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Swatzyna RJ, Morrow LM, Collins DM, Barr EA, Roark AJ, Turner RP. Evidentiary Significance of Routine EEG in Refractory Cases: A Paradigm Shift in Psychiatry. Clin EEG Neurosci 2024:15500594231221313. [PMID: 38238932 DOI: 10.1177/15500594231221313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
Over the past decade, the Diagnostic and Statistical Manual's method of prescribing medications based on presenting symptoms has been challenged. The shift toward precision medicine began with the National Institute of Mental Health and culminated with the World Psychiatric Association's posit that a paradigm shift is needed. This study supports that shift by providing evidence explaining the high rate of psychiatric medication failure and suggests a possible first step toward precision medicine. A large psychiatric practice began collecting electroencephalograms (EEGs) for this study in 2012. The EEGs were analyzed by the same neurophysiologist (board certified in electroencephalography) on 1,233 patients. This study identified 4 EEG biomarkers accounting for medication failure in refractory patients: focal slowing, spindling excessive beta, encephalopathy, and isolated epileptiform discharges. Each EEG biomarker suggests underlying brain dysregulation, which may explain why prior medication attempts have failed. The EEG biomarkers cannot be identified based on current psychiatric assessment methods, and depending upon the localization, intensity, and duration, can all present as complex behavioral or psychiatric issues. The study highlights that the EEG biomarker identification approach can be a positive step toward personalized medicine in psychiatry, furthering the clinical thinking of "testing the organ we are trying to treat."
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Affiliation(s)
| | | | - Diana M Collins
- Child, Adolescent, and Adult Psychiatry, Sugar Land, TX, USA
| | - Emma A Barr
- Houston Neuroscience Brain Center, Houston, TX, USA
| | | | - Robert P Turner
- Network Neurology, LLC, University of South Carolina School of Medicine, Charleston, SC, USA
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2
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Visual electrophysiology and neuropsychology in bipolar disorders: a review on current state and perspectives. Neurosci Biobehav Rev 2022; 140:104764. [DOI: 10.1016/j.neubiorev.2022.104764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/21/2022] [Accepted: 07/01/2022] [Indexed: 11/21/2022]
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3
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Yamaguchi A, Iwamoto K, Ando M, Fujita K, Yokoyama M, Akiyama T, Igarashi Y, Ozaki N. Driving performance of euthymic outpatients with bipolar disorder undergoing real-world pharmacotherapy. Psychiatry Clin Neurosci 2022; 76:172-178. [PMID: 35037335 DOI: 10.1111/pcn.13332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/12/2021] [Accepted: 12/27/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Medications for the treatment of bipolar disorder (BD) could affect patients' cognitive function. Patients with BD present with neurocognitive impairment even in a remission state. Little research is available on the daily functioning, especially driving performance, of stable outpatients with BD under pharmacological treatment. METHODS In total, 58 euthymic outpatients with BD undergoing real-world pharmacotherapy and 80 sex- and age-matched healthy controls (HCs) were enrolled. Three driving tasks using a driving simulator-road-tracking, car-following, and harsh-braking-and three cognitive tasks-Continuous Performance Test, Wisconsin Card Sorting Test, and Trail-Making Test-were evaluated. Symptom assessment scales-Young Mania Rating Scale, Structured Interview Guide for the Hamilton Depression Rating Scale, Beck Depression Inventory-II, Social Adaptation Self-evaluation Scale, and Stanford Sleepiness Scale-were also completed. RESULTS Car-following and road-tracking performance were significantly impaired in patients with BD compared with HCs after adjusting for demographic variables, but these performances generally overlapped. Broad neurocognitive functions were significantly lower in the patients with BD compared to HCs, but car-following performance was significantly negatively correlated with sustained attention only. Although most patients received multiple medications rather than monotherapy, no relationship between prescriptions and driving performance was found. CONCLUSION Euthymic patients with BD under steady-state pharmacotherapy had impaired driving performance compared with HCs, but the overlapping distributions of driving performance suggested that driving performance is not always deteriorated in patients with BD. Therefore, attentional function may be a useful clinical feature for judging driving aptitude in patients with BD.
