治疗药物监测(Therapeutic drug monitoring,TDM),如通过定量测定血清或血浆药物浓度指导用药剂量优化,已经成为对患者进行精神药物治疗的很有价值的工具。在患者用药依从性难以判断、药物耐受性不佳、治疗剂量下无效以及可能存在药代...治疗药物监测(Therapeutic drug monitoring,TDM),如通过定量测定血清或血浆药物浓度指导用药剂量优化,已经成为对患者进行精神药物治疗的很有价值的工具。在患者用药依从性难以判断、药物耐受性不佳、治疗剂量下无效以及可能存在药代动力学药物-药物相互作用等情况下,测定药物浓度是很有用的。在精神科,有可能明显获益于TDM的主要患者群体包括儿童、孕妇、老年患者、智力障碍患者、涉及司法的患者、已知或怀疑携带药代动力学相关基因变异的患者,以及合并躯体疾病影响药代动力学的患者。然而,只有将TDM充分整合到临床治疗过程中去,才能发挥其优化药物治疗的潜在优势。为了促进TDM的合理应用,神经精神药理学与药物精神病学协会(Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie,AGNP)的TDM专家组在2004年发表了精神药物治疗药物监测指南。之后,随着知识不断更新,又有许多可能需要进行TDM的新药上市。因此,本次更新将神经精神药物的种类扩展到了128种,并将其TDM必要性划分为从"强烈推荐"到"可能有用"的四个等级。经过大量细致且全面的文献检索与分门别类的汇总整理,将基于循证医学理念的"治疗参考浓度范围"和"剂量相关参考浓度范围"呈现给大家。本共识指南引入了"实验室警戒浓度"的新概念,即实验室需要马上告知治疗医生的药物浓度上限。本共识指南还给出了诸如药物作为细胞色素P450酶的底物和抑制剂的性质,代谢物与母药浓度比值的常见范围,以及与结果解释相关的内容,还提供了何时将TDM与遗传药理学检测相结合的建议。遵循本指南,有助于改善许多患者精神药物治疗的效果,特别是那些存在药代动力学异常的患者。TDM是一门交叉学科,有时针对看起来不一致的数据,需要多学科坦诚地讨论,只有这样,患者才能从这种合作中获益。展开更多
Irritable bowel syndrome(IBS)is regarded as a multifactorial disease in which alterations in the brain-gut axis signaling play a major role.The biopsychosocial model applied to the understanding of IBS pathophysiology...Irritable bowel syndrome(IBS)is regarded as a multifactorial disease in which alterations in the brain-gut axis signaling play a major role.The biopsychosocial model applied to the understanding of IBS pathophysiology assumes that psychosocial factors,interacting with peripheral/central neuroendocrine and immune changes,may induce symptoms of IBS,modulate symptom severity,influence illness experience and quality of life,and affect outcome.The present review focuses on the role of negative affects,including depression,anxiety,and anger,on pathogenesis and clinical expression of IBS.The potential role of the autonomic nervous system,stress-hormone system,and immune system in the pathophysiology of both negative affects and IBS are taken into account.Psychiatric comorbidity and subclinical variations in levels of depression,anxiety,and anger are further discussed in relation to the main pathophysiological and symptomatic correlates of IBS,such as sensorimotor functions,gut microbiota,inflammation/immunity,and symptom reporting.展开更多
The review focuses on those personality traits(neuroticism, extraversion, openness to experience, agreeableness, and conscientiousness), constructs(alexithymia and distressed- Type D personality) and emotional pattern...The review focuses on those personality traits(neuroticism, extraversion, openness to experience, agreeableness, and conscientiousness), constructs(alexithymia and distressed- Type D personality) and emotional patterns(negative and positive) that are of particular concern in health psychology, with the aim to highlight their potential role on the pathogenesis, onset, symptom clusters, clinical course, and outcome of irritable bowel syndrome(IBS). Personality traits and emotional patterns play key roles in affecting autonomic, immune, inflammatory, and endocrine functions, thus contributing not only to IBS clinical expression and symptomatic burden, but also to disease physiopathology. In this sense, psychological treatments should address those personality traits and emotional features that are constitutive of, and integral to IBS. The biopsychosocial model of illness applied to IBS acknowledges the interaction between biological, psychological, environmental, and social factors in relation to pain and functional disability. A holistic approach to IBS should take into account the heterogeneous nature of the disorder, and differentiate treatments for different types of IBS, also considering the marked individual differences in prevalent personality traits and emotional patterns. Beyond medications, and lifestyle/dietary interventions, psychological and educational treatments may provide the optimal chance of addressing clinical symptoms, comorbid conditions, and quality of life in IBS patients.展开更多
AIM To investigate whether the adipocytes derived hormone adiponectin(ADPN) affects the mechanical responses in strips from the mouse gastric fundus. METHODS For functional experiments, gastric strips from the fundal ...AIM To investigate whether the adipocytes derived hormone adiponectin(ADPN) affects the mechanical responses in strips from the mouse gastric fundus. METHODS For functional experiments, gastric strips from the fundal region were cut in the direction of the longitudinal muscle layer and placed in organ baths containing KrebsHenseleit solution. Mechanical responses were recorded via force-displacement transducers, which were coupled to a polygraph for continuous recording of isometric tension. Electrical field stimulation(EFS) was applied via two platinum wire rings through which the preparation was threaded. The effects of ADPN were investigated on the neurally-induced contractile and relaxant responses elicited by EFS. The expression of ADPN receptors, Adipo-R1 and Adipo-R2, was also evaluated by touchdown-PCR analysis. RESULTS In the functional experiments, EFS(4-16 Hz) elicited tetrodotoxin(TTX)-sensitive contractile responses. Addition of ADPN to the bath medium caused a reduction in amplitude of the neurally-induced contractile responses(P < 0.05). The effects of ADPN were no longer observed in the presence of the nitric oxide(NO) synthesis inhibitor L-NG-nitro arginine(L-NNA)(P > 0.05). The direct smooth muscle response to methacholine was not influenced by ADPN(P > 0.05). In carbachol precontracted strips and in the presence of guanethidine, EFS induced relaxant responses. Addition of ADPN to the bath medium, other than causing a slight and progressive decay of the basal tension, increased the amplitude of the neurally-induced relaxant responses(P < 0.05). Touchdown-PCR analysis revealed the expression of both Adipo-R1 and Adipo-R2 in the gastric fundus.CONCLUSION The results indicate for the first time that ADPN is able to influence the mechanical responses in strips from the mouse gastric fundus.展开更多
治疗药物监测(Therapeutic Drug Monitoring,TDM)通过定量测定和解释血药浓度以优化药物治疗。TDM着眼于药代动力学的个体差异,使个体化药物治疗成为可能。在精神病学和神经病学领域中,有可能明显获益于TDM的主要患者群体包括少年儿童...治疗药物监测(Therapeutic Drug Monitoring,TDM)通过定量测定和解释血药浓度以优化药物治疗。TDM着眼于药代动力学的个体差异,使个体化药物治疗成为可能。在精神病学和神经病学领域中,有可能明显获益于TDM的主要患者群体包括少年儿童、孕妇、老年患者、智障患者、药物滥用者、涉法精神病患者、已知或怀疑药代动力学异常的患者以及合并躯体疾病影响药代动力学的患者。常规剂量下治疗无效,用药依从性难以判断,药物耐受性不佳,以及可能存在药代动力学方面的药物-药物相互作用等情况都是治疗药物监测的典型指征。然而,只有将TDM充分整合到临床治疗过程中,才能发挥其优化药物治疗的潜在优势。为了向临床医生和实验室提供有效的TDM信息,神经精神药理学与药物精神病学协会(Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie,AGNP)的TDM专家组在2004年发表了第一版《精神科治疗药物监测指南》。2011年进行了更新之后,现在再次更新。遵循新版指南,可能会改善神经精神药物治疗的效果,加快很多患者的康复,并降低医疗费用。展开更多
