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Stip E, Javaid SF, Abdel Aziz K, Arnone D. Happy Birthday "One Flew Over the Cuckoo's Nest": A Momentous Tale in the Quest for an Effective and Ethical Approach to Psychosurgery. Can J Psychiatry 2023; 68:887-893. [PMID: 37424267 PMCID: PMC10657581 DOI: 10.1177/07067437231182658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
The anniversary of the publication of 'One Flew Over the Cuckoo's Nest' by Ken Kesey offers an opportunity for reflection on the use of neurosurgery in psychiatry. We used a narrative, historical and dialectical method to deliver an account of the controversial subject. A balanced representation of the negative and positive aspects, acknowledging some of the questionable ethical practices while describing well-reasoned applications is provided. It includes neurosurgeons, psychiatrists who have embraced these procedures with unwarranted enthusiasm and those who have opposed. Neurosurgical techniques for the treatment of severe mental disorders have evolved from rudimentary procedures which were used to 'correct' unwanted behaviours associated with a wide range of severe mental disorders to more refined and selective approaches used as a last resort to treat specific mental health conditions. In the absence of specific aetiological models to guide ablative surgical targets, non-ablative, stimulatory techniques have more recently been developed to allow reversibility when surgical treatment fails to obtain a sizeable improvement in quality of life. The subject is concretely illustrated by two eloquent clinical images: one on a series of brain computed tomography scans carried out on a Canadian population of subjects, who underwent leukotomy decades ago, and the other more contemporary on an implantation surgery to epidural stimulation. Alongside technical advances in psychosurgery, a regulatory framework has gradually developed to ensure vigilance in the appropriateness of patients' selection. Nevertheless, harmonisation of protocols around the world is necessary to ensure consistency in obtaining and maintaining the highest possible ethical standards for the benefit of patients. If the neurosciences promise today, in their new, better framed, and reversible applications, to provide answers to unmet therapeutic needs, we still must remain attentive to drifts linked the introduction of intrusive technologies for purposes of domination or behaviour modification that would impede our individual freedom.
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Affiliation(s)
- E. Stip
- Université de Montréal, Institut Universitaire en Santé Mentale de Montréal, Montréal, Canada
- Department of Psychiatry and Behaviour Science, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - S. F. Javaid
- Department of Psychiatry and Behaviour Science, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - K. Abdel Aziz
- Department of Psychiatry and Behaviour Science, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - D. Arnone
- Department of Psychiatry and Behaviour Science, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
- Centre for Affective Disorders, Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Wise T, Marwood L, Perkins AM, Herane-Vives A, Williams SCR, Young AH, Cleare AJ, Arnone D. A morphometric signature of depressive symptoms in unmedicated patients with mood disorders. Acta Psychiatr Scand 2018; 138:73-82. [PMID: 29682732 DOI: 10.1111/acps.12887] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/09/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVE A growing literature indicates that unipolar depression and bipolar depression are associated with alterations in grey matter volume. However, it is unclear to what degree these patterns of morphometric change reflect symptom dimensions. Here, we aimed to predict depressive symptoms and hypomanic symptoms based on patterns of grey matter volume using machine learning. METHOD We used machine learning methods combined with voxel-based morphometry to predict depressive and self-reported hypomanic symptoms from grey matter volume in a sample of 47 individuals with unmedicated unipolar and bipolar depression. RESULTS We were able to predict depressive severity from grey matter volume in the anteroventral bilateral insula in both unipolar depression and bipolar depression. Self-reported hypomanic symptoms did not predict grey matter loss with a significant degree of accuracy. DISCUSSION The results of this study suggest that patterns of grey matter volume alteration in the insula are associated with depressive symptom severity across unipolar and bipolar depression. Studies using other modalities and exploring other brain regions with a larger sample are warranted to identify other systems that may be associated with depressive and hypomanic symptoms across affective disorders.
