1
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He J, Chan SH, Lin J, Tsang HW. Integration of tai chi and repetitive transcranial magnetic stimulation for sleep disturbances in older adults: A pilot randomized controlled trial. Sleep Med 2024; 122:35-44. [PMID: 39121822 DOI: 10.1016/j.sleep.2024.07.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 07/19/2024] [Accepted: 07/23/2024] [Indexed: 08/12/2024]
Abstract
BACKGROUND The arousal state has been demonstrated to be involved in the fundamental pathophysiological mechanism of sleep disturbances. Tai chi (TC) and repetitive transcranial magnetic stimulation (rTMS) have been documented to alleviate sleep disturbances by interfering with different arousal components. It is reasonable to assume that combining TC and rTMS could induce synergistic and longer-lasting benefits for sleep disturbances. METHODS Thirty-eight older community-dwelling people were randomly assigned to one of three groups: TC plus rTMS (n = 12), TC alone (n = 13), and treat-as-usual (TAU) (n = 13). The interventions were conducted three times per week for 4 weeks for the two intervention groups. The primary outcome was the insomnia severity, while the secondary outcomes were the actigraphy-assessed sleep patterns, use of hypnotic medications, mood states, and quality of life. The mediator outcomes included self-reported somatic arousal and cognitive arousal as well as electroencephalogram (EEG)-assessed cortical arousal. The assessments were conducted at baseline (T0), post-intervention (T1), and 3-month follow-up (T2). RESULTS Significant improvements in the insomnia severity were observed in the TC plus rTMS group compared with the TAU group at T1 (Cohen's d = 1.62, p = 0.003) and T2 (Cohen's d = 1.97, p < 0.001). In contrast, significant improvements in the TC alone group were found only at T2 (Cohen's d = 1.03, p = 0.010) when compared with the TAU group. Significant interaction effects were noted on the actigraphy-assessed sleep efficiency (p = 0.015) and total sleep time (p = 0.004), depression (p = 0.003) and stress scores (p = 0.002), and mental function in relation to quality of life (p = 0.042). However, none of the mediators elucidated how combining TC and rTMS could improve the insomnia severity. CONCLUSION The research findings are expected to guide further clinical practice in the management of sleep disturbances among older adults using various interventions. Future studies are needed to unravel the underlying mechanism and optimize the protocol to maximize the therapeutic benefits.
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Affiliation(s)
- Jiali He
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Sunny Hw Chan
- Centre for Health and Clinical Research, University of the West of England, United Kingdom
| | - Jingxia Lin
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong; Mental Health Research Centre, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Hector Wh Tsang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong; Mental Health Research Centre, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong.
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2
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Curtis BJ, McKinney TL, Euler M, Anderson JS, Baron KG, Smith TW, Williams PG. Sleepy without stimulation: subjective and objective sleepiness in actigraphy-verified natural short sleepers. J Sleep Res 2024; 33:e14170. [PMID: 38351626 DOI: 10.1111/jsr.14170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 12/28/2023] [Accepted: 01/30/2024] [Indexed: 10/18/2024]
Abstract
Natural short sleepers (NSS)-individuals who report minimal sleepiness or daytime dysfunction despite habitually sleeping less than the recommended amount (i.e., <7 h)-are a focus of growing interest in sleep research. Yet, the predominance of research on NSS has relied on subjective reports of functionality. The present study examined subjective and objective sleepiness among actigraphy-verified NSS in comparison with recommended (7-9 h/day) length sleepers (RLS) who reported similarly minimal daytime dysfunction. The study tested the hypothesis that under conditions of low environmental stimulation, NSS have increased risk of drowsiness and sleep onset, regardless of perceived alertness. The NSS and RLS groups were identified via screening and verified with a 14 day assessment with actigraphy, sleep diaries, and morning ratings of sleep restoration. In-laboratory resting electroencephalography (EEG) data were analysed using a computerised EEG-based algorithm (Vigilance Algorithm Leipzig; VIGALL) to classify second-by-second changes in objective sleepiness ranging from cognitively active alertness to sleep onset. Results demonstrated that NSS exhibited significantly higher drowsiness and sleep onset ('microsleeps') across 15 min of resting EEG despite perceptions of lower subjective sleepiness compared to RLS. Findings suggest that irrespective of perceived sleep restoration and alertness, NSS appear to be at high risk of objective sleepiness that is rapidly unmasked under conditions of low environmental stimulation. Such apparent discrepancy between subjective and objective sleepiness has potentially important public health implications. Future research directions, including tests of mechanisms and tailored sleep extension intervention, are discussed.
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Affiliation(s)
- Brian J Curtis
- Department of Psychology, University of Utah, Salt Lake City, Utah, USA
| | - Ty L McKinney
- Department of Psychology, University of Utah, Salt Lake City, Utah, USA
| | - Matthew Euler
- Department of Psychology, University of Utah, Salt Lake City, Utah, USA
| | - Jeffrey S Anderson
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Kelly G Baron
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Timothy W Smith
- Department of Psychology, University of Utah, Salt Lake City, Utah, USA
| | - Paula G Williams
- Department of Psychology, University of Utah, Salt Lake City, Utah, USA
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3
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Deiber MP, Piguet C, Berchio C, Michel CM, Perroud N, Ros T. Resting-State EEG Microstates and Power Spectrum in Borderline Personality Disorder: A High-Density EEG Study. Brain Topogr 2024; 37:397-409. [PMID: 37776472 PMCID: PMC11026215 DOI: 10.1007/s10548-023-01005-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 08/30/2023] [Indexed: 10/02/2023]
Abstract
Borderline personality disorder (BPD) is a debilitating psychiatric condition characterized by emotional dysregulation, unstable sense of self, and impulsive, potentially self-harming behavior. In order to provide new neurophysiological insights on BPD, we complemented resting-state EEG frequency spectrum analysis with EEG microstates (MS) analysis to capture the spatiotemporal dynamics of large-scale neural networks. High-density EEG was recorded at rest in 16 BPD patients and 16 age-matched neurotypical controls. The relative power spectrum and broadband MS spatiotemporal parameters were compared between groups and their inter-correlations were examined. Compared to controls, BPD patients showed similar global spectral power, but exploratory univariate analyses on single channels indicated reduced relative alpha power and enhanced relative delta power at parietal electrodes. In terms of EEG MS, BPD patients displayed similar MS topographies as controls, indicating comparable neural generators. However, the MS temporal dynamics were significantly altered in BPD patients, who demonstrated opposite prevalence of MS C (lower than controls) and MS E (higher than controls). Interestingly, MS C prevalence correlated positively with global alpha power and negatively with global delta power, while MS E did not correlate with any measures of spectral power. Taken together, these observations suggest that BPD patients exhibit a state of cortical hyperactivation, represented by decreased posterior alpha power, together with an elevated presence of MS E, consistent with symptoms of elevated arousal and/or vigilance. This is the first study to investigate resting-state MS patterns in BPD, with findings of elevated MS E and the suggestion of reduced posterior alpha power indicating a disorder-specific neurophysiological signature previously unreported in a psychiatric population.
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Affiliation(s)
- Marie-Pierre Deiber
- Department of Psychiatry, University Hospitals of Geneva, Chemin du Petit-Bel-Air 2, 1226 Thônex, Geneva, Switzerland.
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
| | - Camille Piguet
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Department of Pediatrics, University Hospitals of Geneva, Geneva, Switzerland
| | - Cristina Berchio
- Department of Pediatrics, University of Geneva, Geneva, Switzerland
| | - Christoph M Michel
- Functional Brain Mapping Laboratory, Department of Fundamental Neuroscience, University of Geneva, Geneva, Switzerland
- Center for Biomedical Imaging, CIBM, Lausanne, Switzerland
| | - Nader Perroud
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Psychiatric Specialties, Department of Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Tomas Ros
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Center for Biomedical Imaging, CIBM, Lausanne, Switzerland
- Department of Neuroscience, University of Geneva, Geneva, Switzerland
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4
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Andrillon T, Taillard J, Strauss M. Sleepiness and the transition from wakefulness to sleep. Neurophysiol Clin 2024; 54:102954. [PMID: 38460284 DOI: 10.1016/j.neucli.2024.102954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 02/02/2024] [Accepted: 02/03/2024] [Indexed: 03/11/2024] Open
Abstract
The transition from wakefulness to sleep is a progressive process that is reflected in the gradual loss of responsiveness, an alteration of cognitive functions, and a drastic shift in brain dynamics. These changes do not occur all at once. The sleep onset period (SOP) refers here to this period of transition between wakefulness and sleep. For example, although transitions of brain activity at sleep onset can occur within seconds in a given brain region, these changes occur at different time points across the brain, resulting in a SOP that can last several minutes. Likewise, the transition to sleep impacts cognitive and behavioral levels in a graded and staged fashion. It is often accompanied and preceded by a sensation of drowsiness and the subjective feeling of a need for sleep, also associated with specific physiological and behavioral signatures. To better characterize fluctuations in vigilance and the SOP, a multidimensional approach is thus warranted. Such a multidimensional approach could mitigate important limitations in the current classification of sleep, leading ultimately to better diagnoses and treatments of individuals with sleep and/or vigilance disorders. These insights could also be translated in real-life settings to either facilitate sleep onset in individuals with sleep difficulties or, on the contrary, prevent or control inappropriate sleep onsets.
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Affiliation(s)
- Thomas Andrillon
- Paris Brain Institute, Sorbonne Université, Inserm-CNRS, Paris 75013, France; Monash Centre for Consciousness & Contemplative Studies, Monash University, Melbourne, VIC 3800, Australia
| | - Jacques Taillard
- Univ. Bordeaux, CNRS, SANPSY, UMR 6033, F-33000 Bordeaux, France
| | - Mélanie Strauss
- Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (H.U.B), CUB Hôpital Érasme, Services de Neurologie, Psychiatrie et Laboratoire du sommeil, Route de Lennik 808 1070 Bruxelles, Belgium; Neuropsychology and Functional Neuroimaging Research Group (UR2NF), Center for Research in Cognition and Neurosciences (CRCN), Université Libre de Bruxelles, B-1050 Brussels, Belgium.