BACKGROUND Emergence delirium(EmD)is a troublesome motoric,emotional,and cognitive disturbance associated with morbidity.It is often misdiagnosed despite being present in a substantial proportion of children and adole...BACKGROUND Emergence delirium(EmD)is a troublesome motoric,emotional,and cognitive disturbance associated with morbidity.It is often misdiagnosed despite being present in a substantial proportion of children and adolescents during emergence from anesthesia.AIM To evaluate the summary diagnostic accuracy of Pediatric Anesthesia Emergence Delirium Scale(PAEDS)for EmD among children and adolescents.METHODS Two researchers electronically and hand searched the published literature from May 2004 to February 2021 that evaluated the diagnostic accuracy of PAEDS for EmD among children and adolescents,using appropriate terms.Two independent researchers extracted the diagnostic parameters and appraised the study quality with QUADAS-2.Overall,the diagnostic accuracy of the measures was calculated with the summary receiver operating characteristic curve(SROC),the summary sensitivity and specificity,and diagnostic odds ratio(DOR)for EmD.Various diagnostic cut-off points were evaluated for their diagnostic accuracy.Heterogeneity was analyzed by meta-regression.RESULTS Nine diagnostic accuracy studies of EmD that conformed to our selection criteria and PRISMA guidelines were included in the final analysis.There was no publication bias.The area under the SROC was 0.97(95%confidence interval[CI]:95%-98%).Summary sensitivity and specificity were 0.91(95%CI:0.81-0.96;I2=92.93%)and 0.94(95%CI:0.89-0.97;I2=87.44%),respectively.The summary DOR was 148.33(95%CI:48.32-455.32).The effect size for the subgroup analysis of PAEDS cut-off scores of<10,≥10,and≥12 was 3.73,2.19,and 2.93,respectively;they were not statistically significantly different.The setting of the study and reference standard were statistically significantly related to the sensitivity of PAEDS but not specificity.CONCLUSION The PAEDS is an accurate diagnostic measure for the diagnosis of EmD among children and adolescents.Further studies should document its clinical utility.展开更多
BACKGROUND The prevalence of post-natal depression(PND)is high in India,as it is in many other low to middle income countries.There is an urgent need to identify PND and treat the mother as early as possible.Among the...BACKGROUND The prevalence of post-natal depression(PND)is high in India,as it is in many other low to middle income countries.There is an urgent need to identify PND and treat the mother as early as possible.Among the many paper and pencil tests available to identify PND,the Edinburgh Postnatal Depression Scale(EPDS)is a widely used and validated measure in India.However,the summary diagnostic accuracy and clinical utility data are not available for this measure.AIM To establish summary data for the global diagnostic accuracy parameter as well as the clinical utility of the non-English versions of the EPDS in India.METHODS Two researchers independently searched the PubMed,EMBASE,MEDKNOW and IndMED databases for published papers,governmental publications,conference proceedings and grey literature from 2000-2018.Seven studies that evaluated the diagnostic accuracy of EPDS in five Indian languages against DSM/ICD were included in the final analysis.Two other investigators extracted the Participants’details,Index measures,Comparative reference measures,and Outcomes of diagnostic accuracy data,and appraised the study quality using QUADS-2.Deek’s plots were used to evaluate publication bias.We used the area under the curve of the hierarchical summary area under the receiver operating characteristic curve,with the random effect model,to summarize the global diagnostic accuracy of EPDS.Using the 2×2 table,we calculated positive and negative likelihood ratios.From the likelihood ratios,the Fagan’s nomogram was built for evaluating clinical utility using the Bayesian approach.We calculated the 95%confidence interval(95%CI)whenever indicated.STATA(version 15)with MIDAS and METANDI modules were used.RESULTS There was no publication bias.The area under the curve for EPDS was 0.97(95%CI:0.95-0.98).The pre-test probability for the nomogram was 22%.For a positive likelihood ratio of 9,the positive post-test probability was 72%(95%CI:68%,76%)and for a negative LR of 0.08,the negative post-test probability was 2%(95%CI:1%,3%).CONCLUSION In this meta-analysis,we established the summary global diagnostic parameter and clinical utility of the non-English versions of the EPDS in India.This work demonstrates that these non-English versions are accurate in their diagnosis of PND and can help clinicians in their diagnostic reasoning.展开更多
According to a generalized magnitude system, the representation of time, space and number relies on a common cognitive mechanism. However, in the context of negative emotional stimuli, temporal durations undergo a sub...According to a generalized magnitude system, the representation of time, space and number relies on a common cognitive mechanism. However, in the context of negative emotional stimuli, temporal durations undergo a subjective overestimation, while numerosity judgments are underestimated. This finding clearly challenged the existence of a generalized magnitude system. In this study, we aimed to investigate whether angry faces biases both temporal and spatial estimates compared to neutral faces in children aged 5 - 6-year-old and 9 - 10-year-old. Children were to judge as short or long either the temporal interval or the distance separating two visual stimuli in a bisection task. Overall, the study suggests that negative emotion with high arousal (angry faces) leads to a distortion of both duration and distance. Such distortion is reported early in development, even before the maturation of time perception.展开更多
Background The incidence of paediatric cancers has increased in recent years;however,with advances in the treatment of paediatric cancer,almost 80%of children and adolescents who receive a diagnosis of cancer become l...Background The incidence of paediatric cancers has increased in recent years;however,with advances in the treatment of paediatric cancer,almost 80%of children and adolescents who receive a diagnosis of cancer become long-term survivors.Given the high stress levels associated with cancer,it becomes important to ascertain the risk and likelihood of psychiatric disorders in adult paediatric cancer survivors.Aims This study aims to investigate the relationship between defence styles and predisposition to psychiatric diseases in adults with a history of paediatric cancer.Methods We performed an explorative study on a sample of 66 clinically healed adults with a history of paediatric cancer(survivors)during follow-up visits at the University Hospital‘Policlinico G Rodolico’of Catania(Italy)and 98 healthy controls among medicine students.We administered the Defence Mechanism Inventory(DMI)to assess defence styles.The Symptom Checklist-90-Revised(SCL-90-R)and the Davidson Trauma Scale(DTS)were administered to assess psychopathological indices.We conducted comprehensive statistical analysis based on correlation analysis and mediation analysis to investigate the relationship between defence styles and psychopathological outcomes in survivors compared with controls.Results The survivors obtained statistically significant lower values in TAO,PRO and TAS defence styles and a higher value in REV.Both groups showed non-pathlogical mean scores in DTS and SCL-90-R(with an exception of the obsessive-compulsive subscale),with lower mean values among survivors.The results of mediation analysis showed that TAS had mediation effects on interpersonal sensitivity,anxiety,PSDI,GSI and avoidance,while TAO had mediation effects on DTS total score and intrusivity.Thus,for these psychopathological indices,the effect of the oncological pathology was indirect and mediated by TAO or TAS.Our analysis exlcluded mediation effects between the remaining variables and defence styles.Conclusion Integrating data from mediation and correlation analysis,we found how the decreasing of TAS utilization in survivors as the consequence of cancer history,has decreased interpersonal sensitivity,anxiety and GSI score in these subjects compared with controls.Similary,the decrease of TAO utilization played a role in lower values of DTS total score and intrusivity subscale.Unexpectedly,our analysis excluded relationships between cancer history,other defence styles and psycopathological scores as we initially assumed.展开更多
