Neuroendocrine brain asymmetry and physical complaints

Dual-Brain Psychology: A novel theory and treatment based on cerebral laterality and psychopathology

Dual-Brain Psychology is a theory and its clinical applications that come out of the author's clinical observations and from the Split-brain Studies. The theory posits, based on decades of rigorous, peer-reviewed experiments and clinical reports, that, in most patients, one brain's cerebral hemisphere (either left or right) when stimulated by simple lateral visual field stimulation, or unilateral transcranial photobiomodulation, reveals a dramatic change in personality such that stimulating one hemisphere evokes, as a trait, a personality that is more childlike and more presently affected by childhood maltreatments that are usually not presently appreciated but are the proximal cause of the patient's symptoms. The personality associated with the other hemisphere is much more mature, less affected by the traumas, and less symptomatic. The theory can be applied to in-depth psychotherapy in which the focus is on helping the troubled side to bear and process the traumas with the help of the therapist and the healthier personality. A person's symptoms can be evoked to aid the psychotherapy with hemispheric stimulation and the relationship between the dual personalities can be transformed from conflicted and sabotaging to cooperating toward overall health. Stimulating the positive hemisphere in most therapy patients rapidly relieves symptoms such as anxiety, depression, or substance cravings. Two randomized controlled trials used unilateral transcranial photobiomodulation to the positive hemisphere as a stand-alone treatment for opioid cravings and both revealed high effect sizes. The theory is supported by brain imaging and rTMS studies. It is the first psychological theory and application that comes out of and is supported by rigorous peer-reviewed experimentation.

Individual Differences in Hemispheric Emotional Valence by Computerized Test Correlate with Lateralized Differences in Nucleus Accumbens, Hippocampal and Amygdala Volumes

Purpose

Conventional theories of hemispheric emotional valence (HEV) postulate fixed hemispheric differences in emotional processing. Schiffer’s dual brain psychology proposes that there are prominent individual differences with a substantial subset showing a reversed laterality pattern. He further proposed that hemispheric differences were more akin to differences in personality than in emotional processing. This theory is supported by findings that unilateral treatments, such as transcranial magnetic stimulation, are effective if they accurately target individual differences in laterality. The aim of this paper was to assess if a computer test of hemispheric emotional valence (CTHEV) could effectively identify individual differences in HEV and to ascertain if these individual differences were associated with underlying differences in brain structure and connectivity.

Patients and Methods

The CTHEV was administered to 50 (18 male/32 female) right-handed participants, aged 18–19 years, enrolled in a study assessing the neurobiological effects of childhood maltreatment. Based on a literature review, we determined whether CTHEV correlated with lateralized volumes of the nucleus accumbens, amygdala, hippocampus, and subgenual anterior cingulate as well as volume of the corpus callosum.

Results

CTHEV scores correlated with laterality indices of the nucleus accumbens (p = 0.00016), amygdala (p = 0.0138) and hippocampus (p = 0.031). A positive left hemispheric valence was associated with a larger left-sided nucleus accumbens and hippocampus and a smaller left amygdala. We identified four eigenvector network centrality DTI measures that predict CTHEV, most notably the left amygdala, and found that CTHEV results correlated with total and segment-specific corpus callosal volumes.

Conclusion

Individual differences in HEV can be readily assessed by computer test and correlate with differences in brain structure and connectivity that could provide a mechanistic understanding. These findings provide further support for a revised understanding of HEV and provide a tool that could be used to guide lateralized brain treatments.

