Cerebral Perfusion Response
to Successful Treatment of
Depression With Different
Serotoninergic Agents with antidepressant therapy have been reported in a number of studies.2–4 In contrast, decreases in the ventral anterior cingulate blood flow were found in response to desipramine,5 electroshock therapy,6 and flu-7
Chair & Presenter, Bruce Cree, MD, PhD, MAS and Lauren B. Krupp, MD, prepared useful Practice Aids pertaining to multiple sclerosis for this CME/MOC/NCPD/CPE activity titled “Exploring the Convergence of Advances in S1P Receptor Modulation With Progress in Understanding Brain Atrophy and Cognition Measures in Multiple Sclerosis.” For the full presentation and complete CME/MOC/NCPD/CPE information, and to apply for credit, please visit us at http://bit.ly/2ZRy5Ys. CME/MOC/NCPD/CPE credit will be available until November 25, 2022.
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
Treatment Options for Drug-Resistant Epilepsy
In some people with drug resistant epilepsy, there are effective treatment options, with a high chance of seizure freedom. These include:
Resective Epilepsy Surgery
Resective epilepsy surgery consists of removing the area of the brain that is causing the seizures. However, for a patient to be a good candidate for surgery, the following conditions have to be met:
The area of the brain where seizures originate is clearly identified.
That area of the brain can be safely removed with surgery. In other words if the risk is greater than “minimal risk,” the patient is not a candidate.
The probability to achieve seizure freedom with epilepsy surgery varies depending on the structures of the brain involved. For example, patients whose seizures originate in the temporal lobe have a 50% to 70% chance of achieving seizure-freedom.
Today, newer, less-invasive techniques are being used in the place of resective surgery in appropriate cases. These include the use of laser, in which a laser probe burns the area of the brain causing the seizures. However, these new techniques may not work for all candidates for resective surgery.
Specific Metabolic Treatment
While metabolic causes of epilepsy are uncommon, identifying some of these conditions can lead to specific treatments to allow the body to compensate for the metabolic change.
Examples are treatment with a ketogenic diet for GLUT1 deficiency, treatment with pyridoxine or pyridoxal-5-phosphate for vitamin dependent epilepsies, and creatine supplementation for creatine deficiency syndromes.
Specific Genetic Causes
Identifying a specific genetic cause can help your doctor choose the best treatment for seizures.
For example, with SCN1A pathogenic variants, medications such as Oxcarbazepine (Trileptal), Carbamazepine (Tegretol) or Phenytoin (Dilantin) should be avoided. Whereas with other types of pathogenic variants, such as SCN2A and SCN8A variants, these medications can be very helpful.
Some specific treatments which target the underlying problem caused by the genetic variant are in clinical trials, and may improve learning and development as well as help with seizures.
Immunotherapy
In the last decade, the role of inflammatory processes in certain types of epilepsy has been recognized. In these cases, medications that counteract these processes have been used with success. However, they have to be used with caution as they are associated with a variety of adverse events.
Schizophrenia is a chronic and disabling mental illness affecting millions of people worldwide. The symptoms of schizophrenia are classified into positive, negative and cognitive symptoms. New receptor targets and drugs have being evaluated for addressing the multifaceted syndrome of schizophrenia.
is a chronic and disabling mental illness affecting millions of people worldwide. The symptoms of schizophrenia are classified into positive, negative and cognitive symptoms. New receptor targets and drugs have being evaluated for addressing the multifaceted syndrome of schizophrenia.
Chair & Presenter, Bruce Cree, MD, PhD, MAS and Lauren B. Krupp, MD, prepared useful Practice Aids pertaining to multiple sclerosis for this CME/MOC/NCPD/CPE activity titled “Exploring the Convergence of Advances in S1P Receptor Modulation With Progress in Understanding Brain Atrophy and Cognition Measures in Multiple Sclerosis.” For the full presentation and complete CME/MOC/NCPD/CPE information, and to apply for credit, please visit us at http://bit.ly/2ZRy5Ys. CME/MOC/NCPD/CPE credit will be available until November 25, 2022.
