1) Neuroimaging studies of schizophrenia have found reductions in gray matter volume in brain regions like the left superior temporal gyrus, hippocampus, and amygdala.
2) White matter abnormalities have also been found in fiber tracts like the corpus callosum, uncinate fasciculus, and inferior fronto-occipital fasciculus in patients with schizophrenia.
3) Studies of first-episode patients suggest these changes may occur within the first year of illness, especially in auditory processing regions of the superior temporal gyrus.
This presentation looks at generalised periodic epileptiform discharges and the various disorders like Creutzfeldt Jacob disease (CJD), SSPE and metabolic encephalopathies in which it is seen. SIRPID is also discussed. Triphasic waves are described. Radermacker complexes in SSPE are described.
Neuroimaging of Alzheimer’s disease and Healthy Aging
BY DR WASIM
UNDER THE GUIDANCE OF
DR R.K.SOLANKI
ANATOMICAL BRAIN IMAGING
CT – cerebral tomography
MRI – magnetic resonance imaging
FUNCTIONAL BRAIN IMAGING
SPECT – single photon emission computed tomography
PET – FDG – Positron emission tomography
BRAIN CHEMISTRY MEASUREMENT
MRS (spectroscopy – NAA/Cr: estimate neuronal volume)
BRAIN PATHOLOGY IMAGING
FDDNP – neurofibrillary pathology
Evolution of Neuroimaging in AD
Computed Tomography
MRI
Volumetric MRI
Functional MRI
FDG Glucose PET
Amyloid Imaging
FDG-PET in AD and MCI
Delivery of electrical current to a specific subcortical grey matter target to stimulate a desired group of nerve cells which results in specific modulation the output of the involved neurocirciut.
Magnetic resonance imaging (MRI) is an imaging technique used primarily in medical settings to produce high quality images of the soft tissues of the human body.
This presentation looks at generalised periodic epileptiform discharges and the various disorders like Creutzfeldt Jacob disease (CJD), SSPE and metabolic encephalopathies in which it is seen. SIRPID is also discussed. Triphasic waves are described. Radermacker complexes in SSPE are described.
Neuroimaging of Alzheimer’s disease and Healthy Aging
BY DR WASIM
UNDER THE GUIDANCE OF
DR R.K.SOLANKI
ANATOMICAL BRAIN IMAGING
CT – cerebral tomography
MRI – magnetic resonance imaging
FUNCTIONAL BRAIN IMAGING
SPECT – single photon emission computed tomography
PET – FDG – Positron emission tomography
BRAIN CHEMISTRY MEASUREMENT
MRS (spectroscopy – NAA/Cr: estimate neuronal volume)
BRAIN PATHOLOGY IMAGING
FDDNP – neurofibrillary pathology
Evolution of Neuroimaging in AD
Computed Tomography
MRI
Volumetric MRI
Functional MRI
FDG Glucose PET
Amyloid Imaging
FDG-PET in AD and MCI
Delivery of electrical current to a specific subcortical grey matter target to stimulate a desired group of nerve cells which results in specific modulation the output of the involved neurocirciut.
Magnetic resonance imaging (MRI) is an imaging technique used primarily in medical settings to produce high quality images of the soft tissues of the human body.
This slide includes various neuroimaging methods. Firstly, brief backgrounds of positron emission tomography (PET), diffusion tensor MRI, voxel-based morphometry will be introduced. Secondly, a theoretical explanation of BOLD fMRI and preprocessing will be introduced.
http://skyeong.net
This slide will provide a tutorial for preprocessing of fMRI data. The step-by-step process will be provided.
visit my website for more information:
http:/skyeong.net
These are slides for an introductory lecture on fMRI/MRI and analysis of fMRI data. The corresponding tutorial is available on my website kathiseidlrathkopf.com
A simple introduction to fMRI study design for social science and other researchers outside the field who might want to design a study using fMRI brain scanning technology
The human brain is one of the most complicated objects in the universe. Although it weighs less than 3 pounds, it manages everything from our heart rates to our thoughts and feelings. The functions of the brain are varied, and include: thinking, perception (sensing), emotion, signaling, and many of our physical functions. Our cognition, feelings and behavior are all the result of our brains.