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Affiliation(s)
- T Wise
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Wellcome Trust Centre for Neuroimaging, University College London, London, UK.,Max Planck, UCL Centre for Computational Psychiatry and Ageing Research, London, UK
| | - L Marwood
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,National Institute for Health Research Biomedical Research Centre, South London and Maudsley NSH Foundation Trust, London, UK
| | - A M Perkins
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,National Institute for Health Research Biomedical Research Centre, South London and Maudsley NSH Foundation Trust, London, UK
| | - A Herane-Vives
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Departamento de Clínicas, Facultad de Medicina, Universidad Católica del Norte, Coquimbo, Chile.,South London and Maudsley NHS Foundation Trust, London, UK
| | - S C R Williams
- National Institute for Health Research Biomedical Research Centre, South London and Maudsley NSH Foundation Trust, London, UK.,Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - A H Young
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,National Institute for Health Research Biomedical Research Centre, South London and Maudsley NSH Foundation Trust, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - A J Cleare
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,National Institute for Health Research Biomedical Research Centre, South London and Maudsley NSH Foundation Trust, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - D Arnone
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
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Arnone D, Wise T, Walker C, Cowen PJ, Howes O, Selvaraj S. The effects of serotonin modulation on medial prefrontal connectivity strength and stability: A pharmacological fMRI study with citalopram. Prog Neuropsychopharmacol Biol Psychiatry 2018; 84:152-159. [PMID: 29409920 PMCID: PMC5886357 DOI: 10.1016/j.pnpbp.2018.01.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 01/12/2018] [Accepted: 01/30/2018] [Indexed: 01/26/2023]
Abstract
BACKGROUND Static and dynamic functional connectivity are being increasingly used to measure the effects of disease and a range of different interventions on brain networks. While preliminary evidence suggests that static connectivity can be modulated by chronic antidepressants administration in healthy individuals and in major depression, much less is known about the acute effects of antidepressants especially on dynamic functional connectivity changes. Here we examine acute effects of antidepressants on dynamic functional connectivity within the default mode network. The default mode network is a well described network with many functions in which the role of serotonin is not clear. METHODS In this work we measured acute pharmacological effects of an infusion of the selective serotonin reuptake inhibitor (SSRI) citalopram (10 mg) in a sample of thirteen healthy volunteers randomised to receive on two occasions the active compound or placebo in a cross over dosing. RESULTS Acute citalopram administration relative to placebo increased static connectivity between the medial prefrontal cortex and right dorsolateral prefrontal cortex and posterior cingulate cortex. The SSRI also induced a reduction in variability of connectivity with the medial prefrontal cortex in the precuneus and posterior cingulate cortex. DISCUSSION The measured changes are compatible with modified serotonin cortical availability.
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Affiliation(s)
- D Arnone
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; South London and Maudsley NHS Foundation Trust, UK.
| | - T Wise
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Max Planck UCL Centre for Computational Psychiatry and Ageing Research, University College London, London, UK; Wellcome Trust Centre for Neuroimaging, University College London, London, UK
| | - C Walker
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - P J Cowen
- Neurosciences Building, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - O Howes
- Medical Research Council Clinical Sciences Centre (CSC), Institute of Clinical Sciences (ICS), Imperial College London, UK; Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - S Selvaraj
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, Texas, USA.
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Herane-Vives A, de Angel V, Papadopoulos A, Wise T, Chua KC, Strawbridge R, Castillo D, Arnone D, Young AH, Cleare AJ. Short-term and long-term measures of cortisol in saliva and hair in atypical and non-atypical depression. Acta Psychiatr Scand 2018; 137:216-230. [PMID: 29397570 DOI: 10.1111/acps.12852] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/20/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Atypical depression may show lowered rather than raised short-term cortisol levels. Atypical major depressive episodes (A-MDE) may also be more closely linked to environmental factors and show overlap with somatic symptom disorders. Hair specimens allow measuring long-term cortisol levels. METHODS Twenty-seven A-MDE and 44 NA-MDE patients and 40 matched controls were tested. Measures of hair cortisol concentration [HCC] covering the previous 3 months and short-term cortisol parameters (six saliva specimens to assess the cortisol awakening response [CAR] and total daily cortisol output calculated as the area under the curve [AUCg]) were taken alongside measures of environmental factors and clinical variables. RESULTS There were no differences in HCC between the three groups (P = 0.8), and no difference in the CAR (P = 0.95). However, A-MDE showed lowered short-term cortisol output (AUCg) compared to controls (P = 0.04). A-MDE patients also reported a higher number of daily hassles, and higher levels of fatigue and impaired concentration than NA-MDE. CONCLUSIONS Normal long-term (HCC) and reduced short-term (AUCg) cortisol levels in A-MDE could suggest a disrupted long-term cortisol rhythm, perhaps affected by environmental factors or by certain symptoms, such as mid-nocturnal insomnia. However, other underlying explanations for these findings should also be investigated in the future.