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Affiliation(s)
- Akiko Yamaguchi
- Department of Psychiatry, Nagoya University, Graduate School of Medicine, Nagoya, Japan
| | - Kunihiro Iwamoto
- Department of Psychiatry, Nagoya University, Graduate School of Medicine, Nagoya, Japan
| | - Masahiko Ando
- Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Kiyoshi Fujita
- Department of Psychiatry, Okehazama Hospital, Toyoake, Japan
| | | | - Tsuyoshi Akiyama
- Department of Neuropsychiatry, NTT Medical Center Tokyo, Tokyo, Japan
| | | | - Norio Ozaki
- Department of Psychiatry, Nagoya University, Graduate School of Medicine, Nagoya, Japan
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4
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Calzada-Reyes A, Alvarez-Amador A, Galán-Garcia L, Valdés-Sosa M. Electroencephalographic and morphometric abnormalities in psychopath offenders. BEHAVIORAL SCIENCES & THE LAW 2021; 39:597-610. [PMID: 34800344 DOI: 10.1002/bsl.2548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 10/21/2021] [Accepted: 11/02/2021] [Indexed: 06/13/2023]
Abstract
The main goals of the present study were to replicate and extend current knowledge related to paralimbic dysfunctions associated with psychopathy. The research evaluated the quantitative electroencephalography, current density (CD) source and synchronization likelihood analysis during the rest condition and structural magnetic resonance imaging images to compare volumetric and cortical thickness, in inmates recruited from two prisons located in Havana City. The Psychopathy Checklist-Revised (PCL-R) was used as a quantitative measure of psychopathy. This study showed most beta energy and less alpha activity in male psychopath offenders. Low-resolution electromagnetic tomography signified an increase of beta activity in psychopath offender groups within paralimbic regions. The superior temporal gyrus volume was associated with the F1 factor while the fusiform, anterior cingulate and associative occipital areas were primarily associated with the F2 factor of PCL-R scale. Cortical thickness in the left dorsal anterior cingulate cortex and the temporal pole was negatively associated with PCL-R total score.
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Affiliation(s)
- Ana Calzada-Reyes
- Department of Clinical Neurophysiology, Cuban Center for Neuroscience, Havana, Cuba
| | | | | | - Mitchell Valdés-Sosa
- Department of Cognitive Neurosciences, Cuban Center for Neuroscience, Havana, Cuba
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5
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Chiarenza GA. Quantitative EEG in Childhood Attention Deficit Hyperactivity Disorder and Learning Disabilities. Clin EEG Neurosci 2021; 52:144-155. [PMID: 33012168 DOI: 10.1177/1550059420962343] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The clinical use of the quantitative EEG (QEEG) from the pioneering work of John has received a new impetus thanks to new neuroimaging techniques and the possibility of using a number of normative databases both of normal subjects and of subjects with definite pathologies. In this direction, the term personalized medicine is becoming more and more common, a medical procedure that separates patients into different groups based on their predicted response to the quantitative EEG. This has allowed the study of single subjects and to customize health care, with decisions and treatments tailored to each individual patient, as well as improvement of knowledge of the pathophysiological mechanisms of specific diseases. This review article will present the most recent evidence in the field of developmental neuropsychiatric disorders obtained from the application of quantitative EEG both in clinical group studies (attention deficit hyperactivity disorder, developmental dyslexia, oppositional defiant disorder) and in individual case studies not yet published.
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6
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Sari Gokten E, Tulay EE, Beser B, Elagoz Yuksel M, Arikan K, Tarhan N, Metin B. Predictive Value of Slow and Fast EEG Oscillations for Methylphenidate Response in ADHD. Clin EEG Neurosci 2019; 50:332-338. [PMID: 31304784 DOI: 10.1177/1550059419863206] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder and is characterized by symptoms of inattention and/or hyperactivity and impulsivity. In the current study, we obtained quantitative EEG (QEEG) recordings of 51 children aged between 6 and 12 years before the initiation of methylphenidate treatment. The relationship between changes in the scores of ADHD symptoms and initial QEEG features (power/power ratios values) were assessed. In addition, the children were classified as responder and nonresponder according to the ratio of their response to the medication (>25% improvement after medication). Logistic regression analyses were performed to analyze the accuracy of QEEG features for predicting responders. The findings indicate that patients with increased delta power at F8, theta power at Fz, F4, C3, Cz, T5, and gamma power at T6 and decreased beta powers at F8 and P3 showed more improvement in ADHD hyperactivity symptoms. In addition, increased delta/beta power ratio at F8 and theta/beta power ratio at F8, F3, Fz, F4, C3, Cz, P3, and T5 showed negative correlations with Conners' score difference of hyperactivity as well. This means, those with greater theta/beta and delta/beta powers showed more improvement in hyperactivity following medication. Theta power at Cz and T5 and theta/beta power ratios at C3, Cz, and T5 have significantly classified responders and nonresponders according to the logistic binary regression analysis. The results show that slow and fast oscillations may have predictive value for treatment response in ADHD. Future studies should seek for more sensitive biomarkers.