We have read with interest the publication that describes the available data related to the use of neuromodulation strategies for the treatment of posttraumatic stress disorder(PTSD).Despite treatment advances,however...We have read with interest the publication that describes the available data related to the use of neuromodulation strategies for the treatment of posttraumatic stress disorder(PTSD).Despite treatment advances,however,a substantial proportion of PTSD patients receiving psychological and/or pharmacological treatment do not reach an adequate clinical response.In their paper,the authors draw attention to the current understanding of the use of repetitive transcranial magnetic stimulation(rTMS)as a potential treatment for PTSD.Most of the previous studies indeed applied both inhibitory(1 Hz)and excitatory(>1 Hz,up to 20 Hz)rTMS to the right and/or left dorsolateral prefrontal cortex.Despite larger therapeutic effects observed when high-frequency stimulation was applied,the question of which side and frequency of stimulation is the most successful is still debated.The authors also reported on the after-effect of rTMS related to neuroplasticity and identified the intermittent theta burst stimulation as a technique of particular interest because of it showed the most effective improvement on PTSD symptoms.However,although numerous studies have highlighted the possible beneficial use of rTMS protocols for PTSD,the exact mechanism of action remains unclear.In their conclusions,the authors stated that rTMS has been demonstrated to be effective for the treatment of PTSD symptoms.Nevertheless,we believe that further research with homogeneous samples,standardized protocols,and objective outcome measures is needed to identify specific therapeutic targets and to better define significant changes when active and sham stimulation procedures are compared.展开更多
The present study describes the occurrence of psychiatric comorbid disorders in a cohort of 86 high functioning autism (HFA)/Asperger syndrome (AS) patients, examined at Child Neurology and Psychiatry Unit of Tor Verg...The present study describes the occurrence of psychiatric comorbid disorders in a cohort of 86 high functioning autism (HFA)/Asperger syndrome (AS) patients, examined at Child Neurology and Psychiatry Unit of Tor Vergata University. 38 patients out of 86 (44.2%) presented one or more psychiatric comorbidities, such as mood disorders, Attention Deficit/Hyperactivity Disorder (ADHD), Tourette syndrome (TS), anxiety disorders, including obsessive-compulsive disorder (OCD), and psychotic symptoms. We compared our sample with the evidences from the scientific literature on psychiatric comorbidity in ASD patient, in particular in HFA/AS. In this paper we focus on the high frequency of comorbid psychiatric disorders in HFA/AS patients, such as mood disorders, Attention Deficit/Hyperactivity Disorder (ADHD), Tourette syndrome (TS), anxiety disorders, including obsessive-compulsive disorder (OCD), and psychosis, including schizophrenia. We analyzed rates of all psichiatric comorbidities diagnosed in a sample of HFA/AS subjects and we compared findings from our study with the evidences from the scientific literature on psychiatric comorbidity in ASD patients, in particular HFA/AS. We point out that comorbid psychiatric symptoms can be hardly diagnosed, because they could present atipically in ASDs then in general population. Furthermore, they could be masked by ASD core symptoms.展开更多
<b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:Verdana;"> Incarceration does not vitiate sexual desire. Therefore, sexual activit...<b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:Verdana;"> Incarceration does not vitiate sexual desire. Therefore, sexual activities occur behind bars, regardless of the stringent rules in correctional institutions. However, little has been documented about risky sexual behaviors, determinants, and experiences among inmates of correctional institutions in Katsina State, Nigeria. The study determined the sexual practices, prevalence, and determinants of risky sexual behaviors among prison inmates in Katsina. <b></b></span><b><b><span style="font-family:Verdana;">Methodology:</span></b><span style="font-family:Verdana;"></span></b> A descriptive cross-sectional design with concurrent mixed methods of data collection was used to interview 216 inmates using a semi-structured questionnaire supplemented with 22 in-depth interviews. <b><b><span style="font-family:Verdana;">Result:</span></b><span style="font-family:Verdana;"></span></b> Most (94%) respondents were male, almost half (44.4%) had secondary education, more than half (55.1%) were engaged in business or trading before incarceration, and the majority (75.9%) were awaiting trial. Nearly all inmates (98.6%) reported having sexual desire. Drug use (80.1%) and unprotected sex (79.2%) were quite common but sexual violence was low (7.4%). The number of sexual partners of respondents remained a significant predictor of sexual activity. Inmates who had one (1) or no sexual partner were 64% less likely to engage in risky sexual activity within the confines of the prison (AOR = 0.36, 95% CI = 0.20 <span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-size:10.0pt;font-family:;" "=""><span style="white-space:nowrap;"><span style="white-space:nowrap;">-</span></span></span></span></span></span><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;"> 0.63, p = 0.01). Qualitative interviews revealed the denial of occurrence of sexual activity in prison despite sexual desire felt by inmates;loneliness, poverty, and curiosity as motives for sexual relations;denial of occurrence of sexual violence in prison;and drug use and use of unsterilized sharps as risky sexual behaviors. <b></b></span><b><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"></span></b> Despite the disciplinary action meted out on inmates, prisoners still engaged in a range of risky sexual behaviors. Conjugal visitations for married inmates could be considered to reduce sexually deviant and risky alternatives of relieving sexual desire among prisoners.</span></span></span>展开更多