Due to the indicative synaptic elimination as a core phenomenon co-occurring or predicating schizophreniform pathogenesis and the temporal comorbidity of anomalous self-experience, we posit that the neurobiological etiology of formal thought disorder in schizophrenia arises from robust loss of synaptic density at young adulthood mediated by dysregulation of Rho GTPase proteins marked by overzealous targeting from the innate immune system complement cascade.
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Running head: SCHIZOPHRENIA
1
Schizophrenia
Vernessa Combs
PSY350: Physiological Psychology
December 10, 2019
Schizophrenia
The topic selected was schizophrenia. This is a severe and chronic mental disorder affecting the way humans think, feel and behave. Although this mental disorder is not very common, it has disabling symptoms.
Schizophrenia has continuously been viewed as a disorder that occurs in neurodevelopment. It is associated with a microdeletion syndrome of a chromosome. Neurons migrate to the pial surface from the brain's ventricular zone. "Migration of the neuron cell body is mediated via microtubule-based transport organized by the centrosome. First, the centrosome moves up the microtubule, followed by the nucleus and the cell body” (Pearlson, 2015). Neuronal migrations are reportedly caused by Reelin.
The etiology of schizophrenia is unknown, however, several risk factors have been associated with its development. These include environmental and genetic factors. Genetic factors are, however, insufficient to account for the development of the disease. They must be accompanied by other factors for the disease to develop. "Because the concordance rate for monozygotic twins only approaches 50%, genetic makeup alone is not sufficient for the development of schizophrenia, and non-genetic or sporadic forms of the disorder must exist” (Miyamoto et al, 2013).
Environmental factors that play an important role in the etiology of schizophrenia include obstetric complications such as hypoxia, preeclampsia, and premature birth. Other environmental factors include maternal viral infections and stress occurring in neurodevelopment. Stress during neurodevelopment may be caused by other factors such as microbial infections.
The pathology of schizophrenia includes the transcriptional dysregulation at the cerebral cortex and chromosomal conformations. “Anatomic, neurotransmitter and immune system abnormalities have been implicated in the pathophysiology of schizophrenia” (Miyamoto et al, 2013). Differences have been observed in the brains of people with schizophrenia compared to the brains of people without the disease in neuroimaging studies. The medial temporal areas of the brain have a decreased volume while the ventricles are larger. Structural abnormalities such as volume reductions and ventricular enlargements have been associated with the disease.
The dopaminergic system abnormalities are also associated with schizophrenia. The immune system is also disturbed in people with the disease. “Overactivation of the immune system (eg, from prenatal infection or postnatal stress) may result in overexpression of inflammatory cytokines and subsequent alteration of brain structure and function” (Nuckols et al, 2013). Anatomic abnormalities may also be observed in the hippocampus.
In the prefrontal cortex, there has been a reported increase in neuronal density. One of the areas of the prefrontal cortex, area 9, has been found to h ...
The First Appearance of Persistent Dementia and Psychosis after a Generalized...CrimsonpublishersPPrs
The First Appearance of Persistent Dementia and
Psychosis after a Generalized Sepsis by C Lazzari in Psychology and Psychotherapy: Research Study_Crimson Publishers
Since the mid twentieth century, psychologists, psychiatrists, and neuroscientists have sought to explain mental illness in biological terms. In this talk, we'll discuss the emergence of influential biological models such as the monoamine hypothesis of depression, the rise of neuropsychopharmacology (the prescription and widespread use of medications such Prozac and Zoloft), and the complexity of studying complex conditions like generalized anxiety and schizophrenia in biological terms.
In their review “The Role of Stress in Neurodegenerative Diseases and Mental Disorders,” Tobias Esch and colleagues assess the impact of stress as a cause or an enhancer of neurological and neuroendocrine disorders including Alzheimer’s, Depression, and Post-traumatic stress disorder.
Targeting abnormal neural circuits in mood and anxiety disorders:from the la...Kaan Y
My article presentation at the Journal Club on 22 January 2008
Targeting abnormal neural circuits in mood and anxiety disorders: from the laboratory to the clinic
Kerry J Ressler & Helen S Mayberg
VOLUME 10 NUMBER 9
SEPTEMBER 2007
1116-1124
NATURE NEUROSCIENCE
For a free full text of the article:
http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2444035
Most people with dementia undergo behavioral changes during the course of the disease. They may become anxious or repeat the same question or activity over and over. The unpredictability of these changes can be stressful for caregivers. As the disease progresses, your loved one's behavior may seem inappropriate, childlike or impulsive. Anticipating behavioral changes and understanding the causes can help you deal with them more effectively.
