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Singaram S, Ramakrishnan K, Selvam J, Senthil M, Narayanamurthy V. Sweat gland morphology and physiology in diabetes, neuropathy, and nephropathy: a review. Arch Physiol Biochem 2024; 130:437-451. [PMID: 36063413 DOI: 10.1080/13813455.2022.2114499] [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: 01/16/2022] [Accepted: 08/02/2022] [Indexed: 11/02/2022]
Abstract
Context: Sweat glands (SGs) play a vital role in thermal regulation. The function and structure are altered during the different pathological conditions.Objective: These alterations are studied through three techniques: biopsy, sweat analytes and electrical activity of SG.Methods: The morphological study of SG through biopsy and various techniques involved in quantifying sweat analytes is focussed on here. Electrical activities of SG in diabetes, neuropathy and nephropathy cases are also discussed, highlighting their limitations and future scope.Results and Conclusion: The result of this review identified three areas of the knowledge gap. The first is wearable sensors to correlate pathological conditions. Secondly, there is no device to look for its structure and quantify its associated function. Finally, therapeutic applications of SG are explored, especially for renal failure. With these aspects, this paper provides information collection and correlates SG with pathologies related to diabetes. Hence this could help researchers develop suitable technologies for the gaps identified.
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Affiliation(s)
- Sudha Singaram
- Department of Biomedical Engineering, Rajalakshmi Engineering College, Chennai, Tamil Nadu, India
| | - Kalpana Ramakrishnan
- Department of Biomedical Engineering, Rajalakshmi Engineering College, Chennai, Tamil Nadu, India
| | - Jayashree Selvam
- Department of Biomedical Engineering, Rajalakshmi Engineering College, Chennai, Tamil Nadu, India
| | - Mallika Senthil
- Department of Biomedical Engineering, Rajalakshmi Engineering College, Chennai, Tamil Nadu, India
| | - Vigneswaran Narayanamurthy
- Faculty of Electrical and Electronic Engineering Technology, Universiti Teknikal Malaysia Melaka, Melaka, Malaysia
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HRV analysis: undependability of approximate entropy at locating optimum complexity in malnourished children. Cardiol Young 2022; 32:425-430. [PMID: 34134801 DOI: 10.1017/s1047951121002316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Approximate Entropy is an extensively enforced metric to evaluate chaotic responses and irregularities of RR intervals sourced from an eletrocardiogram. However, to estimate their responses, it has one major problem - the accurate determination of tolerances and embedding dimensions. So, we aimed to overt this potential hazard by calculating numerous alternatives to detect their optimality in malnourished children. MATERIALS AND METHODS We evaluated 70 subjects split equally: malnourished children and controls. To estimate autonomic modulation, the heart rate was measured lacking any physical, sensory or pharmacologic stimuli. In the time series attained, Approximate Entropy was computed for tolerance (0.1→0.5 in intervals of 0.1) and embedding dimension (1→5 in intervals of 1) and the statistical significances between the groups by their Cohen's ds and Hedges's gs were totalled. RESULTS The uppermost value of statistical significance accomplished for the effect sizes for any of the combinations was -0.2897 (Cohen's ds) and -0.2865 (Hedges's gs). This was achieved with embedding dimension = 5 and tolerance = 0.3. CONCLUSIONS Approximate Entropy was able to identify a reduction in chaotic response via malnourished children. The best values of embedding dimension and tolerance of the Approximate Entropy to identify malnourished children were, respectively, embedding dimension = 5 and embedding tolerance = 0.3. Nevertheless, Approximate Entropy is still an unreliable mathematical marker to regulate this.
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Development of Autonomic Nervous System Assays as Point-of-Care Tests to Supplement Clinical Judgment in Risk Assessment for Suicidal Behavior: A Review. Curr Psychiatry Rep 2022; 24:11-21. [PMID: 35076889 DOI: 10.1007/s11920-022-01315-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/09/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW A biomarker point-of-care (POC) test that supplements the psychiatric interview and improves detection of patients at risk for suicide would be of value, and assays of autonomic nervous system (ANS) activity would satisfy the logistical requirements for a POC test. We performed a selective review of the available literature of ANS assays related to risk for suicide. RECENT FINDINGS We searched PubMed and Web of Science with the strategy: "suicide OR suicidal" AND "electrodermal OR heart rate variability OR pupillometry OR pupillography." The search produced 119 items, 21 of which provided original data regarding ANS methods and suicide. These 21 studies included 6 for electrodermal activity, 14 for heart rate variability, and 1 for the pupillary light reflex. The 21 papers showed associations between ANS assays and suicide risk in a direction suggesting underlying hyperarousal in patients at risk for suicide. ANS assays show promise for future development as POC tests to supplement clinical decision making in estimating risk for suicide.
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Büki A, Kekesi G, Horvath G, Vécsei L. A Potential Interface between the Kynurenine Pathway and Autonomic Imbalance in Schizophrenia. Int J Mol Sci 2021; 22:10016. [PMID: 34576179 PMCID: PMC8467675 DOI: 10.3390/ijms221810016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/08/2021] [Accepted: 09/09/2021] [Indexed: 02/07/2023] Open
Abstract
Schizophrenia is a neuropsychiatric disorder characterized by various symptoms including autonomic imbalance. These disturbances involve almost all autonomic functions and might contribute to poor medication compliance, worsened quality of life and increased mortality. Therefore, it has a great importance to find a potential therapeutic solution to improve the autonomic disturbances. The altered level of kynurenines (e.g., kynurenic acid), as tryptophan metabolites, is almost the most consistently found biochemical abnormality in schizophrenia. Kynurenic acid influences different types of receptors, most of them involved in the pathophysiology of schizophrenia. Only few data suggest that kynurenines might have effects on multiple autonomic functions. Publications so far have discussed the implication of kynurenines and the alteration of the autonomic nervous system in schizophrenia independently from each other. Thus, the coupling between them has not yet been addressed in schizophrenia, although their direct common points, potential interfaces indicate the consideration of their interaction. The present review gathers autonomic disturbances, the impaired kynurenine pathway in schizophrenia, and the effects of kynurenine pathway on autonomic functions. In the last part of the review, the potential interaction between the two systems in schizophrenia, and the possible therapeutic options are discussed.
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Affiliation(s)
- Alexandra Büki
- Department of Physiology, Albert Szent-Györgyi Medical School, University of Szeged, Dóm tér 10., H-6720 Szeged, Hungary; (A.B.); (G.K.); (G.H.)
| | - Gabriella Kekesi
- Department of Physiology, Albert Szent-Györgyi Medical School, University of Szeged, Dóm tér 10., H-6720 Szeged, Hungary; (A.B.); (G.K.); (G.H.)
| | - Gyongyi Horvath
- Department of Physiology, Albert Szent-Györgyi Medical School, University of Szeged, Dóm tér 10., H-6720 Szeged, Hungary; (A.B.); (G.K.); (G.H.)