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Affiliation(s)
- Emel Sari Gokten
- 1 Department of Child and Adolescent Psychiatry, NPIstanbul Brain Hospital, Istanbul, Turkey
| | - Emine Elif Tulay
- 2 Technology Transfer Office, Uskudar University, Istanbul, Turkey
| | - Birsu Beser
- 3 Neuroscience Department, Istanbul University, Istanbul, Turkey
| | - Mine Elagoz Yuksel
- 1 Department of Child and Adolescent Psychiatry, NPIstanbul Brain Hospital, Istanbul, Turkey
| | - Kemal Arikan
- 4 Department of Psychology, Faculty of Humanities and Social Sciences, Uskudar University, Istanbul, Turkey
| | - Nevzat Tarhan
- 4 Department of Psychology, Faculty of Humanities and Social Sciences, Uskudar University, Istanbul, Turkey.,5 Department of Psychiatry, NPIstanbul Brain Hospital, Istanbul, Turkey
| | - Baris Metin
- 4 Department of Psychology, Faculty of Humanities and Social Sciences, Uskudar University, Istanbul, Turkey
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7
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Yokota T, Struzik ZR, Jurica P, Horiuchi M, Hiroyama S, Li J, Takahara Y, Ogawa K, Nishitomi K, Hasegawa M, Cichocki A. Semi-Automated Biomarker Discovery from Pharmacodynamic Effects on EEG in ADHD Rodent Models. Sci Rep 2018; 8:5202. [PMID: 29581452 PMCID: PMC5980101 DOI: 10.1038/s41598-018-23450-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 03/13/2018] [Indexed: 11/16/2022] Open
Abstract
We propose a novel semi-automatic approach to design biomarkers for capturing pharmacodynamic effects induced by pharmacological agents on the spectral power of electroencephalography (EEG) recordings. We apply this methodology to investigate the pharmacodynamic effects of methylphenidate (MPH) and atomoxetine (ATX) on attention deficit/hyperactivity disorder (ADHD), using rodent models. We inject the two agents into the spontaneously hypertensive rat (SHR) model of ADHD, the Wistar-Kyoto rat (WKY), and the Wistar rat (WIS), and record their EEG patterns. To assess individual EEG patterns quantitatively, we use an integrated methodological approach, which consists of calculating the mean, slope and intercept parameters of temporal records of EEG spectral power using a smoothing filter, outlier truncation, and linear regression. We apply Fisher discriminant analysis (FDA) to identify dominant discriminants to be heuristically consolidated into several new composite biomarkers. Results of the analysis of variance (ANOVA) and t-test show benefits in pharmacodynamic parameters, especially the slope parameter. Composite biomarker evaluation confirms their validity for genetic model stratification and the effects of the pharmacological agents used. The methodology proposed is of generic use as an approach to investigating thoroughly the dynamics of the EEG spectral power.
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Affiliation(s)
- Tatsuya Yokota
- RIKEN Brain Science Institute, Hirosawa, Wako, Saitama, Japan
| | | | - Peter Jurica
- RIKEN Brain Science Institute, Hirosawa, Wako, Saitama, Japan
| | | | | | - Junhua Li
- RIKEN Brain Science Institute, Hirosawa, Wako, Saitama, Japan
| | - Yuji Takahara
- SHIONOGI & Co., Ltd., Futaba, Toyonaka, Osaka, Japan
| | - Koichi Ogawa
- SHIONOGI & Co., Ltd., Futaba, Toyonaka, Osaka, Japan.
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8
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An Exploratory Study of Intensive Neurofeedback Training for Schizophrenia. Behav Neurol 2017; 2017:6914216. [PMID: 28701821 PMCID: PMC5497641 DOI: 10.1155/2017/6914216] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Revised: 04/23/2017] [Accepted: 05/28/2017] [Indexed: 12/01/2022] Open
Abstract
Schizophrenia is a chronic and devastating brain disorder with ongoing cognitive, behavioral, and emotional deteriorated functions. Neurofeedback training, which enables the individuals to regulate their brain activity using a real-time feedback loop, is increasingly investigated as a potential alternative intervention for schizophrenia. This study aimed to explore the effect of short but intensive neurofeedback training for schizophrenic patients with difficulty for long-time training. A middle-aged woman with chronic schizophrenia completed the intensive training of alpha/beta2 (20–30 Hz) in four consecutive days with a total training duration of 13.5 hours. The results showed that her alpha/beta2 increased over sessions, and her behavior performance including short-term memory, mood, and speech pattern was improved at the end of neurofeedback training. Importantly, a 22-month follow-up found a dramatic improvement in both positive and negative symptoms. These positive outcomes suggest that such intensive neurofeedback training may provide new insight into the treatment of schizophrenia and thus deserves further study to fully examine its scope.