This lecture details the science of sepsis care in 2015 with compliments to the multiple online sources used, some of which are other lectures on SlideShare.
Safalta Digital marketing institute in Noida, provide complete applications that encompass a huge range of virtual advertising and marketing additives, which includes search engine optimization, virtual communication advertising, pay-per-click on marketing, content material advertising, internet analytics, and greater. These university courses are designed for students who possess a comprehensive understanding of virtual marketing strategies and attributes.Safalta Digital Marketing Institute in Noida is a first choice for young individuals or students who are looking to start their careers in the field of digital advertising. The institute gives specialized courses designed and certification.
for beginners, providing thorough training in areas such as SEO, digital communication marketing, and PPC training in Noida. After finishing the program, students receive the certifications recognised by top different universitie, setting a strong foundation for a successful career in digital marketing.
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
Honest Reviews of Tim Han LMA Course Program.pptxtimhan337
Personal development courses are widely available today, with each one promising life-changing outcomes. Tim Han’s Life Mastery Achievers (LMA) Course has drawn a lot of interest. In addition to offering my frank assessment of Success Insider’s LMA Course, this piece examines the course’s effects via a variety of Tim Han LMA course reviews and Success Insider comments.
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
Biological screening of herbal drugs: Introduction and Need for
Phyto-Pharmacological Screening, New Strategies for evaluating
Natural Products, In vitro evaluation techniques for Antioxidants, Antimicrobial and Anticancer drugs. In vivo evaluation techniques
for Anti-inflammatory, Antiulcer, Anticancer, Wound healing, Antidiabetic, Hepatoprotective, Cardio protective, Diuretics and
Antifertility, Toxicity studies as per OECD guidelines
Introduction to AI for Nonprofits with Tapp NetworkTechSoup
Dive into the world of AI! Experts Jon Hill and Tareq Monaur will guide you through AI's role in enhancing nonprofit websites and basic marketing strategies, making it easy to understand and apply.
2. Why neuroimaging? The research agenda for DSM-V emphasizes a need to translatebasic and clinical neuroscience research findings into a newclassification system for all psychiatric disorders based uponpathophysiologic and etiological processes Etiologic and pathophysiologically-based diagnostic system v. symptomatologic and syndromic approach of DSM-III and DSM-IV Philips, ML. The Emerging Role of Neuroimaging in Psychiatry: Characterizing Treatment-Relevant Endophenotypes Am J Psychiatry 164:697-699, May 2007
3. Why neuroimaging? Although structural imaging techniques are most useful for ruling out medical etiologies of mental status disturbances, functional neuroimaging techniques currently have an adjunctive role in the evaluation of dementia and seizure disorders and show promise for the evaluation of primary psychiatric disorders in the future. Rauch SL, Renshaw PF. Clinical neuroimaging in psychiatry. HarvRev Psychiatry. 1995 Mar-Apr;2(6):297-312.
4.
5. Culpepper L et al. Are antipsychotics overprescribed? http://www.medscape.com/viewarticle/737587?src=mp&spon=17
6.
7. Neuroimaging Modalities CT MRI PET SPECT fMRI MRS *schizophrenics show over-activation of the cingulate gyrus, while controls seem to activate prefrontal cortex more than schizophrenics. Rauch SL, Renshaw PF. Clinical neuroimaging in psychiatry. HarvRev Psychiatry. 1995 Mar-Apr;2(6):297-312.