| | - László Vécsei
- Department of Neurology, Albert Szent-Györgyi Medical School, University of Szeged, Semmelweis u. 6., H-6725 Szeged, Hungary
- MTA-SZTE Neuroscience Research Group, H-6725 Szeged, Hungary
- Interdisciplinary Excellence Center, Department of Neurology, Albert Szent-Györgyi Medical School, University of Szeged, Semmelweis u. 6., H-6725 Szeged, Hungary
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Ghiasi S, Greco A, Barbieri R, Scilingo EP, Valenza G. Assessing Autonomic Function from Electrodermal Activity and Heart Rate Variability During Cold-Pressor Test and Emotional Challenge. Sci Rep 2020; 10:5406. [PMID: 32214158 PMCID: PMC7096472 DOI: 10.1038/s41598-020-62225-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 02/28/2020] [Indexed: 12/11/2022] Open
Abstract
Standard functional assessment of autonomic nervous system (ANS) activity on cardiovascular control relies on spectral analysis of heart rate variability (HRV) series. However, difficulties in obtaining a reliable measure of sympathetic activity from HRV spectra limits the exploitation of sympatho-vagal metrics. On the other hand, measures of electrodermal activity (EDA) have been demonstrated to provide a reliable quantifier of sympathetic dynamics. In this study we propose novel indices of phasic autonomic regulation mechanisms by combining HRV and EDA correlates and thoroughly investigating their time-varying dynamics. HRV and EDA series were gathered from 26 healthy subjects during a cold-pressor test and emotional stimuli. Instantaneous linear and nonlinear (bispectral) estimates of vagal dynamics were obtained from HRV through inhomogeneous point-process models, and combined with a sensitive maker of sympathetic tone from EDA spectral power. A wavelet decomposition analysis was applied to estimate phasic components of the proposed sympatho-vagal indices. Results show significant statistical differences for the proposed indices between the cold-pressor elicitation and previous resting state. Furthermore, an accuracy of 73.08% was achieved for the automatic emotional valence recognition. The proposed nonlinear processing of phasic ANS markers brings novel insights on autonomic functioning that can be exploited in the field of affective computing and psychophysiology.
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Affiliation(s)
- Shadi Ghiasi
- Department of Information Engineering & Bioengineering and Robotics Research Center E. Piaggio, School of Engineering, University of Pisa, Pisa, Italy.
| | - Alberto Greco
- Department of Information Engineering & Bioengineering and Robotics Research Center E. Piaggio, School of Engineering, University of Pisa, Pisa, Italy
| | - Riccardo Barbieri
- Department of Electronics, Informatics and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Enzo Pasquale Scilingo
- Department of Information Engineering & Bioengineering and Robotics Research Center E. Piaggio, School of Engineering, University of Pisa, Pisa, Italy
| | - Gaetano Valenza
- Department of Information Engineering & Bioengineering and Robotics Research Center E. Piaggio, School of Engineering, University of Pisa, Pisa, Italy
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Schumann A, Kietzer S, Ebel J, Bär KJ. Sympathetic and Parasympathetic Modulation of Pupillary Unrest. Front Neurosci 2020; 14:178. [PMID: 32218721 PMCID: PMC7078331 DOI: 10.3389/fnins.2020.00178] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 02/17/2020] [Indexed: 11/13/2022] Open
Abstract
Pupillary unrest is an established indicator of drowsiness or sleepiness. How sympathetic and parasympathetic activity contribute to pupillary unrest is not entirely unclear. In this study, we investigated 83 young healthy volunteers to assess the relationship of pupillary unrest to other markers of the autonomic nervous system. Sample entropy (SE) and the established pupillary unrest index (PUI) were calculated to characterize pupil size variability. Autonomic indices were derived from heart rate, blood pressure, respiration, and skin conductance. Additionally, we assessed individual levels of calmness, vigilance, and mood. In an independent sample of 26 healthy participants, we stimulated the cardiovagal system by a deep breathing test. PUI was related to parasympathetic cardiac indices and sleepiness. A linear combination of vagal heart rate variability [root mean square of heart beat interval differences (RMSSD)] and skin conductance fluctuations (SCFs) was suited best to explain interindividual variance of PUI. Complexity of pupil diameter (PD) variations correlated to indices of sympathetic skin conductance. Furthermore, we found that spontaneous fluctuations of skin conductance are accompanied by increases of pupil size. In an independent sample, we were able to corroborate the relation of PUI with RMSSD and skin conductance. A slow breathing test enhanced RMSSD and PUI proportionally to each other, while complexity of PD dynamics decreased. Our data suggest that the slow PD oscillations (f < 0.15 Hz) quantified by PUI are related to the parasympathetic modulation. Sympathetic arousal as detected by SCFs is associated to transient pupil size increases that increase non-linear pupillary dynamics.
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Affiliation(s)
- Andy Schumann
- Lab for Autonomic Neuroscience, Imaging and Cognition (LANIC), Department of Psychosomatic Medicine and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Stephanie Kietzer
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Juliane Ebel
- Lab for Autonomic Neuroscience, Imaging and Cognition (LANIC), Department of Psychosomatic Medicine and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Karl Jürgen Bär
- Lab for Autonomic Neuroscience, Imaging and Cognition (LANIC), Department of Psychosomatic Medicine and Psychotherapy, Jena University Hospital, Jena, Germany
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Lozupone M, La Montagna M, D'Urso F, Daniele A, Greco A, Seripa D, Logroscino G, Bellomo A, Panza F. The Role of Biomarkers in Psychiatry. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1118:135-162. [PMID: 30747421 DOI: 10.1007/978-3-030-05542-4_7] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Psychiatric illnesses are cognitive and behavioral disorders of the brain. At present, psychiatric diagnosis is based on DSM-5 criteria. Even if endophenotype specificity for psychiatric disorders is discussed, it is difficult to study and identify psychiatric biomarkers to support diagnosis, prognosis, or clinical response to treatment. This chapter investigates the innovative biomarkers of psychiatric diseases for diagnosis and personalized treatment, in particular post-genomic data and proteomic analyses.
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Affiliation(s)
- Madia Lozupone
- Neurodegenerative Disease Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Maddalena La Montagna
- Psychiatric Unit, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Francesca D'Urso
- Psychiatric Unit, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Antonio Daniele
- Institute of Neurology, Catholic University of Sacred Heart, Rome, Italy.,Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Antonio Greco
- Geriatric Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, Foggia, Italy
| | - Davide Seripa
- Geriatric Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, Foggia, Italy
| | - Giancarlo Logroscino
- Neurodegenerative Disease Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy.,Department of Clinical Research in Neurology, University of Bari Aldo Moro, Lecce, Italy
| | - Antonello Bellomo
- Psychiatric Unit, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Francesco Panza
- Neurodegenerative Disease Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy. .,Geriatric Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, Foggia, Italy. .,Department of Clinical Research in Neurology, University of Bari Aldo Moro, Lecce, Italy.
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Thomas BL, Claassen N, Becker P, Viljoen M. Validity of Commonly Used Heart Rate Variability Markers of Autonomic Nervous System Function. Neuropsychobiology 2019; 78:14-26. [PMID: 30721903 DOI: 10.1159/000495519] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 11/13/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Despite strong reservations regarding the validity of a number of heart rate variability (HRV) measures, these are still being used in recent studies. AIMS We aimed to compare the reactivity of ostensible sympathetic HRV markers (low and very low frequency [LF and VLF]) to that of electrodermal activity (EDA), an exclusively sympathetic marker, in response to cognitive and orthostatic stress, investigate the possibility of LF as a vagal-mediated marker of baroreflex modulation, and compare the ability of HRV markers of parasympathetic function (root mean square of successive differences [RMSSD] and high frequency [HF]) to quantify vagal reactivity to cognitive and orthostatic stress. RESULTS None of the purported sympathetic HRV markers displayed a reactivity that correlated with electrodermal reactivity. LF (ms2) reactivity correlated with the reactivity of both RMSSD and HF during baroreflex modulation. RMSSD and HF indexed the reactivity of the parasympathetic nervous system under conditions of normal breathing; however, RMSSD performed better as a marker of vagal activity when the task required breathing changes. CONCLUSIONS Neither LF (in ms2 or normalized units [nu]) nor VLF represent cardiac sympathetic modulation of the heart. LF (ms2) may reflect vagally mediated baroreflex cardiac effects. HRV linear analysis therefore appears to be restricted to the determination of vagal influences on heart rate. With regard to HRV parasympathetic markers, this study supports the suggestion that HRV frequency domain analyses, such as HF, should not be used as an index of vagal activity in study tasks where verbal responses are required, as these responses may induce respiratory changes great enough to distort HF power.