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Affiliation(s)
- A Herane-Vives
- Department of Psychological Medicine, Affective Disorders Research Group, Centre for Affective Disorders, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Departamento de Clínicas, Facultad de Medicina, Universidad Católica del Norte, Coquimbo, Chile
| | - V de Angel
- Department of Psychological Medicine, Affective Disorders Research Group, Centre for Affective Disorders, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - A Papadopoulos
- Department of Psychological Medicine, Affective Disorders Research Group, Centre for Affective Disorders, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - T Wise
- Department of Psychological Medicine, Affective Disorders Research Group, Centre for Affective Disorders, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - K-C Chua
- Department of Psychological Medicine, Affective Disorders Research Group, Centre for Affective Disorders, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - R Strawbridge
- Department of Psychological Medicine, Affective Disorders Research Group, Centre for Affective Disorders, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - D Castillo
- Instituto Psiquiátrico José Horwitz Barak, Santiago, Chile
| | - D Arnone
- Department of Psychological Medicine, Affective Disorders Research Group, Centre for Affective Disorders, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - A H Young
- Department of Psychological Medicine, Affective Disorders Research Group, Centre for Affective Disorders, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - A J Cleare
- Department of Psychological Medicine, Affective Disorders Research Group, Centre for Affective Disorders, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Wise T, Radua J, Via E, Cardoner N, Abe O, Adams TM, Amico F, Cheng Y, Cole JH, de Azevedo Marques Périco C, Dickstein DP, Farrow TFD, Frodl T, Wagner G, Gotlib IH, Gruber O, Ham BJ, Job DE, Kempton MJ, Kim MJ, Koolschijn PCMP, Malhi GS, Mataix-Cols D, McIntosh AM, Nugent AC, O'Brien JT, Pezzoli S, Phillips ML, Sachdev PS, Salvadore G, Selvaraj S, Stanfield AC, Thomas AJ, van Tol MJ, van der Wee NJA, Veltman DJ, Young AH, Fu CH, Cleare AJ, Arnone D. Common and distinct patterns of grey-matter volume alteration in major depression and bipolar disorder: evidence from voxel-based meta-analysis. Mol Psychiatry 2017; 22:1455-1463. [PMID: 27217146 PMCID: PMC5622121 DOI: 10.1038/mp.2016.72] [Citation(s) in RCA: 357] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 03/01/2016] [Accepted: 03/23/2016] [Indexed: 12/11/2022]
Abstract
Finding robust brain substrates of mood disorders is an important target for research. The degree to which major depression (MDD) and bipolar disorder (BD) are associated with common and/or distinct patterns of volumetric changes is nevertheless unclear. Furthermore, the extant literature is heterogeneous with respect to the nature of these changes. We report a meta-analysis of voxel-based morphometry (VBM) studies in MDD and BD. We identified studies published up to January 2015 that compared grey matter in MDD (50 data sets including 4101 individuals) and BD (36 data sets including 2407 individuals) using whole-brain VBM. We used statistical maps from the studies included where available and reported peak coordinates otherwise. Group comparisons and conjunction analyses identified regions in which the disorders showed common and distinct patterns of volumetric alteration. Both disorders were associated with lower grey-matter volume relative to healthy individuals in a number of areas. Conjunction analysis showed smaller volumes in both disorders in clusters in the dorsomedial and ventromedial prefrontal cortex, including the anterior cingulate cortex and bilateral insula. Group comparisons indicated that findings of smaller grey-matter volumes relative to controls in the right dorsolateral prefrontal cortex and left hippocampus, along with cerebellar, temporal and parietal regions were more substantial in major depression. These results suggest that MDD and BD are characterised by both common and distinct patterns of grey-matter volume changes. This combination of differences and similarities has the potential to inform the development of diagnostic biomarkers for these conditions.