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5
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Rüesch A, Ip CT, Bankwitz A, Villar de Araujo T, Hörmann C, Adank A, Schoretsanitis G, Kleim B, Olbrich S. EEG wakefulness regulation in transdiagnostic patients after a recent suicide attempt. Clin Neurophysiol 2023; 156:272-280. [PMID: 37749014 DOI: 10.1016/j.clinph.2023.08.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 08/11/2023] [Accepted: 08/22/2023] [Indexed: 09/27/2023]
Abstract
OBJECTIVE Decades of research have not yet produced statistically reliable predictors of preparatory behavior eventually leading to suicide attempts or deaths by suicide. As the nature of suicidal behavior is complex, it is best investigated in a transdiagnostic approach, while assessing objective markers, as proposed by the Research Domain Criteria (Cuthbert, 2013). METHODS A 15-min resting-state EEG was recorded in 45 healthy controls, and 49 transdiagnostic in-patients with a recent (<6 months) suicide attempt. Brain arousal regulation in eyes-closed condition was assessed with the Vigilance Algorithm Leipzig (VIGALL) (Sander et al., 2015). RESULTS A significant incline of median vigilance and vigilance slope was observed in patients within the first 3-min of the EEG recording. Additionally, a significant positive correlation of self-reported suicidal ideation with the vigilance slope over 15-min recording time, as well as a significant negative correlation with EEG vigilance stage A1 during the first 3-min was found. CONCLUSIONS Transdiagnostic patients with a recent suicide attempt show a distinct vigilance regulation pattern. Further studies including a control group consisting of patients without life-time suicide attempts are needed to increase the clinical utility of the findings. SIGNIFICANCE These findings might serve as potential objective markers of suicidal behavior.
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Affiliation(s)
- Annia Rüesch
- University of Zurich, Psychiatric University Hospital Zurich, Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich, Switzerland.
| | - Cheng-Teng Ip
- Center for Cognitive and Brain Sciences, University of Macau, Taipa, Macau SAR, China
| | - Anna Bankwitz
- University of Zurich, Psychiatric University Hospital Zurich, Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich, Switzerland
| | - Tania Villar de Araujo
- University of Zurich, Psychiatric University Hospital Zurich, Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich, Switzerland
| | - Christoph Hörmann
- University of Zurich, Psychiatric University Hospital Zurich, Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich, Switzerland
| | - Atalìa Adank
- University of Zurich, Psychiatric University Hospital Zurich, Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich, Switzerland
| | - Georgios Schoretsanitis
- Psychiatric University Hospital Zurich, Zurich, Switzerland; The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, NY, USA; Department of Psychiatry, Zucker School of Medicine at Northwell/Hofstra, Hempstead, NY, USA
| | - Birgit Kleim
- University of Zurich, Psychiatric University Hospital Zurich, Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich, Switzerland; University of Zurich, Institute of Psychology, Experimental Psychopathology and Psychotherapy, Zurich, Switzerland
| | - Sebastian Olbrich
- University of Zurich, Psychiatric University Hospital Zurich, Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich, Switzerland
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6
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Rountree-Harrison D, Berkovsky S, Kangas M. Heart and brain traumatic stress biomarker analysis with and without machine learning: A scoping review. Int J Psychophysiol 2023; 185:27-49. [PMID: 36720392 DOI: 10.1016/j.ijpsycho.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 01/22/2023] [Accepted: 01/25/2023] [Indexed: 01/31/2023]
Abstract
The enigma of post-traumatic stress disorder (PTSD) is embedded in a complex array of physiological responses to stressful situations that result in disruptions in arousal and cognitions that characterise the psychological disorder. Deciphering these physiological patterns is complex, which has seen the use of machine learning (ML) grow in popularity. However, it is unclear to what extent ML has been used with physiological data, specifically, the electroencephalogram (EEG) and electrocardiogram (ECG) to further understand the physiological responses associated with PTSD. To better understand the use of EEG and ECG biomarkers, with and without ML, a scoping review was undertaken. A total of 124 papers based on adult samples were identified comprising 19 ML studies involving EEG and ECG. A further 21 studies using EEG data, and 84 studies employing ECG meeting all other criteria but not employing ML were included for comparison. Identified studies indicate classical ML methodologies currently dominate EEG and ECG biomarkers research, with derived biomarkers holding clinically relevant diagnostic implications for PTSD. Discussion of the emerging trends, algorithms used and their success is provided, along with areas for future research.
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Affiliation(s)
- Darius Rountree-Harrison
- Macquarie University, Balaclava Road, Macquarie Park, New South Wales 2109, Australia; New South Wales Service for the Rehabilitation and Treatment of Torture and Trauma Survivors (STARTTS), 152-168 The Horsley Drive Carramar, New South Wales 2163, Australia.
| | - Shlomo Berkovsky
- Macquarie University, Balaclava Road, Macquarie Park, New South Wales 2109, Australia
| | - Maria Kangas
- Macquarie University, Balaclava Road, Macquarie Park, New South Wales 2109, Australia
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7
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Smit DJA, Andreassen OA, Boomsma DI, Burwell SJ, Chorlian DB, de Geus EJC, Elvsåshagen T, Gordon RL, Harper J, Hegerl U, Hensch T, Iacono WG, Jawinski P, Jönsson EG, Luykx JJ, Magne CL, Malone SM, Medland SE, Meyers JL, Moberget T, Porjesz B, Sander C, Sisodiya SM, Thompson PM, van Beijsterveldt CEM, van Dellen E, Via M, Wright MJ. Large-scale collaboration in ENIGMA-EEG: A perspective on the meta-analytic approach to link neurological and psychiatric liability genes to electrophysiological brain activity. Brain Behav 2021; 11:e02188. [PMID: 34291596 PMCID: PMC8413828 DOI: 10.1002/brb3.2188] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 03/12/2021] [Accepted: 04/30/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND AND PURPOSE The ENIGMA-EEG working group was established to enable large-scale international collaborations among cohorts that investigate the genetics of brain function measured with electroencephalography (EEG). In this perspective, we will discuss why analyzing the genetics of functional brain activity may be crucial for understanding how neurological and psychiatric liability genes affect the brain. METHODS We summarize how we have performed our currently largest genome-wide association study of oscillatory brain activity in EEG recordings by meta-analyzing the results across five participating cohorts, resulting in the first genome-wide significant hits for oscillatory brain function located in/near genes that were previously associated with psychiatric disorders. We describe how we have tackled methodological issues surrounding genetic meta-analysis of EEG features. We discuss the importance of harmonizing EEG signal processing, cleaning, and feature extraction. Finally, we explain our selection of EEG features currently being investigated, including the temporal dynamics of oscillations and the connectivity network based on synchronization of oscillations. RESULTS We present data that show how to perform systematic quality control and evaluate how choices in reference electrode and montage affect individual differences in EEG parameters. CONCLUSION The long list of potential challenges to our large-scale meta-analytic approach requires extensive effort and organization between participating cohorts; however, our perspective shows that these challenges are surmountable. Our perspective argues that elucidating the genetic of EEG oscillatory activity is a worthwhile effort in order to elucidate the pathway from gene to disease liability.
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Affiliation(s)
- Dirk J A Smit
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Ole A Andreassen
- Norwegian Centre for Mental Disorders Research (NORMENT), Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Dorret I Boomsma
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Scott J Burwell
- Department of Psychology, Minnesota Center for Twin and Family Research, University of Minnesota, Minneapolis, MN, USA.,Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
| | - David B Chorlian
- Henri Begleiter Neurodynamics Laboratory, Department of Psychiatry, Downstate Health Sciences University, Brooklyn, NY, USA
| | - Eco J C de Geus
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Torbjørn Elvsåshagen
- Norwegian Centre for Mental Disorders Research (NORMENT), Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Reyna L Gordon
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN, USA.,Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA.,Vanderbilt Brain Institute, Vanderbilt University, Nashville, TN, USA
| | - Jeremy Harper
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
| | - Ulrich Hegerl
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Goethe Universität Frankfurt am Main, Frankfurt, Germany
| | - Tilman Hensch
- Department of Psychiatry and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany.,LIFE - Leipzig Research Center for Civilization Diseases, Universität Leipzig, Leipzig, Germany.,IU International University, Erfurt, Germany
| | - William G Iacono
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Philippe Jawinski
- LIFE - Leipzig Research Center for Civilization Diseases, Universität Leipzig, Leipzig, Germany.,Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Erik G Jönsson
- TOP-Norment, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Clinical Neuroscience, Centre for Psychiatric Research, Karolinska Institutet & Stockholm Health Care Services, Stockholm Region, Stockholm, Sweden
| | - Jurjen J Luykx
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Department of Translational Neuroscience, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Outpatient Second Opinion Clinic, GGNet Mental Health, Apeldoorn, The Netherlands
| | - Cyrille L Magne
- Psychology Department, Middle Tennessee State University, Murfreesboro, TN, USA.,Literacy Studies Ph.D. Program, Middle Tennessee State University, Mufreesboro, TN, USA
| | - Stephen M Malone
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Sarah E Medland
- QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
| | - Jacquelyn L Meyers
- Henri Begleiter Neurodynamics Laboratory, Department of Psychiatry, Downstate Health Sciences University, Brooklyn, NY, USA.,Department of Psychiatry, State University of New York Downstate Health Sciences University, Brooklyn, NY, USA
| | - Torgeir Moberget
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
| | - Bernice Porjesz
- Henri Begleiter Neurodynamics Laboratory, Department of Psychiatry, Downstate Health Sciences University, Brooklyn, NY, USA
| | - Christian Sander
- Department of Psychiatry and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - Sanjay M Sisodiya
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK.,Chalfont Centre for Epilepsy, Chalfont-St-Peter, UK
| | - Paul M Thompson
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | | | - Edwin van Dellen
- Department of Psychiatry, Department of Intensive Care Medicine, Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Marc Via
- Brainlab-Cognitive Neuroscience Research Group, Department of Clinical Psychology and Psychobiology, and Institute of Neurosciences (UBNeuro), Universitat de Barcelona, Barcelona, Spain.,Institut de Recerca Sant Joan de Déu (IRSJD), Esplugues de Llobregat, Spain
| | - Margaret J Wright
- Queensland Brain Institute, University of Queensland, Brisbane, QLD, Australia.,Centre for Advanced Imaging, University of Queensland, Brisbane, QLD, Australia
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Boland C, Jalihal V, Organ C, Oak K, McLean B, Laugharne R, Woldman W, Beck R, Shankar R. EEG Markers in Emotionally Unstable Personality Disorder-A Possible Outcome Measure for Neurofeedback: A Narrative Review. Clin EEG Neurosci 2021; 52:254-273. [PMID: 32635758 DOI: 10.1177/1550059420937948] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Objectives. There is growing evidence for the use of biofeedback (BF) in affective disorders, dissocial personality disorder, and in children with histories of abuse. Electroencephalogram (EEG) markers could be used as neurofeedback in emotionally unstable personality disorder (EUPD) management especially for those at high risk of suicide when emotionally aroused. This narrative review investigates the evidence for EEG markers in EUPD. Methods. PRISMA guidelines were used to conduct a narrative review. A structured search method was developed and implemented in collaboration with an information specialist. Studies were identified via 3 electronic database searches of MEDLINE, Embase, and PsycINFO. A predesigned inclusion/exclusion criterion was applied to selected papers. A thematic analysis approach with 5 criteria was used. Results. From an initial long list of 5250 papers, 229 studies were identified and screened, of which 44 met at least 3 of the predesigned inclusion criteria. No research to date investigates EEG-based neurofeedback in EUPD. A number of different EEG biomarkers are identified but there is poor consistency between studies. Conclusions. The findings heterogeneity may be due to the disorder complexity and the variable EEG related parameters studied. An alternative explanation may be that there are a number of different neuromarkers, which could be clustered together with clinical symptomatology, to give new subdomains. Quantitative EEGs in particular may be helpful to identify more specific abnormalities. EEG standardization of neurofeedback protocols based on specific EEG abnormalities detected may facilitate targeted use of neurofeedback as an intervention in EUPD.
