Gudrun Sartory

Disgust implicated in obsessive-compulsive disorder.

Psychiatric classificatory systems consider obsessions and compulsions as forms of anxiety disorder. However, the neurology of diseases associated with obsessive–compulsive symptoms suggests the involvement of fronto–striatal regions likely to be involved in the mediation of the emotion of disgust, suggesting that dysfunctions of disgust should be considered alongside anxiety in the pathogenesis of obsessive–compulsive behaviours. We therefore tested recognition of facial expressions of basic emotions (including disgust) by groups of participants with obsessive–compulsive disorder (OCD) and with Gilles de la Tourettes syndrome (GTS) with and without co–present obsessive–compulsive behaviours (GTS with OCB; GTS without OCB). A group of people suffering from panic disorder and generalized anxiety were also included in the study. Both groups with obsessive–compulsive symptoms (OCD; GTS with OCB) showed impaired recognition of facial expressions of disgust. Such problems were not evident in participants with panic disorder and generalized anxiety, or for participants with GTS without obsessions or compulsions, indicating that the deficit is closely related to the presence of obsessive–compulsive symptoms. Participants with OCD were able to assign words to emotion categories without difficulty, showing that their problem with disgust is linked to a failure to recognize this emotion in others and not a comprehension or response criterion effect. Impaired recognition of disgust is consistent with the neurology of OCD and with the idea that abnormal experience of disgust may be involved in the genesis of obsessions and compulsions.

Further parameters of insight and neuropsychological deficit in schizophrenia and other chronic mental disease.

Evidence has begun to accumulate which suggests that lack of awareness of illness in schizophrenia is related to and possibly the result of a cognitive deficit involving prefrontal cerebral dysfunction. This study further explores this relationship along with other domains of self-awareness in chronic schizophrenics and other subjects with serious mental disorders. One hundred eight schizophrenics and 21 bipolar subjects from three separate sites in Britain, Germany, and Canada were administered the Wisconsin Card Sorting Test and three measures of self-awareness. Lack of illness awareness and other domains of self-knowledge were significantly more related to poorer neuropsychological performance in schizophrenia patients than in the other subjects. The results support the hypothesis that lack of illness awareness is related to defective frontal lobe functioning as indexed by neuropsychological measures.

Comparison between one-session psychological treatment and benzodiazepine in dental phobia

To compare the effects of a single session of psychological treatment and acute administration of benzodiazepine, 50 dental phobic patients were allocated either to psychological treatment, benzodiazepine, or no treatment for anxiety. Psychological treatment consisted of stress management training and imaginal exposure to phobic stimuli with homework assignments. Benzodiazepine was administered 30 min before dental treatment. Both treatment conditions led to less anxiety during dental surgery than did the control condition. Phobic patients in the benzodiazepine condition showed a relapse after dental treatment, whereas those in the psychological treatment condition showed further improvement until the follow-up 2 months later. Of the latter group, 70% continued dental treatment; only 20% and 10% returned in the benzodiazepine and control conditions, respectively.

Synchronous and desynchronous changes during fear reduction

Abstract The purpose of this experiment, carried out on 27 subjects with intense and circumscribed fears, was to test one main hypothesis and several subsidiary predictions. The prediction that a high-demand in vivo treatment condition produces desynchronous changes and a low-demand treatment condition synchronous changes, was supported by some inter-session findings but not by the intra-session findings. The clear linear relation between heart-rate and reported fear was confirmed, as was the rapid habituation of the heart-rate response to phobic stimulation. The fear-reactions and fear-reductions of psychiatric and non-psychiatric were indistinguishable. High heart-rate responders and low heart-rate responders showed similar patterns of improvement. The constrained laboratory ‘treatment’ procedure used in the experiment produced large and rapid reductions in fear.

Attention, heart rate, and startle response during exposure to trauma-relevant pictures: a comparison of recent trauma victims and patients with posttraumatic stress disorder.

Victims of a recent trauma were compared with posttraumatic stress disorder (PTSD) patients and healthy controls to assess whether a specific anxiety response and an attentional bias were evident initially or only in chronic PTSD. Heart rate (HR) and startle response were measured, and a dot-probe task was carried out using trauma-relevant pictures. Severely affected recent trauma victims and chronic PTSD patients showed HR acceleration to trauma-related material, which was the only significant group difference. A bias away from trauma-related material was related to severity of intrusions in recent trauma victims, and the bias toward trauma-related material increased with amplitude of the HR response in PTSD patients. A specific anxiety reaction is present initially in severely affected trauma victims.