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Affiliation(s)
- T Wise
- Department of Psychological Medicine, Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - J Radua
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Research Unit, FIDMAG Germanes Hospitalàries – CIBERSAM, Sant Boi de Llobregat, Barcelona, Spain
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - E Via
- Mental Health, Parc Taulí Sabadell-CIBERSAM, University Hospital, Sabadell, Barcelona, Spain
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
| | - N Cardoner
- Mental Health, Parc Taulí Sabadell-CIBERSAM, University Hospital, Sabadell, Barcelona, Spain
| | - O Abe
- Department of Radiology, Nihon University School of Medicine, Tokyo, Japan
| | - T M Adams
- Department of Psychological Medicine, Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - F Amico
- Department of Psychiatry, Trinity College Institute of Neuroscience, Trinity College, Dublin, Ireland
| | - Y Cheng
- Department of Psychiatry, The 1st Affiliated Hospital of Kunming Medical University, Kunming, PR China
| | - J H Cole
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Department of Medicine, Imperial College London, London, UK
| | - C de Azevedo Marques Périco
- Department of Neuroscience, Medical School, Fundação do ABC, Santo André, SP, Brazil
- ABC Center of Studies on Mental Health, Santo André, SP, Brazil
| | - D P Dickstein
- PediMIND Program, Bradley Hospital, Department of Psychiatry, Brown University, East Providence, RI, USA
| | - T F D Farrow
- Academic Clinical Neurology, Department of Neuroscience, University of Sheffield, Sheffield, UK
| | - T Frodl
- Department of Psychiatry and Psychotherapy, Otto-von-Guericke University, Magdeburg, Germany
- Department of Psychiatry, University of Dublin, Trinity College, Dublin, Ireland
| | - G Wagner
- Psychiatric Brain and Body Research Group Jena, Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - I H Gotlib
- Department of Psychology, Stanford University, Stanford, CA, USA
| | - O Gruber
- Section for Experimental Psychopathology and Neuroimaging, Department of General Psychiatry, Heidelberg University Hospital, Heidelberg, Germany
| | - B J Ham
- Department of Psychiatry, Korea University College of Medicine, Seoul, South Korea
| | - D E Job
- Neuroimaging Sciences, University of Edinburgh, Edinburgh, UK
- Scottish Imaging Network–A Platform for Scientific Excellence (SINAPSE), Giffnock, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - M J Kempton
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - M J Kim
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH, USA
| | - P C M P Koolschijn
- Department of Psychology, Dutch Autism and ADHD Research Center, Brain and Cognition, University of Amsterdam, Amsterdam, The Netherlands
| | - G S Malhi
- CADE Clinic, Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - D Mataix-Cols
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - A M McIntosh
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
| | - A C Nugent
- Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - J T O'Brien
- Institute for Ageing and Health, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - S Pezzoli
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Department of Neuroscience, Medical School, University of Sheffield, Sheffield, UK
| | - M L Phillips
- Department of Psychiatry, University of Pittsburgh, School of Medicine, Pittsburgh, PA
| | - P S Sachdev
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Randwick, NSW, Australia
- Neuropsychiatric Institute, Prince of Wales Hospital, Randwick, NSW, Australia
| | - G Salvadore
- Janssen Research and Development, Titusville, NJ, USA
| | - S Selvaraj
- Department of Psychiatry and Behavioral Sciences, Center of Excellence on Mood Disorders, Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - A C Stanfield
- The Patrick Wild Centre, Royal Edinburgh Hospital, University of Edinburgh, Edinburgh, UK
| | - A J Thomas
- Institute for Ageing and Health, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - M J van Tol
- NeuroImaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - N J A van der Wee
- Department of Psychiatry, Leiden University Medical Center, Leiden University, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden, The Netherlands
| | - D J Veltman
- Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
| | - A H Young
- Department of Psychological Medicine, Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - C H Fu
- Department of Psychological Medicine, Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- School of Psychology, University of East London, London, UK
| | - A J Cleare
- Department of Psychological Medicine, Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - D Arnone
- Department of Psychological Medicine, Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
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Wise T, Marwood L, Perkins AM, Herane-Vives A, Joules R, Lythgoe DJ, Luh WM, Williams SCR, Young AH, Cleare AJ, Arnone D. Instability of default mode network connectivity in major depression: a two-sample confirmation study. Transl Psychiatry 2017; 7:e1105. [PMID: 28440813 PMCID: PMC5416685 DOI: 10.1038/tp.2017.40] [Citation(s) in RCA: 119] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Revised: 12/14/2016] [Accepted: 01/09/2017] [Indexed: 12/12/2022] Open
Abstract
Major depression is associated with altered static functional connectivity in various brain networks, particularly the default mode network (DMN). Dynamic functional connectivity is a novel tool with little application in affective disorders to date, and holds the potential to unravel fluctuations in connectivity strength over time in major depression. We assessed stability of connectivity in major depression between the medial prefrontal cortex (mPFC) and posterior cingulate cortex (PCC), key nodes in the DMN that are implicated in ruminative cognitions. Functional connectivity stability between the mPFC and PCC over the course of a resting-state functional magnetic resonance imaging (fMRI) scan was compared between medication-free patients with major depression and healthy controls matched for age, sex and handedness. We tested replicability of the results in an independent sample using multi-echo resting-state fMRI. The primary sample included 20 patients and 19 controls, while the validation sample included 19 patients and 19 controls. Greater connectivity variability was detected in major depression between mPFC and PCC. This was demonstrated in both samples indicating that the results were reliable and were not influenced by the fMRI acquisition approach used. Our results demonstrate that alterations within the DMN in major depression go beyond changes in connectivity strength and extend to reduced connectivity stability within key DMN regions. Findings were robustly replicated across two independent samples. Further research is necessary to better understand the nature of these fluctuations in connectivity and their relationship to the aetiology of major depression.