An Effective and Safe Novel Treatment of Opioid Use Disorder: Unilateral Transcranial Photobiomodulation

Background: The opioid epidemic is a global tragedy even with current treatments, and a novel, safe, and effective treatment would be welcomed. We report here our findings from our second randomized controlled trial to evaluate unilateral transcranial photobiomodulation as a treatment for opioid use disorder. Methods: We enrolled 39 participants with active opioid cravings at 2 sites, 19 received the active treatment which consisted of a 4-min twice weekly (every 3 or 4 days) application of a light-emitting diode at 810 nm with an irradiance of 250 mW/cm2 and a fluence of 60 J/cm2 to the forehead over either the left or right dorsolateral prefrontal cortex with a fluence to the brain of 2.1 J/cm2. Twenty participants received a sham treatment with the same device with foil over the bulb. The side of the treatment was based on Dual-Brain Psychology, which posits that one hemisphere is more affected by past maltreatments and is more prone to anxiety and drug cravings that the other hemisphere. We treated the hemisphere with the more positive hemispheric emotional valence (HEV) by 2 tests for HEV. Results: Our primary outcome was changes in pre-treatment opioid craving scale (OCS) minus baseline, and we found using a mixed model that the active group had a highly significant treatment * time benefit over the sham group, p < 0.0001, effect size at the last follow-up of 1.5. The active treatment benefited those not on buprenorphine as well as those not on it. The TimeLine Follow Back measure of opioid use was significantly better in the actively treated group, p = 0.0001, with an effect size of 0.45. We observed no adverse effects. Conclusion: Active unilateral transcranial photobiomodulation to the brain hemisphere with the better HEV was better than sham in the reduction of opioid cravings and opioid use to a very significant degree in a RCT of 39 participants at 2 independent sites. In the active group those on buprenorphine and those not on it both had improvements in cravings over the study. No adverse responses were reported in either group. ClinicalTrials.gov Identifier: NCT04340622.

A Dual Mind Approach to Understanding the Conscious Self and Its Treatment

In this paper I will address questions about will, agency, choice, consciousness, relevant brain regions, impacts of disorders, and their therapeutics, and I will do this by referring to my theory, Dual-brain Psychology, which posits that within most of us there exist two mental agencies with different experiences, wills, choices, and behaviors. Each of these agencies is associated as a trait with one brain hemisphere (either left or right) and its composite regions. One of these agencies is more adversely affected by past traumas, and is more immature and more symptomatic, while the other is more mature and healthier. The theory has extensive experimental support through 17 peer-reviewed publications with clinical and non-clinical research. I will discuss how this theory relates to the questions about the nature of agency and I will also discuss my published theory on the physical nature of subjective experience and its relation to the brain, and how that theory interacts with Dual-Brain Psychology, leading to further insights into our human nature and its betterment.

Unilateral transcranial photobiomodulation for opioid addiction in a clinical practice: A clinical overview and case series

INTRODUCTION

Opioid Use Disorders (OUD) cause great disfunction and pain to individuals, families, and societies. There are few good treatments. This paper presents a novel, easily applied, painless, therapy that can be applied as an adjunct to psychotherapies and medications.

METHODS

The author presents a retrospective overview and 4 brief case reports. Two are typical of very positively responsive patients, one is of a positively but not remarkably responsive patient, and one of a non-responsive patient. The author used unilateral transcranial photobiomodulation (UtPBM), near infrared mode, applied to the hemisphere with the more positive hemispheric emotional valence (HEV) as a treatment to augment the patients' usual treatment.

RESULTS

The case reports are from 42 consecutive patients in his practice with OUD where he has given 382 treatments over 18 months, as needed. The author's subjective clinical observations were that of the 42 patients, 26 (62%) consistently had responses to the UtPBM (as described in the case reports) that were easily observable to the patient and the author as strikingly beneficial, 8 (19%) had helpful, but not remarkable responses, and 8 (19%) had no noticeable response. These 3 characterizations will be illustrated with clinical examples. There were no side-effects reported or observed aside from 2 women who experienced anxiety which resolved with psychotherapy.

CONCLUSIONS

Using UtPBM as an adjunctive treatment to the author's usual in-depth psychotherapy and medication management, he found subjectively that for the majority of his patients, this treatment was a valuable, safe benefit to their treatment for OUD.