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
Treatment Options for Drug-Resistant Epilepsy
In some people with drug resistant epilepsy, there are effective treatment options, with a high chance of seizure freedom. These include:
Resective Epilepsy Surgery
Resective epilepsy surgery consists of removing the area of the brain that is causing the seizures. However, for a patient to be a good candidate for surgery, the following conditions have to be met:
The area of the brain where seizures originate is clearly identified.
That area of the brain can be safely removed with surgery. In other words if the risk is greater than “minimal risk,” the patient is not a candidate.
The probability to achieve seizure freedom with epilepsy surgery varies depending on the structures of the brain involved. For example, patients whose seizures originate in the temporal lobe have a 50% to 70% chance of achieving seizure-freedom.
Today, newer, less-invasive techniques are being used in the place of resective surgery in appropriate cases. These include the use of laser, in which a laser probe burns the area of the brain causing the seizures. However, these new techniques may not work for all candidates for resective surgery.
Specific Metabolic Treatment
While metabolic causes of epilepsy are uncommon, identifying some of these conditions can lead to specific treatments to allow the body to compensate for the metabolic change.
Examples are treatment with a ketogenic diet for GLUT1 deficiency, treatment with pyridoxine or pyridoxal-5-phosphate for vitamin dependent epilepsies, and creatine supplementation for creatine deficiency syndromes.
Specific Genetic Causes
Identifying a specific genetic cause can help your doctor choose the best treatment for seizures.
For example, with SCN1A pathogenic variants, medications such as Oxcarbazepine (Trileptal), Carbamazepine (Tegretol) or Phenytoin (Dilantin) should be avoided. Whereas with other types of pathogenic variants, such as SCN2A and SCN8A variants, these medications can be very helpful.
Some specific treatments which target the underlying problem caused by the genetic variant are in clinical trials, and may improve learning and development as well as help with seizures.
Immunotherapy
In the last decade, the role of inflammatory processes in certain types of epilepsy has been recognized. In these cases, medications that counteract these processes have been used with success. However, they have to be used with caution as they are associated with a variety of adverse events.
Schizophrenia is a chronic and disabling mental illness affecting millions of people worldwide. The symptoms of schizophrenia are classified into positive, negative and cognitive symptoms. New receptor targets and drugs have being evaluated for addressing the multifaceted syndrome of schizophrenia.
is a chronic and disabling mental illness affecting millions of people worldwide. The symptoms of schizophrenia are classified into positive, negative and cognitive symptoms. New receptor targets and drugs have being evaluated for addressing the multifaceted syndrome of schizophrenia.
Regulation of depression by a new type of brain stimulation in addicted patie...Mrsunny4
Depression is also known as clinical depression and major depressive disorder (MDD). This severe medical illness affects 15 million American adults every year or about 5-8% of the adult population of the US. Women are nearly twice as likely as men to develop major depression.
Dr. Cady presented this CME program on depression and TMS (Transcranial magnetic stimulation) to the medical staff of the Community Methodist Hospital in Henderson, KY on February 8, 2012. It reviews accurate diagnosis of depression, use of new medications, cautions on drug-drug interactions, and a review of the new development of TMS in the current treatments of 21st Century psychiatry.
Different gray matter patterns in chronic schizophrenia and chronic bipolar d...Benjamin Cortes
Abstract: Gray matter (GM) volume deficits have been described in patients with schizophrenia (Sz) and bipolar disorder (BD), but to date, few studies have directly compared GM volumes between these syndromes with methods allowing for whole-brain comparisons. We have used structural magnetic resonance imaging (MRI) and voxel-based morphometry (VBM) to compare GM volumes between 38 Sz and 19 BD chronic patients. We also included 24 healthy controls. The results revealed a widespread cortical (dorsolateral and medial prefrontal and precentral) and cerebellar deficit as well as GM deficits in putamen and thalamus in Sz when compared to BD patients. Besides, a subcortical GM deficit was shown by Sz and BD groups when compared to the healthy controls, although a putaminal reduction was only evident in the Sz patients. In this comparison, the BD patients showed a limited cortical and subcortical GM deficit. These results support a partly different pattern of GM deficits associated to chronic Sz and chronic BD, with some degree of overlapping.