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9
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Kim JW, Lee YS, Han DH, Min KJ, Lee J, Lee K. Diagnostic utility of quantitative EEG in un-medicated schizophrenia. Neurosci Lett 2015; 589:126-31. [PMID: 25595562 DOI: 10.1016/j.neulet.2014.12.064] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 12/16/2014] [Accepted: 12/31/2014] [Indexed: 11/19/2022]
Abstract
The aim of the current study was to evaluate the quantitative electroencephalography (QEEG) characteristics of patients with un-medicated schizophrenia (SPR) and to investigate the diagnostic utility of QEEG in assessing such patients during resting conditions. The subjects included 90 patients with schizophrenia and 90 normal controls. Spectral analysis was performed on the absolute power of all of the electrodes across five frequency bands following artifact removal. We conducted a repeated-measures ANOVA to examine group differences within the five frequency bands across several brain regions and receiver operator characteristic (ROC) analyses to examine the discrimination ability of each frequency band. Compared with controls, patients with schizophrenia showed increased delta and theta activity and decreased alpha 2 activity, particularly in the frontocentral area. There were no significant differences in the alpha 1 and beta activity. The ROC analysis performed on the delta frequency band generated the best result, with an overall classification accuracy of 62.2%. The results of this study confirmed the characteristics of the QEEG power in un-medicated schizophrenia patients compared with normal controls. These findings suggest that a resting EEG test can be a supportive tool for evaluating patients with schizophrenia.
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Affiliation(s)
- Jun Won Kim
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University College of Medicine, Seoul, South Korea; Department of Psychiatry, Graduate School, Chung-Ang University, Seoul, South Korea
| | - Young Sik Lee
- Department of Psychiatry, Chung-Ang University, College of Medicine, Seoul, South Korea.
| | - Doug Hyun Han
- Department of Psychiatry, Chung-Ang University, College of Medicine, Seoul, South Korea
| | - Kyung Joon Min
- Department of Psychiatry, Chung-Ang University, College of Medicine, Seoul, South Korea
| | - Jaewon Lee
- Addiction Brain Center, Eulji Addiction Institute, Gangnam Eulji Hospital, Eulji University, Seoul, South Korea
| | - Kounseok Lee
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea
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10
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Ros T, J Baars B, Lanius RA, Vuilleumier P. Tuning pathological brain oscillations with neurofeedback: a systems neuroscience framework. Front Hum Neurosci 2014; 8:1008. [PMID: 25566028 PMCID: PMC4270171 DOI: 10.3389/fnhum.2014.01008] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 11/26/2014] [Indexed: 12/03/2022] Open
Abstract
Neurofeedback (NFB) is emerging as a promising technique that enables self-regulation of ongoing brain oscillations. However, despite a rise in empirical evidence attesting to its clinical benefits, a solid theoretical basis is still lacking on the manner in which NFB is able to achieve these outcomes. The present work attempts to bring together various concepts from neurobiology, engineering, and dynamical systems so as to propose a contemporary theoretical framework for the mechanistic effects of NFB. The objective is to provide a firmly neurophysiological account of NFB, which goes beyond traditional behaviorist interpretations that attempt to explain psychological processes solely from a descriptive standpoint whilst treating the brain as a “black box”. To this end, we interlink evidence from experimental findings that encompass a broad range of intrinsic brain phenomena: starting from “bottom-up” mechanisms of neural synchronization, followed by “top-down” regulation of internal brain states, moving to dynamical systems plus control-theoretic principles, and concluding with activity-dependent as well as homeostatic forms of brain plasticity. In support of our framework, we examine the effects of NFB in several brain disorders, including attention-deficit hyperactivity (ADHD) and post-traumatic stress disorder (PTSD). In sum, it is argued that pathological oscillations emerge from an abnormal formation of brain-state attractor landscape(s). The central thesis put forward is that NFB tunes brain oscillations toward a homeostatic set-point which affords an optimal balance between network flexibility and stability (i.e., self-organised criticality (SOC)).
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Affiliation(s)
- Tomas Ros
- Laboratory for Neurology and Imaging of Cognition, Department of Neurosciences, University of Geneva Geneva, Switzerland
| | - Bernard J Baars
- Theoretical Neurobiology, The Neurosciences Institute La Jolla, CA, USA
| | - Ruth A Lanius
- Department of Psychiatry, University of Western Ontario London, ON, Canada
| | - Patrik Vuilleumier
- Laboratory for Neurology and Imaging of Cognition, Department of Neurosciences, University of Geneva Geneva, Switzerland
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11
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Zimmerman EM, Konopka LM. Preliminary Findings of Single- and Multifocused Epileptiform Discharges in Nonepileptic Psychiatric Patients. Clin EEG Neurosci 2014; 45:285-292. [PMID: 24293160 DOI: 10.1177/1550059413506001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2012] [Revised: 07/15/2013] [Accepted: 08/14/2013] [Indexed: 11/17/2022]
Abstract
Epileptiform discharges (EDs) in nonepileptic populations remain controversial as to their role in psychopathology. Previous studies have unsuccessfully attempted to correlate specific waveforms of EDs, defined by duration and morphology, with broad diagnostic categories such as depression and anxiety. These diagnostic categories often include heterogeneous patient populations, with potentially divergent biological underpinnings of clinical presentation. This study examined epileptiform activities as a single phenomenon, identifying the relationships between distribution patterns of EDs and endorsement of clinical symptoms across affective, cognitive, and somatic domains. In a sample of 71 nonepileptic psychiatric patients, those with EDs appearing in homologous electrode pairs endorsed significantly fewer symptoms related to affective deregulation. These patients were also significantly less likely to endorse a history of severe symptomatology, including suicidal ideation/previous attempt, self-injurious behavior, psychoses or dissociation, and previous psychiatric hospitalization. Conversely, patients with isolated EDs focused to a single brain region endorsed greater affective deregulation and severe clinical symptoms. These findings offer new possibilities regarding the potentially protective role that EDs may play when distributed across hemispheres, particularly in light of recent theories exploring functional connectivity of neuronal networks.
