One of the most frequent indications of psychosurgical treatment is incurable obsessions. Up to now, capsulotomy or cingulotomy has been preferred. In our opinion, the variety of obsessive conditions require a more thorough approach to the selection of interbrain targets. Forty-seven patients with pure obsessive-compulsive disorders as well as disorders connected with depressions, epileptic syndrome, schizophreniform state and Gilles de la Tourette''s syndrome with extremely severe resistance to medical therapy were examined. Eighteen patients were operated on. Surgical treatment is permissible only in cases fulfilling the three following criteria: (1) clinicopsychopathological permissibility (duration of disease, resistance to medication, psychopathological status); (2) physiological permissibility (the presence of a brain target, defining the psychopathological status), and (3) technical permissibility (the availability of proper stereotactic, imaging, electrophysiological and other apparatus necessary to carry out the surgical treatment). One supposes that the outcome of surgical treatment is determined by all three criteria. For the purpose of improving the efficiency of stereotactic treatment, a number of methods of surgical treatment depending on the psychopathological status are suggested. For example, in case of comorbidity of obsession with the epileptiform syndrome, we suggest cingulotomy (capsulotomy) and amygdalotomy; in case of comorbidity with depression we suggest cingulotomy and innominatotomy. The long-term observation of the outcome of stereotactic treatment covers a period from 2 up to 9 years.
Introduction: Depression is one of the most common mental health problem and it grows greater every year around the world. Aims: The main aims were to analyze the possibility of using functional and structural neuroimaging methods in diagnosis of different depression types and to find the predictors of pharmacological resistance. Materials & methods: 46 patients with depression syndrome were distributed into 3 groups: 1) Neurotic Depression (Diagnosis: Adjustment disorders)-ND group; 2) Endogenous Depression (Diagnosis: Recurrent Depression, Bipolar Affective Disorder-current depressive episode, Schizoaffective disorder, depressive type)-PD group, 3) Depression due to organic pathology (Diagnosis: Organic depressive disorder, Organic mixed affective disorder)-OD group. Controls were 18 years old-and gender-matched healthy participants. We used several methods of functional (positron-emission tomography, functional magnetic resonance imaging) and structural (voxel-based morphometry, diffusion-tensor imaging) neuroimaging. Results: We found several functional and structural abnormalities in limbic structures within all three groups. Some of them were the same, some were different. Also we found several functional and structural predictors of pharmacological resistance. Conclusions: We found several functional and structural abnormalities in all three depressive groups. Almost all of them were parts of so-called frontal-subcortical circuits, dysfunction of which, according to the present knowledge, could play crucial role in depression pathogenesis. Summarizing our own results and analyzing the data of our colleagues, we complement a theory of depression pathogenesis and propose an original point of view for neurobiological basis of different types of depressive disorders and its pharmacological resistance.
Introduction: Depressed patients demonstrate low frustration tolerance which increases the risk of suicide and causes difficulties in social adaptation. Resting-state neuroimaging studies revealed abnormalities in "default-mode" network in Major Depressive Disorder (MDD). To our knowledge, functional network responsible for frustration has not been investigated in depressed subjects previously. Aim: To investigate functional responses to frustration in MDD subjects and healthy controls (HCs). Methods: 15 subjects with MDD and 15 HCs underwent 10-min fMRI scanning. We used modified Stroop-test to investigate subjects' responses to frustration. There were two sessions: during the first one the subject had to determine the color of the text by pressing corresponding button while scanning; the second one was a "frustrative" part when the subject had to respond within a short period of time. We modified this interval so that it was almost impossible to respond correctly and keep within the allotted time. The subject was being informed on its performance during the test. Independent component analysis was used to isolate the frustration network in each subject. Group maps of the response network were compared. A within-group analysis was performed in the MDD group to explore effects of depression scores on functional connectivity. Results: We revealed differences in limbic functional connectivity patterns during the test perfomance in MDD in comparison to HCs. Conclusions: The findings suggest that low frustration tolerance in depressed patients can be explained by the impaired function of stress-response brain network and reveal perspectives for future research on depression and suicide risk.
Introduction: The neuroleptics, which were invented in the middle of the last century, have changed psychiatry as the clinical discipline, and a problem of the pharmacological resistance insensibly has become the main problem. A radical way to overcome the resistance of the anxious and depressive disorders lies in the field of the modern neurosurgical techniques. However, the verification of the resistance still requires more developed approach. Aim: The main aim of our study was to develop and test an integrated neuropsychiatric approach in order to objectify the resistance and the disease severity for the selection of patients for surgical treatment. Methods and participants: We used different types of neuroimaging techniques for reviewing clinical and neurophysiological correlations: positron-emission tomography (PET), functional magnetic resonance imaging (fMRI), diffusion-tensor imaging (DTI) and its relations to the electroencephalography (EEG) data. We examined 110 patients with depressive and anxious-obsessive disorders. 40 of them were examined using fMRI, 35 using PET and 35 using DTI. The patients were divided into groups by the ICD-10 criteria. The average age of the group was 46.3 years, the number of males and females in groups was approximately equal. Results: It was revealed that the degree of resistance had a significant correlation with the number of functional and structural neuroimaging indicators.