No association between prepulse inhibition of the startle reflex and neuropsyc...Benjamin Cortes
Abstract: Sensorimotor gating deficits are relevant in schizophrenia and can be measured using prepulse inhibition (PPI) of the startle reflex. It is conceivable that such deficits may hinder the cognitive functions in schizophrenia patients. In this study, using PPI and a neuropsychological battery, we studied this possibility in a group of 23 acute, neuroleptic-free schizophrenia patients and 16 controls. A non-significant decrease in PPI was found in the patients as compared to the controls, as well as significant differences in the performance of Trail A and B in Wisconsin
Card Sorting and Digit/Symbol Tests. No statistically significant correlations between PPI and neuropsychological performance were found after the correction for multiple comparisons in any group. Our results suggest that PPI deficits in schizophrenia patients may not contribute to the cognitive deficits typical of that illness, at least in patients with a non-significant PPI decrease.
Hans Jürgen-Current situation and future perspetives of antipsychotics in sch...Fundación Ramón Areces
'Psiquiatría: situación actual y perspectivas de futuro'. Este es el título del simposio internacional que organizamos el 16 de junio de 2016 en la Fundación Ramón Areces con las fundaciones Juan José López-Ibor y Lilly en homenaje al doctor Juan José López-Ibor, fallecido en enero de 2015. Durante esta jornada, expertos internacionales abordaráon la profunda crisis que atraviesa la psiquiatría como disciplina científica y especialidad médica. Además, a las 19.00 horas, se presentará el libro con el mismo título del simposio, también en recuerdo del doctor López-Ibor.
A guideline for discontinuing antiepileptic drugs in seizure-free patients – ...Dr. Rafael Higashi
Aula apresentada por Dr. Rafael Higashi, médico neurologista sobre quando retirar droga antiepilética. A guideline for discontinuing antiepileptic drugs in seizure-free patients – Summary Statement
EIS technology : bioimpedance application in selective serotonin reuptakeES-Teck India
Through the 6 tactile electrodes, a weak DC current is sending alternatively between 2 electrodes with a sequence and the EIS-GS system is recording the electrical conductance of 11 pathways of the human body.
EIS Technology: bioimpedance chronoamperometry in adjunct to screen the prost...ES-Teck India
Through the 6 tactile electrodes, a weak DC current is sending alternatively between 2 electrodes with a sequence and the EIS system is recording the electrical conductance of 11 pathways of the human body.
Summary of clinical investigations es teck complex systemES-Teck India
Summary of the clinical investigations E.S.Teck Complex March, 20, 2010
Summary of Clinical Investigations ES Teck Complex system EIS System in adjunct to Treatments’ monitoring and to diagnosis with the conventional methods
Photoplethysmographic assessment of pulse wave reflection: Blunted response to mellitus -adrenergic vasodilation in type II diabetes 2
endothelium-dependent beta
Comparison of Invasive vs Noninvasive Pulse Wave Indices in Detection of Signifi cant Coronary Artery Disease: Can We Use Noninvasive Pulse Wave Indices as Screening Test
Noninvasive Cardiac Output Estimation Using a Novel
Photoplethysmogram Index
31st Annual International Conference of the IEEE EMBS Minneapolis, Minnesota, USA, September 2-6, 2009
Guidelines heart rate_variability_ft_1996[1]ES-Teck India
Guidelines
Heart rate variability
Standards of measurement, physiological interpretation, and
clinical use
Task Force of The European Society of Cardiology and The North American
Society of Pacing and Electrophysiology (Membership of the Task Force listed in
the Appendix)
Hypertension:Volume 32(2)August 1998pp 365-370
Assessment of Vasoactive Agents and Vascular Aging by the Second Derivative of
Photoplethysmogram Waveform
[Third Workshop On Structure And Function Of Large Arteries: Part Ii]
Summary
Chronobiology International
1993, Vol. 10, No. 6, Pages 442-448
Effects of Intracisternally Injected Serotonin on Cerebral Blood Flow in Cats During Winter and Summer, and After Dark Exposure
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
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Serotonin ssri effects
1. Cerebral Perfusion Response with antidepressant therapy have been reported in a
number of studies.2–4 In contrast, decreases in the ven-
to Successful Treatment of tral anterior cingulate blood flow were found in re-
Depression With Different sponse to desipramine,5 electroshock therapy,6 and flu-
oxetine.7 The specific effects of the treatment with 5-HT2
Serotoninergic Agents receptor antagonists on CBF in major depressive disor-
der (MDD) have not yet been reported.