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Affiliation(s)
- Cailín Boland
- Saint James's Hospital, Dublin, Ireland.,8809Trinity College Dublin, Dublin, Ireland
| | | | | | - Katy Oak
- 8028Royal Cornwall Hospitals Trust, Truro, UK
| | | | - Richard Laugharne
- 7491Cornwall Partnership NHS Foundation Trust, Truro, UK.,151756Exeter Medical School, Exeter, UK
| | | | - Randy Beck
- Institute of Functional Neuroscience, Perth, Western Australia, Australia
| | - Rohit Shankar
- 7491Cornwall Partnership NHS Foundation Trust, Truro, UK.,151756Exeter Medical School, Exeter, UK
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9
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Mayeli A, Al Zoubi O, Misaki M, Stewart JL, Zotev V, Luo Q, Phillips R, Fischer S, Götz M, Paulus MP, Refai H, Bodurka J. Integration of Simultaneous Resting-State Electroencephalography, Functional Magnetic Resonance Imaging, and Eye-Tracker Methods to Determine and Verify Electroencephalography Vigilance Measure. Brain Connect 2020; 10:535-546. [PMID: 33112650 DOI: 10.1089/brain.2019.0731] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background/Introduction: Concurrent electroencephalography and resting-state functional magnetic resonance imaging (rsfMRI) have been widely used for studying the (presumably) awake and alert human brain with high temporal/spatial resolution. Although rsfMRI scans are typically collected while individuals are instructed to focus their eyes on a fixated cross, objective and verified experimental measures to quantify degree of vigilance are not readily available. Electroencephalography (EEG) is the modality extensively used for estimating vigilance, especially during eyes-closed resting state. However, pupil size measured using an eye-tracker device could provide an indirect index of vigilance. Methods: Three 12-min resting scans (eyes open, fixating on the cross) were collected from 10 healthy control participants. We simultaneously collected EEG, fMRI, physiological, and eye-tracker data and investigated the correlation between EEG features, pupil size, and heart rate. Furthermore, we used pupil size and EEG features as regressors to find their correlations with blood-oxygen-level-dependent fMRI measures. Results: EEG frontal and occipital beta power (FOBP) correlates with pupil size changes, an indirect index for locus coeruleus activity implicated in vigilance regulation (r = 0.306, p < 0.001). Moreover, FOBP also correlated with heart rate (r = 0.255, p < 0.001), as well as several brain regions in the anticorrelated network, including the bilateral insula and inferior parietal lobule. Discussion: In this study, we investigated whether simultaneous EEG-fMRI combined with eye-tracker measurements can be used to determine EEG signal feature associated with vigilance measures during eyes-open rsfMRI. Our results support the conclusion that FOBP is an objective measure of vigilance in healthy human subjects. Impact statement We revealed an association between electroencephalography frontal and occipital beta power (FOBP) and pupil size changes during an eyes-open resting state, which supports the conclusion that FOBP could serve as an objective measure of vigilance in healthy human subjects. The results were validated by using simultaneously recorded heart rate and functional magnetic resonance imaging (fMRI). Interestingly, independently verified heart rate changes can also provide an easy-to-determine measure of vigilance during resting-state fMRI. These findings have important implications for an analysis and interpretation of dynamic resting-state fMRI connectivity studies in health and disease.
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Affiliation(s)
- Ahmad Mayeli
- Laureate Institute for Brain Research, Tulsa, Oklahoma, USA.,School of Electrical and Computer Engineering, University of Oklahoma, Tulsa, Oklahoma, USA
| | - Obada Al Zoubi
- Laureate Institute for Brain Research, Tulsa, Oklahoma, USA.,School of Electrical and Computer Engineering, University of Oklahoma, Tulsa, Oklahoma, USA
| | - Masaya Misaki
- Laureate Institute for Brain Research, Tulsa, Oklahoma, USA
| | | | - Vadim Zotev
- Laureate Institute for Brain Research, Tulsa, Oklahoma, USA
| | - Qingfei Luo
- Laureate Institute for Brain Research, Tulsa, Oklahoma, USA
| | | | | | | | | | - Hazem Refai
- School of Electrical and Computer Engineering, University of Oklahoma, Tulsa, Oklahoma, USA
| | - Jerzy Bodurka
- Laureate Institute for Brain Research, Tulsa, Oklahoma, USA.,Stephenson School of Biomedical Engineering, University of Oklahoma, Tulsa, Oklahoma, USA
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Arikan MK, Metin B, Günver MG, Tarhan N. Borderline Personality and Bipolar Disorders Cannot Be Differentiated Electrophysiologically. Clin EEG Neurosci 2019; 50:383-388. [PMID: 31282204 DOI: 10.1177/1550059419860028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives. Certain studies have claimed that borderline personality disorder (BPD) could be evaluated as a subtype of bipolar disorder (BD), whereas others have argued that BPD should be regarded as an independent disorder because of its distinct clinical features. The aim of this study was to investigate if there was a difference between these 2 disorders biologically based on EEG recordings. Methods. A total of 111 subjects (11 healthy, 25 BPD, 75 BD) who had resting EEG recordings were included. The EEGs were analyzed to compute absolute power values. Results. One-way analysis of variance results revealed statistically significant differences among the 3 groups on 55 out of 229 EEG variables. However, post hoc analysis indicated that all of the significant changes were between healthy and patient groups and no significant differences were found between 2 clinical groups. Conclusion. The findings suggested that these 2 clinical entities are biologically similar; however, further research should be performed to explain the basis clinical differences between the 2 disorders.
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Affiliation(s)
- Mehmet Kemal Arikan
- 1 Department of Psychology, Uskudar University, Istanbul, Turkey.,2 Kemal Arikan Clinic of Psychiatry, Istanbul, Turkey
| | - Barış Metin
- 1 Department of Psychology, Uskudar University, Istanbul, Turkey
| | - Mehmet Güven Günver
- 3 Channel Management Department Halk Hayat ve Emeklilik A. Ş., Istanbul, Turkey
| | - Nevzat Tarhan
- 1 Department of Psychology, Uskudar University, Istanbul, Turkey
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11
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Combined cognitive, psychomotor and electrophysiological biomarkers in major depressive disorder. Eur Arch Psychiatry Clin Neurosci 2019; 269:823-832. [PMID: 30392042 DOI: 10.1007/s00406-018-0952-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 10/24/2018] [Indexed: 12/14/2022]
Abstract
The diagnosis of major depressive disorder (MDD) should be based on multimodal evidence, because MDD not only affects mood, but also psychomotor and cognitive functions. Clinical markers such as executive dysfunctions and a reduction in daily motor activity have been observed in MDD. Neurophysiological biomarkers have also been described. In this study, we investigate the utility of combining biomarkers related to executive dysfunctions, motor activity, neurophysiological patterns (i.e. alpha power asymmetry and EEG-vigilance as indicators of brain arousal), and the interaction of these parameters in the diagnosis of MDD. Twenty (female: 11) patients with MDD (age: 51.05 ± 10.50) and 20 (female: 13) healthy controls (HC; age: 47.15 ± 12.57) underwent a 10-min resting EEG. Executive dysfunctions were assessed using the Trail Making Test B (TMT B). Motor activity was analysed by actigraphy measurements. MDD patients displayed significant impairments in executive functions and reduced daily motor activity. In the EEG, MDD patients showed more right than left frontal activity and lower brain arousal relative to HC. TMT B and asymmetrical frontal alpha power alone discriminated between MDD patients and HC with an accuracy of 78%. The interaction of motor activity and the EEG-vigilance stage alongside TMT B increased the accuracy of the discrimination test to 81%. This improved accuracy suggests that the combination of these biomarkers in a discriminant analysis resulted in a more reliable identification of MDD patients.