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Affiliation(s)
- Bianca Lee Thomas
- Department of Human Anatomy and Physiology, University of Johannesburg, Johannesburg, South Africa, .,Department of Psychiatry, University of Pretoria, Pretoria, South Africa,
| | - Nicolaas Claassen
- School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| | - Piet Becker
- Research Office, University of Pretoria, Pretoria, South Africa
| | - Margaretha Viljoen
- Department of Psychiatry, University of Pretoria, Pretoria, South Africa
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9
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Guccione C, di Scalea GL, Ambrosecchia M, Terrone G, Di Cesare G, Ducci G, Schimmenti A, Caretti V. Early Signs of Schizophrenia and Autonomic Nervous System Dysregulation: A Literature Review. CLINICAL NEUROPSYCHIATRY 2019; 16:86-97. [PMID: 34908942 PMCID: PMC8662712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Recent research suggests that early signs of schizophrenia can be detected several years before its onset. Evidence suggests that the identification of at-risk individuals before the psychotic onset can significantly improve the course of the disorder. However, instruments employed for the detection of prodromal symptoms are far from being accurate in the prediction of a future transition to psychosis. The aim of the present review is to summarize literature on the early signs of schizophrenia and to identify physiological markers that may aid the identification of the disorder before psychotic transition. METHOD This critical review includes studies published between 1979 and 2018 that were indexed in major databases with the following keywords: schizophrenia, prodromal phase, basic symptoms, autonomic nervous system, heart rate variability. RESULTS The examination of the relevant literature showed that, despite recent progress in the identification of at-risk states, the currently employed instruments do not allow an effective prediction of a future psychotic onset. Also, evidence suggests a significant association between alterations in the autonomic nervous system (ANS) functioning and psychotic disorders. However, literature on the association between ANS functioning and at-risk states for psychosis is still scarce. The addition of physiological risk indicators may represent a step forward in the detection of at-risk individuals. CONCLUSIONS Overall, the present literature review highlights that a future schizophrenic onset cannot be strongly predicted with current available measures. Given the established correlation between schizophrenia and autonomic dysregulation, an investigation of the ANS functioning in individuals who are at increased risk of developing schizophrenia may be particularly useful to improve the quality of the assessment, to identify at an early stage the dysregulated physiological patterns that have been linked with schizophrenia, and therefore to develop tailored interventions. Accordingly, it is crucial that future research investigates the presence of autonomic deficits in individuals at risk for psychosis.
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Affiliation(s)
| | | | | | - Grazia Terrone
- Department of Humanities, Literature, and Cultural Heritage, University of Foggia
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Heart Rate Variability Analysis: Higuchi and Katz’s Fractal Dimensions in Subjects with Type 1 Diabetes Mellitus. ROMANIAN JOURNAL OF DIABETES NUTRITION AND METABOLIC DISEASES 2018. [DOI: 10.2478/rjdnmd-2018-0034] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Background and aims: Statistical markers are valuable when assessing physiological status over periods of time and in certain disease states. We assess if type 1 diabetes mellitus promote modification in the autonomic nervous system using the main two types of algorithms to estimate a Fractal Dimension: Higuchi and Katz.
Material and methods: 46 adults were divided into two equal groups. The autonomic evaluation consisted of recording heart rate variability (HRV) for 30 minutes in supine position in absence of any other stimuli. Fractal dimensions ought then able to determine which series of interbeat intervals are derived from diabetics’ or not. We then equated results to observe which assessment gave the greatest significance by One-way analysis of variance (ANOVA1), Kruskal-Wallis technique and Cohen’s d effect sizes.
Results: Katz’s fractal dimension is the most robust algorithm when assisted by a cubic spline interpolation (6 Hz) to increase the number of samples in the dataset. This was categorical after two tests for normality; then, ANOVA1, Kruskal-Wallis and Cohen’s d effect sizes (p≈0.01 and Cohen’s d=0.814143 –medium effect size).
Conclusion: Diabetes significantly reduced the chaotic response as measured by Katz’s fractal dimension. Katz’s fractal dimension is a viable statistical marker for subjects with type 1 diabetes mellitus.
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Herbsleb M, Schumann A, Malchow B, Puta C, Schulze PC, Gabriel HW, Bär KJ. Chronotropic incompetence of the heart is associated with exercise intolerance in patients with schizophrenia. Schizophr Res 2018. [PMID: 29526454 DOI: 10.1016/j.schres.2018.02.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The elevated cardiovascular risk of patients with schizophrenia contributes to a reduced life expectancy of 15-20years. This study investigated whether cardiac autonomic dysfunction (CADF) in schizophrenia is related to chronotropic incompetence, an established cardiovascular risk marker. We investigated thirty-two patients suffering from paranoid schizophrenia and thirty-two control subjects matched for age, sex, body mass index and fat free mass. A cardiopulmonary exercise test (CPET) was performed to study heart rate responses to exercise as well as submaximal (ventilatory threshold 1, VT1) and maximal endurance capacities (peak oxygen consumption, VO2peak; peak power output, Ppeak). In addition, epinephrine and norepinephrine levels were assessed in a subset of patients. Fitness parameters were significantly reduced in all patients. Most investigated physiological parameters were significantly different at rest as well as during peak exercise being in line with previously described CADF in schizophrenia. In particular, 14 out of 32 patients were classified as chronotropically incompetent whereas no control subject was below the cut-off value. In addition, a positive correlation of a slope reflecting chronotropic incompetence with peak oxygen uptake (p<0.001) was observed in patients only indicating a close correlation to the lack of physical fitness. The catecholamine increase was reduced in patients after exercise. This study identified a novel cardiac risk factor in patients with schizophrenia. Moreover, it seems to be associated with reduced physical fitness and indicates targets for exercise intervention studies. Future studies are warranted to elucidate pathophysiological mechanisms of this cardiac condition.
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Affiliation(s)
- Marco Herbsleb
- Department of Sports Medicine and Health Promotion, Friedrich-Schiller-University of Jena, Germany
| | - Andy Schumann
- Psychiatric Brain and Body Research Group, Department of Psychiatry and Psychotherapy, University Hospital Jena, Germany
| | - Berend Malchow
- Psychiatric Brain and Body Research Group, Department of Psychiatry and Psychotherapy, University Hospital Jena, Germany
| | - Christian Puta
- Department of Sports Medicine and Health Promotion, Friedrich-Schiller-University of Jena, Germany
| | - P Christian Schulze
- Department of Internal Medicine I, Division of Cardiology, University Hospital Jena, Friedrich-Schiller-University Jena, Jena, Germany
| | - Holger W Gabriel
- Department of Sports Medicine and Health Promotion, Friedrich-Schiller-University of Jena, Germany
| | - Karl-Jürgen Bär
- Psychiatric Brain and Body Research Group, Department of Psychiatry and Psychotherapy, University Hospital Jena, Germany.