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Affiliation(s)
| | - Lukasz M Konopka
- Yellowbrick, Evanston, IL, USA.,Loyola University, Chicago, IL, USA
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12
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Sand T, Bjørk MH, Vaaler AE. Is EEG a useful test in adult psychiatry? TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2013; 133:1200-4. [PMID: 23759782 DOI: 10.4045/tidsskr.12.1253] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND We present a brief overview of the use of EEG in psychiatry, with particular emphasis on differential diagnosis examination in case of acute psychiatric conditions. METHOD The article is based on a literature search in PubMed and the authors' own collections of articles and personal experience. RESULTS Onset of epilepsy, encephalitis or other cerebral diseases may be accompanied by psychiatric or cognitive symptoms. Slow EEG activity may be an unspecific sign of cerebral disease. Psychiatric patients are also at an increased risk of epilepsy. In case of seizure symptoms such as convulsions or conditions with rapid changes in affective states, epileptiform activity during EEG is a specific sign of epileptic aetiology or comorbidity. Quantitative frequency analysis (QEEG) is useful for research purposes and in exceptional cases also in a clinical context. No QEEG method has as yet become accepted as providing reliable, independent markers for psychiatric disease or treatment response. INTERPRETATION EEG should be undertaken in case of newly occurring psychoses and for conditions with a fluctuating or progradiating loss of cognitive function. Adult psychiatric patients with seizure symptoms or rapid changes in affective states should also be referred to EEG.
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Affiliation(s)
- Trond Sand
- Department of Neurology and Clinical, Neurophysiology, St. Olavs Hospital, Norway.
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13
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Lee MG, Kim M, Roh M, Jang IS, Won SH. Differences between Physostigmine- and Yohimbine-induced States Are Visualized in Canonical Space Constructed from EEG during Natural Sleep-wake Cycle in Rats. Exp Neurobiol 2011; 20:54-65. [PMID: 22110362 PMCID: PMC3213735 DOI: 10.5607/en.2011.20.1.54] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Accepted: 01/14/2011] [Indexed: 11/19/2022] Open
Abstract
Although quantitative EEG parameters, such as spectral band powers, are sensitive to centrally acting drugs in dose- and time-related manners, changes of the EEG parameters are redundant. It is desirable to reduce multiple EEG parameters to a few components that can be manageable in a real space as well as be considered as parameters representing drug effects. We calculated factor loadings from normalized values of eight relative band powers (powers of 0.5, 1.0~2.0, 2.5~4.0, 4.5~5.5, 6.0~8.0, 8.5~12.0, 12.5~24.5, and 25~49.5 Hz bands expressed as ratios of the power of 0.5-49.5 Hz band) of EEG during pre-drug periods (11:00~12:00) by factor analysis and constructed a two-dimensional canonical space (reference canonical space) by canonical correlation analysis. Eight relative band powers of EEG produced by either physostigmine or yohimbine were reduced to two canonical scores in the reference canonical space. While changes of the band powers produced by physostigmine and yohimbine were too redundant to describe the difference between two drugs, locations of two drugs in the reference canonical space represented the difference between two drug's effects on EEG. Because the distance between two locations in the canonical space (Mahalanobis distance) indicates the magnitude of difference between two different sets of EEG parameters statistically, the canonical scores and the distance may be used to quantitatively and qualitatively describe the dose-dependent and time-dependent effects and also tell similarity and dissimilarity among effects. Then, the combination of power spectral analysis and statistical analysis may help to classify actions of centrally acting drugs.