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12
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Kramer L, Sander C, Bertsch K, Gescher DM, Cackowski S, Hegerl U, Herpertz SC. EEG-vigilance regulation in Borderline Personality Disorder. Int J Psychophysiol 2019; 139:10-17. [PMID: 30796933 DOI: 10.1016/j.ijpsycho.2019.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 12/05/2018] [Accepted: 02/15/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Borderline Personality Disorder (BPD) is characterized by emotional instability, impulsivity, disturbed cognition, sleeplessness and states of high inner tension. Altered arousal regulation which is regarded as a higher domain of functioning according to the research domain criteria of the NIMH and which has previously been reported in several psychiatric disorders, such as mania or major depression could be involved in these features of BPD. METHODS 40 unmedicated patients with BPD and 42 matched healthy volunteers participated in a twenty minute resting-state EEG measurement with closed eyes. EEG-vigilance regulation was assessed with VIGALL2.0 (Vigilance Algorithm Leipzig), which allows a classification of consecutive 1-s segments in different vigilance stages ranging from high alertness/relaxed wakefulness (stages 0, A1, A2, A3) to drowsiness (B1, B2/3) and sleep onset (C). RESULTS Across 20 min, both groups showed a similar decline from higher to lower vigilance stages, but patients with BPD remained in higher stages of vigilance compared to healthy volunteers across the whole measurement (p = .013). Contrary to this, pre-experimental ratings indicated enhanced subjective sleepiness but no differences in self-reported sleep quantity in the previous night in patients with BPD compared to healthy volunteers. CONCLUSIONS The results of an elevated arousal regulation (in combination with increased subjective sleepiness) might reflect several symptoms, such as aversive inner tension and impoverished sense of self in patients with BPD. As arousal is linked to the noradrenergic system, further investigations in this field seem to be promising.
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Affiliation(s)
- Lucas Kramer
- Department of General Psychiatry, Center of Psychosocial Medicine, University of Heidelberg, Germany.
| | - Christian Sander
- Department of Psychiatry and Psychotherapy, University of Leipzig, Germany
| | - Katja Bertsch
- Department of General Psychiatry, Center of Psychosocial Medicine, University of Heidelberg, Germany
| | - Dorothee Maria Gescher
- Department of General Psychiatry, Center of Psychosocial Medicine, University of Heidelberg, Germany
| | - Sylvia Cackowski
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany
| | - Ulrich Hegerl
- Department of Psychiatry and Psychotherapy, University of Leipzig, Germany
| | - Sabine C Herpertz
- Department of General Psychiatry, Center of Psychosocial Medicine, University of Heidelberg, Germany
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13
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Objective assessment of the degree of improvement or deterioration with patients by means of Ipsative Trend Analysis of resting electroencephalograms. Med Hypotheses 2018. [PMID: 29523287 DOI: 10.1016/j.mehy.2018.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
We report on a new quantitative EEG-approach, called Ipsative Trend Assessment which is based on the spatio-temporally defined patterns which are generated by the global interaction of cortical neurons. METHODS The data were acquired from EEGs being recorded under resting conditions. Target variables are not the usually employed absolute values of the spectral parameters but rather their change being calculated from successive recordings with a single subjects design. RATIONALE Since the resting-EEG does not provide specific information, we had to decide what else might be addressed by that method. CONCLUSIONS Our hypothesis according to which the SR-EEG indicates Selye's behaviorally non-specific General Adaptation Syndrome is based on good evidence. MAIN FINDINGS Dynamic pattern comparison between subsequent EEGs on the single case level is a hitherto neglected method, which may be utilize, for instance, with regard to objective therapeutic outcome assessment. SIGNIFICANCE In order to substantiate the clinical meaningfulness of our new approach we report two case vignettes of psychiatric impairments. Apart from that, our procedure should provide the desperately needed objective assessment of the therapeutic effect with any disease displaying a certain proportion of unspecific symptoms.
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14
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Geissmann L, Gschwind L, Schicktanz N, Deuring G, Rosburg T, Schwegler K, Gerhards C, Milnik A, Pflueger MO, Mager R, de Quervain DJF, Coynel D. Resting-state functional connectivity remains unaffected by preceding exposure to aversive visual stimuli. Neuroimage 2017; 167:354-365. [PMID: 29175611 DOI: 10.1016/j.neuroimage.2017.11.046] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 11/06/2017] [Accepted: 11/21/2017] [Indexed: 01/07/2023] Open
Abstract
While much is known about immediate brain activity changes induced by the confrontation with emotional stimuli, the subsequent temporal unfolding of emotions has yet to be explored. To investigate whether exposure to emotionally aversive pictures affects subsequent resting-state networks differently from exposure to neutral pictures, a resting-state fMRI study implementing a two-group repeated-measures design in healthy young adults (N = 34) was conducted. We focused on investigating (i) patterns of amygdala whole-brain and hippocampus connectivity in both a seed-to-voxel and seed-to-seed approach, (ii) whole-brain resting-state networks with an independent component analysis coupled with dual regression, and (iii) the amygdala's fractional amplitude of low frequency fluctuations, all while EEG recording potential fluctuations in vigilance. In spite of the successful emotion induction, as demonstrated by stimuli rating and a memory-facilitating effect of negative emotionality, none of the resting-state measures was differentially affected by picture valence. In conclusion, resting-state networks connectivity as well as the amygdala's low frequency oscillations appear to be unaffected by preceding exposure to widely used emotionally aversive visual stimuli in healthy young adults.
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Affiliation(s)
- Léonie Geissmann
- Division of Cognitive Neuroscience, Department of Psychology, University of Basel, Birmannsgasse 8, 4055 Basel, Switzerland; Transfaculty Research Platform Molecular and Cognitive Neurosciences (MCN), University of Basel, Birmannsgasse 8, 4055 Basel, Switzerland.
| | - Leo Gschwind
- Division of Cognitive Neuroscience, Department of Psychology, University of Basel, Birmannsgasse 8, 4055 Basel, Switzerland; Transfaculty Research Platform Molecular and Cognitive Neurosciences (MCN), University of Basel, Birmannsgasse 8, 4055 Basel, Switzerland; Division of Molecular Neuroscience, Department of Psychology, University of Basel, Birmannsgasse 8, 4055 Basel, Switzerland
| | - Nathalie Schicktanz
- Division of Cognitive Neuroscience, Department of Psychology, University of Basel, Birmannsgasse 8, 4055 Basel, Switzerland; Transfaculty Research Platform Molecular and Cognitive Neurosciences (MCN), University of Basel, Birmannsgasse 8, 4055 Basel, Switzerland
| | - Gunnar Deuring
- Department of Forensic Psychiatry, University Psychiatric Clinics Basel, Wilhelm Klein-Strasse 27, 4002 Basel, Switzerland
| | - Timm Rosburg
- Department of Forensic Psychiatry, University Psychiatric Clinics Basel, Wilhelm Klein-Strasse 27, 4002 Basel, Switzerland
| | - Kyrill Schwegler
- Division of Cognitive Neuroscience, Department of Psychology, University of Basel, Birmannsgasse 8, 4055 Basel, Switzerland; Transfaculty Research Platform Molecular and Cognitive Neurosciences (MCN), University of Basel, Birmannsgasse 8, 4055 Basel, Switzerland; Psychiatric University Clinics, University of Basel, 4055 Basel, Switzerland
| | - Christiane Gerhards
- Division of Cognitive Neuroscience, Department of Psychology, University of Basel, Birmannsgasse 8, 4055 Basel, Switzerland; Transfaculty Research Platform Molecular and Cognitive Neurosciences (MCN), University of Basel, Birmannsgasse 8, 4055 Basel, Switzerland
| | - Annette Milnik
- Transfaculty Research Platform Molecular and Cognitive Neurosciences (MCN), University of Basel, Birmannsgasse 8, 4055 Basel, Switzerland; Division of Molecular Neuroscience, Department of Psychology, University of Basel, Birmannsgasse 8, 4055 Basel, Switzerland; Psychiatric University Clinics, University of Basel, 4055 Basel, Switzerland
| | - Marlon O Pflueger
- Department of Forensic Psychiatry, University Psychiatric Clinics Basel, Wilhelm Klein-Strasse 27, 4002 Basel, Switzerland
| | - Ralph Mager
- Department of Forensic Psychiatry, University Psychiatric Clinics Basel, Wilhelm Klein-Strasse 27, 4002 Basel, Switzerland
| | - Dominique J F de Quervain
- Division of Cognitive Neuroscience, Department of Psychology, University of Basel, Birmannsgasse 8, 4055 Basel, Switzerland; Transfaculty Research Platform Molecular and Cognitive Neurosciences (MCN), University of Basel, Birmannsgasse 8, 4055 Basel, Switzerland; Psychiatric University Clinics, University of Basel, 4055 Basel, Switzerland
| | - David Coynel
- Division of Cognitive Neuroscience, Department of Psychology, University of Basel, Birmannsgasse 8, 4055 Basel, Switzerland; Transfaculty Research Platform Molecular and Cognitive Neurosciences (MCN), University of Basel, Birmannsgasse 8, 4055 Basel, Switzerland
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15
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Sander C, Hensch T, Wittekind DA, Böttger D, Hegerl U. Assessment of Wakefulness and Brain Arousal Regulation in Psychiatric Research. Neuropsychobiology 2016; 72:195-205. [PMID: 26901462 DOI: 10.1159/000439384] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 08/11/2015] [Indexed: 11/19/2022]
Abstract
During the last few decades, much knowledge has been gained about sleep being a heterogeneous condition with several distinct sleep stages that represent fundamentally different physiological states. The same applies for the wake state which also comprises distinct global functional states (called vigilance stages). However, various terms and concepts have been introduced describing different aspects of wakefulness, and accordingly several methods of assessment exist, e.g. sleep laboratory assessments (Multiple Sleep Latency Test, Maintenance of Wakefulness Test), questionnaires (Epworth Sleepiness Scale, Karolinska Sleepiness Scale), behavioural tasks (Psychomotor Vigilance Test) or electroencephalography (EEG)-based assessments (Alpha Attenuation Test, Karolinska Drowsiness Test). Furthermore, several theoretical concepts about the regulation of sleep and wakefulness have been put forward, and physiological correlates have been identified. Most relevant for healthy functioning is the regulation of brain arousal and the adaption of wakefulness to the environmental and situational needs so that the optimal balance between energy conservation and responsiveness can be obtained. Since one approach to the assessment of brain arousal regulation is the classification of EEG vigilance stages, a computer-based algorithm (Vigilance Algorithm Leipzig) has been introduced, allowing classification of EEG vigilance stages in EEG recordings under resting conditions. The time course of EEG vigilance stages in EEGs of 15-20 min duration allows estimation of the individual arousal regulation (hyperstable, adaptive, or unstable vigilance pattern). The vigilance model of affective disorders and attention-deficit/hyperactivity disorder links a disturbed arousal regulation to the pathogenesis of psychiatric disorders and accordingly helps to explain and possibly also predict treatment effects of pharmacological and non-pharmacological interventions for these conditions.