A Novel Treatment of Opioid Cravings With an Effect Size of .73 for Unilateral Transcranial Photobiomodulation Over Sham

BACKGROUND

Opioid use disorders (OUDs) are an epidemic causing catastrophic consequences to individuals, families, and society despite treatments including psychotherapy, substitution therapy or receptor blockers, and psychoeducation. We have developed a novel treatment that combines unilateral transcranial photobiomodulation (t-PBM) to the hemisphere with a more positive valence by Dual Brain Psychology (DBP).

METHODS

We used a randomized, double blind, placebo-controlled protocol in which 22 patients with significant opioid cravings and a history of recent or current OUD attended three 1-h weekly sessions. After baseline measures of opioid craving and other psychometrics, subjects received two unilateral t-PBM applications (810 nm CW LED, 250 mW/cm², 60 J/cm², 4 min) or a sham (foil-covered LED) at F3 or F4. Prior to any treatment we used two tests to determine which hemisphere was more associated with a negative outlook and cravings and treated that side before the more positive hemisphere. Primary outcome measure was an opioid craving scale (OCS). Secondary outcomes were weekly Hamilton Depression (HDRS) and Anxiety (HARS) Rating Scales prior to treatments and at follow-up.

RESULTS

Immediately after treatment the OCS improved significantly for both the sham and active treatments, but one week later the active treatment showed a 51.0% (SD 33.7) decrease in OCS while a week after the sham treatments there was a decrease of only 15.8% (SD 35.0) (by Wilcoxon Sign Rank Test, p = 0.004) and by a mixed model it was p = 0.0071. The effect size for the differences between active and sham was 0.73. For the active treatment from before and after treatment the effect size was 1.51 and for the sham, 0.45. The HDRS improved from a baseline of 15.1 to 8.8 (SD 10.3) a week after the active treatment and to 13.3 (SD 12.9) after the sham (p = 0.0071). HARS improved from 14.7 to 8.0 (SD 13.2) after the active treatments and to 14.3 (SD 16.0) after the sham, p = 0.08. Active treatment of the positive hemisphere after the negative hemisphere significantly improved the OCS, but there was no significant difference after the sham treatment. One patient complained of 2 h of abdominal bloating and dropped out; no other adverse effects were observed.

DISCUSSION

Unilateral t-PBM to the hemisphere with a more positive hemispheric emotional valence was an effective and safe treatment for opioid cravings as well as for depression and anxiety. Our results also lend support to the underlying premises of DBP.

Abnormal cortical asymmetry as a target for neuromodulation in neuropsychiatric disorders: A narrative review and concept proposal

Recent advances in knowledge relating to the organization of neural circuitry in the human brain have increased understanding of disorders involving brain circuit asymmetry. These asymmetries, which can be measured and identified utilizing EEG and LORETA analysis techniques, may be a factor in mental disorders. New treatments involving non-invasive brain stimulation (NIBS), including trans-cranial magnetic stimulation, direct current stimulation and vagal nerve stimulation, have emerged in recent years. We propose that EEG identification of circuit asymmetry geometries can direct non-invasive brain stimulation more specifically for treatments of mental disorders. We describe as a narrative review new NIBS therapies that have been developed and delivered, and suggest that they are proving effective in certain patient groups. A brief narrative of influence of classical and operant conditioning of neurofeedback on EEG coherence, phase, abnormalities and Loreta's significance is provided. We also discuss the role of Heart rate variability and biofeedback in influencing EEG co-relates. Clinical evidence is at an early stage, but the basic science evidence and early case studies suggest that this may be a promising new modality for treating mental disorders and merits further research.