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Sarlon J, Plaszczyk S, Engel S, Oertel-Knöchel V. Electrophysiological parameters as biomarkers for psychiatry: Intra-individual variability and influencing factors. Int J Psychophysiol 2017; 123:42-47. [PMID: 29155050 DOI: 10.1016/j.ijpsycho.2017.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 10/21/2017] [Accepted: 11/15/2017] [Indexed: 12/22/2022]
Affiliation(s)
- Jan Sarlon
- Laboratory for Neuroimaging, Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe University, Heinrich-Hoffmann-Str. 10, 60528 Frankfurt am Main, Germany; Psychiatric Hospital, Oberbergkliniken, Oberberg 1, 78132 Hornberg, Germany.
| | - Simone Plaszczyk
- Laboratory for Neuroimaging, Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe University, Heinrich-Hoffmann-Str. 10, 60528 Frankfurt am Main, Germany
| | - Sinah Engel
- Laboratory for Neuroimaging, Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe University, Heinrich-Hoffmann-Str. 10, 60528 Frankfurt am Main, Germany; Department of Neurology, University of Mainz, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Viola Oertel-Knöchel
- Laboratory for Neuroimaging, Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe University, Heinrich-Hoffmann-Str. 10, 60528 Frankfurt am Main, Germany
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13
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Tian Y, Bian Y, Han P, Wang P, Gao F, Chen Y. Physiological Signal Analysis for Evaluating Flow during Playing of Computer Games of Varying Difficulty. Front Psychol 2017; 8:1121. [PMID: 28725206 PMCID: PMC5495833 DOI: 10.3389/fpsyg.2017.01121] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 06/19/2017] [Indexed: 11/24/2022] Open
Abstract
Flow is the experience of effortless attention, reduced self-consciousness, and a deep sense of control that typically occurs during the optimal performance of challenging tasks. On the basis of the person–artifact–task model, we selected computer games (tasks) with varying levels of difficulty (difficult, medium, and easy) and shyness (personality) as flow precursors to study the physiological activity of users in a flow state. Cardiac and respiratory activity and mean changes in skin conductance (SC) were measured continuously while the participants (n = 40) played the games. Moreover, the associations between self-reported psychological flow and physiological measures were investigated through a series of repeated-measures analyses. The results showed that the flow experience is related to a faster respiratory rate, deeper respiration, moderate heart rate (HR), moderate HR variability, and moderate SC. The main effect of shyness was non-significant, whereas the interaction of shyness and difficulty influenced the flow experience. These findings are discussed in relation to current models of arousal and valence. The results indicate that the flow state is a state of moderate mental effort that arises through the increased parasympathetic modulation of sympathetic activity.
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Affiliation(s)
- Yu Tian
- Department of Psychology, Shandong Normal UniversityJinan, China
| | - Yulong Bian
- Department of Computer Science and Technology, Shandong UniversityJinan, China
| | - Piguo Han
- Department of Psychology, Shandong Normal UniversityJinan, China
| | - Peng Wang
- Department of Psychology, Shandong Normal UniversityJinan, China
| | - Fengqiang Gao
- Department of Psychology, Shandong Normal UniversityJinan, China
| | - Yingmin Chen
- Department of Psychology, Shandong Normal UniversityJinan, China
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Reinertsen E, Osipov M, Liu C, Kane JM, Petrides G, Clifford GD. Continuous assessment of schizophrenia using heart rate and accelerometer data. Physiol Meas 2017; 38:1456-1471. [PMID: 28653659 DOI: 10.1088/1361-6579/aa724d] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Schizophrenia has been associated with changes in heart rate (HR) and physical activity measures. However, the relationship between analysis window length and classifier accuracy using these features has yet to be quantified. APPROACH Here we used objective HR and activity data to classify contiguous days of data as belonging to a schizophrenia patient or a healthy control. HR and physical activity recordings were made on 12 medicated subjects with schizophrenia and 12 healthy controls. Features derived from these data included classical statistical characteristics, rest-activity metrics, transfer entropy, and multiscale fuzzy entropy. We varied the analysis window length from two to eight days, and selected features via minimal-redundancy-maximal-relevance. A support vector machine was trained to classify schizophrenia from control windows on a daily basis. Model performance was assessed via subject-wise leave-one-out-crossfold-validation. MAIN RESULTS An analysis window length of eight days resulted in an area under a receiver operating characteristic curve (AUC) of 0.96. Reducing the analysis window length to two days only lowered the AUC to 0.91. The type of most predictive features varied with analysis window length. SIGNIFICANCE Our results suggest continuous tracking of subjects with schizophrenia over short time scales may be sufficient to estimate illness severity on a daily basis.
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Affiliation(s)
- Erik Reinertsen
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, United States of America
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15
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Schmidt M, Schumann A, Müller J, Bär KJ, Rose G. ECG derived respiration: comparison of time-domain approaches and application to altered breathing patterns of patients with schizophrenia. Physiol Meas 2017; 38:601-615. [DOI: 10.1088/1361-6579/aa5feb] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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16
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Greco FA, Deutsch CK. Carl Gustav Jung and the psychobiology of schizophrenia. Brain 2016; 140:e1. [PMID: 28031224 DOI: 10.1093/brain/aww273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Frank A Greco
- 1 Research Service, Veterans Administration Medical Center, Bedford MA 01730, USA
| | - Curtis K Deutsch
- 2 Psychobiology Program, Eunice Kennedy Shriver Center UMMS, Worcester MA 01655, USA .,3 Research Service, Veterans Administration Medical Center, Bedford MA 01730, USA
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Houck JM, Çetin MS, Mayer AR, Bustillo JR, Stephen J, Aine C, Cañive J, Perrone-Bizzozero N, Thoma RJ, Brookes MJ, Calhoun VD. Magnetoencephalographic and functional MRI connectomics in schizophrenia via intra- and inter-network connectivity. Neuroimage 2016; 145:96-106. [PMID: 27725313 DOI: 10.1016/j.neuroimage.2016.10.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 10/05/2016] [Accepted: 10/07/2016] [Indexed: 12/11/2022] Open
Abstract
Examination of intrinsic functional connectivity using functional MRI (fMRI) has provided important findings regarding dysconnectivity in schizophrenia. Extending these results using a complementary neuroimaging modality, magnetoencephalography (MEG), we present the first direct comparison of functional connectivity between schizophrenia patients and controls, using these two modalities combined. We developed a novel MEG approach for estimation of networks using MEG that incorporates spatial independent component analysis (ICA) and pairwise correlations between independent component timecourses, to estimate intra- and intern-network connectivity. This analysis enables group-level inference and testing of between-group differences. Resting state MEG and fMRI data were acquired from a large sample of healthy controls (n=45) and schizophrenia patients (n=46). Group spatial ICA was performed on fMRI and MEG data to extract intrinsic fMRI and MEG networks and to compensate for signal leakage in MEG. Similar, but not identical spatial independent components were detected for MEG and fMRI. Analysis of functional network connectivity (FNC; i.e., pairwise correlations in network (ICA component) timecourses) revealed a differential between-modalities pattern, with greater connectivity among occipital networks in fMRI and among frontal networks in MEG. Most importantly, significant differences between controls and patients were observed in both modalities. MEG FNC results in particular indicated dysfunctional hyperconnectivity within frontal and temporal networks in patients, while in fMRI FNC was always greater for controls than for patients. This is the first study to apply group spatial ICA as an approach to leakage correction, and as such our results may be biased by spatial leakage effects. Results suggest that combining these two neuroimaging modalities reveals additional disease-relevant patterns of connectivity that were not detectable with fMRI or MEG alone.