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16
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Andreou C, Nolte G, Leicht G, Polomac N, Hanganu-Opatz IL, Lambert M, Engel AK, Mulert C. Increased Resting-State Gamma-Band Connectivity in First-Episode Schizophrenia. Schizophr Bull 2015; 41:930-9. [PMID: 25170031 PMCID: PMC4466170 DOI: 10.1093/schbul/sbu121] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Schizophrenia has long been suggested to represent a disorder with prominent neural dysconnectivity. Gamma-band oscillations are highly relevant in this context, due both to their proposed involvement in neuronal synchronization and to their association with neurotransmitter systems relevant for schizophrenia. Several task-related studies have confirmed reduced power and synchronization of gamma-band oscillations in schizophrenia, but it has been suggested that these findings might not apply to the resting state. The present study aimed to investigate resting-state gamma-band connectivity in patients with schizophrenia. METHODS Sixty-four channel resting-state electroencephalography (eyes closed) was recorded in 22 patients with first-episode schizophrenia and 22 healthy controls matched for age and gender. Orthogonalized power envelope correlation was used as a measure of connectivity across 80 cortical regions at 40 Hz. Mean connectivity at each region was compared across groups using the nonparametric randomization approach. Additionally, the network-based statistic was applied to identify affected networks in patients. RESULTS Patients displayed increased mean functional gamma-band connectivity compared to controls in the left rolandic operculum. Network-based analyses indicated increased connectivity in patients within a strongly lateralized network consisting mainly of left inferior frontal/orbitofrontal, lateral and medial temporal, and inferior parietal areas. Within this network, gamma-band connectivity was higher in patients with low positive and disorganization symptom levels. CONCLUSIONS The present study provides a link between resting-state gamma-band connectivity and the core symptoms of schizophrenia. The observed findings are different than those reported by task-related studies, suggesting that resting-state studies might reveal new aspects in the pathophysiology of schizophrenia.
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Affiliation(s)
- Christina Andreou
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany;
| | - Guido Nolte
- Department of Neurophysiology and Pathophysiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gregor Leicht
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nenad Polomac
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ileana L. Hanganu-Opatz
- Developmental Neurophysiology, Institute of Neuroanatomy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Lambert
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andreas K. Engel
- Department of Neurophysiology and Pathophysiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Mulert
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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17
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Perugi G, Quaranta G, Bucci N. The use of agomelatine in OCD: effects on the motivational aspects and dysregulated circadian rhythms. Expert Opin Investig Drugs 2015; 24:705-13. [DOI: 10.1517/13543784.2015.1021918] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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18
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Andreou C, Leicht G, Nolte G, Polomac N, Moritz S, Karow A, Hanganu-Opatz IL, Engel AK, Mulert C. Resting-state theta-band connectivity and verbal memory in schizophrenia and in the high-risk state. Schizophr Res 2015; 161:299-307. [PMID: 25553979 DOI: 10.1016/j.schres.2014.12.018] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 12/08/2014] [Accepted: 12/10/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Disturbed functional connectivity is assumed to underlie neurocognitive deficits in patients with schizophrenia. As neurocognitive deficits are already present in the high-risk state, identification of the neural networks involved in this core feature of schizophrenia is essential to our understanding of the disorder. Resting-state studies enable such investigations, while at the same time avoiding the known confounder of impaired task performance in patients. The aim of the present study was to investigate EEG resting-state connectivity in high-risk individuals (HR) compared to first episode patients with schizophrenia (SZ) and to healthy controls (HC), and its association with cognitive deficits. METHODS 64-channel resting-state EEG recordings (eyes closed) were obtained for 28 HR, 19 stable SZ, and 23 HC, matched for age, education, and parental education. The imaginary coherence-based multivariate interaction measure (MIM) was used as a measure of connectivity across 80 cortical regions and six frequency bands. Mean connectivity at each region was compared across groups using the non-parametric randomization approach. Additionally, the network-based statistic was applied to identify affected networks in patients. RESULTS SZ displayed increased theta-band resting-state MIM connectivity across midline, sensorimotor, orbitofrontal regions and the left temporoparietal junction. HR displayed intermediate theta-band connectivity patterns that did not differ from either SZ or HC. Mean theta-band connectivity within the above network partially mediated verbal memory deficits in SZ and HR. CONCLUSIONS Aberrant theta-band connectivity may represent a trait characteristic of schizophrenia associated with neurocognitive deficits. As such, it might constitute a promising target for novel treatment applications.
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Affiliation(s)
- Christina Andreou
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Gregor Leicht
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Guido Nolte
- Department of Neurophysiology and Pathophysiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nenad Polomac
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Karow
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ileana L Hanganu-Opatz
- Developmental Neurophysiology, Institute of Neuroanatomy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andreas K Engel
- Department of Neurophysiology and Pathophysiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Mulert
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Hasler G, Hopwood CJ, Jacob GA, Brändle LS, Schulte-Vels T. Patient-reported outcomes in borderline personality disorder. DIALOGUES IN CLINICAL NEUROSCIENCE 2014. [PMID: 25152662 PMCID: PMC4140517 DOI: 10.31887/dcns.2014.16.2/ghasler] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Patient-reported outcome (PRO) refers to measures that emphasize the subjective view of patients about their health-related conditions and behaviors. Typically, PROs include self-report questionnaires and clinical interviews. Defining PROs for borderline personality disorder (BPD) is particularly challenging given the disorder's high symptomatic heterogeneity, high comorbidity with other psychiatric conditions, highly fluctuating symptoms, weak correlations between symptoms and functional outcomes, and lack of valid and reliable experimental measures to complement self-report data. Here, we provide an overview of currently used BPD outcome measures and discuss them from clinical, psychometric, experimental, and patient perspectives. In addition, we review the most promising leads to improve BPD PROs, including the DSM-5 Section III, the Recovery Approach, Ecological Momentary Assessments, and novel experimental measures of social functioning that are associated with functional and social outcomes.
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Affiliation(s)
- Gregor Hasler
- Psychiatric University Hospital, University of Bern, Bern, Switzerland
| | | | | | - Laura S Brändle
- Psychiatric University Hospital, University of Bern, Bern, Switzerland
| | - Thomas Schulte-Vels
- Department of Psychiatry and Psychotherapy, University Hospital, Zurich, Switzerland
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20
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Stone MH. The spectrum of borderline personality disorder: a neurophysiological view. Curr Top Behav Neurosci 2014; 21:23-46. [PMID: 24850076 DOI: 10.1007/7854_2014_308] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Borderline Personality Disorder (BPD) has been defined as a personality disorder in all editions of DSM since 1980; namely, DSM III through V. The criteria are a mixture of symptoms and traits; the etiology, a heterogeneous array of genetic, constitutional, and environmental factors. Until recently the diagnosis relied on clinical descriptions. In the last two decades, neurophysiological data, including MRI and fMRI, have established correlates in various brain regions, particularly those involving the frontal lobes and various limbic structures, that show promise of providing a more substantial basis for diagnosis-relying primarily on (internal) brain changes, rather than on (external) clinical observation. Some of the changes in BPD consist of decreased volume in the orbitofrontal and dorsolateral prefrontal cortices and smaller volume in both the amygdala and hippocampus, though with heightened reactivity in the amygdala. Similar abnormalities have been noted in bipolar disorders (BDs) and in ADHD, both of which often accompany BPD and share certain clinical features. Persons with strong genetic predisposition to BDs can develop BPD even in the absence of adverse environmental factors; those with extreme adverse environmental factors (chiefly, early sexual molestation) can develop BPD in the absence of bipolar vulnerability. In some BPD patients, both sets of factors are present. As ideal treatment depends on careful analysis of these factors, neurophysiological testing may permit both more rational, brain-based diagnostic decisions and more appropriate therapeutic strategies.
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Affiliation(s)
- Michael H Stone
- Professor of Clinical Psychiatry, Columbia College of Physicians and Surgeons, 225 Central Park West, New York, NY, 10024, USA,
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21
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Gruberger M, Maron-Katz A, Sharon H, Hendler T, Ben-Simon E. The wandering mood: psychological and neural determinants of rest-related negative affect. Front Psychol 2013; 4:961. [PMID: 24421771 PMCID: PMC3872732 DOI: 10.3389/fpsyg.2013.00961] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Accepted: 12/06/2013] [Indexed: 11/25/2022] Open
Abstract
Rest related negative affect (RRNA) has gained scientific interest in the past decade. However, it is mostly studied within the context of mind-wandering (MW), and the relevance of other psychological and neural aspects of the resting state to its’ occurrence has never been studied. Several indications associate RRNA with internally directed attention, yet the nature of this relation remains largely unknown. Moreover, the role of neural networks associated with rest related phenomenology – the default mode (DMN), executive (EXE), and salience (SAL) networks, has not been studied in this context. To this end, we explored two 5 (baseline) and 15-minute resting-state simultaneous fMRI-EEG scans of 29 participants. As vigilance has been shown to affect attention, and thus its availability for inward allocation, EEG-based vigilance levels were computed for each participant. Questionnaires for affective assessment were administered before and after scans, and retrospective reports of MW were additionally collected. Results revealed increased negative affect following rest, but only among participants who retained high vigilance levels. Among low-vigilance participants, changes in negative affect were negligible, despite reports of MW occurrence in both groups. In addition, in the high-vigilance group only, a significant increase in functional connectivity (FC) levels was found between the DMN-related ventral anterior cingulate cortex (ACC), associated with emotional processing, and the EXE-related dorsal ACC, associated with monitoring of self and other’s behavior. These heightened FC levels further correlated with reported negative affect among this group. Taken together, these results demonstrate that, rather than an unavoidable outcome of the resting state, RRNA depends on internal allocation of attention at rest. Results are discussed in terms of two rest-related possible scenarios which defer in mental and neural processing, and subsequently, in the occurrence of RRNA.