Patterns of Functional Brain Organization and Migraine

The purpose of this study was to examine the relationship between the patterns of functional organization of the brain, as evaluated by the number of anomalous brain conditions or phenomena (ABCP), and the prevalence of migraine in a group of 434 women with lifetime major depressive disorder. ABCP are conditions or phenomena which are clearly related to brain function whose prevalence significantly deviates from the statistical mean for the general population. Eighteen ABCP (e.g. mixed or left handedness, enuresis after age 5, learning and speech disorders) were used in this study as ‘markers’ for their associated patterns of functional brain organization. The relationship between the number of ABCP and the prevalence of migraine was highly significant. The correlation between the number of ABCP and the prevalence of migraine was 0.36 ( P < 0.0001, confidence interval 0.26, 0.43). The prevalence of migraine in patients with no ABCP ( n = 11) was 9%, while that of those with eight or more ABCP ( n = 40) was 85%. This supports the hypothesis that there is a relationship between patterns of functional brain organization and migraine prevalence.

Aphasia severity and salivary cortisol over time

The current study explored the complicated interplay between aphasia and the stress biomarker, cortisol, in left-hemisphere (LH) and right-hemisphere (RH) stroke patients. Nineteen LH patients and 12 RH patients began the study between one to six months post stroke and were followed for three months. During this time, language skills were assessed monthly while afternoon salivary cortisol samples were collected biweekly. The LH and RH groups showed improvements in language test scores over the course of three months; however, only naming skills in the RH group appeared to be associated with afternoon salivary cortisol levels. Furthermore, contradicting previous reports regarding laterality and cortisol regulation in humans, the current study found that both LH patients and RH patients exhibited similar afternoon salivary cortisol levels across all time points.

Illness as a source of variation of laterality in lions (Panthera leo)

Brain asymmetry--i.e. the specialisation of each cerebral hemisphere for sensorimotor processing mechanisms and for specific cognitive functions-is widely distributed among vertebrates. Several factors, such as embryological manipulations, sex, age, and breeds, can influence the maintenance, strength, and direction of laterality within a certain vertebrate species. Brain lateralisation is a universal phenomenon characterising not only cerebral control of cognitive or emotion-related functions but also cerebral regulation of somatic processes, and its evolution is strongly influenced by social selection pressure. Diseases are well known to be a cost of sociality but their role in influencing behaviour has received very little attention. The present study investigates the influence of illness conditions as a source of variation on laterality in a social keystone vertebrate predator model, the lion. In a preliminary stage, the clinical conditions of 24 adult lions were assessed. The same animals were scored for forelimb preference when in the quadrupedal standing position. Lions show a marked forelimb preference with a population bias towards the use of the right forelimb. Illness conditions strongly influenced the strength of laterality bias, with a significant difference between clinically healthy and sick lions. According to these results, health conditions should be recognised as an important source of variation in brain lateralisation.

The experience-dependent maturation of a regulatory system in the orbital prefrontal cortex and the origin of developmental psychopathology

The maturation of corticolimbic systems that neurobiologically mediate essential affective and social regulatory functions is experience dependent. During the first and second years of life, the infant's affective experiences, especially those embedded in the relationship with the primary caregiver, elicit patterns of psychobiological alterations that influence the activity of subcortically produced trophic bioamines, peptides, and steroids that regulate the critical period growth and organization of the developing neocortex. Interactive attachment experiences of psychobiological attunemcnt, stressful misattunement, and stress-regulating repair and reattunement that maximize positive and minimize negative affect are imprinted into the orbitofrontal cortex — the hierarchical apex of the limbic system that is expanded in the early developing right hemisphere. During the critical period of maturation of thissystem, prolonged episodes of intense and unregulated interactive stress are manifest in disorganizing experiences of heightened negative affect and altered levels of stress hormones, and this chaotic biochemical alteration of the internal environment triggers an extensive apoptotic panellation of corticolimbic circuitries. In this manner less than optimal affect-regulating experiences with the primary caregiver are imprinted into the circuits of this frontolimbic system that is instrumental to attachment functions, thereby producing orbitofrontal organizations that neurobiologically express different patterns of insecure attachments. Such pathomorphogenetic outcomes result in structurally defective systems that, under stress, inefficiently regulate subcortical mechanisms that mediate the physiological processes that underlie emotion. The functional impairments of the cortical-subcortical circuitries of this prefrontal system are implicated in an enduring vulnerability to and the pathophysiology of various later forming psychiatric disorders.