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Affiliation(s)
- T Wise
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK,South London and Maudsley NHS Foundation Trust, London, UK,Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 103 Denmark Hill, London SE5 8AF, UK. E-mail:
| | - L Marwood
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK,South London and Maudsley NHS Foundation Trust, London, UK
| | - A M Perkins
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK,South London and Maudsley NHS Foundation Trust, London, UK
| | - A Herane-Vives
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK,Departamento de Clínicas, Facultad de Medicina, Universidad Católica del Norte, Coquimbo, Chile
| | - R Joules
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - D J Lythgoe
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - W-M Luh
- Cornell MRI Facility, Cornell University, Ithaca, New York, NY, USA
| | - S C R Williams
- South London and Maudsley NHS Foundation Trust, London, UK,Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - A H Young
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK,South London and Maudsley NHS Foundation Trust, London, UK
| | - A J Cleare
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK,South London and Maudsley NHS Foundation Trust, London, UK
| | - D Arnone
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK,South London and Maudsley NHS Foundation Trust, London, UK
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Cheng Y, Xu J, Arnone D, Nie B, Yu H, Jiang H, Bai Y, Luo C, Campbell RAA, Shan B, Xu L, Xu X. Resting-state brain alteration after a single dose of SSRI administration predicts 8-week remission of patients with major depressive disorder. Psychol Med 2017; 47:438-450. [PMID: 27697079 DOI: 10.1017/s0033291716002440] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND The present study investigated alteration of brain resting-state activity induced by antidepressant treatment and attempted to investigate whether treatment efficacy can be predicted at an early stage of pharmacological treatment. METHOD Forty-eight first-episode medication-free patients diagnosed with major depression received treatment with escitalopram. Resting-state functional magnetic resonance imaging was administered prior to treatment, 5 h after the first dose, during the course of pharmacological treatment (week 4) and at endpoint (week 8). Resting-state activity was evaluated in the course of the 8-week treatment and in relation to clinical improvement. RESULTS Escitalopram dynamically modified resting-state activity in depression during the treatment. After 5 h the antidepressant induced a significant decrease in the signal in the occipital cortex and an increase in the dorsolateral and dorsomedial prefrontal cortices and middle cingulate cortex. Furthermore, while remitters demonstrated more obvious changes following treatment, these were more modest in non-responders suggesting possible tonic and dynamic differences in the serotonergic system. Changes after 5 h in the caudate, occipital and temporal cortices were the best predictor of clinical remission at endpoint. CONCLUSIONS This study revealed the possibility of using the measurement of resting-state neural changes a few hours after acute administration of antidepressant to identify individuals likely to remit after a few weeks of treatment.
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Affiliation(s)
- Y Cheng
- Department of Psychiatry,First Affiliated Hospital of Kunming Medical University,Kunming,China
| | - J Xu
- Department of Internal Medicine,First Affiliated Hospital of Kunming Medical University,Kunming,China
| | - D Arnone
- Department of Psychological Medicine,Centre for Affective Disorders, King's College London,London,UK
| | - B Nie
- Key Laboratory of Nuclear Analysis Techniques,Institute of High Energy Physics, Chinese Academy of Sciences,Beijing,China
| | - H Yu
- Magnetic Resonance Imaging Center,the First Hospital of Kunming City,Kunming,China
| | - H Jiang
- Department of Psychiatry,First Affiliated Hospital of Kunming Medical University,Kunming,China
| | - Y Bai
- Department of Psychiatry,First Affiliated Hospital of Kunming Medical University,Kunming,China
| | - C Luo
- Magnetic Resonance Imaging Center,the First Hospital of Kunming City,Kunming,China
| | - R A A Campbell
- Department of Neuroscience,Cold Spring Harbor Laboratory,New York,USA
| | - B Shan
- Key Laboratory of Nuclear Analysis Techniques,Institute of High Energy Physics, Chinese Academy of Sciences,Beijing,China
| | - L Xu
- Key Laboratory of Animal Models and Human Disease Mechanisms,Chinese Academy of Sciences & Yunnan Province, Kunming Institute of Zoology,Kunming,China
| | - X Xu
- Department of Psychiatry,First Affiliated Hospital of Kunming Medical University,Kunming,China