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Affiliation(s)
- Jon M Houck
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, New Mexico, United States; Mind Research Network, Albuquerque, New Mexico, United States.
| | - Mustafa S Çetin
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, New Mexico, United States; Mind Research Network, Albuquerque, New Mexico, United States; Department of Electrical and Computer Engineering, University of New Mexico, Albuquerque, New Mexico, United States
| | - Andrew R Mayer
- Mind Research Network, Albuquerque, New Mexico, United States
| | - Juan R Bustillo
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, New Mexico, United States; Department of Psychiatry, University of New Mexico, Albuquerque, New Mexico, United States
| | - Julia Stephen
- Mind Research Network, Albuquerque, New Mexico, United States
| | - Cheryl Aine
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, New Mexico, United States; Mind Research Network, Albuquerque, New Mexico, United States; Department of Radiology, University of New Mexico, Albuquerque, New Mexico, United States
| | - Jose Cañive
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, New Mexico, United States; Department of Psychiatry, University of New Mexico, Albuquerque, New Mexico, United States
| | - Nora Perrone-Bizzozero
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, New Mexico, United States; Department of Neurosciences, University of New Mexico, Albuquerque, New Mexico, United States
| | - Robert J Thoma
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, New Mexico, United States; Department of Psychiatry, University of New Mexico, Albuquerque, New Mexico, United States
| | - Matthew J Brookes
- Department of Psychiatry, University of New Mexico, Albuquerque, New Mexico, United States; University of Nottingham, United Kingdom
| | - Vince D Calhoun
- Mind Research Network, Albuquerque, New Mexico, United States; Department of Electrical and Computer Engineering, University of New Mexico, Albuquerque, New Mexico, United States
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Kalra P, Yeragani VK, Prasanna Kumar KM. Cardiac autonomic function and vascular profile in subclinical hypothyroidism: Increased beat-to-beat QT variability. Indian J Endocrinol Metab 2016; 20:605-611. [PMID: 27730068 PMCID: PMC5040038 DOI: 10.4103/2230-8210.190527] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Patients with subclinical hypothyroidism (SH) may have higher incidence of coronary heart disease and autonomic dysfunction. DESIGN OF THE STUDY Prospective case control study. AIM AND OBJECTIVES To evaluate beat-to-beat QT variability and vascular stiffness in patients with SH compared to normal controls. MATERIALS AND METHODS We compared linear and nonlinear measures of cardiac repolarization liability using beat-to-beat QT intervals derived from the surface electrocardiogram during supine posture and vascular indices including pulse wave velocity and ankle-brachial index (ABI) during supine posture between female patients with SH and age- and sex-matched normal controls. Spectral analysis was done at very low frequency (LF) (0.003-0.04 Hz), Low frequency (LF) (0.04-0.15 Hz), and high frequency (HF) (0.15-0.4 Hz). The HF represents vagal regulation (parasympathetic) and LF represents both parasympathetic and sympathetic regulation. RESULTS We recruited 58 women with a mean age of 31.83 ± 8.9 years and 49 controls with mean age of 32.4 ± 9.9 years (P = NS). QT variability index (QTvi) was higher in cases compared to controls (P = 0.01). The ratio of LF/HF of R-R interval which is an index of sympathovagal tone was significantly more in cases compared to controls (P = 0.02). The difference in the left minus the right ABI was significant between cases and controls (P = 0.03). CONCLUSIONS The cases had lower parasympathetic activity as compared to controls, and there was a predominance of sympathetic activity in cases. QTvi may be an important noninvasive tool in this group of patients to study the risk of cardiovascular mortality.
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Affiliation(s)
- Pramila Kalra
- Department of Endocrinology, M.S. Ramaiah Medical College, Bengaluru, Karnataka, India
| | - Vikram K. Yeragani
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada
| | - K. M. Prasanna Kumar
- Centre for Diabetes and Endocrine Care, Bangalore Diabetes Hospital, Bengaluru, Karnataka, India
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Nonlinear causal influences assessed by mutual compression entropy. CURRENT DIRECTIONS IN BIOMEDICAL ENGINEERING 2016. [DOI: 10.1515/cdbme-2016-0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Autonomic control of the heart rate was demonstrated to be complex and nonlinear. Respiratory sinus arrhythima plays a crucial role in heart rate vagal modulation. Here we present an approach of assessing nonlinear causal relationships in bivariate time series, called mutual compression entropy (MCE). We applied MCE to cardiorespiratory data of 29 patients with acute schizophrenia and 29 matched controls. The method is based on data compression and estimates to which extend a (target) time series can be compressed regarding another time series (driver). In schizophrenia an elevated sympathetic and reduced parasympathetic heart rate modulation was found. The nonlinear influence of respiration on heart rate variability was demonstrated by a highly significant reduction of MCE (0.816 vs. 0.808, p¡0.01). In healthy subjects MCE was mainly related to sympathovagal balance. We conclude, that this index has the potential to uncover physiological information beyond linear measures.
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Schulz S, Bolz M, Bär KJ, Voss A. Central- and autonomic nervous system coupling in schizophrenia. PHILOSOPHICAL TRANSACTIONS. SERIES A, MATHEMATICAL, PHYSICAL, AND ENGINEERING SCIENCES 2016; 374:rsta.2015.0178. [PMID: 27044986 PMCID: PMC4822441 DOI: 10.1098/rsta.2015.0178] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/10/2016] [Indexed: 05/03/2023]
Abstract
The autonomic nervous system (ANS) dysfunction has been well described in schizophrenia (SZ), a severe mental disorder. Nevertheless, the coupling between the ANS and central brain activity has been not addressed until now in SZ. The interactions between the central nervous system (CNS) and ANS need to be considered as a feedback-feed-forward system that supports flexible and adaptive responses to specific demands. For the first time, to the best of our knowledge, this study investigates central-autonomic couplings (CAC) studying heart rate, blood pressure and electroencephalogram in paranoid schizophrenic patients, comparing them with age-gender-matched healthy subjects (CO). The emphasis is to determine how these couplings are composed by the different regulatory aspects of the CNS-ANS. We found that CAC were bidirectional, and that the causal influence of central activity towards systolic blood pressure was more strongly pronounced than such causal influence towards heart rate in paranoid schizophrenic patients when compared with CO. In paranoid schizophrenic patients, the central activity was a much stronger variable, being more random and having fewer rhythmic oscillatory components. This study provides a more in-depth understanding of the interplay of neuronal and autonomic regulatory processes in SZ and most likely greater insights into the complex relationship between psychotic stages and autonomic activity.