BACKGROUND Burden due to intellectual disability(ID) is only third to the depressive disorders and anxiety disorders in India. This national burden significantly contributes to the global burden of ID and hence one ha...BACKGROUND Burden due to intellectual disability(ID) is only third to the depressive disorders and anxiety disorders in India. This national burden significantly contributes to the global burden of ID and hence one has to think globally and act locally to reduce this burden. At its best the collective prevalence of ID is in the form of narrative reviews. There is an urgent need to document the summary prevalence of ID to enhance further policymaking, national programs and resource allocation.AIM To establish the summary prevalence of ID during the past 60 years in India.METHODS Two researchers independently and electronically searched Pub Med, Scopus, and the Cochrane library from January 1961 to December 2020 using appropriate search terms. Two other investigators extracted the study design, setting, participant characteristics, and measures used to identify ID. Two other researchers appraised the quality of the studies using the Joanna Briggs Institute critical appraisal format for Prevalence Studies. Funnel plot and Egger’s regression test were used to ascertain the publication and small study effect on the prevalence. To evaluate the summary prevalence of ID, we used the random effects model with arcsine square-root transformation. Heterogeneity of I^(2)≥ 50% was considered substantial and we determined the heterogeneity with meta-regression. The analyses were performed using STATA(version 16).RESULTS Nineteen studies were included in the meta-analysis. There was publication bias;the trim-and-fill method was used to further ascertain bias. Concerns with control of confounders and the reliable measure of outcome were noted in the critical appraisal. The summary prevalence of ID was 2% [(95%CI: 2%, 3%);I^(2)= 98%] and the adjusted summary prevalence was 1.4%. Meta-regression demonstrated that age of the participants was statistically significantly related to the prevalence;other factors did not influence the prevalence or heterogeneity.CONCLUSION The summary prevalence of ID in India was established to be 2% taking into consideration the individual prevalence studies over the last six decades. This knowledge should improve the existing disability and mental health policies, national programs and service delivery to reduce the national and global burden associated with ID.展开更多
Although many functional magnetic resonance imaging(f MRI) studies have investigated the neurophysiology of attention deficit hyperactivity disorder(ADHD),the existing studies have not yielded consistent findings.This...Although many functional magnetic resonance imaging(f MRI) studies have investigated the neurophysiology of attention deficit hyperactivity disorder(ADHD),the existing studies have not yielded consistent findings.This may be related to the different properties of different frequency bands. To investigate the frequency-specific regional homogeneity(Re Ho) of spontaneous neural activities in ADHD, the current study used resting-state f MRI to explore the Re Ho properties of five frequency bands, slow-5(0.01–0.027 Hz), slow-4(0.027–0.073 Hz),slow-3(0.073–0.198 Hz), slow-2(0.198–0.25 Hz) and the extra-low frequency(0–0.01 Hz), in 30 drug-naive boys with ADHD and 30 healthy controls. Compared with controls, the ADHD group showed decreased Re Ho in the default mode network(DMN) including the medial prefrontal cortex and precuneus, middle frontal gyrus and angular gyrus. ADHD patients also showed increased Re Ho in the posterior cerebellum. Significant interactions between frequency band and group were observed predominantly in the dorsolateral prefrontal and parietal cortices, orbital frontal cortex, supplementary motor area,inferior occipital gyrus, thalamus and anterior cerebellum.In particular, we found that the between-group difference in the extra-low frequency band(0–0.01 Hz) seemed to be greater than that in the other frequency bands for most brain regions. The findings suggest that ADHD children display widespread abnormalities in regional brain activity,particularly in the DMN and attention network, and these abnormalities show frequency specificity.展开更多
Tuberous sclerosis complex(TSC)is a rare multisystem,autosomal dominant neurocutaneous syndrome in which epilepsy is the most common of several neurological and psychiatric manifestations.Around two thirds of patients...Tuberous sclerosis complex(TSC)is a rare multisystem,autosomal dominant neurocutaneous syndrome in which epilepsy is the most common of several neurological and psychiatric manifestations.Around two thirds of patients develop drug-resistant epilepsy for whom surgical resection of epileptogenic foci is indicated when seizures remain inadequately controlled following trial of two antiseizure medications.The challenge with presurgical and surgical approaches with patients with TSC is overcoming the complexity from the number of tubers and the multiplex epileptogenic network forming the epileptogenic zone.Data suggest that seizure freedom is achieved by 55%-60%of patients,but predictive factors for success have remained elusive,which makes for unconfident selection of surgical candidates.This article presents three different cases as illustrations of the potential challenges faced when assessing the suitability of TSC patients for epilepsy surgery.展开更多
Schizophrenia is a complex disorder characterized by multiple neurochemical abnormalities and structural changes in the brain.These abnormalities may begin before recognizable clinical symptoms appear and continue as ...Schizophrenia is a complex disorder characterized by multiple neurochemical abnormalities and structural changes in the brain.These abnormalities may begin before recognizable clinical symptoms appear and continue as a dynamic process throughout the illness.Recent advances in imaging techniques have significantly enriched our comprehension of these structural alterations,particularly focusing on gray and white matter irregularities and prefrontal,temporal,and cingulate cortex alterations.Some of the changes suggest treatment resistance to antipsychotic medications,while treatment nonadherence and relapses may further exacerbate structural abnormalities.This narrative review aims to discuss the literature about alterations and deficits within the brain,which could improve the understanding of schizophrenia and how to interpret neurostructural changes.展开更多
Acute symptomatic seizures are the main sign of neurological dysfunction in newborns.This is linked to the unique characteristics of the neonatal brain,making it hyperexcitable compared to older ages,and to the common...Acute symptomatic seizures are the main sign of neurological dysfunction in newborns.This is linked to the unique characteristics of the neonatal brain,making it hyperexcitable compared to older ages,and to the common occurrence of some forms of acquired brain injury,namely hypoxic-ischemic encephalopathy.In this narrative review we will provide an overview of neonatal seizures definition,their main underlying etiologies,diagnostic work-up and differential diagnoses,and will discuss about therapeutic options and prognostic outlook.The latest publications from the ILAE Task Force on Neonatal Seizures will be presented and discussed.Of note,they highlight the current lack of robust evidence in this field of clinical neurology.We will also report on specificities pertaining to low-and-middle income countries in terms of incidence,main etiologies and diagnosis.The possibilities offered by telemedicine and automated seizures detection will also be summarized in order to provide a framework for future directions in seizures diagnosis and management with a global perspective.Many challenges and opportunities for improving identification,monitoring and treatment of acute symptomatic seizures in newborns exist.All current caveats potentially represent different lines of research with the aim to provide better care and reach a deeper understanding of this important topic of neonatal neurology.展开更多
