Danilo Pesic

Brain structural abnormalities in patients with major depression with or without generalized anxiety disorder comorbidity

An overlap frequently occurs between major depression disorder (MDD) and generalized anxiety disorder (GAD). Aim of this study was to assess cortical and white matter (WM) alterations in MDD patients with or without GAD comorbidity. Seventy-one MDD patients and 71 controls were recruited. All subjects underwent T1-weighted and diffusion tensor (DT)/MRI. MRI metrics of cortical thickness and WM integrity were obtained from atlas-based cortical regions and the interhemispheric and major long association WM tracts. Between-group MRI comparisons and multiple regressions with clinical scale scores were performed. Compared to controls, both MDD and MDD-GAD patients showed a cortical thinning of the middle frontal cortex bilaterally, left medial frontal gyrus and frontal pole. Compared to controls and MDD patients, MDD-GAD cases also showed a thinning of the right medial orbitofrontal and fusiform gyri, and left temporal pole and lateral occipital cortices. Compared to controls, MDD patients showed DT MRI abnormalities of the right parahippocampal tract and superior longitudinal fasciculus bilaterally, while no WM alterations were found in MDD-GAD. In all patients, brain abnormalities were related with symptom severity. MDD and MDD-GAD share a common pattern of cortical alterations located in the frontal regions. However, while both the cortex and WM integrity are affected in MDD, only the former is affected in MDD-GAD. These findings support the notion of MDD-GAD as a distinct clinical entity, providing insights into patient vulnerability for specific networks as well as into patient resilience factors reflected by the integrity of other cerebral circuits.

Cerebellar Cognitive Affective Syndrome Presented as Severe Borderline Personality Disorder

An increasing number of findings confirm the significance of cerebellum in affecting regulation and early learning. Most consistent findings refer to association of congenital vermis anomalies with deficits in nonmotor functions of cerebellum. In this paper we presented a young woman who was treated since sixteen years of age for polysubstance abuse, affective instability, and self-harming who was later diagnosed with borderline personality disorder. Since the neurological and neuropsychological reports pointed to signs of cerebellar dysfunction and dysexecutive syndrome, we performed magnetic resonance imaging of brain which demonstrated partially developed vermis and rhombencephalosynapsis. These findings match the description of cerebellar cognitive affective syndrome and show an overlap with clinical manifestations of borderline personality disorder.

Characteristics of two distinct clinical phenotypes of functional (psychogenic) dystonia: follow-up study

BackgroundThe fixed dystonia phenotype was originally established as a prototype of functional dystonia. Nevertheless, in recent reports different functional dystonia phenotypes have been recognized with dystonic movement comprising phasic instead of tonic contraction.ObjectivesTo examine clinical characteristic in all patients with dystonia who fulfilled the criteria for functional movement disorders irrespective of phenotype in an attempt to determine parameters of clinical presentations that might impact the disease progression pattern and outcome.MethodsPatients presented with dystonia features incompatible with organic disease without other features required for the diagnosis of functional movement disorders were analyzed and prospectively followed-up. The two-step cluster analysis was performed to obtain the subgroups of dystonia phenotypes.ResultsThe two-step cluster analysis extracted two subgroup of patients. Patients of the first cluster (68.8%) presented with “mobile” dystonia (84.9%), of cranial/neck/trunk localization (90.9%), fluctuated clinical course (69.7%), with frequent additional movement or other functional neurological disorders (63.6%) during follow-up. In the second cluster (31.2%) all of the patients presented with “fixed” dystonia of extremities, and the clinical course was characterized by either the disease progression (60%), or continuous without improvement (26.7%), and rare occurrence of additional functional neurological disorders (13.3%).ConclusionIn terms of clinical and demographic features as well as pattern of disease progression there are two clinical phenotypes in patients with functional dystonia. Distinctive features of incongruence and inconstancy are characteristic for “mobile” functional dystonia subgroup of patients.