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Affiliation(s)
- Michal Gruberger
- Functional Brain Center, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel Aviv University Tel Aviv, Israel ; School of Psychological Sciences, Tel Aviv University Tel Aviv, Israel
| | - Adi Maron-Katz
- Functional Brain Center, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel Aviv University Tel Aviv, Israel ; Sackler Faculty of Medicine, Tel Aviv University Tel Aviv, Israel
| | - Haggai Sharon
- Functional Brain Center, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel Aviv University Tel Aviv, Israel ; Sackler Faculty of Medicine, Tel Aviv University Tel Aviv, Israel
| | - Talma Hendler
- Functional Brain Center, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel Aviv University Tel Aviv, Israel ; School of Psychological Sciences, Tel Aviv University Tel Aviv, Israel ; Sackler Faculty of Medicine, Tel Aviv University Tel Aviv, Israel
| | - Eti Ben-Simon
- Functional Brain Center, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel Aviv University Tel Aviv, Israel ; Sackler Faculty of Medicine, Tel Aviv University Tel Aviv, Israel
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Courtney-Seidler EA, Klein D, Miller AL. Borderline personality disorder in adolescents. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2013. [DOI: 10.1111/cpsp.12051] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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23
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Schubert JR, Coles ME. Obsessive-compulsive symptoms and characteristics in individuals with delayed sleep phase disorder. J Nerv Ment Dis 2013; 201:877-84. [PMID: 24080675 DOI: 10.1097/nmd.0b013e3182a5eb13] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Research has demonstrated a relationship between circadian disruption and severe obsessive-compulsive disorder (OCD). Misalignment of sleep timing/endogenous biological rhythms with the 24-hour light/dark cycle may result in difficulty dismissing intrusive thoughts, thus increasing vulnerability to disorders characterized by intrusive thoughts, such as OCD. Deficits in inhibition of intrusive thoughts are posited to play a role in OCD. The current study investigated whether individuals with delayed sleep phase disorder (DSPD) report elevated symptoms of OCD and have greater difficulty inhibiting intrusive thoughts than do individuals without DSPD. Community participants with and without DSPD completed questionnaires and performed behavioral tasks designed to elicit intrusive thoughts. The participants with DSPD (n = 27) had elevated OCD symptoms and greater rates of disorders characterized by intrusive thoughts on a structured interview, as compared with the participants without DSPD (n = 19). These results support a link between the timing of sleep and symptoms of OCD. Implications and future directions are discussed.
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Olbrich S, Olbrich H, Adamaszek M, Jahn I, Hegerl U, Stengler K. Altered EEG lagged coherence during rest in obsessive-compulsive disorder. Clin Neurophysiol 2013; 124:2421-30. [PMID: 23968842 DOI: 10.1016/j.clinph.2013.05.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 05/01/2013] [Accepted: 05/17/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Functional magnetic resonance imaging (fMRI) studies found alterations of functional connectivity in obsessive compulsive disorder (OCD). However, there is little knowledge about region of interest (ROI) based electroencephalogram (EEG) connectivity, i.e. lagged non-linear and linear coherence in OCD. Goal of this study was to compare these EEG measures during rest and at different vigilance stages between patients and healthy controls (HC). METHODS A 15 min resting-state EEG was recorded in 30 unmedicated patients and 30 matched HC. Intracortical lagged non-linear coherence of the main EEG-frequency bands within a set of frontal ROIs and within the default mode network (DMN) were computed and compared using intracortical exact low resolution electromagnetic tomography (eLORETA) software. RESULTS Lagged non-linear but not linear coherence was significantly decreased for patients in comparison to HC for the beta 2 frequency between frontal brain areas but not within the DMN. When analysing separate EEG-vigilance stages, only high vigilance stages yielded decreased frontal phase synchronisation at beta and theta frequencies. CONCLUSIONS The results underline an altered neuronal communication within frontal brain areas during rest in OCD. SIGNIFICANCE These findings encourage further research on connectivity measures as possible biomarkers for physiological homogeneous subgroups.
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Affiliation(s)
- Sebastian Olbrich
- Clinic for Psychiatry and Psychotherapy, University Hospital Leipzig, Germany; LIFE - Leipzig Research Centre for Civilization Diseases, University of Leipzig, Germany.
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Buzsáki G, Watson BO. Brain rhythms and neural syntax: implications for efficient coding of cognitive content and neuropsychiatric disease. DIALOGUES IN CLINICAL NEUROSCIENCE 2013. [PMID: 23393413 PMCID: PMC3553572 DOI: 10.31887/dcns.2012.14.4/gbuzsaki] [Citation(s) in RCA: 304] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The perpetual activity of the cerebral cortex is largely supported by the variety of oscillations the brain generates, spanning a number of frequencies and anatomical locations, as well as behavioral correlates. First, we review findings from animal studies showing that most forms of brain rhythms are inhibition-based, producing rhythmic volleys of inhibitory inputs to principal cell populations, thereby providing alternating temporal windows of relatively reduced and enhanced excitability in neuronal networks. These inhibition-based mechanisms offer natural temporal frames to group or "chunk" neuronal activity into cell assemblies and sequences of assemblies, with more complex multi-oscillation interactions creating syntactical rules for the effective exchange of information among cortical networks. We then review recent studies in human psychiatric patients demonstrating a variety alterations in neural oscillations across all major psychiatric diseases, and suggest possible future research directions and treatment approaches based on the fundamental properties of brain rhythms.
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Affiliation(s)
- György Buzsáki
- NYU Neuroscience Institute, School of Medicine, New York University, New York, NY 10016, USA.
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EEG-vigilance regulation during the resting state in obsessive–compulsive disorder. Clin Neurophysiol 2013; 124:497-502. [DOI: 10.1016/j.clinph.2012.08.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Revised: 08/28/2012] [Accepted: 08/30/2012] [Indexed: 11/20/2022]
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Hegerl U, Hensch T. The vigilance regulation model of affective disorders and ADHD. Neurosci Biobehav Rev 2012; 44:45-57. [PMID: 23092655 DOI: 10.1016/j.neubiorev.2012.10.008] [Citation(s) in RCA: 135] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Revised: 10/09/2012] [Accepted: 10/15/2012] [Indexed: 10/27/2022]
Abstract
According to the recently proposed vigilance model of affective disorders (vigilance in the sense of "brain arousal"), manic behaviour is partly interpreted as an autoregulatory attempt to stabilise vigilance by creating a stimulating environment, and the sensation avoidance and withdrawal in Major Depressive Disorder (MDD) is seen as an autoregulatory reaction to tonically increased vigilance. Indeed, using a newly developed EEG-based algorithm, hyperstable vigilance was found in MDD, and the contrary, with rapid drops to sleep stages, in mania. Furthermore, destabilising vigilance (e.g. by sleep deprivation) triggers (hypo)mania and improves depression, whereas stabilising vigilance, e.g. by prolonged sleep, improves mania. ADHD and mania have common symptoms, and the unstable vigilance might be a common pathophysiology. There is even evidence that psychostimulants might ameliorate both ADHD and mania. Hyperactivity of the noradrenergic system could explain both the high vigilance level in MDD and, as recently argued, anhedonia and behavioural inhibition. Interestingly, antidepressants and electroconvulsions decrease the firing rate of neurons in the noradrenergic locus coeruleus, whereas many antimanic drugs have opposite effects.
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Key Words
- Vigilance regulation, Arousal, EEG, Autoregulatory behaviour, Sensation seeking, Novelty seeking, Mania, ADHD, Bipolar disorder, Depression, Noradrenergic system, Norepinephrine, Locus coeruleus, Anti-manic drugs, Antidepressants
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Affiliation(s)
- Ulrich Hegerl
- Department of Psychiatry and Psychotherapy, University of Leipzig, Semmelweisstr. 10, 04103, Leipzig, Germany.
| | - Tilman Hensch
- Department of Psychiatry and Psychotherapy, University of Leipzig, Semmelweisstr. 10, 04103, Leipzig, Germany
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Minkwitz J, Trenner MU, Sander C, Olbrich S, Sheldrick AJ, Hegerl U, Himmerich H. Time perception at different EEG-vigilance levels. Behav Brain Funct 2012; 8:50. [PMID: 22998925 PMCID: PMC3506441 DOI: 10.1186/1744-9081-8-50] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Accepted: 07/27/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Human time perception is influenced by various factors such as attention and drowsiness. Nevertheless, the impact of cerebral vigilance fluctuations on temporal perception has not been sufficiently explored. We assumed that the state of vigilance ascertained by electroencephalography (EEG) during the perception of a given auditory rhythm would influence its reproduction. Thus, we hypothesised that the re-tapping interval length and the accuracy of reproduction performance would vary depending on the state of vigilance determined by EEG. METHODS 12 female and 9 male subjects ranging from 21 to 38 years (M = 25.52, SD = 3.75) participated in a test paradigm comprising a) a resting EEG for the determination of vigilance while an auditory rhythm was presented, b) a short activity of the proband to be sure of sufficient alertness, and c) a tapping task to reproduce the presented rhythm. Vigilance states of three consecutive 1-sec-EEG-segments of the resting EEG before the reproduction phase were classified using the Vigilance Algorithm Leipzig (VIGALL). RESULTS AND DISCUSSION Reproduction accuracy was more precise after high EEG-vigilance stages. Thus, the subjects' mean deviation from the given rhythm was lower (t(17) = -2.733, p < 0.05) after high vigilance stage A (MW = 0.046, SD = 0.049) than after low vigilance stage B (MW = 0.065, SD = 0.067). The re-tapping-length was significantly shorter (t(17) = -2.190, p < 0.05) for reproduction phases following high EEG-vigilance stage A compared to the lower EEG-vigilance stage B. CONCLUSION These findings support the hypothesis of a varying time perception and of speed alterations of the internal clock after different states of EEG-vigilance, which were automatically classified by VIGALL. Thus, alterations of cognitive processing may be assessable by specific EEG-patterns.