Andrei Vlassenko, M.D., Ph.D.
Yvette I. Sheline, M.D. Some of the discrepancies among previous studies
Keith Fischer, M.D. may be related to clinical considerations, including di-
Mark A. Mintun, M.D. agnostic criteria, inclusion of both bipolar and unipolar
subjects, demographic characteristics, illness severity,
and medication status. In a number of studies, one dif-
In 19 patients with major depressive disorder, ef-
ficulty is the alignment of scans from one subject to the
fective treatment with selective serotonin reuptake
next in the absence of anatomical data, which increases
inhibitors (SSRIs) or amesergide (AMSG) was as- the possibility of obscuring significant findings or find-
sociated with increased cerebral perfusion in ante- ing artifacts due to misalignment.
rior cingulate cortex (SSRI and AMSG) and in We used [Tc99m]hexamethylpropyleneamineoxime
medial prefrontal cortex (AMSG). Both selective (HMPAO) single photon emission computed tomogra-
serotonin reuptake inhibitors and AMSG exert phy (SPECT) images of CBF co-registered with anatom-
antidepressant action through the serotonin (5- ical magnetic resonance (MRI) imaging to compare the
HT) system as reuptake inhibitors. Amesergide changes in cerebral perfusion in response to treatment
differs from SSRIs in that it is also a highly selec- with SSRIs or AMSG.
tive 5-HT antagonist, which may in part account
for differences in cerebral blood flow response to
METHOD
treatment.
(The Journal of Neuropsychiatry and Clinical
Nineteen subjects meeting DSM-IV criteria for MDD
Neurosciences 2004; 16:360–363)
were recruited from referrals from other psychiatrists
and also from the community by advertisement. Inclu-
B oth selective serotonin reuptake inhibitors (SSRIs)
and amesergide (AMSG; LY237733) appear to pro-
duce an antidepressant effect through their action upon
sion criteria were a current episode meeting criteria for
MDD, right-handedness, and no other medical illness
potentially affecting the brain. A psychiatrist experi-
the serotonin (5-HT) system. They differ, however, in enced in the use of the Diagnostic Interviews for Genetic
that AMSG is a reuptake inhibitor as well as a highly Studies, a structured interview with high reliability,8 as-
selective antagonist at the 5-HT receptor. AMSG shows sessed all subjects clinically. Exclusion criteria com-
affinity at 5-HT2 receptors similar to that seen for other prised a current or past neurological disorder, head
potent 5-HT2 receptor antagonists such as ketanserin, trauma, uncontrolled hypertension, myocardial infarc-
ritanserin, and setoperone. In contrast to these agents, tion or ischemia, diabetes, Cushing’s disease, steroid
however, AMSG has low to negligible effects at -, b-, use, drug/alcohol abuse, and use of any psychotropic
dopamine, histamine, c-aminobutyric acid, benzodiaz-
epine, and muscarinic receptors.1 Received September 18, 2002; revised December 15, 2002; accepted
January 13, 2003. From the Department of Radiology, Department of
The literature reports contradictory findings for de- Psychiatry, Washington University School of Medicine, St. Louis, Mis-
pression and treatment associated cerebral blood flow souri. Correspondence and reprints: Dr. Sheline, Associate Professor
of Psychiatry and Radiology, Box 8134, WUSM 4940 Childrens Place
(CBF) changes. Increases in dorsal frontal and dorsal an- St. Louis, MO 63110. E-mail: yvette@npg.wustl.edu.
terior cingulate hypoperfusion and hypometabolism Copyright 2004 American Psychiatric Publishing, Inc.
360 J Neuropsychiatry Clin Neurosci 16:3, Summer 2004
2. VLASSENKO et al.
medication within 3 weeks prior to inclusion in the warped and resliced according to the transformation
study. Depression severity was rated using the Hamil- matrix generated from combining the two types of co-
ton Depression Rating Scale9 (HAMD) on the day of the registration.