Background Tuberous sclerosis complex(TSC)is a genetic disorder caused by inactivating mutations in the TSCl and TSC2 genes,causing overactivation of the mechanistic(previously referred to as mammalian)target of rapam...Background Tuberous sclerosis complex(TSC)is a genetic disorder caused by inactivating mutations in the TSCl and TSC2 genes,causing overactivation of the mechanistic(previously referred to as mammalian)target of rapamycin(mTOR)signaling pathway in fetal life.The mTOR pathway plays a crucial role in several brain processes leading to TSC-related epilepsy,intellectual disability,and autism spectrum disorder(ASD).Pre-natal or early post-natal diagnosis of TSC is now possible in a growing number of pre-symptomatic infants.Data sources We searched PubMed for peer-reviewed publications published between January 2010 and April 2023 with the terms“tuberous sclerosis",“autism",or“autism spectrum disorder""animal models",“preclinical studies",“neurobiology",and“treatment".Results Prospective studies have highlighted that developmental trajectories in TSC infants who were later diagnosed with ASD already show motor,visual and social communication skills in the first year of life delays.Reliable genetic,cellular,electroencephalography and magnetic resonance imaging biomarkers can identify pre-symptomatic TSC infants at high risk for having autism and epilepsy.Conclusions Preventing epilepsy or improving therapy for seizures associated with prompt and tailored treatment strategies for autism in a sensitive developmental time window could have the potential to mitigate autistic symptoms in infants with TSC.展开更多
文摘治疗药物监测(Therapeutic drug monitoring,TDM),如通过定量测定血清或血浆药物浓度指导用药剂量优化,已经成为对患者进行精神药物治疗的很有价值的工具。在患者用药依从性难以判断、药物耐受性不佳、治疗剂量下无效以及可能存在药代动力学药物-药物相互作用等情况下,测定药物浓度是很有用的。在精神科,有可能明显获益于TDM的主要患者群体包括儿童、孕妇、老年患者、智力障碍患者、涉及司法的患者、已知或怀疑携带药代动力学相关基因变异的患者,以及合并躯体疾病影响药代动力学的患者。然而,只有将TDM充分整合到临床治疗过程中去,才能发挥其优化药物治疗的潜在优势。为了促进TDM的合理应用,神经精神药理学与药物精神病学协会(Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie,AGNP)的TDM专家组在2004年发表了精神药物治疗药物监测指南。之后,随着知识不断更新,又有许多可能需要进行TDM的新药上市。因此,本次更新将神经精神药物的种类扩展到了128种,并将其TDM必要性划分为从"强烈推荐"到"可能有用"的四个等级。经过大量细致且全面的文献检索与分门别类的汇总整理,将基于循证医学理念的"治疗参考浓度范围"和"剂量相关参考浓度范围"呈现给大家。本共识指南引入了"实验室警戒浓度"的新概念,即实验室需要马上告知治疗医生的药物浓度上限。本共识指南还给出了诸如药物作为细胞色素P450酶的底物和抑制剂的性质,代谢物与母药浓度比值的常见范围,以及与结果解释相关的内容,还提供了何时将TDM与遗传药理学检测相结合的建议。遵循本指南,有助于改善许多患者精神药物治疗的效果,特别是那些存在药代动力学异常的患者。TDM是一门交叉学科,有时针对看起来不一致的数据,需要多学科坦诚地讨论,只有这样,患者才能从这种合作中获益。
文摘Irritable bowel syndrome(IBS)is regarded as a multifactorial disease in which alterations in the brain-gut axis signaling play a major role.The biopsychosocial model applied to the understanding of IBS pathophysiology assumes that psychosocial factors,interacting with peripheral/central neuroendocrine and immune changes,may induce symptoms of IBS,modulate symptom severity,influence illness experience and quality of life,and affect outcome.The present review focuses on the role of negative affects,including depression,anxiety,and anger,on pathogenesis and clinical expression of IBS.The potential role of the autonomic nervous system,stress-hormone system,and immune system in the pathophysiology of both negative affects and IBS are taken into account.Psychiatric comorbidity and subclinical variations in levels of depression,anxiety,and anger are further discussed in relation to the main pathophysiological and symptomatic correlates of IBS,such as sensorimotor functions,gut microbiota,inflammation/immunity,and symptom reporting.
文摘The review focuses on those personality traits(neuroticism, extraversion, openness to experience, agreeableness, and conscientiousness), constructs(alexithymia and distressed- Type D personality) and emotional patterns(negative and positive) that are of particular concern in health psychology, with the aim to highlight their potential role on the pathogenesis, onset, symptom clusters, clinical course, and outcome of irritable bowel syndrome(IBS). Personality traits and emotional patterns play key roles in affecting autonomic, immune, inflammatory, and endocrine functions, thus contributing not only to IBS clinical expression and symptomatic burden, but also to disease physiopathology. In this sense, psychological treatments should address those personality traits and emotional features that are constitutive of, and integral to IBS. The biopsychosocial model of illness applied to IBS acknowledges the interaction between biological, psychological, environmental, and social factors in relation to pain and functional disability. A holistic approach to IBS should take into account the heterogeneous nature of the disorder, and differentiate treatments for different types of IBS, also considering the marked individual differences in prevalent personality traits and emotional patterns. Beyond medications, and lifestyle/dietary interventions, psychological and educational treatments may provide the optimal chance of addressing clinical symptoms, comorbid conditions, and quality of life in IBS patients.
基金the Florence University(No.RTD CO 090101010107 RICATEN14)Fondazione CRF(No.2017.0777)
文摘AIM To investigate whether the adipocytes derived hormone adiponectin(ADPN) affects the mechanical responses in strips from the mouse gastric fundus. METHODS For functional experiments, gastric strips from the fundal region were cut in the direction of the longitudinal muscle layer and placed in organ baths containing KrebsHenseleit solution. Mechanical responses were recorded via force-displacement transducers, which were coupled to a polygraph for continuous recording of isometric tension. Electrical field stimulation(EFS) was applied via two platinum wire rings through which the preparation was threaded. The effects of ADPN were investigated on the neurally-induced contractile and relaxant responses elicited by EFS. The expression of ADPN receptors, Adipo-R1 and Adipo-R2, was also evaluated by touchdown-PCR analysis. RESULTS In the functional experiments, EFS(4-16 Hz) elicited tetrodotoxin(TTX)-sensitive contractile responses. Addition of ADPN to the bath medium caused a reduction in amplitude of the neurally-induced contractile responses(P < 0.05). The effects of ADPN were no longer observed in the presence of the nitric oxide(NO) synthesis inhibitor L-NG-nitro arginine(L-NNA)(P > 0.05). The direct smooth muscle response to methacholine was not influenced by ADPN(P > 0.05). In carbachol precontracted strips and in the presence of guanethidine, EFS induced relaxant responses. Addition of ADPN to the bath medium, other than causing a slight and progressive decay of the basal tension, increased the amplitude of the neurally-induced relaxant responses(P < 0.05). Touchdown-PCR analysis revealed the expression of both Adipo-R1 and Adipo-R2 in the gastric fundus.CONCLUSION The results indicate for the first time that ADPN is able to influence the mechanical responses in strips from the mouse gastric fundus.