Computerized cognitive remediation improves verbal learning and processing speed in schizophrenia

Computerized cognitive remediation has resulted in improved executive function in schizophrenia, whereas results with regard to verbal memory were inconsistent. In the present study, 42 inpatients with schizophrenia were randomly assigned to a computerized cognitive remediation group or to a treatment-as-usual (TAU) control group. The remediation group received 15 sessions of computerized cognitive training (Cogpack) over a 3-week period. Neurocognitive functions were assessed at the beginning and end of this period. Compared to the control condition, remediation training resulted in improvements in verbal learning, processing speed and executive function (verbal fluency). The results indicate that cognitive remediation may lead to improvements beyond those of executive function.

Case histories and shorter communications: Vagal innervation techniques in the treatment of panic disorder

Abstract The clinical efficacy of vagal innervation techniques designed to terminate tachycardias was tested in the treatment of panic disorder patients. The control group was trained in breathing and relaxation techniques whereas the experimental group received additional training in vagal innervation methods. Both groups had improved after four treatment sessions but the experimental group reported being less disrupted by panics and also reported less generalised cognitive anxiety. It is thought that vagal innervation techniques engender a greater measure of perceived control over panics than do breathing techniques.

In Search of the Trauma Memory: A Meta-Analysis of Functional Neuroimaging Studies of Symptom Provocation in Posttraumatic Stress Disorder (PTSD)

Notwithstanding some discrepancy between results from neuroimaging studies of symptom provocation in posttraumatic stress disorder (PTSD), there is broad agreement as to the neural circuit underlying this disorder. It is thought to be characterized by an exaggerated amygdalar and decreased medial prefrontal activation to which the elevated anxiety state and concomitant inadequate emotional regulation are attributed. However, the proposed circuit falls short of accounting for the main symptom, unique among anxiety disorders to PTSD, namely, reexperiencing the precipitating event in the form of recurrent, distressing images and recollections. Owing to the technical demands, neuroimaging studies are usually carried out with small sample sizes. A meta-analysis of their findings is more likely to cast light on the involved cortical areas. Coordinate-based meta-analyses employing ES-SDM (Effect Size Signed Differential Mapping) were carried out on 19 studies with 274 PTSD patients. Thirteen of the studies included 145 trauma-exposed control participants. Comparisons between reactions to trauma-related stimuli and a control condition and group comparison of reactions to the trauma-related stimuli were submitted to meta-analysis. Compared to controls and the neutral condition, PTSD patients showed significant activation of the mid-line retrosplenial cortex and precuneus in response to trauma-related stimuli. These midline areas have been implicated in self-referential processing and salient autobiographical memory. PTSD patients also evidenced hyperactivation of the pregenual/anterior cingulate gyrus and bilateral amygdala to trauma-relevant, compared to neutral, stimuli. Patients showed significantly less activation than controls in sensory association areas such as the bilateral temporal gyri and extrastriate area which may indicate that the patients’ attention was diverted from the presented stimuli by being focused on the elicited trauma memory. Being involved in associative learning and priming, the retrosplenial cortex may have an important function in relation to trauma memory, in particular, the intrusive reexperiencing of the traumatic event.

A comparison of psychological and pharmacological treatment of pediatric migraine

A comparison was carried out of the efficacy of psychological and drug treatments for children with migraine. Forty-three children aged between 8 and 16 years (mean age: 11.3 years) who suffered from migraine received either progressive relaxation or cephalic vasomotor feedback, both with stress management training, or metoprolol, a beta-blocker. Psychological treatment was administered in ten sessions lasting six weeks and the drug treatment lasted ten weeks. Relaxation and stress management training reduced the headache index (frequency x intensity of headache episodes), more effectively than metoprolol with cephalic vasomotor feedback and stress management training in between. An overall improvement over time was found with regard to frequency and intensity of headache episodes and analgesics intake. When comparing pre- to post-treatment data, children treated with relaxation training improved significantly in headache frequency and intensity, whereas those treated with cephalic vasomotor feedback improved significantly in headache frequency and duration as well as mood. The clinical improvement was stable at an 8-months follow-up.

The intensity dependence of the auditory evoked N1 component as a predictor of reponse to Citalopram treatment in patients with major depression

The intensity dependence of the auditory evoked N1 ERP component (IDAP) has been suggested as an indicator of central serotonergic neurotransmission with relevance to pharmacological treatment. We report the results of a study evaluating the IDAP in 16 in-patients fulfilling DSM-IV criteria for major depressive episode in the course of treatment with the SSRI Citalopram. Our data revealed a significant correlation between the intensity slopes of the N1 amplitude prior to Citalopram treatment and treatment response: patients with higher intensity slopes of N1 amplitude showed a significantly stronger decrease of HDRS-Score after Citalopram treatment than patients within the lower intensity slope ranges. Our results indicate an association of N1 amplitude intensity dependence with response to antidepressant treatment with Citalopram.