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Strawbridge R, Arnone D, Danese A, Papadopoulos A, Herane Vives A, Cleare AJ. Inflammation and clinical response to treatment in depression: A meta-analysis. Eur Neuropsychopharmacol 2015; 25:1532-43. [PMID: 26169573 DOI: 10.1016/j.euroneuro.2015.06.007] [Citation(s) in RCA: 415] [Impact Index Per Article: 46.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 06/12/2015] [Indexed: 01/26/2023]
Abstract
The depressive state has been characterised as one of elevated inflammation, which holds promise for better understanding treatment-resistance in affective disorders as well as for future developments in treatment stratification. Aiming to investigate alterations in the inflammatory profiles of individuals with depression as putative biomarkers for clinical response, we conducted meta-analyses examining data from 35 studies that investigated inflammation before and after treatment in depressed patients together with a measure of clinical response. There were sufficient data to analyse IL-6, TNFα and CRP. Levels of IL-6 decreased with antidepressant treatment regardless of outcome, whereas persistently elevated TNFα was associated with prospectively determined treatment resistance. Treatment non-responders tended to have higher baseline inflammation, using a composite measure of inflammatory markers. Our findings suggest that elevated levels of inflammation are contributory to treatment resistance. Combining inflammatory biomarkers might prove a useful tool to improve diagnosis and detection of treatment refractoriness, and targeting persistent inflammation in treatment-resistant depression may offer a potential target for the development of novel intervention strategies.
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Affiliation(s)
- R Strawbridge
- Affective Disorders Research Group, Centre for Affective Disorders, Psychological Medicine, Institute of Psychiatry, King׳s College London, London, UK.
| | - D Arnone
- Affective Disorders Research Group, Centre for Affective Disorders, Psychological Medicine, Institute of Psychiatry, King׳s College London, London, UK
| | - A Danese
- Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, King׳s College London, London, UK; Department of Child & Adolescent Psychiatry, Institute of Psychiatry, King׳s College London, London, UK
| | - A Papadopoulos
- Affective Disorders Research Group, Centre for Affective Disorders, Psychological Medicine, Institute of Psychiatry, King׳s College London, London, UK
| | - A Herane Vives
- Affective Disorders Research Group, Centre for Affective Disorders, Psychological Medicine, Institute of Psychiatry, King׳s College London, London, UK; Psychiatric University Clinic, University of Chile, Santiago, Chile
| | - A J Cleare
- Affective Disorders Research Group, Centre for Affective Disorders, Psychological Medicine, Institute of Psychiatry, King׳s College London, London, UK; National Institute for Health Research (NIHR) Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, King׳s College London, London, UK
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Arnone D, McKie S, Elliott R, Juhasz G, Thomas EJ, Downey D, Williams S, Deakin JFW, Anderson IM. State-dependent changes in hippocampal grey matter in depression. Mol Psychiatry 2013; 18:1265-72. [PMID: 23128153 DOI: 10.1038/mp.2012.150] [Citation(s) in RCA: 196] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Revised: 08/20/2012] [Accepted: 09/07/2012] [Indexed: 12/11/2022]
Abstract
Reduced hippocampal volume has been reported in depression and may be involved in the aetiology of depressive symptoms and vulnerability to depressive relapse. Neuroplasticity following antidepressant drug treatment in the hippocampus has been demonstrated in animal models but adaptive changes after such treatment have not been shown in humans. In this study, we determined whether grey matter loss in the hippocampus in depression (1) is present in medication-free depressed (2) changes in response to antidepressant treatment and (3) is present as a stable trait in medication-free remitted patients. Sixty-four medication-free unipolar depressed patients: 39 currently depressed and 25 in remission, and 66 healthy controls (HC) underwent structural magnetic resonance imaging in a cross-sectional and longitudinal design. Thirty-two currently depressed participants were then treated with the antidepressant citalopram for 8 weeks. Adherence to treatment was evaluated by measuring plasma citalopram concentration. We measured regional variation in grey matter concentration by using voxel-based morphometry-Diffeomorphic Anatomical Registration Through Exponentiated Lie algebra. Patients with current depression had bilaterally reduced grey matter in the hippocampus compared with HC and untreated patients in stable remission with the latter groups not differing. An increase in grey matter was observed in the hippocampus following treatment with citalopram in currently depressed patients. Grey matter reduction in the hippocampus appears specific to the depressed state and is a potential biomarker for a depressive episode.