10. Schizotypal Personality Disorder Cluster A: Odd/Eccentric Cluster A patients tend to be detached and distrustful SPD involves social withdrawal and emotional coldness but also includes oddities of thinking, perception, and communication, such as magical thinking, clairvoyance, ideas of reference, or paranoid ideation. These oddities suggest schizophrenia but are never severe enough to meet its criteria. People with schizotypal personality are believed to have a muted expression of the genes that cause schizophrenia. http://www.merckmanuals.com/professional/sec15/ch201/ch201a.html?qt=schizotypal&alt=sh
11. Schizotypal personality disorder STG is involved in the perception of emotions in facial stimuli Contains Brodmann areas 41, 42 (primary auditory) and 22p (Wernicke’s) Reduction of left STG gray matter volume in SPD subjects when compared to normal controls. Comparisons with chronic schizophrenics previously studied showed the SPD group had a similarity of left STG gray matter volume reduction, but fewer medial temporal lobe abnormalities. This finding supports the hypothesis of the importance of STG involvement in the schizophrenia spectrum disorders. Possible that presence of medial temporal lobe abnormalities may help to differentiate who will develop schizophrenia and who will develop SPD 3D reconstruction of the cortex and superior temporal gyrus, shown in red. Chandlee, CD et al. Schizotypal Personality Disorder and MRI Abnormalities of Temporal Lobe Gray Matter. Biol Psychiatry 1999;45:1393–1402
12. Imaging Summary SPD - Reduction of left STG gray matter volume; fewer medial temporal lobe abnormalities
13. Schizophrenia A recent World Health Organization (WHO) report estimates that nearly 1% of the population in the US is affected by schizophrenia. A growing body of evidence suggests that early detection and treatment of schizophrenia (and many other brain disorders) is critical in forming and predicting the course and outcome of the disorder. McGlashan, T.: Early detection and intervention in schizophrenia: editors introduction. Schizophr Bull 22(2), 197–199 (1996)
14. Schizophrenia Schizophrenia is characterized by psychosis (loss of contact with reality), hallucinations (false perceptions), delusions (false beliefs), disorganized speech and behavior, flattened affect (restricted range of emotions), cognitive deficits (impaired reasoning and problem solving), and occupational and social dysfunction. Although its specific cause is unknown, schizophrenia has a biologic basis, as evidenced by alterations in brain structure (eg, enlarged cerebral ventricles, decreased size of the anterior hippocampus and other brain regions) and by changes in neurotransmitters, especially altered activity of dopamine and glutamate. 5 Subtypes: Paranoid, Catatonic, Disorganized, Residual, Undifferentiated
15. Schizophrenia No definitive test for schizophrenia exists Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Text Revision (DSM-IV-TR), the diagnosis requires both of the following: ≥ 2 characteristic symptoms (delusions, hallucinations, disorganized speech, disorganized behavior, negative symptoms) for a significant portion of a 1-mo period Prodromal or attenuated signs of illness with social, occupational, or self-care impairments evident for a 6-mo period that includes 1 mo of active symptoms Treatment is with antipsychotic drugs, psychotherapy and rehabilitation/community support http://www.merckmanuals.com/professional/sec15/ch202/ch202e.html
16. Schizophrenia MRI has been useful in revealing subtle structural brain abnormalities in schizophrenia patients, including ventricular enlargement, volume reduction in the frontal and parietal lobes, and gray matter reduction of medial temporal lobe structures It is unknown whether the brain abnormalities observed with MRI in schizophrenia are confounded by chronicity or whether there is a continual degenerative process. Chronic schizophrenia patients may demonstrate pathology secondary to chronic neuroleptic medication and long-term institutionalization. Heschl'sgyrus and planumtemporale regions drawn on a coronal MR slice (left), and a 3D rendering shown overlayedon an axial MR slice. Shenton, ME et al. A review of MRI findings in schizophrenia Schizophrenia Research 49 (2001) 1-52.
17. Schizophrenia Heschl’sgyrus (AKA transverse temporal gyrus) Found in primary auditory cortex - Brodmann 41, 42 First cortical structure to process incoming auditory information Active during auditory processing under fMRI for tone and semantic tasks. Planumtemporale Posterior to Heschl’sgyrus within Sylvian fissure Most asymmetrical of all brain structures Significant L/R asymmetry is normal 5x larger on left in some individuals Evolutionary ancestral origins shown in primates Functions in sound location, language, music Heschl'sgyrus and planumtemporale regions drawn on a coronal MR slice (left), and a 3D rendering shown overlayedon an axial MR slice.