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Affiliation(s)
- Steffen Schulz
- Institute of Innovative Health Technologies, University of Applied Sciences, Jena, Germany
| | - Mathias Bolz
- Department of Child and Adolescent Psychiatry, Pain and Autonomics-Integrative Research, University Hospital, Jena, Germany
| | - Karl-Jürgen Bär
- Department of Psychiatry and Psychotherapy, Pain and Autonomics-Integrative Research, University Hospital, Jena, Germany
| | - Andreas Voss
- Institute of Innovative Health Technologies, University of Applied Sciences, Jena, Germany
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21
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Alvares GA, Quintana DS, Hickie IB, Guastella AJ. Autonomic nervous system dysfunction in psychiatric disorders and the impact of psychotropic medications: a systematic review and meta-analysis. J Psychiatry Neurosci 2016; 41:89-104. [PMID: 26447819 PMCID: PMC4764485 DOI: 10.1503/jpn.140217] [Citation(s) in RCA: 264] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Autonomic nervous system (ANS) dysfunction is a putative underlying mechanism for increased cardiovascular disease risk in individuals with psychiatric disorders. Previous studies suggest that this risk may be related to psychotropic medication use. In the present study we systematically reviewed and analyzed published studies of heart rate variability (HRV), measuring ANS output, to determine the effect of psychiatric illness and medication use. METHODS We searched for studies comparing HRV in physically healthy adults with a diagnosed psychiatric disorder to controls and comparing HRV pre- and post-treatment with a psychotropic medication. RESULTS In total, 140 case-control (mood, anxiety, psychosis, dependent disorders, k = 151) and 30 treatment (antidepressants, antipsychotics; k = 43) studies were included. We found that HRV was reduced in all patient groups compared to controls (Hedges g = -0.583) with a large effect for psychotic disorders (Hedges g = -0.948). Effect sizes remained highly significant for medication-free patients compared to controls across all disorders. Smaller and significant reductions in HRV were observed for specific antidepressants and antipsychotics. LIMITATIONS Study quality significantly moderated effect sizes in case-control analyses, underscoring the importance of assessing methodological quality when interpreting HRV findings. CONCLUSION Combined findings confirm substantial reductions in HRV across psychiatric disorders, and these effects remained significant even in medication-free individuals. Reductions in HRV may therefore represent a significant mechanism contributing to elevated cardiovascular risk in individuals with psychiatric disorders. The negative impact of specific medications on HRV suggest increased risk for cardiovascular disease in these groups, highlighting a need for treatment providers to consider modifiable cardiovascular risk factors to attenuate this risk.
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Affiliation(s)
| | | | | | - Adam J. Guastella
- Correspondence to: A.J. Guastella, Brain & Mind Centre, University of Sydney, 94 Mallett St, Camperdown NSW Australia;
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22
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Clamor A, Lincoln TM, Thayer JF, Koenig J. Resting vagal activity in schizophrenia: meta-analysis of heart rate variability as a potential endophenotype. Br J Psychiatry 2016; 208:9-16. [PMID: 26729841 DOI: 10.1192/bjp.bp.114.160762] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Cardiac vagal tone, indexed by heart rate variability (HRV), is a proxy for the functional integrity of feedback mechanisms integrating central and peripheral physiology. AIMS To quantify differences in HRV in individuals with schizophrenia compared with healthy controls. METHOD Databases were systematically searched for studies eligible for inclusion. Random effect meta-analyses of standardised mean differences were calculated for vagal activity indicated by high-frequency HRV and the root mean square of successive R-R interval differences (RMSSD). RESULTS Thirty-four studies were included. Significant main effects were found for high-frequency HRV (P = 0.0008; Hedges' g = -0.98, 95% CI -1.56 to -0.41, k = 29) and RMSSD (P<0.0001; g = -0.91, 95% CI -1.19 to -0.62, k = 24), indicating lower vagal activity in individuals with schizophrenia than in healthy controls. Considerable heterogeneity was evident but effects were robust in subsequent sensitivity analyses. CONCLUSIONS Given the association between low HRV, threat processing, emotion regulation and executive functioning, reduced vagal tone may be an endophenotype for the development of psychotic symptoms.
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Affiliation(s)
- Annika Clamor
- Annika Clamor, MSc, Tania M. Lincoln, Dr. rer. nat., University of Hamburg, Department of Clinical Psychology and Psychotherapy, Hamburg, Germany; Julian F. Thayer, PhD, The Ohio State University, Department of Psychology, Columbus, Ohio, USA; Julian Koenig, Dr. sc. hum., University of Heidelberg, Department of Child and Adolescent Psychiatry, Section for Translational Psychobiology in Child and Adolescent Psychiatry, Heidelberg, Germany
| | - Tania M Lincoln
- Annika Clamor, MSc, Tania M. Lincoln, Dr. rer. nat., University of Hamburg, Department of Clinical Psychology and Psychotherapy, Hamburg, Germany; Julian F. Thayer, PhD, The Ohio State University, Department of Psychology, Columbus, Ohio, USA; Julian Koenig, Dr. sc. hum., University of Heidelberg, Department of Child and Adolescent Psychiatry, Section for Translational Psychobiology in Child and Adolescent Psychiatry, Heidelberg, Germany
| | - Julian F Thayer
- Annika Clamor, MSc, Tania M. Lincoln, Dr. rer. nat., University of Hamburg, Department of Clinical Psychology and Psychotherapy, Hamburg, Germany; Julian F. Thayer, PhD, The Ohio State University, Department of Psychology, Columbus, Ohio, USA; Julian Koenig, Dr. sc. hum., University of Heidelberg, Department of Child and Adolescent Psychiatry, Section for Translational Psychobiology in Child and Adolescent Psychiatry, Heidelberg, Germany
| | - Julian Koenig
- Annika Clamor, MSc, Tania M. Lincoln, Dr. rer. nat., University of Hamburg, Department of Clinical Psychology and Psychotherapy, Hamburg, Germany; Julian F. Thayer, PhD, The Ohio State University, Department of Psychology, Columbus, Ohio, USA; Julian Koenig, Dr. sc. hum., University of Heidelberg, Department of Child and Adolescent Psychiatry, Section for Translational Psychobiology in Child and Adolescent Psychiatry, Heidelberg, Germany
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Osipov M, Behzadi Y, Kane JM, Petrides G, Clifford GD. Objective identification and analysis of physiological and behavioral signs of schizophrenia. J Ment Health 2015; 24:276-82. [PMID: 26193048 PMCID: PMC4776688 DOI: 10.3109/09638237.2015.1019048] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND A patient's physical activity is often used by psychiatrists to contribute to the diagnostic process for mental disorders. Typically, it is based mostly on self-reports or observations, and hardly ever upon actigraphy. Other signals related to physiology are rarely used, despite the fact that the autonomic nervous system is often affected by mental disorders. AIM This study attempted to fuse physiological and physical activity data and discover features that are predictive for schizophrenia. METHOD Continuous simultaneous heart rate (HR) and physical activity recordings were made on 16 individuals with schizophrenia and 19 healthy controls. Statistical characteristics of the recorded data were analyzed, as well as non-linear rest-activity measures and disorganization measures. RESULTS Four most predictive features for schizophrenia were identified, namely, the standard deviation and mode of locomotor activity, dynamics of Multiscale Entropy change over scales of HR signal and the mean HR. A classifier trained on these features provided a cross-validation accuracy of 95.3% (AUC = 0.99) for differentiating between schizophrenia patients and controls, compared to 78.5 and 85.5% accuracy (AUC = 0.85 and AUC = 0.90) using only the HR or locomotor activity features. CONCLUSION Physiological and physical activity signals provide complimentary information for assessment of mental health.