Determination of hemispheric emotional valence in individual subjects: a new approach with research and therapeutic implications

BACKGROUND

Much has been theorized about the emotional properties of the hemispheres. Our review of the dominant hypotheses put forth by Schore, Joseph, Davidson, and Harmon-Jones on hemispheric emotional valences (HEV) shows that none are supported by robust data. Instead, we propose that individual's hemispheres are organized to have differing HEVs that can be lateralized in either direction.

METHODS

Probe auditory evoked potentials (AEP) recorded during a neutral and an upsetting memory were used to assess HEV in 28 (20 F) right-handed subjects who were either victims of childhood maltreatment (N = 12) or healthy controls. In a sub-population, we determined HEV by emotional response to lateral visual field stimulation (LVFS), in which vision is limited to one, then the other hemifield. We compare a number of morphometric and functional brain measures between individuals who have right-negative versus left-negative HEV.

RESULTS

Using AEPs to determine HEV, we found 62% of controls and 67% of maltreated subjects had right negative HEV. There was a strong interaction between HEV-laterality and gender, which together accounted for 60% of individual variability in total grey matter volume (GMV). HEV-laterality was associated with differences in hippocampal volume, amygdala/hippocampal ratios, and measures of verbal, visual and global memory. HEV-laterality was associated also with different constellations of symptoms comparing maltreated subjects to controls. Emotional response to LVFS provided a convenient and complementary measure of HEV-laterality that correlated significantly with the HEVs determined by AEPs.

CONCLUSION

Our findings suggest that HEV-laterality, like handedness or gender, is an important individual difference with significant implications for brain and behavioral research, and for guiding lateralized treatments such as rTMS.

Lateral visual field stimulation reveals extrastriate cortical activation in the contralateral hemisphere: an fMRI study

We examined whether lateral visual field stimulation (LSTM) could activate contralateral extrastriate cortical areas as predicted by a large experimental literature. We asked seven unscreened, control subjects to wear glasses designed to allow vision out of either the left (LVF) or right lateral visual field (RVF) depending upon which side the subject looked toward. Each subject participated in a block design functional magnetic resonance imaging (fMRI) study with alternating 30-s epochs in which he was asked to look to one side and then the other for a total of five epochs. On each side of the bore of the scanner, we taped a photograph for the subject to view in the LVF and RVF. The data were analyzed with SPM99 using a fixed effect, box-car design with contrasts for the LVF and the RVF conditions. Both LVF and RVF conditions produced the strongest fMRI activation in the contralateral occipitotemporal and posterior parietal areas as well as the contralateral dorsolateral prefrontal cortex. LSTM appears to increase contralateral fMRI activation in striate and extrastriate cortical areas as predicted by earlier studies reporting differential cognitive and/or emotional effects from unilateral sensory or motor stimulation.

Associations between EEG asymmetries and electrodermal lability in low vs. high depressive and anxious normal individuals

In order to investigate one aspect of cortical-autonomic control, cortical activation asymmetries, measured by EEG, were related to activity of the sympathetic nervous system, measured by EDA (electrodermal lability, number of spontaneous fluctuations), in two large samples. Since it may help to explain the participation of psychological factors in the development of various somatic complaints and disorders, we examined whether inter-individual differences in autonomic nervous system regulation may exist that are related to stress/anxiety and depression within the normal range. Results demonstrate substantial modifications of functional hemisphere asymmetries in the modulation of EDA by these emotional factors and suggest that activation asymmetries in orbital and dorsolateral frontal regions reflect two different cortical sub-systems regulating electrodermal activity. The findings may, to some extent, provide an explanation for contradictory results in previous studies and may encourage research in psychosomatics and other clinical fields (e.g. schizophrenia).

Emotions, brain development, and psychopathologic vulnerability

Emotional reactivity in infancy and early childhood may play a role in the regulation of brain plasticity and hemispheric organization, which has possible implications for vulnerability to psychopathology. Empiric findings demonstrate the role of attachment patterns in emotional reactivity modulation and limbic circuitry shaping.