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Affiliation(s)
- D Arnone
- Neuroscience and Psychiatry Unit, University of Manchester, Manchester, UK
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Thomas EJ, Elliott R, McKie S, Arnone D, Downey D, Juhasz G, Deakin JFW, Anderson IM. Interaction between a history of depression and rumination on neural response to emotional faces. Psychol Med 2011; 41:1845-1855. [PMID: 21306660 DOI: 10.1017/s0033291711000043] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Both past depressive episodes and the personality trait of depressive rumination are strong risk factors for future depression. Depression is associated with abnormal emotional processing, which may be a neurobiological marker for vulnerability to depression. A consistent picture has yet to emerge as to how a history of depression and the tendency to ruminate influence emotional processing. The aim of this study was to investigate the relationship between rumination, past depression and neural responses when processing face emotions. METHOD The Ruminative Responses Scale (RRS) was completed by 30 remitted depressives and 37 controls who underwent functional magnetic resonance imaging (fMRI) scanning while viewing happy, sad, fearful and neutral faces. RESULTS The remitted depressives showed overall reductions in neural responses to negative emotions relative to the controls. However, in the remitted depressives, but not the controls, RRS scores were correlated with increased neural responses to negative emotions and decreased responses to happiness in limbic regions. CONCLUSIONS Automatic emotion processing biases and rumination seem to be correlated to aspects of vulnerability to depression. However, remission from depression may be maintained by a general suppression of limbic responsiveness to negative emotion.
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Affiliation(s)
- E J Thomas
- Neuroscience and Psychiatry Unit, University of Manchester and Manchester Academic Health Science Centre, UK.
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Abstract
BACKGROUND A growing number of European studies, particularly from Nordic countries, suggest an increased frequency of autism in children of immigrant parents. In contrast, North American studies tend to conclude that neither maternal ethnicity nor immigrant status are related to the rate of autism-spectrum disorders. AIMS To examine the hypotheses that maternal ethnicity and/or immigration are linked to the rate of childhood autism-spectrum disorders. METHOD Retrospective case-note analysis of all 428 children diagnosed with autism-spectrum disorders presenting to the child development services in two centres during a 6-year period. RESULTS Mothers born outside Europe had a significantly higher risk of having a child with an autism-spectrum disorder compared with those born in the UK, with the highest risk observed for the Caribbean group (relative risks (RRs) in the two centres: RR = 10.01, 95% CI 5.53-18.1 and RR = 8.89, 95% CI 5.08-15.5). Mothers of Black ethnicity had a significantly higher risk compared with White mothers (RR = 8.28, 95% CI 5.41-12.7 and RR = 3.84, 95% CI 2.93-5.02). Analysis of ethnicity and immigration factors together suggests the increased risk is predominately related to immigration. CONCLUSIONS Maternal immigration is associated with substantial increased risk of autism-spectrum disorders with differential risk according to different region of birth and possibly ethnicity.
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Affiliation(s)
- D V Keen
- Consultant Neurodevelopmental Paediatrician, Room 2.35, 2nd Floor Clare House, St George's Hospital, Blackshaw Road, London SW17 0QT, UK.
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Arnone D, Pegg EJ, McKie S, Downey D, Elliott R, Williams SR, Deakin JFW, Anderson IM. Neural responses to sad facial expressions in current versus remitted major depression. Neuroimage 2009. [DOI: 10.1016/s1053-8119(09)70433-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Arnone D, Pegg E, Mckie S, Downey D, Elliott R, Deakin J, Anderson I. Self-reported Rumination as Trait Marker for Depression: Evidence from Functional Neuroimaging. Eur Psychiatry 2009. [DOI: 10.1016/s0924-9338(09)70604-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background:Research using fMRI indicates that sustained limbic activity is linked to processing negative words and self-reported rumination in currently depressed individuals. It is unknown whether this is also present in remitted depressed individuals. We tested the hypothesis that a tendency to ruminate constitutes a trait for depression by using a standard covert fMRI emotional task face in previously and never depressed volunteers and postulated that high rumination scores would correlate with activity in brain areas previously associated with depression.Methods:37 controls (25 female) and 30 remitted depressed (RD, 22 female) were enrolled. Volunteers completed the Ruminative Responses Scale (RRS) and underwent fMRI scanning using a standard covert fMRI emotional task faces. Significance level was set at p < 0.05 (FWE).Results:With RRS score controlled for RD showed reduced subcortical and limbic activity to sad and fearful faces compared to controls. Correlations between RRS scores and neural activity in all participants and control participants alone were very limited. However, in RD, RRS score was negatively correlated with neural response to happy faces and positively correlated with neural response to sad and fearful faces, in cortical and limbic regions associated with depression (hippocampus, thalamus, caudate, insula and cingulate gyrus).Conclusion:The results suggest that reduced limbic activity is associated with remission, possibly as a maintenance mechanism. However, within the remitted group the more ruminative participants show greater response in these areas to negative stimuli, and less to positive stimuli. This could be a neurobiological marker for risk of relapse