18. Schizophrenia Inferior fronto-occipital fasciculus The ability to suppress one's impulses and actions constitutes a fundamental mechanism of cognitive control, thought to be subserved by the right inferior frontal cortex (rIFC) Uncinate fasciculus Function unknown but traditionally assigned to the limbic system links the forward portions of the temporal lobe with the inferior frontal gyrus and the lower surfaces of the frontal lobe Tract integrity measured by fractional ansiotropy; higher values mean diffusion occurs along one axis FOF displayed in green Forstmann, BU et al. Function and Structure of the Right Inferior Frontal Cortex Predict Individual Differences in Response Inhibition: A Model-Based Approach. The Journal of Neuroscience, 24 September 2008, 28(39): 9790-9796; doi: 10.1523/
19. Schizophrenia Examining first episode patients can thus obviate chronicity-related confounders. Findings suggest that within the first year changes are observed in the superior temporal gyrus region of the temporal lobe, including Heschl'sgyrus and planumtemporale, brain regions important in primary and secondary auditory processing. Data suggests that first-episode schizophrenia might also be associated with disruptions in extensive portions of white matter fiber tracts, especially in the corpus callosum, uncinate fasciculus, inferior fronto-occipital fasciculus and internal capsule, and that negative symptoms are associated with white matter abnormalities related to the right inferior fronto-occipital fasciculus. Heschl'sgyrus and planumtemporale regions drawn on a coronal MR slice (left), and a 3D rendering shown overlayedon an axial MR slice. LaVenture A et al. Abnormalities in White Matter Integrity in First Episode Schizophrenia Using Atlas-Based Segmentation. Mysell Harvard Research Day, Psychiatry Annual Meeting 2010
20. Schizophrenia Left-lateralized reductions in gray matter volume in anterior hippocampus / amygdala, parahippocampalgyrus, and superior temporal gyrus Hallmark clinical symptom of thought disorder is associated with a specific reduction in the volume of left posterior superior temporal gyrus gray matter, which encompasses primary auditory cortex and association cortex, including planumtemporale (neuroanatomical substrates of language) Coronal MR scans from a chronic schizophrenic (right) and normal comparison subject (left). Note increase in CSF in left amygdala-hippocampal complex.
21. Coronal MR scans from a chronic schizophrenic (right) and normal comparison subject (left). Note increase in CSF in left amygdala-hippocampal complex(smaller amygdala on left)
22. Imaging Summary SPD - Reduction of left STG gray matter volume; fewer medial temporal lobe abnormalities Schizophrenia - first year changes are observed in the superior temporal gyrus region of the temporal lobe, including Heschl'sgyrus and planumtemporale Schizophrenia – chronic changes - left-lateralized reductions in gray matter volume in anterior hippocampus / amygdala, parahippocampalgyrus, and superior temporal gyrus
23. Posttraumatic stress disorder Posttraumatic stress disorder (PTSD) causes recurring, intrusive recollections of an overwhelming traumatic incident that persist > 1 mo, as well as emotional numbing and hyperarousal. Traumatic events commonly associated with these disorders include assaults, sexual assaults, car accidents, dog attacks, and injuries (especially burns). In young children, domestic violence is the most common cause of PTSD. Treatment is with behavioral therapy, SSRIs, and antiadrenergic drugs. SSRIs often help reduce emotional numbing and reexperiencing of symptoms but are less effective for hyperarousal. Antiadrenergic drugs (clonidine, prazosine) may help relieve hyperarousal symptoms, but supportive data are preliminary.
24. Posttraumatic stress disorder Studies in PTSD Vietnam combat veterans revealed: Reduced left and right hippocampal volume Volume reductions were associated with severity of combat exposure, suggesting that the severe stress of military combat both damages the hippocampus A similar study was undertaken with Gulf war veterans in Israel, and these data are have shown similar findings Hippocampus (green), Fornix (blue) and Mammilary Bodies (gray) are shown in 3D. Boone, Omar et al. Longitudinal MRI Study of Hippocampal Volume in Trauma Survivors With PTSD. Am J Psychiatry 2001; 158:1248–1251
25. Posttraumatic stress disorder Smaller hippocampal volume is not a necessary risk factor for developing PTSD and does not occur within 6 months of expressing the disorder This brain abnormality might occur in individuals with chronic or complicated PTSD. Boone, Omar et al. Longitudinal MRI Study of Hippocampal Volume in Trauma Survivors With PTSD. Am J Psychiatry 2001; 158:1248–1251
26. Posttraumatic stress disorder A study reported in Nature-Neuroscience evaluated MR brain morphometry of the hippocampus in monozygotic twins discordant for PTSD. The PTSD twin was diagnosed with PTSD as a result of combat exposure in the Vietnam War. The twin aspect of this study was important as it showed that individuals discordant for PTSD showed reduced hippocampal volume compared with twins where PTSD was present in neither twin. This finding suggests that there may be a predisposition or vulnerability factor involved in the genesis of PTSD Gilberson, MW et al. Smaller hippocampal volume predicts pathologic vulnerability to psychological trauma. Nature-Neuroscience, October 2002
27. Imaging Summary SPD - Reduction of left STG gray matter volume; fewer medial temporal lobe abnormalities Schizophrenia - first year changes are observed in the superior temporal gyrus region of the temporal lobe, including Heschl'sgyrus and planumtemporale Schizophrenia – chronic changes - left-lateralized reductions in gray matter volume in anterior hippocampus / amygdala, parahippocampalgyrus, and superior temporal gyrus PTSD – reduced hippocampal volume past 6 months
28. Bipolar Disorder Bipolar I disorder (BPI) affects at least 1% of the population, is associated with increased mortality, and is among the top 10 most disabling illnesses worldwide. Bipolar disorders usually begin in the teens, 20s, or 30s. When one takes into account those with bipolar II and subthreshold bipolar disorder capturing those with briefer or only treatment-emergent hypomania, lifetime prevalence rates approach 5%. Merikangas KR, Akiskal HS, Angst J, et al. Lifetime and 12-month prevalence of bipolar spectrum disorder in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2007;64:543–552.