Attachment and the regulation of the right brain

It has been three decades since John Bowlby first presented an over-arching model of early human development in his groundbreaking volume, Attachment. In the present paper I refer back to Bowlby's original charting of the attachment landscape in order to suggest that current research and clinical models need to return to the integration of the psychological and biological underpinnings of the theory. Towards that end, recent contributions from neuroscience are offered to support Bowlby's assertions that attachment is instinctive behavior with a biological function, that emotional processes lie at the foundation of a model of instinctive behavior, and that a biological control system in the brain regulates affectively driven instinctive behavior. This control system can now be identified as the orbitofrontal system and its cortical and subcortical connections. This 'senior executive of the emotional brain' acts as a regulatory system, and is expanded in the right hemisphere, which is dominant in human infancy and centrally involved in inhibitory control. Attachment theory is essentially a regulatory theory, and attachment can be defined as the interactive regulation of biological synchronicity between organisms. This model suggests that future directions of attachment research should focus upon the early-forming psychoneurobiological mechanisms that mediate both adaptive and maladaptive regulatory processes. Such studies will have direct applications to the creation of more effective preventive and treatment methodologies.

Role of brain organization in the pathogenesis of physical disease

While genetic and environmental factors are known to make substantial contributions to the pathogenesis of physical disease, the role of the brain in these processes is largely unknown. It is hypothesized that the manner in which the brain is functionally organized is an integral factor in physical health outcomes, both positive and negative. It is further hypothesized that changes in certain patterns of the functional organization of the brain play a significant role in the pathogenesis of physical disease, mediating between an individual's genetic endowment, the environment, and other relevant brain systems to initiate, modulate and/or maintain these disorders. There are many currently available treatment modalities which have the capacity to change the pattern of functional brain organization. Such interventions have the potential to become valuable aids in both the treatment and prevention of physical disease.

Hemisphere asymmetry in sympathetic control of the human myocardium

Hemisphere asymmetry in sympathetic control of myocardial performance was studied in healthy human subjects using lateralized film presentation for selective sensory stimulation of the hemispheres and impedance cardiography for the evaluation of cardiac output, systolic time intervals and myocardial contractility. Results revealed a clear and consistent right hemisphere predominance in sympathetically mediated control of various components of myocardial performance. There is reason to assume that the obtained hemisphere differences in autonomic control of the heart are self-reliant processes not depending on emotion-related hemisphere asymmetry. As far as we know, this is the first study examining the distinct roles of the cerebral hemispheres in neural control of ventricular myocardial functions.

Heart rate and skin conductance reactivity to brief psychological stress in brain-injured patients

Autonomic reactivity in response to two mentally challenging tasks was studied in 74 patients with traumatic brain injury (TBI; n=33), cerebrovascular insults (CVA; n=27), and hypoxic brain damage (n = 14). Heart rate, skin conductance level, and number of spontaneous skin conductance responses were recorded during baseline and two problem-solving stress conditions consisting of Raven progressive matrices and mental arithmetic. CVA and TBI patients with focal right hemisphere injury showed significantly reduced stress reactivity compared to patients with focal left hemisphere injury. This right-left hemisphere difference was maintained when controlled for diagnosis, gender, sex, age, and stressor task performance and involvement. The results indicate that lateralization of lesion rather than diagnosis or etiology is the critical factor in autonomic stress hyporeactivity in brain-injured patients. The results are discussed in relation to brain lateralization of autonomic reactivity and possible clinical consequences of autonomic hyporeactivity for rehabilitation of patients with acquired brain injury.