SPECT study. All patients were then randomized to
treatment with AMSG 15–30 mg daily (Eli Lilly, Inc.) Statistical Parametric Mapping (SPM) Analysis
(n 10) or SSRI 20 mg daily (n 9) (fluoxetine n 6 or Statistical parametric mapping 96 (Wellcome Depart-
paroxetine n 3). In the case of AMSG this was part of ment of Cognitive Neurology, University College, Lon-
a double-blinded, placebo-controlled study. In the case don) was used to detect significant (P 0.001) regional
of SSRI it was an open-label study. After 12 weeks, de- changes in CBF between the baseline and treatment
pressed subjects were scanned again during their final scans for both AMSG and SSRI groups combined and in
week of antidepressant treatment. Clinical response was contrast to one another. Correction of global differences
defined as a posttreatment HAMD score 12 or a 50% and detection of voxel-by-voxel changes were per-
decrease compared to the initial HAMD score. formed using an analysis of covariance. Single photon
Written informed consent was obtained from all sub- emission computed tomography data was filtered with
jects after the procedures had been fully explained. The a 12 mm full width three-dimensional Gaussian filter at
Human Studies Committee and Radioactive Drug Re- half maximum prior to processing.
search Committee of Washington University School of A chi-square statistic was calculated to determine
Medicine approved the study. whether the gender distribution across the two groups
was significantly different, and a Student’s unpaired t
SPECT test was used to determine differences in age and base-
All SPECT CBF scans were performed on a Prism 3000 line HAMD score.
triple-headed scanner fitted with a high-resolution low-
energy collimator (Picker International, Cleveland) after
the injection of 16 mCi of HMPAO. The imaging proto- RESULTS
col acquired 120 brain images parallel to the orbitomea-
tal line in 40 steps with 360 rotation of the camera. Re- Subjects in SSRI and AMSG groups were similar in gen-
construction of SPECT images used a ramp filter to yield der (male/female ratio was 4/5 and 4/6, respectively;
transverse slices with a matrix of 128 128 128 pixels v2 0.038, P 0.84), age (41.7 11.0 years, and
and voxel size 2.8 2.8 2.8 mm. 45.6 13.4 years, respectively) (t 0.7, df 17, P 0.49)
and baseline HAMD scores (22.8 6.3 and 21.3 4.4, re-
MRI spectively) (t 0.6, df 17, P 0.55). In AMSG group,
MRI scans were performed on a Magnetom SP-4000 1.5- 80% of subjects improved clinically after the treatment
T imaging system (Siemens, Iselin, N.J.). A magnetiza- (posttreatment HAMD was 5.3 3.4, a decrease from
tion prepared rapid gradient echo (MPRAGE) acquisi- initial value was 76% 16%) as compared with 67% in
tion was used to acquire anatomic images, which the SSRI group (posttreatment HAMD score and de-
consisted of 128 contiguous 1.25 mm thick sagittal slices. crease from initial value were 5.8 3.5 and 75% 16%,
Scanning parameters were TR 10 msec, TE 4 msec, respectively.) (Shown in Table 1.)
inversion time 300 msec, flip angle 8 , matrix Statistical parametric mapping was used to detect
256 256 pixels, voxel size 1 1 1.25 mm. CBF changes between baseline and posttreatment scans
in the SSRI and AMSG responders. Regions that in-
SPECT-MRI Co-Registration creased significantly following treatment with AMSG or
The MRI images were manually segmented using AN- SSRI included the left anterior cingulate gyrus (coordi-
ALYZE (Mayo Clinic, USA) to remove the scalp, skull, nates: 21, 22, 20), which extended towards the midline
and meninges, then resized to isotropic voxels. The seg- (covering the middle anterior cingulated gyrus [coor-
mented magnetic resonance (MR) brain images and dinates: 5, 45, 20]), the left superior temporal gyrus
SPECT images were co- registered using Automated Im- (coordinates: 57, 17, 6) and the orbital prefrontal cor-
age Alignment (AIR) software.10 The MR images were tex (coordinates: 11, 51, 29) (Figure 1). Regions that
transformed to a reference MRI in Talairach atlas decreased significantly following treatment with AMSG
space.11 SPECT scans were then rotated, translated, or SSRI included the left inferior frontal gyrus (coordi-
J Neuropsychiatry Clin Neurosci 16:3, Summer 2004 361