29. Bipolar disorder Diagnosis is based on identification of symptoms of mania or hypomania plus a history of remission and relapse Thyroxine (T4) and thyroid-stimulating hormone levels to exclude hyperthyroidism Exclusion of stimulant drug abuse clinically or by urine testing
30. Bipolar disorder Bipolar disorders are classified as Bipolar I disorder: Defined by the presence of at least one full-fledged (ie, disrupting normal social and occupational function) manic or mixed episode and usually depressive episodes Bipolar II disorder: Defined by the presence of major depressive episodes with at least one hypomanic episode but no full-fledged manic episodes Bipolar disorder not otherwise specified (NOS): Disorders with clear bipolar features that do not meet the specific criteria for other bipolar disorders Bipolar disorder. Merck Manual – http://www.merckmanuals.com/professional/sec15/ch200/ch200c.html?qt=bipolar&alt=sh
31. Bipolar disorder Treatment is with Mood stabilizers (eg lithium) and certain anticonvulsants (eg carbamazepine), 2ndgeneration antipsychotic (egaripiprazole, risperidone) or both Support and psychotherapy ECT for depression refractory to treatment Treatment in 3 phases Acute – To stabilize and control the initial, sometimes severe manifestations Continuation – To attain full remission Maintenance – To keep paients in remission
32. Bipolar disorder One major issue in diagnosing and treating bipolar disorder is the high rate of misdiagnosis or late diagnosis In one community sample of diagnosed bipolar disorder patients, approximately 70% had a missed diagnosis. A total of 60% of those were diagnosed with major depressive disorder, with one third going 10 years or more without a correct diagnosis. In addition, these patients had on average 3.5 other diagnoses and saw on average four physicians before receiving the correct diagnosis. Hirschfeld RM, Lewis L, Vornik LA. Perceptions and impact of bipolar disorder: how far have we really come? Results of the National Depressive and Manic-depressive Association 2000 survey of individuals with bipolar disorder. J Clin Psychiatry. 2003;64:161–174.
33. Bipolar disorder Fewer than half of the people who were previously diagnosed with bipolar disorder could be said to have the disorder when strict diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders-IV were applied. Dangers to overdiagnosis, chief among them unnecessary exposure to mood stabilizers and all their powerful side effects Role for neuroimaging Reference Zimmerman. Journal of Clinical Psychiatry. May 2008 http://www.webmd.com/bipolar-disorder/news/20080506/bipolar-disorder-overdiagnosed
34. Bipolar disorder Identifying endophenotypic markers for bipolar disorder at this time would seek to serve two main goals: To clarify diagnosis and discriminate the depression in bipolar disorder from that of UPD to treat accordingly To identify at-risk individuals for early diagnosis with the goal of intervening before illness onset. Keener, MT et al. Neuroimaging in bipolar disorder: A critical review of current findings. Curr Psychiatry Rep. 2007 December; 9(6): 512–520
35. Two overlapping neural systems implicated in bipolar disorder. An anterior limbic subcortical system (left) is responsible for emotion processing. Lateral prefrontal cortical regions (right) are implicated in executive control. These two systems interact and overlap in ventral frontal areas such as the orbitofrontal cortex (OFC) that are responsible for decision making about emotional material and attentional control during emotional stimuli processing. Directional findings in bipolar disorder are represented by size of nodes and vertical arrows. DLFPC—dorsolateral prefrontal cortex; DMPFC—dorsomedial prefrontal cortex; Dorsal ACG—dorsal cingulate gyrus; VLPFC—ventrolateral prefrontal cortex; VMPFC—ventromedial prefrontal cortex.