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Affiliation(s)
- Maan-Gee Lee
- Department of Pharmacology, School of Medicine, Kyungpook National University, Daegu 700-422, Korea
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14
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Vahia IV, Palmer BW, Depp C, Fellows I, Golshan S, Kraemer HC, Jeste DV. Is late-onset schizophrenia a subtype of schizophrenia? Acta Psychiatr Scand 2010; 122:414-26. [PMID: 20199491 PMCID: PMC3939834 DOI: 10.1111/j.1600-0447.2010.01552.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine whether late-onset schizophrenia (LOS, onset after age 40) should be considered a distinct subtype of schizophrenia. METHOD Participants included 359 normal comparison subjects (NCs) and 854 schizophrenia out-patients age >40 (110 LOS, 744 early-onset schizophrenia or EOS). Assessments included standardized measures of psychopathology, neurocognition, and functioning. RESULTS Early-onset schizophrenia and LOS groups differed from NCs on all measures of psychopathology and functioning, and most cognitive tests. Early-onset schizophrenia and LOS groups had similar education, severity of depressive, negative, and deficit symptoms, crystallized knowledge, and auditory working memory, but LOS patients included more women and married individuals, had less severe positive symptoms and general psychopathology, and better processing speed, abstraction, verbal memory, and everyday functioning, and were on lower antipsychotic doses. Most EOS-LOS differences remained significant after adjusting for age, gender, severity of negative or deficit symptoms, and duration of illness. CONCLUSION Late-onset schizophrenia should be considered a subtype of schizophrenia.
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Affiliation(s)
- Ipsit V. Vahia
- Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, La Jolla, CA
| | - Barton W. Palmer
- Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, La Jolla, CA,Department of Psychiatry, University of California, San Diego, La Jolla, CA
| | - Colin Depp
- Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, La Jolla, CA,Department of Psychiatry, University of California, San Diego, La Jolla, CA
| | - Ian Fellows
- Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, La Jolla, CA
| | - Shahrokh Golshan
- Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, La Jolla, CA
| | | | - Dilip V. Jeste
- Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, La Jolla, CA,Department of Psychiatry, University of California, San Diego, La Jolla, CA
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15
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Zimmermann R, Gschwandtner U, Wilhelm FH, Pflueger MO, Riecher-Rössler A, Fuhr P. EEG spectral power and negative symptoms in at-risk individuals predict transition to psychosis. Schizophr Res 2010; 123:208-16. [PMID: 20850950 DOI: 10.1016/j.schres.2010.08.031] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2010] [Revised: 08/12/2010] [Accepted: 08/22/2010] [Indexed: 10/19/2022]
Abstract
INTRODUCTION EEG power in the delta, theta and beta1 bands has been shown to be positively correlated with negative symptoms in first episode psychotic patients. The present study investigates this correlation in an "at risk mental state for psychosis" (ARMS) with the aim to improve prediction of transition to psychosis. METHODS Thirteen ARMS patients with later transition to psychosis (ARMS-T) and fifteen without (follow-up period of at least 4 years) (ARMS-NT) were investigated using spectral resting EEG data (of 8 electrodes over the fronto-central scalp area placed according to the 10-20 system) and summary score of the Scale for the Assessment of Negative Symptoms (SANS). Linear regressions were used to evaluate the correlation of SANS and EEG power in seven bands (delta, theta, alpha1, alpha2, beta1, beta2, beta3) in both ARMS groups and logistic regressions were used to predict transition to psychosis. Potentially confounding factors were controlled. RESULTS ARMS-T and ARMS-NT showed differential correlations of EEG power and SANS in delta, theta, and beta1 bands (p<.05): ARMS-T showed positive and ARMS-NT negative correlations. Logistic regressions showed that neither SANS score nor EEG spectral power alone predicted transition to psychosis. However, SANS score in combination with power in the delta, theta, beta1, and beta2 bands, respectively, predicted transition significantly (p<.03). CONCLUSIONS ARMS-T and ARMS-NT show differential correlations of SANS summary score and EEG power in delta, theta, and beta bands. Prediction of transition to psychosis is possible using combined information from a negative symptom scale and EEG spectral data.
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Affiliation(s)
- Ronan Zimmermann
- University Psychiatric Outpatient Department, Psychiatric University Clinics, Basel, Switzerland.