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Affiliation(s)
- Juliane Minkwitz
- Department of Psychiatry and Psychotherapy, University of Leipzig, Semmelweisstr, 10, 04103 Leipzig, Germany
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Hegerl U, Wilk K, Olbrich S, Schoenknecht P, Sander C. Hyperstable regulation of vigilance in patients with major depressive disorder. World J Biol Psychiatry 2012; 13:436-46. [PMID: 21722018 DOI: 10.3109/15622975.2011.579164] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES This study tested the hypothesis that patients with depression show less and later declines into lower EEG vigilance stages (different global functional brain states) under resting conditions than healthy controls, as proposed by the vigilance theory of affective disorders. METHODS Thirty patients with Major Depressive Disorder (19 female; mean age: 37.2 years, SD: 12.6) without psychotropic medication and 30 carefully age- and sex-matched controls (19 female; mean age: 37.3 years, SD: 12.8) without past or present mental disorders underwent a 15-min resting EEG. EEG-vigilance regulation was determined with a computer-based vigilance classification algorithm (VIGALL, Vigilance Algorithm Leipzig), allowing a classification of vigilance stages A (with substages A1, A2 and A3), B (with substages B1 and B2/3) and C. RESULTS Depressive patients spent significantly more time in the highest EEG vigilance substage A1, and less time in substages A2, A3 and B2/3 than controls. In depressive patients, a significantly longer latency until the occurrence of substages A2, A3 and B2/3 was observed. No significant group differences in the percentage of B1 segments or the latency until occurrence of B1 were found. CONCLUSIONS The results confirm the hypothesis that patients with depression show less (and later) declines into lower EEG vigilance stages under resting conditions than healthy controls, and support the vigilance theory of affective disorders linking a hyperstable vigilance regulation to depression.
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Affiliation(s)
- Ulrich Hegerl
- Department of Psychiatry and Psychotherapy, University Hospital Leipzig, Leipzig, Germany
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Minkwitz J, Trenner MU, Sander C, Olbrich S, Sheldrick AJ, Schönknecht P, Hegerl U, Himmerich H. Prestimulus vigilance predicts response speed in an easy visual discrimination task. Behav Brain Funct 2011; 7:31. [PMID: 21816115 PMCID: PMC3163185 DOI: 10.1186/1744-9081-7-31] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Accepted: 08/05/2011] [Indexed: 11/30/2022] Open
Abstract
Background Healthy adults show considerable within-subject variation of reaction time (RT) when performing cognitive tests. So far, the neurophysiological correlates of these inconsistencies have not yet been investigated sufficiently. In particular, studies rarely have focused on alterations of prestimulus EEG-vigilance as a factor which possibly influences the outcome of cognitive tests. We hypothesised that a low EEG-vigilance state immediately before a reaction task would entail a longer RT. Shorter RTs were expected for a high EEG-vigilance state. Methods 24 female students performed an easy visual discrimination task while an electroencephalogram (EEG) was recorded. The vigilance stages of 1-sec-EEG-segments before stimulus presentation were classified automatically using the computer-based Vigilance Algorithm Leipzig (VIGALL). The mean RTs of each EEG-vigilance stage were calculated for each subject. A paired t-test for the EEG-vigilance main stage analysis (A vs. B) and a variance analysis for repeated measures for the EEG-vigilance sub-stage analysis (A1, A2, A3, B1, B2/3) were calculated. Results Individual mean RT was significantly shorter for events following the high EEG-vigilance stage A compared to the lower EEG-vigilance stage B. The main effect of the sub-stage analysis was marginal significant. A trend of gradually increasing RT was observable within the EEG-vigilance stage A. Conclusion We conclude that an automatically classified low EEG-vigilance level is associated with an increased RT. Thus, intra-individual variances in cognitive test might be explainable in parts by the individual state of EEG-vigilance. Therefore, the accuracy of neuro-cognitive investigations might be improvable by simultaneously controlling for vigilance shifts using the EEG and VIGALL.
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Affiliation(s)
- Juliane Minkwitz
- Department of Psychiatry and Psychotherapy, University of Leipzig, Semmelweisstr, 10, 04103 Leipzig, Germany
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Dysfunctional pain modulation in somatoform pain disorder patients. Eur Arch Psychiatry Clin Neurosci 2011; 261:267-75. [PMID: 20924589 DOI: 10.1007/s00406-010-0148-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2009] [Accepted: 09/01/2010] [Indexed: 10/19/2022]
Abstract
To date, pain perception is thought to be a creative process of modulation carried out by an interplay of pro- and anti-nociceptive mechanisms. Recent research demonstrates that pain experience constitutes the result of top-down processes represented in cortical descending pain modulation. Cortical, mainly medial and frontal areas, as well as subcortical structures such as the brain stem, medulla and thalamus seem to be key players in pain modulation. An imbalance of pro- and anti-nociceptive mechanisms are assumed to cause chronic pain disorders, which are associated with spontaneous pain perception without physiologic scaffolding or exaggerated cortical activation in response to pain exposure. In contrast to recent investigations, the aim of the present study was to elucidate cortical activation of somatoform pain disorder patients during baseline condition. Scalp EEG, quantitative Fourier-spectral analyses and LORETA were employed to compare patient group (N = 15) to age- and sex-matched controls (N = 15) at rest. SI, SII, ACC, SMA, PFC, PPC, insular, amygdale and hippocampus displayed significant spectral power reductions within the beta band range (12-30 Hz). These results suggest decreased cortical baseline arousal in somatoform pain disorder patients. We finally conclude that obtained results may point to an altered baseline activity, maybe characteristic for chronic somatoform pain disorder.
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Graef S, Schönknecht P, Sabri O, Hegerl U. Cholinergic receptor subtypes and their role in cognition, emotion, and vigilance control: an overview of preclinical and clinical findings. Psychopharmacology (Berl) 2011; 215:205-29. [PMID: 21212938 DOI: 10.1007/s00213-010-2153-8] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Accepted: 12/15/2010] [Indexed: 01/10/2023]
Abstract
RATIONALE The cholinergic system has long been linked to cognitive processes. Two main classes of acetylcholine (ACh) receptors exist in the human brain, namely muscarinic and nicotinic receptors, of which several subtypes occur. OBJECTIVES This review seeks to provide an overview of previous findings on the influence of cholinergic receptor manipulations on cognition in animals and humans, with particular emphasis on the role of selected cholinergic receptor subtypes. Furthermore, the involvement of these receptor subtypes in the regulation of emotion and brain electrical activity as measured by electroencephalography (EEG) shall be addressed since these domains are considered to be important modulators of cognitive functioning. RESULTS In regard to cognition, the muscarinic receptor subtypes have been implicated mainly in memory functions, but have also been linked to attentional processes. The nicotinic α7 receptor subtype is involved in working memory, whereas the α4β2* subtype has been linked to tests of attention. Both muscarinic and nicotinic cholinergic mechanisms play a role in modulating brain electrical activity. Nicotinic receptors have been strongly associated with the modulation of depression and anxiety. CONCLUSIONS Cholinergic receptor manipulations have an effect on cognition, emotion, and brain electrical activity as measured by EEG. Changes in cognition can result from direct cholinergic receptor manipulation or from cholinergically induced changes in vigilance or affective state.
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Affiliation(s)
- Susanne Graef
- Department of Psychiatry, University of Leipzig, Semmelweisstr. 10, 04103 Leipzig, Germany.
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Guenther T, Schönknecht P, Becker G, Olbrich S, Sander C, Hesse S, Meyer PM, Luthardt J, Hegerl U, Sabri O. Impact of EEG-vigilance on brain glucose uptake measured with [18F]FDG and PET in patients with depressive episode or mild cognitive impairment. Neuroimage 2011; 56:93-101. [DOI: 10.1016/j.neuroimage.2011.01.059] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Revised: 01/04/2011] [Accepted: 01/20/2011] [Indexed: 11/30/2022] Open
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Gevensleben H, Moll GH, Heinrich H. [Neurofeedback training in children with ADHD: behavioral and neurophysiological effects]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2011; 38:409-19; quiz 419-20. [PMID: 21128217 DOI: 10.1024/1422-4917/a000070] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
In a multicentre randomised controlled trial, we evaluated the clinical efficacy of neurofeedback (NF) training in children with ADHD and investigated the mechanisms underlying a successful training. We used an attention skills training, coupled with the training setting and demands made upon participants, as the control condition. At the behavioural level, NF was superior to the control group concerning core ADHD symptomatology as well as associated domains. For the primary outcome measure (improvement in the FBB-HKS total score), the effect size was .60. The same pattern of results was obtained at the 6-month follow-up. Thus, NF may be seen as a clinically effective module in the treatment of children with ADHD. At the neurophysiological level (EEG, ERPs), specific effects for the two NF protocols, theta/beta training, and training of slow cortical potentials were demonstrated. For example, for theta/beta training, a decrease of theta activity in the EEG was associated with a reduction of ADHD symptomatology. SCP training was accompanied inter alia by an increase in the contingent negative variation in the attention network test; thus, children were able to allocate more resources for preparation. EEG- and ERP-based predictors were also found. The present article reviewed the findings of the original papers related to the trial and outlines future research topics.