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Affiliation(s)
- Maxim Osipov
- a Department of Engineering Science , Institute of Biomedical Engineering, University of Oxford , Oxford , UK
| | - Yashar Behzadi
- b Proteus Digital Health, Inc. , Redwood City , CA , USA , and
| | - John M Kane
- c Hofstra North Shore-LIJ School of Medicine, Hofstra University , Hempstead , NY , USA
| | - Georgios Petrides
- c Hofstra North Shore-LIJ School of Medicine, Hofstra University , Hempstead , NY , USA
| | - Gari D Clifford
- a Department of Engineering Science , Institute of Biomedical Engineering, University of Oxford , Oxford , UK
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Multiscale Compression Entropy of Microvascular Blood FlowSignals: Comparison of Results from Laser Speckle Contrastand Laser Doppler Flowmetry Data in Healthy Subjects. ENTROPY 2014. [DOI: 10.3390/e16115777] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Světlák M, Bob P, Roman R, Ježek S, Damborská A, Chládek J, Shaw DJ, Kukleta M. Stress-induced alterations of left-right electrodermal activity coupling indexed by pointwise transinformation. Physiol Res 2014; 62:711-9. [PMID: 24359433 DOI: 10.33549/physiolres.932589] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
In this study, we tested the hypothesis that experimental stress induces a specific change of left-right electrodermal activity (EDA) coupling pattern, as indexed by pointwise transinformation (PTI). Further, we hypothesized that this change is associated with scores on psychometric measures of the chronic stress-related psychopathology. Ninety-nine university students underwent bilateral measurement of EDA during rest and stress-inducing Stroop test and completed a battery of self-report measures of chronic stress-related psychopathology. A significant decrease in the mean PTI value was the prevalent response to the stress conditions. No association between chronic stress and PTI was found. Raw scores of psychometric measures of stress-related psychopathology had no effect on either the resting levels of PTI or the amount of stress-induced PTI change. In summary, acute stress alters the level of coupling pattern of cortico-autonomic influences on the left and right sympathetic pathways to the palmar sweat glands. Different results obtained using the PTI, EDA laterality coefficient, and skin conductance level also show that the PTI algorithm represents a new analytical approach to EDA asymmetry description.
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Affiliation(s)
- M Světlák
- Department of Physiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
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Heart rate variability reflects the natural history of physiological development in healthy children and is not associated with quality of life. PLoS One 2014; 9:e91036. [PMID: 24625571 PMCID: PMC3953202 DOI: 10.1371/journal.pone.0091036] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 02/10/2014] [Indexed: 01/13/2023] Open
Abstract
Background Quality of life (QoL), being the sum expression of diverse influencing factors, is not easy to determine. A clinically relevant option would be to identify and measure quality of life on the basis of physiological parameters which correlate plausibly and statistically with psychometrically measured QoL. Analysis of heart rate variability (HRV) offers readily measurable physiological parameters which could be of use here. A correlation of HRV with both course of disease and QoL has been reported in patients with chronic illness. Various psychometric instruments have been developed for use in paediatric oncology. The aim of this study was to obtain data on HRV and QoL and their correlations, initially in healthy children. Methods Holter ECG and quality of life were examined in 160 children and adolescents (72 male) aged between 8 and 18 years. QoL was determined with the established questionnaire PEDQoL. Standard parameters of HRV from the frequency domain were calculated and correlated with QoL domains using Spearman (nonparametric) correlation analysis. Results Minor but significant associations were revealed only with regard to the PEDQoL domain “autonomy” on the one hand and heart rate and HRV (e.g. MRR, MRRn, MRRd, HRV_ULF, SDNN) parameters which evidently reflect distinct physiological functions on the other. Conclusions In healthy children and adolescents we have a first indication that there is a correlation between parameters of HRV and QoL. However, to a greater extent, HRV reflects associated physiological processes of the autonomic nervous system. A higher correlation is more likely to be found in chronically ill children.
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Herbsleb M, Schulz S, Ostermann S, Donath L, Eisenträger D, Puta C, Voss A, Gabriel HW, Bär KJ. The relation of autonomic function to physical fitness in patients suffering from alcohol dependence. Drug Alcohol Depend 2013; 132:505-12. [PMID: 23664500 DOI: 10.1016/j.drugalcdep.2013.03.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2012] [Revised: 03/09/2013] [Accepted: 03/26/2013] [Indexed: 01/14/2023]
Abstract
BACKGROUND Reduced cardio-vascular health has been found in patients suffering from alcohol dependence. Low cardio-respiratory fitness is an independent predictor of cardio-vascular disease. METHODS We investigated physical fitness in 22 alcohol-dependent patients 10 days after acute alcohol withdrawal and compared results with matched controls. The standardized 6-min walk test (6 MWT) was used to analyze the relationship of autonomic dysfunction and physical fitness. Ventilatory indices and gas exchanges were assessed using a portable spiroergometric system while heart rate recordings were obtained separately. We calculated walking distance, indices of heart rate variability and efficiency parameters of heart rate and breathing. In addition, levels of exhaled carbon monoxide were measured in all participants to account for differences in smoking behaviour. Multivariate analyses of variance (MANOVA) were performed to investigate differences between patients and controls with regard to autonomic and efficiency parameters. RESULTS Patients walked a significantly shorter distance in comparison to healthy subjects during the 6 MWT. Significantly decreased heart rate variability was observed before and after the test in patients when compared to controls, while no such difference was observed during exercise. The efficiency parameters indicated significantly reduced efficiency in physiological regulation when the obtained parameters were normalized to the distance. DISCUSSION The 6 MWT is an easily applied instrument to measure physical fitness in alcohol dependent patients. It can also be used during exercise interventions. Reduced physical fitness, as observed in our study, might partly be caused by autonomic dysfunction, leading to less efficient regulation of physiological processes during exercise.
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Affiliation(s)
- Marco Herbsleb
- Pain & Autonomic Integrative Research (PAIR), Department of Psychiatry and Psychotherapy, University Hospital, Jena, Germany; Department of Sports Medicine and Health Promotion, Friedrich-Schiller-University, Jena, Germany
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Impact of antipsychotics and anticholinergics on autonomic modulation in patients with schizophrenia. J Clin Psychopharmacol 2013; 33:170-7. [PMID: 23422372 DOI: 10.1097/jcp.0b013e3182839052] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Antipsychotics are associated with cardiovascular risk, but the relationship between their anticholinergic properties and cardiac function is not clear. We hypothesize that antipsychotics with a high muscarinic affinity (HMA) may reduce parasympathetic modulation, which should be observable by means of heart rate variability (HRV) measurement. We also assume that anticholinergics, which are commonly used in patients with schizophrenia to treat drug-induced parkinsonism, interact with antipsychotics, and this may also affect HRV. Fifty-five patients with schizophrenia were recruited into this study. Twenty-eight subjects used antipsychotics with an HMA and 27 subjects used antipsychotics with a low muscarinic affinity (LMA). Heart rate variability values between the patients on antipsychotics with HMA and those on antipsychotics with LMA were compared. Correlation and regression analysis were then performed to clarify the relationship between HMA, LMA, and HRV. The influence of anticholinergics was also assessed by correlation analysis. The HMA group showed significantly reduced low-frequency (LF) power, high-frequency (HF) power, total power (TP), and normalized LF (LF%) than the LMA group. Regression analysis supported the hypothesis that muscarinic affinity was related to LF (β = -0.447; P < 0.001), HF (β = -0.390; P = 0.002), and TP (β = -0.399; P = 0.001). The interaction between LMA and anticholinergic use also influenced LF% (β = 0.326; P = 0.006). In the LMA group, the use of anticholinergics was positively correlated with LF% and LF/HF. In the HMA group, after exclusion of the patients using anticholinergics, the equivalent dose of antipsychotics showed a negative correlation with HF. Our results suggest that the muscarinic affinity of antipsychotics affects both sympathetic and parasympathetic modulation and that anticholinergics interact with antipsychotics to influence HRV.