文摘治疗药物监测(Therapeutic Drug Monitoring,TDM)通过定量测定和解释血药浓度以优化药物治疗。TDM着眼于药代动力学的个体差异,使个体化药物治疗成为可能。在精神病学和神经病学领域中,有可能明显获益于TDM的主要患者群体包括少年儿童、孕妇、老年患者、智障患者、药物滥用者、涉法精神病患者、已知或怀疑药代动力学异常的患者以及合并躯体疾病影响药代动力学的患者。常规剂量下治疗无效,用药依从性难以判断,药物耐受性不佳,以及可能存在药代动力学方面的药物-药物相互作用等情况都是治疗药物监测的典型指征。然而,只有将TDM充分整合到临床治疗过程中,才能发挥其优化药物治疗的潜在优势。为了向临床医生和实验室提供有效的TDM信息,神经精神药理学与药物精神病学协会(Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie,AGNP)的TDM专家组在2004年发表了第一版《精神科治疗药物监测指南》。2011年进行了更新之后,现在再次更新。遵循新版指南,可能会改善神经精神药物治疗的效果,加快很多患者的康复,并降低医疗费用。
文摘BACKGROUND Emergence delirium(EmD)is a troublesome motoric,emotional,and cognitive disturbance associated with morbidity.It is often misdiagnosed despite being present in a substantial proportion of children and adolescents during emergence from anesthesia.AIM To evaluate the summary diagnostic accuracy of Pediatric Anesthesia Emergence Delirium Scale(PAEDS)for EmD among children and adolescents.METHODS Two researchers electronically and hand searched the published literature from May 2004 to February 2021 that evaluated the diagnostic accuracy of PAEDS for EmD among children and adolescents,using appropriate terms.Two independent researchers extracted the diagnostic parameters and appraised the study quality with QUADAS-2.Overall,the diagnostic accuracy of the measures was calculated with the summary receiver operating characteristic curve(SROC),the summary sensitivity and specificity,and diagnostic odds ratio(DOR)for EmD.Various diagnostic cut-off points were evaluated for their diagnostic accuracy.Heterogeneity was analyzed by meta-regression.RESULTS Nine diagnostic accuracy studies of EmD that conformed to our selection criteria and PRISMA guidelines were included in the final analysis.There was no publication bias.The area under the SROC was 0.97(95%confidence interval[CI]:95%-98%).Summary sensitivity and specificity were 0.91(95%CI:0.81-0.96;I2=92.93%)and 0.94(95%CI:0.89-0.97;I2=87.44%),respectively.The summary DOR was 148.33(95%CI:48.32-455.32).The effect size for the subgroup analysis of PAEDS cut-off scores of<10,≥10,and≥12 was 3.73,2.19,and 2.93,respectively;they were not statistically significantly different.The setting of the study and reference standard were statistically significantly related to the sensitivity of PAEDS but not specificity.CONCLUSION The PAEDS is an accurate diagnostic measure for the diagnosis of EmD among children and adolescents.Further studies should document its clinical utility.
文摘BACKGROUND The prevalence of post-natal depression(PND)is high in India,as it is in many other low to middle income countries.There is an urgent need to identify PND and treat the mother as early as possible.Among the many paper and pencil tests available to identify PND,the Edinburgh Postnatal Depression Scale(EPDS)is a widely used and validated measure in India.However,the summary diagnostic accuracy and clinical utility data are not available for this measure.AIM To establish summary data for the global diagnostic accuracy parameter as well as the clinical utility of the non-English versions of the EPDS in India.METHODS Two researchers independently searched the PubMed,EMBASE,MEDKNOW and IndMED databases for published papers,governmental publications,conference proceedings and grey literature from 2000-2018.Seven studies that evaluated the diagnostic accuracy of EPDS in five Indian languages against DSM/ICD were included in the final analysis.Two other investigators extracted the Participants’details,Index measures,Comparative reference measures,and Outcomes of diagnostic accuracy data,and appraised the study quality using QUADS-2.Deek’s plots were used to evaluate publication bias.We used the area under the curve of the hierarchical summary area under the receiver operating characteristic curve,with the random effect model,to summarize the global diagnostic accuracy of EPDS.Using the 2×2 table,we calculated positive and negative likelihood ratios.From the likelihood ratios,the Fagan’s nomogram was built for evaluating clinical utility using the Bayesian approach.We calculated the 95%confidence interval(95%CI)whenever indicated.STATA(version 15)with MIDAS and METANDI modules were used.RESULTS There was no publication bias.The area under the curve for EPDS was 0.97(95%CI:0.95-0.98).The pre-test probability for the nomogram was 22%.For a positive likelihood ratio of 9,the positive post-test probability was 72%(95%CI:68%,76%)and for a negative LR of 0.08,the negative post-test probability was 2%(95%CI:1%,3%).CONCLUSION In this meta-analysis,we established the summary global diagnostic parameter and clinical utility of the non-English versions of the EPDS in India.This work demonstrates that these non-English versions are accurate in their diagnosis of PND and can help clinicians in their diagnostic reasoning.
文摘According to a generalized magnitude system, the representation of time, space and number relies on a common cognitive mechanism. However, in the context of negative emotional stimuli, temporal durations undergo a subjective overestimation, while numerosity judgments are underestimated. This finding clearly challenged the existence of a generalized magnitude system. In this study, we aimed to investigate whether angry faces biases both temporal and spatial estimates compared to neutral faces in children aged 5 - 6-year-old and 9 - 10-year-old. Children were to judge as short or long either the temporal interval or the distance separating two visual stimuli in a bisection task. Overall, the study suggests that negative emotion with high arousal (angry faces) leads to a distortion of both duration and distance. Such distortion is reported early in development, even before the maturation of time perception.