IntroductionMajor depressive disorder (MDD) is associated with low frustration tolerance, which is a risk factor for suicide. Hippocampal structural and functional abnormalities have been documented to play one of the crucial roles in the pathophysiology of depression. Recent studies have revealed functional differentiation of the hippocampus. Thus, activity of the anterior part was shown to be associated with negative affect mediation.ObjectivesTo investigate brain mechanisms of frustration, comparing its impact on anterior hippocampal connectivity in MDD patients and healthy controls (HCs).Methods14 MDD and 14 HC right-handed subjects were included in the study and underwent comprehensive clinical assessment. MDD was diagnosed during psychiatric interview according to ICD-10 criteria. The Hamilton Depression Rating Scale was additionally used to assess depressive symptoms. The original Stroop test was modified to evoke a state of frustration by administrering impossible task conditions and negative feedback during 10-min functional magnetic resonance scanning session. Psychophysiological interactions were used to analyze left and right anterior hippocampal functional connectivity changes in response to frustration. The resulted Z-maps were adjusted using Z > 2.3 threshold and a (corrected) cluster significance threshold of p = 0.05.ResultsIncreased functional connectivity of the left anterior hippocampus in response to frustration was significantly higher in MDD patients compared to HCs in the pars opercularis of the right prefrontal cortex and bilateral posterior cingulate regions.ConclusionThe results revealed that depressed patients demonstrate abnormally increased anterior hippocampal response to frustration, suggesting that hippocampal-neocortical network impairment may contribute to decreased frustration tolerance associated with MDD
BackgroundOpioid addiction is a serious mental health problem with substantial impact on society and healthcare. The diagnosis and monitoring of its treatment are almost exclusively clinical tasks and their efficacy is often unsatisfactory. This suggests a need to study potential biomarkers of opiod addiction. In this study, we used functional magnetic resonance imaging (fMRI) and our modification of the Stroop-task to investigate patients’ reactivity to emotionally relevant (drug-related) stimuli and its impact on their cognitive performance as a potential biomarker for opiod dependence syndrome.Methods40 patients with opioid addiction aged 25.9±2.6 years with mean narcotization period of 9±3.4 years were included. The control group consisted of 25 age- and gender-matched healthy subjects. fMRI was performed on 1.5T scanner Toshiba Vantage Titan. The original Strooptask was modified to investigate the effect of emotionally relevant distractor on the task performance by changing the background of the stimuli: emotionally neutral (furniture and everyday objects) and relevant (pictures of drugs, and drug paraphernalia). Group comparison of the activation maps was performed using two-sample T-test.ResultsIn comparison to the control group, patients with opioid addiction showed worse task performance, accompanied by the increased response of the left insula, dorsolateral prefrontal cortex, right amygdala and hippocampus.ConclusionWe found that emotionally relevant stimuli worsen Stroop-task performance in drug addicts, which is accompanied by the increased activation of structures involved in emotional reactivity and cognitive control. The applicability of this combined imaging-neuropsychological task in practice is the matter of our future research.
The aim of study to evaluate possibilities of functional neuroimaging (18F-FDG PET and +H MRS) in diagnosis and treatment evaluation in patients with resistant obsessive-compulsive disorders.18F-FDG PET was performed in 19 patients with treatment resistant OCD. Besides, single voxel MRS was used to image the heads of the caudate nucleus in 13 patients. Examinations were executed at the time of treatment cancellation in all cases. Moreover 18F-FDG PET and H MRS were carried out during every periods of complex treatment (including psychotherapy, psychosurgery (in all cases) and combined stimulation of the head of caudate nucleus and vagus nerve (in 3 cases). Parameters of stimulation and its duration were defined using neuroimaging data.Our results show that application of functional neuroimaging in patients with resistant forms of OCD enables to optimize treatment using adequate medicinal therapy and to prove a choice of brain structures-targets for stereotactic effects. Long-term neuropsychiatric monitoring, neuroimaging data and results of neurostimulation allow to advance a hypothesis about three brain levels of OCD formation in contrast to accepted assumption about four symptom dimensions: symmetry/ordering, hoarding, contamination/cleaning, and obsessions/checking.
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