36.
37. Bipolar Disorder arly Onset. Studies show markedly increased perfusion in bilateral frontal and posterior parietal lobes. There is also hypoperfusion of both orbito-frontal areas, anterior and mesial temporal areas. Mena, Ismael. et al. Bipolar affective disorders: Assessment of functional brain changes by means of Tc99m HMPAO NeuroSPECT. Alasbimn Journal 6(23): January 2004. Article N° AJ23-2.
38. Bipolar disorder PET studies in depressed BPI, bipolar II, and manic individuals have shown increased amygdalar and ventral striatal limbic subcortical activity compared with healthy controls In adults, there are findings of enlarged (or shrunken) amygdalae, decreased dorsal and ventral prefrontal cortices, and smaller or no change in hippocampi. Altshuler LL, Bartzokis G, Grieder T, et al. An MRI study of temporal lobe structures in men with bipolar disorder or schizophrenia. Biol Psychiatry. 2000;48:147–162. Blumberg et al. 2003 "Amygdala and hippocampal volumes in adolescents and adults with bipolar disorder". Arch Gen Psychiatry60 (12): 1201–8.
39. Imaging Summary SPD - Reduction of left STG gray matter volume; fewer medial temporal lobe abnormalities Schizophrenia - first year changes are observed in the superior temporal gyrus region of the temporal lobe, including Heschl'sgyrus and planumtemporale Schizophrenia – chronic changes - left-lateralized reductions in gray matter volume in anterior hippocampus / amygdala, parahippocampalgyrus, and superior temporal gyrus PTSD – reduced hippocampal volume past 6 months Bipolar - increased perfusion in bilateral frontal and posterior parietal lobes. There is also hypoperfusion of both orbito-frontal areas, anterior and mesial temporal areas. Structure - Enlarged amygdalae, decreased dorsal and ventral prefrontal cortices, and smaller or no change in hippocampi.
40. Summary Neuroimaging of psychiatric illness is a rapidly developing field Helps explain biologic basis of mental illness Promises to aid diagnosis and identify early-onset and predisposition to disease Could enhance treatment and reduce misdiagnosis/overdiagnosis
SPECT = single positron emission computed tomography; MRS = magnetic resonance spectroscopy
FA is calculated from eigenvalues (lambda) of the diffusion tensor; Tensors are geometric entities that extend scalers, vectors, matrices to higher orders. Eigenvalues are the directional vectors; thought to reflect fiber density, axonal diameter, and myelination in white matter.
The superior parts of both the anterior and posterior limbs and the genu of the internal capsule are supplied by the lenticulostriate arteries, which are branches off of the M1 segment of the middle cerebral artery.The inferior half of the anterior limb is supplied via the recurrent artery of Heubner, which is a branch of the anterior cerebral artery.The inferior half of the posterior limb is supplied by the anterior choroidal artery, which is a branch of the internal carotid artery.
Amygdala plays primary role in the processing and memory of emotional reactions. Additional studies have shown a link between the amygdala and schizophrenia, noting that the right amygdala is significantly larger than the left in schizophrenic patients. A 2003 study found that adult and adolescent bipolar patients tended to have considerably smaller amygdala volumes and somewhat smaller hippocampal volumes
Parahippocampalgyrus – memory encoding and retrieval
Mammilary bodies - They, along with the anterior and dorsomedial nuclei in the thalamus, are involved with the processing of recognition memory.They are believed to add the element of smell to memories.
Parahippocampalgyrus – memory encoding and retrieval
A 2003 study found that adult and adolescent bipolar patients tended to have considerably smaller amygdala volumes and somewhat smaller hippocampal volumes. amygdala is found to be activated in fMRI when people observe that others are physically close to them, such as when a person being scanned knows that an experimenter is standing immediately next to the scanner, versus standing at a distance
Parahippocampalgyrus – memory encoding and retrieval