文摘Background The incidence of paediatric cancers has increased in recent years;however,with advances in the treatment of paediatric cancer,almost 80%of children and adolescents who receive a diagnosis of cancer become long-term survivors.Given the high stress levels associated with cancer,it becomes important to ascertain the risk and likelihood of psychiatric disorders in adult paediatric cancer survivors.Aims This study aims to investigate the relationship between defence styles and predisposition to psychiatric diseases in adults with a history of paediatric cancer.Methods We performed an explorative study on a sample of 66 clinically healed adults with a history of paediatric cancer(survivors)during follow-up visits at the University Hospital‘Policlinico G Rodolico’of Catania(Italy)and 98 healthy controls among medicine students.We administered the Defence Mechanism Inventory(DMI)to assess defence styles.The Symptom Checklist-90-Revised(SCL-90-R)and the Davidson Trauma Scale(DTS)were administered to assess psychopathological indices.We conducted comprehensive statistical analysis based on correlation analysis and mediation analysis to investigate the relationship between defence styles and psychopathological outcomes in survivors compared with controls.Results The survivors obtained statistically significant lower values in TAO,PRO and TAS defence styles and a higher value in REV.Both groups showed non-pathlogical mean scores in DTS and SCL-90-R(with an exception of the obsessive-compulsive subscale),with lower mean values among survivors.The results of mediation analysis showed that TAS had mediation effects on interpersonal sensitivity,anxiety,PSDI,GSI and avoidance,while TAO had mediation effects on DTS total score and intrusivity.Thus,for these psychopathological indices,the effect of the oncological pathology was indirect and mediated by TAO or TAS.Our analysis exlcluded mediation effects between the remaining variables and defence styles.Conclusion Integrating data from mediation and correlation analysis,we found how the decreasing of TAS utilization in survivors as the consequence of cancer history,has decreased interpersonal sensitivity,anxiety and GSI score in these subjects compared with controls.Similary,the decrease of TAO utilization played a role in lower values of DTS total score and intrusivity subscale.Unexpectedly,our analysis excluded relationships between cancer history,other defence styles and psycopathological scores as we initially assumed.
文摘We have read with interest the publication that describes the available data related to the use of neuromodulation strategies for the treatment of posttraumatic stress disorder(PTSD).Despite treatment advances,however,a substantial proportion of PTSD patients receiving psychological and/or pharmacological treatment do not reach an adequate clinical response.In their paper,the authors draw attention to the current understanding of the use of repetitive transcranial magnetic stimulation(rTMS)as a potential treatment for PTSD.Most of the previous studies indeed applied both inhibitory(1 Hz)and excitatory(>1 Hz,up to 20 Hz)rTMS to the right and/or left dorsolateral prefrontal cortex.Despite larger therapeutic effects observed when high-frequency stimulation was applied,the question of which side and frequency of stimulation is the most successful is still debated.The authors also reported on the after-effect of rTMS related to neuroplasticity and identified the intermittent theta burst stimulation as a technique of particular interest because of it showed the most effective improvement on PTSD symptoms.However,although numerous studies have highlighted the possible beneficial use of rTMS protocols for PTSD,the exact mechanism of action remains unclear.In their conclusions,the authors stated that rTMS has been demonstrated to be effective for the treatment of PTSD symptoms.Nevertheless,we believe that further research with homogeneous samples,standardized protocols,and objective outcome measures is needed to identify specific therapeutic targets and to better define significant changes when active and sham stimulation procedures are compared.
文摘The present study describes the occurrence of psychiatric comorbid disorders in a cohort of 86 high functioning autism (HFA)/Asperger syndrome (AS) patients, examined at Child Neurology and Psychiatry Unit of Tor Vergata University. 38 patients out of 86 (44.2%) presented one or more psychiatric comorbidities, such as mood disorders, Attention Deficit/Hyperactivity Disorder (ADHD), Tourette syndrome (TS), anxiety disorders, including obsessive-compulsive disorder (OCD), and psychotic symptoms. We compared our sample with the evidences from the scientific literature on psychiatric comorbidity in ASD patient, in particular in HFA/AS. In this paper we focus on the high frequency of comorbid psychiatric disorders in HFA/AS patients, such as mood disorders, Attention Deficit/Hyperactivity Disorder (ADHD), Tourette syndrome (TS), anxiety disorders, including obsessive-compulsive disorder (OCD), and psychosis, including schizophrenia. We analyzed rates of all psichiatric comorbidities diagnosed in a sample of HFA/AS subjects and we compared findings from our study with the evidences from the scientific literature on psychiatric comorbidity in ASD patients, in particular HFA/AS. We point out that comorbid psychiatric symptoms can be hardly diagnosed, because they could present atipically in ASDs then in general population. Furthermore, they could be masked by ASD core symptoms.
文摘<b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:Verdana;"> Incarceration does not vitiate sexual desire. Therefore, sexual activities occur behind bars, regardless of the stringent rules in correctional institutions. However, little has been documented about risky sexual behaviors, determinants, and experiences among inmates of correctional institutions in Katsina State, Nigeria. The study determined the sexual practices, prevalence, and determinants of risky sexual behaviors among prison inmates in Katsina. <b></b></span><b><b><span style="font-family:Verdana;">Methodology:</span></b><span style="font-family:Verdana;"></span></b> A descriptive cross-sectional design with concurrent mixed methods of data collection was used to interview 216 inmates using a semi-structured questionnaire supplemented with 22 in-depth interviews. <b><b><span style="font-family:Verdana;">Result:</span></b><span style="font-family:Verdana;"></span></b> Most (94%) respondents were male, almost half (44.4%) had secondary education, more than half (55.1%) were engaged in business or trading before incarceration, and the majority (75.9%) were awaiting trial. Nearly all inmates (98.6%) reported having sexual desire. Drug use (80.1%) and unprotected sex (79.2%) were quite common but sexual violence was low (7.4%). The number of sexual partners of respondents remained a significant predictor of sexual activity. Inmates who had one (1) or no sexual partner were 64% less likely to engage in risky sexual activity within the confines of the prison (AOR = 0.36, 95% CI = 0.20 <span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-size:10.0pt;font-family:;" "=""><span style="white-space:nowrap;"><span style="white-space:nowrap;">-</span></span></span></span></span></span><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;"> 0.63, p = 0.01). Qualitative interviews revealed the denial of occurrence of sexual activity in prison despite sexual desire felt by inmates;loneliness, poverty, and curiosity as motives for sexual relations;denial of occurrence of sexual violence in prison;and drug use and use of unsterilized sharps as risky sexual behaviors. <b></b></span><b><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"></span></b> Despite the disciplinary action meted out on inmates, prisoners still engaged in a range of risky sexual behaviors. Conjugal visitations for married inmates could be considered to reduce sexually deviant and risky alternatives of relieving sexual desire among prisoners.</span></span></span>
文摘BACKGROUND Burden due to intellectual disability(ID) is only third to the depressive disorders and anxiety disorders in India. This national burden significantly contributes to the global burden of ID and hence one has to think globally and act locally to reduce this burden. At its best the collective prevalence of ID is in the form of narrative reviews. There is an urgent need to document the summary prevalence of ID to enhance further policymaking, national programs and resource allocation.AIM To establish the summary prevalence of ID during the past 60 years in India.METHODS Two researchers independently and electronically searched Pub Med, Scopus, and the Cochrane library from January 1961 to December 2020 using appropriate search terms. Two other investigators extracted the study design, setting, participant characteristics, and measures used to identify ID. Two other researchers appraised the quality of the studies using the Joanna Briggs Institute critical appraisal format for Prevalence Studies. Funnel plot and Egger’s regression test were used to ascertain the publication and small study effect on the prevalence. To evaluate the summary prevalence of ID, we used the random effects model with arcsine square-root transformation. Heterogeneity of I^(2)≥ 50% was considered substantial and we determined the heterogeneity with meta-regression. The analyses were performed using STATA(version 16).RESULTS Nineteen studies were included in the meta-analysis. There was publication bias;the trim-and-fill method was used to further ascertain bias. Concerns with control of confounders and the reliable measure of outcome were noted in the critical appraisal. The summary prevalence of ID was 2% [(95%CI: 2%, 3%);I^(2)= 98%] and the adjusted summary prevalence was 1.4%. Meta-regression demonstrated that age of the participants was statistically significantly related to the prevalence;other factors did not influence the prevalence or heterogeneity.CONCLUSION The summary prevalence of ID in India was established to be 2% taking into consideration the individual prevalence studies over the last six decades. This knowledge should improve the existing disability and mental health policies, national programs and service delivery to reduce the national and global burden associated with ID.