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ICA-based muscle artefact correction of EEG data: What is muscle and what is brain? Neuroimage 2011; 54:1-3; discussion 4-9. [DOI: 10.1016/j.neuroimage.2010.04.256] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2010] [Revised: 04/12/2010] [Accepted: 04/24/2010] [Indexed: 11/19/2022] Open
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Sander C, Arns M, Olbrich S, Hegerl U. EEG-vigilance and response to stimulants in paediatric patients with attention deficit/hyperactivity disorder. Clin Neurophysiol 2010; 121:1511-1518. [PMID: 20382071 DOI: 10.1016/j.clinph.2010.03.021] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2009] [Revised: 01/06/2010] [Accepted: 03/20/2010] [Indexed: 10/19/2022]
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Schoenknecht P, Olbrich S, Sander C, Spindler P, Hegerl U. Treatment of acute mania with modafinil monotherapy. Biol Psychiatry 2010; 67:e55-7. [PMID: 20138253 DOI: 10.1016/j.biopsych.2009.12.021] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2009] [Revised: 12/18/2009] [Accepted: 12/18/2009] [Indexed: 11/26/2022]
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38
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Sherlin L, Arns M, Lubar J, Sokhadze E. A Position Paper on Neurofeedback for the Treatment of ADHD. ACTA ACUST UNITED AC 2010. [DOI: 10.1080/10874201003773880] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Hegerl U, Himmerich H, Engmann B, Hensch T. Mania and attention-deficit/hyperactivity disorder: common symptomatology, common pathophysiology and common treatment? Curr Opin Psychiatry 2010; 23:1-7. [PMID: 19770771 DOI: 10.1097/yco.0b013e328331f694] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Attention-deficit/hyperactivity disorder (ADHD) and mania show broad symptom overlap, and high comorbidity exists between ADHD and bipolar disorder. This raises the question concerning common neurobiological pathomechanisms and concerning common treatments. RECENT FINDINGS On genetic, biochemical, electrophysiological, brain morphological and neuropsychological levels, the commonalities of ADHD and mania and the commonalities between ADHD and bipolar disorder (independent of manic state) are outlined. An intriguing finding is that both ADHD and mania are characterized by an unstable wakefulness regulation assessed by EEG measures of vigilance, by ratings of sleepiness and by deficits in sustained attention tasks. In both mania and ADHD, this unstable wakefulness regulation is supposed to be a central pathogenetic factor leading to attention deficits and inducing the hyperactive, impulsive and sensation-seeking behavior as an autoregulatory attempt to stabilize wakefulness by increasing external stimulation. Evidence is accumulating to suggest that psychostimulants do not have a high risk of triggering or aggravating mania, but might even be a treatment option in acute mania. SUMMARY ADHD and mania share many symptoms and several pathogenetic aspects. The common belief that stimulants are contraindicated in mania has been challenged, and controlled trials to study the possible antimanic effects of vigilance-stabilizing drugs such as stimulants are justified and necessary.
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Affiliation(s)
- Ulrich Hegerl
- Department of Psychiatry, University of Leipzig, Semmelweisstrasse 10, Leipzig, Germany.
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Gevensleben H, Holl B, Albrecht B, Schlamp D, Kratz O, Studer P, Wangler S, Rothenberger A, Moll GH, Heinrich H. Distinct EEG effects related to neurofeedback training in children with ADHD: a randomized controlled trial. Int J Psychophysiol 2009; 74:149-57. [PMID: 19712709 DOI: 10.1016/j.ijpsycho.2009.08.005] [Citation(s) in RCA: 136] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2009] [Revised: 08/12/2009] [Accepted: 08/16/2009] [Indexed: 10/20/2022]
Abstract
In a randomized controlled trial, neurofeedback (NF) training was found to be superior to a computerised attention skills training concerning the reduction of ADHD symptomatology (Gevensleben et al., 2009). The aims of this investigation were to assess the impact of different NF protocols (theta/beta training and training of slow cortical potentials, SCPs) on the resting EEG and the association between distinct EEG measures and behavioral improvements. In 72 (of initially 102) children with ADHD, aged 8-12, EEG changes after either a NF training (n=46) or the control training (n=26) could be studied. The combined NF training consisted of one block of theta/beta training and one block of SCP training, each block comprising 18 units of 50 minutes (balanced order). Spontaneous EEG was recorded in a two-minute resting condition before the start of the training, between the two training blocks and after the end of the training. Activity in the different EEG frequency bands was analyzed. In contrast to the control condition, the combined NF training was accompanied by a reduction of theta activity. Protocol-specific EEG changes (theta/beta training: decrease of posterior-midline theta activity; SCP training: increase of central-midline alpha activity) were associated with improvements in the German ADHD rating scale. Related EEG-based predictors were obtained. Thus, differential EEG patterns for theta/beta and SCP training provide further evidence that distinct neuronal mechanisms may contribute to similar behavioral improvements in children with ADHD.
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Affiliation(s)
- Holger Gevensleben
- Child and Adolescent Psychiatry, University of Göttingen, v.Siebold-Str. 5, D-37075 Göttingen, Germany
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Kuo JR, Linehan MM. Disentangling emotion processes in borderline personality disorder: physiological and self-reported assessment of biological vulnerability, baseline intensity, and reactivity to emotionally evocative stimuli. JOURNAL OF ABNORMAL PSYCHOLOGY 2009; 118:531-44. [PMID: 19685950 PMCID: PMC4277483 DOI: 10.1037/a0016392] [Citation(s) in RCA: 163] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study investigated M. Linehan's (1993) theory that individuals meeting criteria for borderline personality disorder (BPD) have high biological vulnerability to emotion dysregulation, including high baseline emotional intensity and high reactivity to emotionally evocative stimuli. Twenty individuals with BPD, 20 age-matched individuals with generalized social anxiety disorder (SAD), and 20 age-matched normal controls (NCs) participated in 2 separate emotion induction conditions, a standardized condition, and a personally relevant condition. Respiratory sinus arrhythmia (RSA), skin conductance response (SCR), and self-report measures were collected throughout the experiment. BPD participants displayed heightened biological vulnerability compared with NCs as indicated by reduced basal RSA. BPD participants also exhibited high baseline emotional intensity, characterized by heightened SCR and heightened self-reported negative emotions at baseline. However, the BPD group did not display heightened reactivity, as their physiological and self-reported changes from baseline to the emotion inductions tasks were not greater than the other 2 groups.
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Affiliation(s)
- Janice R Kuo
- Department of Psychology, Stanford University, Stanford, CA 94305, USA.
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Hegerl U, Olbrich S, Schönknecht P, Sander C. [Manic behavior as an autoregulatory attempt to stabilize vigilance]. DER NERVENARZT 2009; 79:1283-4, 1286-90. [PMID: 18758743 DOI: 10.1007/s00115-008-2553-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In situations with low external stimulation, manic patients often present rapid declines in vigilance, with microsleeps occurring even in the 1st min of EEG recordings (lability of vigilance regulation). We postulate that manic symptoms creating a high level of external stimulation serve to stabilize vigilance. Theoretical arguments and empirical results are presented, showing that both mania and ADHD should be interpreted as vigilance autostabilization syndromes. The therapeutic effects of psychostimulants can be explained by their vigilance-stabilizing properties. They are well proven for ADHD and have repeatedly been shown to have a paradoxical effect in manic patients. The proposed concept opens new approaches for the treatment of acute mania.
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Affiliation(s)
- U Hegerl
- Klinik und Poliklinik für Psychiatrie, Universitätsklinikum Leipzig, AöR, Semmelweissstrasse 10, 04107, Leipzig, Germany.
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Olbrich S, Mulert C, Karch S, Trenner M, Leicht G, Pogarell O, Hegerl U. EEG-vigilance and BOLD effect during simultaneous EEG/fMRI measurement. Neuroimage 2008; 45:319-32. [PMID: 19110062 DOI: 10.1016/j.neuroimage.2008.11.014] [Citation(s) in RCA: 246] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2008] [Revised: 11/03/2008] [Accepted: 11/10/2008] [Indexed: 10/21/2022] Open
Abstract
Different EEG-vigilance stages from full alertness to sleep onset can be separated during rest. Also fMRI research recently focused on the resting condition and identified several resting state networks. In order to deepen the understanding of different levels of global brain function from relaxed wakefulness to sleep onset the association between EEG-vigilance stages and BOLD signals was analysed. EEG-vigilance stages were attributed to consecutive 3-sec-EEG-segments by an algorithm using topographic and spectral information. Results of the classification were validated by analysing the heart rates during the different brain states. Vigilance stages served as regressors for the analysis of the simultaneously acquired fMRI data. Additionally resting state networks were derived from the fMRI data using independent component analysis (ICA). Also vigilance associated brain activity revealed by EEG-based standardized low resolution tomography (sLORETA) was compared to the results of the fMRI analysis. Results showed increased BOLD signal in the occipital cortex, the anterior cingulate cortex, the frontal cortex, the parietal cortices and the temporal cortices and decreasing BOLD signals in the thalamus and the frontal cortex for declining vigilance stages (A2, A3, B1, B2/B3) in comparison to the high vigilance stage A1. Resting state networks revealed a spatial overlap with the vigilance stage associated BOLD maps in conjunction analyses. sLORETA showed increased neuroelectric alpha activity at the occipital cortex comparable to occipital BOLD signal decreases when comparing stage A with stage B. Different EEG-vigilance stages during rest are associated with pronounced differences of BOLD signals in several brain areas which partly correspond to the resting state networks. For cognitive fMRI-research it therefore seems important to pay attention to vigilance switches in order to separate vigilance associated BOLD signal changes from those specifically related to cognition.
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Affiliation(s)
- Sebastian Olbrich
- Department of Psychiatry, University of Leipzig, Semmelweisstrasse 10, D-04103 Leipzig, Germany.
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