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Negative symptoms in neuroleptic-naïve patients with first-episode psychosis correlate with QEEG parameters. Schizophr Res 2009; 115:231-6. [PMID: 19683895 DOI: 10.1016/j.schres.2009.06.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2009] [Revised: 06/03/2009] [Accepted: 06/14/2009] [Indexed: 11/22/2022]
Abstract
INTRODUCTION While several studies have shown an association of QEEG band power with negative symptoms in patients with schizophrenia, this has not yet been investigated in a sample with neuroleptic-naïve first-episode patients (NNFE) up to now. From literature we hypothesized delta (0.5-4Hz) and theta (4-8Hz) power to be augmented and alpha (8-12Hz) power to be decreased with increased negative symptoms in NNFE. MATERIALS AND METHODS The sample consisted of 27 NNFE. Psychopathology was rated with the Scale for the Assessment of Negative Symptoms (SANS). EEG was recorded from 21 electrodes according to the 10/20 system. Spectral analysis was performed on mean power of 8 electrodes in seven frequency bands after artefact removal. Linear regressions were calculated with log transformed power as dependent and psychopathology as independent variable. We controlled for medication, drugs, age, sex, education and day time of EEG recording. RESULTS A positive correlation of SANS global score with power in delta and theta frequency bands could be confirmed in NNFE. In the alpha1 (8-10Hz) band we found no significant correlation with negative symptoms and in the alpha2 (10-12Hz) band there was a positive correlation with SANS (p=0.069). Beta1 (12-15Hz) power also correlated positively with SANS. DISCUSSION The present results confirm the correlation of negative symptoms with power of slow frequency bands. In addition to previous studies in chronic schizophrenia patients, the effect was shown in NNFE, which is compatible with augmented slow wave power being a marker for negative symptoms in psychosis.
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The Need for Individualization in Neurofeedback: Heterogeneity in QEEG Patterns Associated with Diagnoses and Symptoms. Appl Psychophysiol Biofeedback 2009; 35:31-6. [DOI: 10.1007/s10484-009-9106-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2008] [Accepted: 07/23/2009] [Indexed: 10/20/2022]
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Cantor DS, Stevens E. QEEG Correlates of Auditory-Visual Entrainment Treatment Efficacy of Refractory Depression. ACTA ACUST UNITED AC 2009. [DOI: 10.1080/10874200902887130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Galderisi S, Mucci A, Volpe U, Boutros N. Evidence-based medicine and electrophysiology in schizophrenia. Clin EEG Neurosci 2009; 40:62-77. [PMID: 19534300 DOI: 10.1177/155005940904000206] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
In research on schizophrenia electrophysiological measures have been investigated to identify biomarkers of the disorder, indices enabling differential diagnosis among psychotic disorders, prognostic indicators or endophenotypes. The present systematic review will focus on the most largely studied electrophysiological indices, i.e., qualitative or quantitative (limited to spectral analysis) EEG and the P300 event-related potential. The PubMed clinical query was used with research methodology filters for each of the following categories: diagnosis/prognosis/ aetiology and a broad sensitive search strategy. The key-words: SCHIZOPHRENIA AND EEG/P3/P300 were used. The search results were then narrowed by including the terms "human" and "English language", and cross-referenced. Systematic reviews and meta-analyses, when available, were also used for cross-referencing. Case reports and studies irrelevant to the topics and methodologies under examination were excluded. The remaining papers were screened to verify the eligibility for this systematic review. Inclusion criteria were: a) a diagnosis of schizophrenia confirmed by DSM-III/ICD-9 criteria (or later editions of the same classification systems); b) the inclusion of both a schizophrenia study group and an healthy control group (when appropriate, i.e., for P300 and quantitative EEG); c) qualitative or spectral EEG findings and amplitude measures for P300. The included studies were then reviewed to verify homogeneity of the results, as well as the presence of the information needed for the present systematic review and meta-analysis. Previous reviews and studies meeting the above requirements (n = 22 for qualitative EEG; n = 45 for spectral EEG and n = 132 for P300) were classified according to the Oxford Centre for Evidence-based Medicine (EBM) levels of evidence criteria. For qualitative EEG as a diagnostic test, the majority of studies predated the introduction of DSM-III and were excluded from the review. Few post DSM-III studies investigated the usefulness of qualitative EEG in the differential diagnosis between schizophrenia and psychosis due to general medical condition. None of them was Oxford CEBM level 3b (non-consecutive-study or cohort-study without consistently-applied reference standard) or better (exploratory or validating cohort-study). No meta-analysis could be conducted due to the lack of reliable quantification methods in the reviewed studies. For spectral EEG as a diagnostic test, most studies qualified as level 4 (case-control study with poor reference standard), and only 24% as level 3b or better. An increase of slow activity in patients is reported by most of these studies. As to meta-analyses examining 29 studies, with 32 independent samples for the delta band and 35 for the theta band, a moderate effect size was found and only 1 study yielded findings in the opposite direction for both measures. There was no identified source for the discrepancy. The analysis of moderator factors included medication, band frequency limits, spectral parameters and disease stage. The medication status was significant for the theta band but the effect was unclear as findings for drug-naïve and drug-free patients were in a different direction. Chronicity had a significant effect on both delta and theta bands, with slow activity increase larger in chronic than in first episode patients. For P3 amplitude reduction as a diagnostic index, 63% of the studies qualified as level 3b or better. Meta-analysis (52 studies, 60 independent samples) results demonstrated a large effect size. None of the studies reported opposite findings. The analysis of moderator factors, including medication status and disease stage, revealed no significant effect on data heterogeneity. In conclusion, the examined indices are good candidates but are not ready yet for clinical applications aimed to improve present diagnostic standards for schizophrenia. Further research carried out according to adequate methodological standards and based on large scale multi-center studies is mandatory.