Higher concentration of interleukin 6 - A possible link between major depressive disorder and childhood abuse

Little is known about the correlation between IL-6 and childhood abuse and neglect which may be risk factors for the development of affective disorders in adulthood. The aim of this study was to analyze differences in serum concentrations of IL-6 between patients with major depressive disorder and healthy controls, and to investigate possible correlations with adverse childhood experiences. Peripheral venous blood samples were obtained from 64 patients who fulfilled DSM-IV-R criteria for a current major depressive episode without psychotic symptoms (MDD) and 53 healthy controls, matched for age and gender. Participants were assessed by the Beck Depression Inventory (BDI), Childhood Trauma Questionnaire (CTQ), Hamilton Depression Rating Scale (HDRS) and Hamilton Anxiety Rating Scale (HARS). The concentration of IL-6 was significantly higher in patients with major depressive disorder compared to healthy controls. The total score of childhood trauma questionnaire highly statistically significantly correlated with IL-6 levels in patient group. Persons who were physically abused, physically neglected and emotionally abused had higher levels of IL-6. Interleukin 6 as a pro-inflammatory immune marker could be an important developmental mediator linking physical and emotional abuse in early life with the development of depressive disorder in adulthood.

Are there two different forms of functional dystonia? A multimodal brain structural MRI study

This study assessed brain structural alterations in two diverse clinical forms of functional (psychogenic) dystonia (FD) – the typical fixed dystonia (FixFD) phenotype and the “mobile” dystonia (MobFD) phenotype, which has been recently described in one study. Forty-four FD patients (13 FixFD and 31 MobFD) and 43 healthy controls were recruited. All subjects underwent 3D T1-weighted and diffusion tensor (DT) magnetic resonance imaging (MRI). Cortical thickness, volumes of gray matter (GM) structures, and white matter (WM) tract integrity were assessed. Normal cortical thickness in both FD patient groups compared with age-matched healthy controls were found. When compared with FixFD, MobFD patients showed cortical thinning of the left orbitofrontal cortex, and medial and lateral parietal and cingulate regions bilaterally. Additionally, compared with controls, MobFD patients showed reduced volumes of the left nucleus accumbens, putamen, thalamus, and bilateral caudate nuclei, whereas MobFD patients compared with FixFD demonstrated atrophy of the right hippocampus and globus pallidus. Compared with both controls and MobFD cases, FixFD patients showed a severe disruption of WM architecture along the corpus callous, corticospinal tract, anterior thalamic radiations, and major long-range tracts bilaterally. This study showed different MRI patterns in two variants of FD. MobFD had alterations in GM structures crucial for sensorimotor processing, emotional, and cognitive control. On the other hand, FixFD patients were characterized by a global WM disconnection affecting main sensorimotor and emotional control circuits. These findings may have important implications in understanding the neural substrates underlying different phenotypic FD expression levels.

Prevalence and clinical correlation of depressive symptoms among patients with schizophrenia in acute and remission phases

Bacground/Aim. Researchers suggest that among people with schizophrenia, the prevalence of depressive symptoms ranges from 7% to 80%. The rate of depressive symptoms among people with schizophrenia varies widely because of the phase of the disease, type of study applied, rating scale for depressive symptoms and diagnostic criteria. The aim of this research was to determine the prevalence of depressive symptoms and the clinical correlation of depressive symptoms with other clinical parameters (type and severity of psychotic symptoms, severity of illness, insight and global functioning) among patients with schizophrenia in acute and remission phases. Methods. This prospective clinical study enrolled 100 consecutive patients with schizophrenia both in acute and remission phases. Psychometric assessments were made using the Positive and Negative Syndrome Scale (PANSS) for rating the symptoms of schizophrenia, Scale to Assess the Unawareness of Mental Disorder (SUMD), Calgary Depression Scale for Schizophrenia (CDSS), and Global Assessment of Functioning Scale. Results. The prevalence of depressive symptoms among patients with schizophrenia in the acute phase was 23% at the study group, while in the remission phase it was 13%. In the acute phase, the CDSS scale correlated with a depressive and positive subscale of the PANSS scale as well as SUMD scale. In the remission phase, the CDSS scale correlated only with a depressive subscale of the PANSS scale. The CDSS scale did not correlate with the negative subscale of the PANSS scale. The subjective nature of depressive symptoms is more pronounced in the remission phase. Conclusion. Our findings showed that depressive symptoms were more pronounced in the acute psychotic phase than in the remission phase of schizophrenia. Targeted, patient oriented, and algorithm-based approach for treatment management, with taking into account different phenotypic expressions of the disorder (patients with and without affective symptoms) is warranted in patients with schizophrenia.

Psychotic experience: things to consider

Kelleher et al ’s study is very interesting and raises some important questions,[1][1] but we think that it also has some confounding factors that need to be addressed before conclusions are made. In addition, there are some methodological issues which we would like to be clarified. The response