the 3-month period before surgery. This value was compared to the postoperative BMI (month 6), revealing a significant increase (p = 0.02). After 6 months of DBS, five participants showed an increase of ≥10% in the BMI-RV. Quality of life was improved (p = 0.03). Three cases presented cutaneous complications. CONCLUSION: DBS may be effective for some patients with severe AN. Cutaneous complications were observed. Longer term data are needed.

Health-related quality of life according to the main caregiver in patients with home nutritional support.

BACKGROUND AND OBJECTIVE: We intended to know the degree of agreement between the quality of life's perception of patients with home nutritional support and that of their main caregiver in the different dimensions. We also aimed to establish the predictive ability of the health-related quality of life (HRQL) punctuation of the caregiver about the patient, fixed up by other variables. METHOD: We evaluated the HRQL with the EuroQol-5D (EQ-5D) questionnaire in 245 patients by means of a direct interview with them and with their main caregiver. The patients came from 13 hospitals of the National Health System and they were selected sequentially according to their visits to the hospital or at home. RESULTS: The agreement obtained in the EQ-5D components was high, except for the anxiety component, which had a 58% concordance (McNemar's test, p = 0.005; kappa = 0.340, p < 0.001). When studying the agreement between the patient punctuation and that of the main caregiver, an intraclass correlation coefficient (ICC) = 0.887 (95% confidence interval [CI], 0.852-0.913) was obtained. When studying the predictive ability of the caregiver's punctuation about the patient, we obtained an R2 = 0.649 with a regression coefficient of 0.803 (95% CI, 0.725-0.882) in the EQ-5D, while in the visual analogical scale an ICC = 0.823 (95% CI, 0.771-0.863) was obtained, and an R2 = 0.475 with a regression coefficient of 0.719 (95% CI, 0.617-0.822) was found. CONCLUSIONS: A caregiver's evaluation can be useful to have an approximation to the patient's perception when he/she does not have the ability to communicate. The approach is better if we consider the variables sex, pathological group, age of the caregiver or the evaluation of changes in the health state for the last 12 months.

Dolor abdominal en el anciano secundario a divertículo sigmoideo gigante / Abdominal pain in an elderly man secondary to giant sigmoid diverticula

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Social-cognitive bias and depressive symptoms in outpatients with bipolar disorder.

A deficit of social cognition in bipolar disorder has been shown, even when patients are stable. This study compares the attribution of intentions (social-cognitive bias) in a group of 37 outpatients with bipolar disorder with 32 matched control subjects. Bipolar patients scored significantly higher in the Ambiguous Intentions Hostility Questionnaire, showing an angry and intentionality bias (P = .001, P = .02). Differences in blame scale and hostility bias did not reach statistical significance, but a trend was found (P = .06). Bipolar patients with depressive symptoms presented a higher score in the angry bias scale (P = .03) and aggressivity bias scale (P = .004). The global functioning (GAF) correlates significantly with intentionality (P = .005), angry (P = .027), and aggressivity (P = .020) biases. Bipolar patients show a social-cognitive bias that may play a role in their functional outcome.

Health-related quality of life according to the main caregiver in patients with home nutritional support

FUNDAMENTO Y OBJETIVO: El objetivo de este estudio ha sido conocer el grado de acuerdo en la valoración de la calidad de vida relacionada con la salud (CVRS) entre los pacientes con soporte nutricional domiciliario y su cuidador, en las diferentes dimensiones, para poder valorarla cuando las dificultades de comunicación de estos pacientes no permiten hacerlo directamente. Asimismo, nos hemos propuesto establecer la capacidad predictiva de la puntuación de CVRS del cuidador sobre la del paciente, ajustada por otras variables. MÉTODO: Hemos valorado la CVRS con el cuestionario EuroQol-5D (EQ-5D) en 245 pacientes mediante entrevista directa a éstos y a sus cuidadores principales. Los pacientes procedían de13 hospitales del Sistema Nacional de Salud y se seleccionaron de forma secuencial según su visita tuviera lugar en el hospital o en el domicilio. RESULTADOS: El acuerdo obtenido en los componentes del EQ-5D fue elevado, con excepción del componente de ansiedad, donde se encontró una concordancia del 58% (test de McNemar, p = 0,005; kappa = 0,340, p < 0,001). Cuando estudiamos la concordancia entre la puntuación del paciente y la del cuidador, se obtuvo un coeficiente de correlación intraclase(CCI) de 0,887 (intervalo de confianza [IC] del 95%, 0,852-0,913). Al estudiar la capacidad predictiva de la puntuación del cuidador sobre la del paciente se obtuvo una R2de 0,649, con un coeficiente de regresión de 0,803 (IC del 95%, 0,725-0,882), en elEQ-5D, mientras que en la escala visual analógica se obtuvo un CCI de 0,823 (IC del 95%, 0,771-0,863) y una R2 de 0,475, con coeficiente de regresión de 0,719 (IC del 95%, 0,617-0,822). CONCLUSIONES: La valoración del cuidador es de utilidad para disponer de una aproximación a la percepción del paciente cuando éste no tiene capacidad para comunicarse, y constituye la mejor aproximación si se tienen en cuenta variables tales como el sexo, el grupo patológico, la edad del cuidador y la evaluación de los cambios en el estado de salud del paciente en los últimos 12 meses

BACKGROUND AND OBJECTIVE: We intended to know the degree of agreement between the quality of life’s perception of patients with home nutritional support and that of their main care giver in the different dimensions. We also aimed to establish the predictive ability of the health-related quality of life (HRQL) punctuation of the caregiver about the patient, fixed up by other variables. METHOD: We evaluated the HRQL with the EuroQol-5D (EQ-5D) questionnaire in 245 patients by means of a direct interview with them and with their main caregiver. The patients came from13 hospitals of the National Health System and they were selected sequentially according to their visits to the hospital or at home. RESULTS: The agreement obtained in the EQ-5D components was high, except for the anxiety component, which had a 58% concordance (McNemar’s test, p = 0.005; kappa = 0.340, p < 0.001).When studying the agreement between the patient punctuation and that of the main caregiver, an intraclass correlation coefficient (ICC) = 0.887 (95% confidence interval [CI], 0.852-0.913) was obtained. When studying the predictive ability of the caregiver’s punctuation about the patient, we obtained an R2 = 0.649 with a regression coefficient of 0.803 (95% CI, 0.725-0.882) in the EQ-5D, while in the visual analogical scale an ICC = 0.823 (95% CI, 0.771-0.863) was obtained, and an R2 = 0.475 with a regression coefficient of 0.719 (95% CI, 0.617-0.822) was found. CONCLUSIONS: A caregiver’s evaluation can be useful to have an approximation to the patient’s perception when he/she does not have the ability to communicate. The approach is better if we consider the variables sex, pathological group, age of the caregiver or the evaluation of changes in the health state for the last 12 months sex, pathological group, age of the caregiver or the evaluation of changes in the health state for the last 12 months