3. CLINICAL AND RESEARCH REPORTS
nates: 65, 17, 22) and left medial temporal gyrus (coor- participate in autonomic, affective, and motivational be-
dinates: 70, 0, 19). Regions in which AMSG differed haviors (rostral and ventral regions), pain perception,
from SSRI with a significantly higher increase than SSRI attention to action and response selection (dorsal re-
in blood flow following treatment included the medial gions), and they have unique reciprocal connections not
prefrontal cortex (coordinates: 10, 65, 26), precuneus only between their rostral and dorsal parts, but also with
(coordinates: 0, 77, 65) and the right inferior parietal selective dorsal neocortical and ventral paralimbic ar-
cortex (coordinates: 46, 60, 50) (Figure 1). There eas.12 Anterior cingulate regions and their projection sites
were no regions in which SSRIs increased blood flow are the areas where blood flow and metabolic changes
significantly more than AMSG. were seen in previous studies2,12,13 and these changes
were improved in MDD patients who responded to anti-
depressant treatment3,12 or electroconvulsive therapy.14
DISCUSSION We did not analyze the nonresponders group sepa-
rately due to few numbers of patients. However, May-
The primary effect we found in this study was that treat- berg et al.12 demonstrated that the metabolic activity in
ment response to both types of serotoninergic antide- anterior cingulate region discriminated eventual re-
pressants is associated with increased CBF in the left and sponders from nonresponders and suggested that this
mid anterior cingulate, left superior temporal gyrus, and area is necessary for the normal integrative processing
orbital prefrontal cortex. This change in regional neural of mood, motor, autonomic and cognitive behaviors, all
activity may be due to the change in mood state or to a of which are disrupted in depression.
common serotonergic effect. Anterior cingulate regions We found response to AMSG treatment to be associ-
TABLE 1. Clinical Characteristics of the Patients
Treatment Gender (M/F) Age (years) HAMD
Baseline Post-treatment % changes
AMSG (n 10)
Responders (n 8) 3/5 46.4 15.0 22.3 4.4 5.3 3.4* 76.1 15.6
Non-responders (n 2) 1/1 42.5 0.7 17.5 0.7 22.5 3.5** -28.3 15.0**
SSRI (n 9)
Responders (n 6) 2/4 38.8 12.2 24.3 7.1 5.8 3.5* 74.7 17.4
Non-responders (n 3) 2/1 47.3 6.7 19.7 3.2 17.0 7.5** 15.9 26.5**
*, different from baseline, two-tailed paired t-test, p 0.01; **, different from responders, two-tailed unpaired t-test, p 0.01.
FIGURE 1. A Statistical Parametric Map Derived From a HMPAO SPECT Study
Regions that show statistically significant changes (p 0.001) after successful treatment are displayed in black. A. Regions that increased
significantly following treatment with both AMSG and SSRI. B. Regions where AMSG had a significantly higher increase of CBF compared to
SSRI treatment.
362 J Neuropsychiatry Clin Neurosci 16:3, Summer 2004
4. VLASSENKO et al.
ated with increased CBF in the medial prefrontal cortex, To our knowledge this study is the first report of me-
which was not seen in the SSRI treated patients. De- dial prefrontal blood flow changes in MDD patients suc-
crease in medial prefrontal CBF associated with the cog- cessfully treated with a 5-HT2 receptor antagonist. Stud-
nitive impairment of depression or so-called depressive ies of other similar drugs (e.g., nefazodone) would be
pseudodementia was demonstrated by Bench et al.,13 informative in determining whether this effect extends
and clinical recovery from depression resulted in CBF to other 5-HT2 antagonists.
increase in these regions.15 Numerous reciprocal con-
nections between anterior cingulate, dorsolateral pre- This study was supported in part by a grant from Eli Lilly,
frontal, and medial prefrontal areas were demonstrated Inc., and NIMH grants MH-01370 and MH-58444 to Dr.
in primate studies,16 and prefrontal areas are considered Sheline, NIMH grant MH-54731 to Dr. Mintun, and grant
to be the sites of convergence for limbic inputs and to RR-00036 from the NIH Division of Research Resources to
serve the function of integration of thought and emo- the General Clinical Research Center at Washington Univer-
tion.17 sity School of Medicine.
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