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Arnone D, Pegg E, Mckie S, Downey D, Elliott R, Deakin J, Anderson I. Self-reported Rumination as Trait Marker for Depression: Evidence from Functional Neuroimaging. Eur Psychiatry 2009. [DOI: 10.1016/s0924-9338(09)70943-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background:Research using fMRI indicates that sustained limbic activity is linked to processing negative words and self-reported rumination in currently depressed individuals. It is unknown whether this is also present in remitted depressed individuals. We tested the hypothesis that a tendency to ruminate constitutes a trait for depression by using a standard covert fMRI emotional task face in previously and never depressed volunteers and postulated that high rumination scores would correlate with activity in brain areas previously associated with depression.Methods:37 controls (25 female) and 30 remitted depressed (RD, 22 female) were enrolled. Volunteers completed the Ruminative Responses Scale (RRS) and underwent fMRI scanning using a standard covert fMRI emotional task faces. Significance level was set at p < 0.05 (FWE).Results:With RRS score controlled for RD showed reduced subcortical and limbic activity to sad and fearful faces compared to controls. Correlations between RRS scores and neural activity in all participants and control participants alone were very limited. However, in RD, RRS score was negatively correlated with neural response to happy faces and positively correlated with neural response to sad and fearful faces, in cortical and limbic regions associated with depression (hippocampus, thalamus, caudate, insula and cingulate gyrus).Conclusion:The results suggest that reduced limbic activity is associated with remission, possibly as a maintenance mechanism. However, within the remitted group the more ruminative participants show greater response in these areas to negative stimuli, and less to positive stimuli. This could be a neurobiological marker for risk of relapse.
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Abstract
OBJECTIVE The corpus callosum (CC) plays a pivotal role in inter-hemispheric transfer and integration of information and is a relatively understudied structure in bipolar disorder (BD). Magnetic resonance imaging (MRI) studies have reported callosal abnormalities in this condition but findings have been inconsistent. Structural changes affecting the CC may underlie functional abnormalities in BD and could contribute to, or explain the pathophysiology of, the condition. METHOD A systematic review was carried out to identify, appraise and summarize MRI studies which compared callosal areas in BD with an unrelated control group. The findings were then synthesized using random effects meta-analysis. Consideration was given to a number of variables to explain heterogeneity. RESULTS Five case-control studies were identified. Bipolar patients showed reduced callosal areas in comparison with healthy volunteers with no evidence of heterogeneity or publication bias. CONCLUSION Findings from this study indicate that callosal areas are reduced in BD and suggest that a failure to integrate information across the hemispheres may contribute to the pathophysiology of the disorder. Further research is necessary to clarify the underlying cellular changes leading to these morphometric differences.
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Affiliation(s)
- D Arnone
- Neuroscience and Psychiatry Unit, University of Manchester, Manchester, UK.
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Arnone D, McIntosh A, Chandra P, Ebmeier K. Meta-analysis of magnetic resonance imaging studies of the corpus callosum in bipolar disorder. Eur Psychiatry 2008. [DOI: 10.1016/j.eurpsy.2008.01.401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Arnone D, Hansen L, Kerr JS. Acute dystonic reaction in an elderly patient with mood disorder after titration of paroxetine: possible mechanisms and implications for clinical care. J Psychopharmacol 2002; 16:395-7. [PMID: 12503843 DOI: 10.1177/026988110201600418] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The administration of a serotonin reuptake inhibitor may lead to extra pyramidal signs, as reported in the literature. The risk seems to be increased in elderly people. We describe a case of acute dystonic reaction to paroxetine treatment in an elderly patient, who presented with a bipolar affective disorder. The underlying mechanism, possibly generated in the subcortical motor areas, is linked to changes that occur in the pharmacokinetic variables, the decreased neuroplasticity of ageing neurones and to previous exposure to neuroleptic medications.
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Affiliation(s)
- D Arnone
- Department of Psychiatry, Old Manor Hospital, Salisbury, UK.
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Caprioglio D, Arnone D. [Standard computerized cephalometric analysis]. Dent Cadmos 1985; 53:49-50, 53-60, 63-70. [PMID: 3867528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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