基金supported by the National Basic Research Development Program of China(2014CB846104)the National Natural Science Foundation of China(81371496+3 种基金3097080281101014)the Program for New Century Excellent Talents in University(NCET-11-0013)supported by the‘‘Qian Jiang Distinguished Professor’’Program
文摘Although many functional magnetic resonance imaging(f MRI) studies have investigated the neurophysiology of attention deficit hyperactivity disorder(ADHD),the existing studies have not yielded consistent findings.This may be related to the different properties of different frequency bands. To investigate the frequency-specific regional homogeneity(Re Ho) of spontaneous neural activities in ADHD, the current study used resting-state f MRI to explore the Re Ho properties of five frequency bands, slow-5(0.01–0.027 Hz), slow-4(0.027–0.073 Hz),slow-3(0.073–0.198 Hz), slow-2(0.198–0.25 Hz) and the extra-low frequency(0–0.01 Hz), in 30 drug-naive boys with ADHD and 30 healthy controls. Compared with controls, the ADHD group showed decreased Re Ho in the default mode network(DMN) including the medial prefrontal cortex and precuneus, middle frontal gyrus and angular gyrus. ADHD patients also showed increased Re Ho in the posterior cerebellum. Significant interactions between frequency band and group were observed predominantly in the dorsolateral prefrontal and parietal cortices, orbital frontal cortex, supplementary motor area,inferior occipital gyrus, thalamus and anterior cerebellum.In particular, we found that the between-group difference in the extra-low frequency band(0–0.01 Hz) seemed to be greater than that in the other frequency bands for most brain regions. The findings suggest that ADHD children display widespread abnormalities in regional brain activity,particularly in the DMN and attention network, and these abnormalities show frequency specificity.
文摘Tuberous sclerosis complex(TSC)is a rare multisystem,autosomal dominant neurocutaneous syndrome in which epilepsy is the most common of several neurological and psychiatric manifestations.Around two thirds of patients develop drug-resistant epilepsy for whom surgical resection of epileptogenic foci is indicated when seizures remain inadequately controlled following trial of two antiseizure medications.The challenge with presurgical and surgical approaches with patients with TSC is overcoming the complexity from the number of tubers and the multiplex epileptogenic network forming the epileptogenic zone.Data suggest that seizure freedom is achieved by 55%-60%of patients,but predictive factors for success have remained elusive,which makes for unconfident selection of surgical candidates.This article presents three different cases as illustrations of the potential challenges faced when assessing the suitability of TSC patients for epilepsy surgery.
文摘Schizophrenia is a complex disorder characterized by multiple neurochemical abnormalities and structural changes in the brain.These abnormalities may begin before recognizable clinical symptoms appear and continue as a dynamic process throughout the illness.Recent advances in imaging techniques have significantly enriched our comprehension of these structural alterations,particularly focusing on gray and white matter irregularities and prefrontal,temporal,and cingulate cortex alterations.Some of the changes suggest treatment resistance to antipsychotic medications,while treatment nonadherence and relapses may further exacerbate structural abnormalities.This narrative review aims to discuss the literature about alterations and deficits within the brain,which could improve the understanding of schizophrenia and how to interpret neurostructural changes.
基金Support for publishing this paper was received from the China Association Against Epilepsy(CAAE).
文摘Acute symptomatic seizures are the main sign of neurological dysfunction in newborns.This is linked to the unique characteristics of the neonatal brain,making it hyperexcitable compared to older ages,and to the common occurrence of some forms of acquired brain injury,namely hypoxic-ischemic encephalopathy.In this narrative review we will provide an overview of neonatal seizures definition,their main underlying etiologies,diagnostic work-up and differential diagnoses,and will discuss about therapeutic options and prognostic outlook.The latest publications from the ILAE Task Force on Neonatal Seizures will be presented and discussed.Of note,they highlight the current lack of robust evidence in this field of clinical neurology.We will also report on specificities pertaining to low-and-middle income countries in terms of incidence,main etiologies and diagnosis.The possibilities offered by telemedicine and automated seizures detection will also be summarized in order to provide a framework for future directions in seizures diagnosis and management with a global perspective.Many challenges and opportunities for improving identification,monitoring and treatment of acute symptomatic seizures in newborns exist.All current caveats potentially represent different lines of research with the aim to provide better care and reach a deeper understanding of this important topic of neonatal neurology.
基金supported by Next-Generation EU(NGEU)and funded by the Ministry of University and Research(MUR)National Recovery and Resilience Plan(NRRP),under project No.MNESYS(PE0000006)-a multiscale integrated approach to the study of the nervous system in health and disease(DN.155311.10.2022).
文摘Background Tuberous sclerosis complex(TSC)is a genetic disorder caused by inactivating mutations in the TSCl and TSC2 genes,causing overactivation of the mechanistic(previously referred to as mammalian)target of rapamycin(mTOR)signaling pathway in fetal life.The mTOR pathway plays a crucial role in several brain processes leading to TSC-related epilepsy,intellectual disability,and autism spectrum disorder(ASD).Pre-natal or early post-natal diagnosis of TSC is now possible in a growing number of pre-symptomatic infants.Data sources We searched PubMed for peer-reviewed publications published between January 2010 and April 2023 with the terms“tuberous sclerosis",“autism",or“autism spectrum disorder""animal models",“preclinical studies",“neurobiology",and“treatment".Results Prospective studies have highlighted that developmental trajectories in TSC infants who were later diagnosed with ASD already show motor,visual and social communication skills in the first year of life delays.Reliable genetic,cellular,electroencephalography and magnetic resonance imaging biomarkers can identify pre-symptomatic TSC infants at high risk for having autism and epilepsy.Conclusions Preventing epilepsy or improving therapy for seizures associated with prompt and tailored treatment strategies for autism in a sensitive developmental time window could have the potential to mitigate autistic symptoms in infants with TSC.
