Cerebral metabolism during vegetative state and after recovery to consciousness One way to approach the study of consciousness is to explore lesional cases in which impairment of consciousness is the prominent clinical sign. Vegetative state is such a condition wherein awareness is abolished whereas arousal persists. It can be diagnosed clinically soon after a brain injury and may be reversible (as in the following case report) or progress to a persistent vegetative state or death. The distinction between vegetative state and persistent vegetative state is that the second is defined as a vegetative state that has continued or endured for at least 1 month. 1 We present a patient who developed a vegetative state after carbon monoxide poisoning and in whom we had the opportunity to measure brain glucose metabolism distribution during the vegetative state and after recovery to consciousness. Using [18 F]fluorodeoxyglucose (FDG) PET and statistical parametric mapping (SPM) we compared both patient's sets to a normal control population. Our findings oVer an insight into the neural correlates of "awareness", pointing to a critical role for posterior associative cortices in consciousness.A 40 year old right handed woman attempted suicide through CO intoxication and was found unconscious. She was treated with hyperbaric oxygen but evolved to a vegetative state diagnosed according to the following criteria: 1 (1) spontaneous eye opening without evidence of awareness of the environment; (2) no evidence of reproducible voluntary behavioural responses to any stimuli; (3) no evidence of language comprehension or expression; (4) intermittent wakefulness and behaviourally assessed sleepwake cycles; (5) normal cardiorespiratory function and blood pressure control; (6) preserved pupillary, oculocephalic, corneal, and vestibulo-ocular reflexes. Brain MRI performed 14 days after admission was normal. Electroencephalography showed a 6 Hz basal activity with more pronounced slowing on the left parietal regions. Auditory evoked potentials were normal. Somaesthetic evoked potentials of the median nerve showed normal latency and amplitude of P14 and N20 potentials without any late cortical components. After remaining in a vegetative state for 19 days the patient regained consciousness. Her sequelae consisted of a bilateral spastic paresis of upper and lower limbs. Neuropsychological testing 1 month after admission showed an attention deficit with moderate impairment of short term memory. One year after the accident she showed a spastic gait with altered fine motor function, most prominent on the right, a slurred speech, and minor short term memory disturbances. FDG-PET was performed during the vegetative state (day 15 after admission) and after recovery to consciousness (day 37).The control population consisted of 48 drug free, healthy volunteers, aged from 18 to 76 years (mean: 42 (SD 21) years).The study was approved by the ethics committee of the University of Liège. Informed consent was obtained by the husband of the patient and ...
La magnitud y el impacto que suponen los trastornos mentales no se corresponden con los recursos que se dedican a su investigación y atención. Aunque hemos avanzado notablemente en su comprensión y en la eficacia de los tratamientos psicológicos que intentan paliarlos, estamos aún lejos de la situación óptima. Este trabajo se centra en uno de los retos y una de las necesidades que consideramos fundamentales, el incremento de la investigación focalizada en psicopatología, especialmente sobre los mecanismos y procesos que explican y mantienen estos problemas, como eje básico para el desarrollo de nuevas intervenciones psicológicas, tanto para la prevención como para el tratamiento y promoción de la salud mental. El objetivo es promover la discusión entre los agentes implicados y reflexionar sobre las líneas de trabajo que creemos prioritarias.
Aunque hemos avanzado notablemente en el desarrollo de recursos preventivos y especialmente, en la eficacia de los tratamientos psicológicos que intentan paliar los trastornos mentales, estamos aún lejos de la situación óptima. Este trabajo se centra en dos grandes cuestiones que consideramos retos y necesidades fundamentales en este ámbito: (a) la necesidad de mejorar y extender la prevención, la intervención temprana y la promoción de la salud mental y (b) la necesidad de una mayor divulgación de los tratamientos psicológicos eficaces, el desarrollo de nuevas intervenciones y la mayor comprensión de los mecanismos de acción de los tratamientos psicológicos. El objetivo es promover la discusión entre los agentes implicados y reflexionar sobre las líneas de trabajo que creemos prioritarias
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