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Affiliation(s)
- Silvana Galderisi
- Department of Psychiatry, University of Naples SUN, Largo Madonna Grazie, Naples, Italy.
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Bjørk MH, Sand T, Bråthen G, Linaker OM, Morken G, Nilsen BM, Vaaler AE. Quantitative EEG findings in patients with acute, brief depression combined with other fluctuating psychiatric symptoms: a controlled study from an acute psychiatric department. BMC Psychiatry 2008; 8:89. [PMID: 19014422 PMCID: PMC2596107 DOI: 10.1186/1471-244x-8-89] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2008] [Accepted: 11/11/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with brief depressive episodes and concurrent rapidly fluctuating psychiatric symptoms do not fit current diagnostic criteria and they can be difficult to diagnose and treat in an acute psychiatric setting. We wanted to study whether these patients had signs of more epileptic or organic brain dysfunction than patients with depression without additional symptomatology. METHODS Sixteen acutely admitted patients diagnosed with a brief depressive episode as well as another concurrent psychiatric diagnosis were included. Sixteen patients with major depression served as controls. Three electroencephalographic studies (EEG) were visually interpreted and the background activity was also analysed with quantitative electroencephalography (QEEG). RESULTS The group with brief depression and concurrent symptoms had multiple abnormal features in their standard EEG compared to patients with major depression, but they did not show significantly more epileptiform activity. They also had significantly higher temporal QEEG delta amplitude and interhemispheric temporal delta asymmetry. CONCLUSION Organic brain dysfunction may be involved in the pathogenesis of patients with brief depressive episodes mixed with rapidly fluctuating psychiatric symptoms. This subgroup of depressed patients should be investigated further in order to clarify the pathophysiology and to establish the optimal evaluation scheme and treatment in an acute psychiatric setting.
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Affiliation(s)
- Marte Helene Bjørk
- Department of Neurology and Clinical Neurophysiology, St Olavs Hospital, Trondheim, Norway.
| | - Trond Sand
- Department of Neurology and Clinical Neurophysiology, St Olavs Hospital, Trondheim, Norway,Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Geir Bråthen
- Department of Neurology and Clinical Neurophysiology, St Olavs Hospital, Trondheim, Norway,Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Olav M Linaker
- Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway,Division of Psychiatry, Department of Research and Development, St Olavs Hospital, Trondheim, Norway
| | - Gunnar Morken
- Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway,Østmarka Psychiatric Department, St Olavs Hospital, Trondheim, Norway
| | - Brigt M Nilsen
- Department of Neurology and Clinical Neurophysiology, St Olavs Hospital, Trondheim, Norway,Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Arne Einar Vaaler
- Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway,Østmarka Psychiatric Department, St Olavs Hospital, Trondheim, Norway
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Price GW, Lee JW, Garvey C, Gibson N. Appraisal of sessional EEG features as a correlate of clinical changes in an rTMS treatment of depression. Clin EEG Neurosci 2008; 39:131-8. [PMID: 18751562 DOI: 10.1177/155005940803900307] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Previous findings on electrophysiological features related to depression predict that these correlate with clinical assessment, and potentially act as proxy measures of state changes. We investigated selected electrophysiological features to evaluate their utility as proxies for clinical ratings and in prediction of treatment outcome. Using typical EEG data from an repetitive transcranial magnetic stimulation (rTMS) treatment regime, we analyzed individual alpha power and frequency, and asymmetry index from 39 patients with treatment resistant depression. The prognostic utility of these features was assessed in terms of group identification, correlation with clinical rating, or association with the time course of treatment. There was no significant group difference in asymmetry between depression patients and normal and clinical controls. Background alpha was significantly less in depression patients than controls, with the schizophrenia group midway between. There was no significant group change in asymmetry index or background alpha activity with treatment. There was a weak effect of rTMS over each session on alpha power and on asymmetry, but in the opposite direction to predictions. There was weak evidence of predicted correlation between asymmetry index change and clinical rating change, as well as in final scores that was opposite to predictions. Finally there was no strong evidence that either feature fitted a linear or more complex model of daily treatment. In conclusion, the findings are not sufficient, under our current clinical treatment regime, to support the use of background alpha activity or frontal asymmetry as proxies for clinical assessment. Several findings, however, provide support for further research in this direction.
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Affiliation(s)
- G W Price
- Clinical Research and Neurophysiology, North Metropolitan Area Health Service-Mental Health, Perth, Australia.
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