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Berger S, Kliem A, Yeragani V, Bär KJ. Cardio-respiratory coupling in untreated patients with major depression. J Affect Disord 2012; 139:166-71. [PMID: 22386048 DOI: 10.1016/j.jad.2012.01.035] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Revised: 01/30/2012] [Accepted: 01/30/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Depressive disorders are known to be associated with higher risks of cardiovascular diseases. Several studies have reported an imbalance within the autonomic nervous system (ANS) as one putative cause. Previous investigations showed decreased cardio-respiratory coupling in depressive patients that were treated with nortriptyline. We aimed to compare parameters of heart rate variability and cardio-respiratory coupling between unmedicated patients suffering from major depressive disorder (MDD) and healthy controls in order to further understand autonomic dysfunction in the disease. METHODS We investigated eighteen unmedicated patients with major depressive disorder and eighteen matched healthy controls. Electrocardiogram and respiratory signals were obtained during a twenty minute resting period. Time- and frequency based parameters of HRV, respiratory sinus arrhythmia (RSA), approximate entropy of heart rate (ApEn(RR)) and respiratory rate (ApEn(Resp)) were calculated. Additionally, cross-ApEn between RR-intervals and respiration time series was determined, reflecting coupling of both signals. RESULTS Patients showed an increased heart rate and LF/HF-ratio. Respiratory sinus arrhythmia (RSA) and ApEn(RR) were reduced in patients in comparison to controls. Breathing rate, ApEn(Resp) and cross-ApEn did not differ between the two groups. DISCUSSION Increased heart rate, increased LF/HF-ratio, reduced RSA and reduced ApEn(RR) indicate a decrease of cardiac vagal modulation in depressive patients. No difference of cardio-respiratory coupling was observed. Respiratory parameters and cross-ApEn did not differ between both groups, and thus we conclude that diminished vagal modulation is mainly limited to cardiac modulation.
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Affiliation(s)
- Sandy Berger
- Pain & Autonomics - Integrative Research (PAIR), Department of Psychiatry and Psychotherapy, University Hospital Jena, Germany
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The phrenic component of acute schizophrenia--a name and its physiological reality. PLoS One 2012; 7:e33459. [PMID: 22438935 PMCID: PMC3306403 DOI: 10.1371/journal.pone.0033459] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Accepted: 02/13/2012] [Indexed: 12/26/2022] Open
Abstract
Decreased heart rate variability (HRV) was shown for unmedicated patients with schizophrenia and their first-degree relatives, implying genetic associations. This is known to be an important risk factor for increased cardiac mortality in other diseases. The interaction of cardio-respiratory function and respiratory physiology has never been investigated in the disease although it might be closely related to the pattern of autonomic dysfunction. We hypothesized that increased breathing rates and reduced cardio-respiratory coupling in patients with acute schizophrenia would be associated with low vagal function. We assessed variability of breathing rates and depth, HRV and cardio-respiratory coupling in patients, their first-degree relatives and controls at rest. Control subjects were investigated a second time by means of a stress task to identify stress-related changes of cardio-respiratory function. A total of 73 subjects were investigated, consisting of 23 unmedicated patients, 20 healthy, first-degree relatives and 30 control subjects matched for age, gender, smoking and physical fitness. The LifeShirt®, a multi-function ambulatory device, was used for data recording (30 minutes). Patients breathe significantly faster (p<.001) and shallower (p<.001) than controls most pronouncedly during exhalation. Patients' breathing is characterized by a significantly increased amount of middle- (p<.001), high- (p<.001), and very high frequency fluctuations (p<.001). These measures correlated positively with positive symptoms as assessed by the PANSS scale (e.g., middle frequency: r = 521; p<.01). Cardio-respiratory coupling was reduced in patients only, while HRV was decreased in patients and healthy relatives in comparison to controls. Respiratory alterations might reflect arousal in acutely ill patients, which is supported by comparable physiological changes in healthy subjects during stress. Future research needs to further investigate these findings with respect to their physiological consequences for patients. These results are invaluable for researchers studying changes of biological signals prone to the influence of breathing rate and rhythm (e.g., functional imaging).
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Chang LR, Lin YH, Kuo TBJ, Wu Chang HC, Liu CM, Liu CC, Hwu HG, Yang CCH. Autonomic modulation and health-related quality of life among schizophrenic patients treated with non-intensive case management. PLoS One 2011; 6:e26378. [PMID: 22073161 PMCID: PMC3208549 DOI: 10.1371/journal.pone.0026378] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Accepted: 09/26/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Schizophrenia is associated with autonomic dysfunction and this may increase cardiovascular mortality. Past studies on autonomic modulation of schizophrenic patients focused on inpatients rather than individuals in a community setting, especially those receiving non-intensive case management (non-ICM). Besides, autonomic modulation and its association with health-related quality of life (HRQoL) in this population remain unexplored. METHODS A total of 25 schizophrenic patients treated by non-ICM and 40 healthy volunteers were matched by age, gender and body mass index; smokers were excluded. Between the two groups, we compared the individuals' 5 min resting assessments of heart rate variability and their HRQoL, which was measured using EuroQoL-5D (EQ-5D). Patients with schizophrenia were assessed for psychopathology using the Positive and Negative Syndrome Scale for Schizophrenia (PANSS). We examined the relationship between heart rate variability measurements, HRQoL scores, PANSS scores, and other clinical variables among the schizophrenic patients treated by non-ICM. RESULTS Compared to the controls, patients with schizophrenia showed a significant impairment of autonomic modulation and a worse HRQoL. Cardiovagal dysfunction among the schizophrenic patients could be predicted independently based on lower educational level and more negative symptoms. Sympathetic predominance was directly associated with anticholinergics use and EQ-5D using a visual analogue scale (EQ-VAS). CONCLUSION Patients with schizophrenia treated by non-ICM show a significant impairment of their autonomic function and HRQoL compared to the controls. Since the sympathovagal dysfunction is associated with more negative symptoms or higher VAS score, the treatment of the negative symptoms as well as the monitoring of HRQoL might help to manage cardiovascular risk among these individuals. In addition, EQ-VAS scores must be interpreted more cautiously in such a population.
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Affiliation(s)
- Li-Ren Chang
- Department of Psychiatry, National Taiwan University Hospital, Yun-Lin Branch, Yunlin, Taiwan
| | - Yu-Hsuan Lin
- Department of Psychiatry, National Taiwan University Hospital, Yun-Lin Branch, Yunlin, Taiwan
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
| | - Terry B. J. Kuo
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
- Sleep Research Center, National Yang-Ming University, Taipei, Taiwan
- Research Center for Adaptive Data Analysis, National Central University, Taoyuan, Taiwan
| | - Hung-Chieh Wu Chang
- Department of Psychiatry, National Taiwan University Hospital, Yun-Lin Branch, Yunlin, Taiwan
| | - Chih-Min Liu
- Department of Psychiatry, National Taiwan University Hospital, Yun-Lin Branch, Yunlin, Taiwan
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
- Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chen-Chung Liu
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
- Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hai-Gwo Hwu
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
- Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Cheryl C. H. Yang
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
- Sleep Research Center, National Yang-Ming University, Taipei, Taiwan
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