Hemisphere asymmetry in parasympathetic control of the heart

Hemisphere asymmetry in the control of parasympathetic outflow to the sino-atrial node of the heart was studied in healthy human subjects using lateralized film presentation for selective sensory stimulation of the hemispheres and power spectral analysis of heart rate variability as a measure of vagal tone. There was a clear and consistent left hemisphere predominance in the control of parasympathetic modulation of cardiac activity which cannot be attributed to differences in emotional processing. Supplementing previous findings of our research group, the present study indicates that control of autonomic cardiac activity at the level of the cerebral cortex seems to be characterized by a division of responsibility between both hemispheres, sympathetic activity being mainly controlled by the right hemisphere and parasympathetic activity being under the left hemisphere's main control.

Brain Asymmetry and Autonomic Control of the Heart

Neurocardiology has shown that the dynamic performance of the heart is strongly influenced by the brain, including the cerebral cortex. Neural control is mediated by sympathetic and parasympathetic fibers innervating the pacemaker, conductile, and contractile tissues of the heart. In this review, evidence is presented that autonomic control of the heart is lateralized, each brain side influencing cardiac activity in a different manner. Moreover, it is shown that asymmetries observed at the level of the cerebral hemispheres are characterized by different principles than asymmetries at the levels of the lower brain stem and the peripheral pathways. Findings on lateralized control of the heart are integrated into a general model of brain asymmetry, in which it is postulated that each hemisphere has a unique and comprehensive response system characterizing its cognitive, emotional, and physiological functioning.

Inferior petrosal sinus sampling in healthy subjects reveals a unilateral corticotropin-releasing hormone-induced arginine vasopressin release associated with ipsilateral adrenocorticotropin secretion

Arginine vasopressin (AVP) acts synergistically with corticotropin-releasing hormone (CRH) to stimulate ACTH release from the anterior pituitary. In a previous study of bilateral simultaneous inferior petrosal sinus (IPS) sampling in healthy human subjects, we observed lateralized ACTH secretion, suggesting lateralized secretion of an ACTH-regulating hypothalamic factor. To investigate this possibility, we measured ACTH, CRH, AVP, and oxytocin (OT) levels in the IPS and the peripheral circulation in nine normal volunteers, before and after 1 microgram/kg i.v. bolus ovine CRH (oCRH). At baseline, ACTH, AVP, and OT exhibited a significant (P < 0.05) two to threefold intersinus gradient (ISG), indicating the existence of a dominant petrosal sinus. Endogenous CRH was undetectable in all samples. Despite similar exogenous oCRH levels in both petrosal sinuses, oCRH caused a significant increase (P < 0.001) in the ACTH ISG (15.8 +/- 5.6, mean +/- SEM), suggesting increased responsiveness of one dominant side of the anterior pituitary. This was associated with an ipsilateral CRH-induced AVP release and a significant increase (P < 0.01) in the AVP ISG (8.6 +/- 2.3), suggesting lateralized AVP secretion by the hypothalamus. Furthermore, the increased AVP ISG after oCRH correlated strongly with the ACTH ISG (r = 0.92, P < 0.01). oCRH administration did not affect OT. These findings suggest that there is a dominant petrosal sinus in healthy volunteers that appears to reflect a dominant side of the adenohypophysis, characterized by increased functional activity and/or responsiveness of the pituitary corticotrophs. This may reflect lateralized hypothalamic and/or suprahypothalamic function resulting in CRH-responsive lateralized secretion of AVP from parvocellular and/or magnocellular axons in the median eminence and the posterior pituitary. Although the functional and teleologic significance of these findings remains to be investigated, our data suggest a novel mechanism for CRH-mediated ACTH release, namely CRH-induced release of AVP which then enhances CRH action on the corticotrophs. Furthermore, our data represent the first direct evidence for the concept of brain lateralization with respect to neuroendocrine secretion.

Cognitive influences on human autonomic nervous system function

Recent studies of human autonomic nervous system function have challenged the traditional view that the parasympathetic and sympathetic branches have opposite effects. In addition, studies of autonomic activity that accompanies attention, orienting and learning have demonstrated that the autonomic nervous system is not simply a 'non-cognitive' and automatic part of brain function. The autonomic and central nervous systems are intimately related, and new research is beginning to link brain function with autonomic function in a dynamic way.