M. Vervaet

SPECT neuropsychological activation procedure with the Verbal Fluency Test in attempted suicide patients

Performance on the Verbal Fluency Test, as a measure of the ability of initiating processes, is reduced in depressed suicidal patients. The hampered results in this prefrontal executive task parallel the reduction in prefrontal blood perfusion and metabolism in depressed subjects. A neuropsychological activation study with the verbal fluency paradigm could evaluate a possible blunted increase in perfusion in the prefrontal cortex in depressed suicidal patients. Twenty clinically depressed patients who had recently attempted suicide and 20 healthy volunteers were included in a single photon emission computed tomography (SPECT) split-dose activation study following a verbal fluency paradigm. Statistical parametric mapping was used to determine voxelwise significant changes. Differences in regional cortical activation between the letter fluency and category fluency tasks in attempted suicide patients were found. These patients showed a blunted increase in perfusion in the prefrontal cortex. Methodological restrictions concerning group uniformity, medication bias and subjective effort of the participants are discussed. Our findings indicate a blunted increase in prefrontal blood perfusion as a possible biological reason for reduced drive and loss of initiative in attempted suicide patients.

Brain perfusion SPECT in impulsivity-related personality disorders

BACKGROUNDnImpulsive behaviours in patients with cluster B personality disorders are associated with low glucose metabolism and regional cerebral blood flow in the frontal cortex and subcortical structures. The aim of this study is to confirm the presence of a particular pattern of brain perfusion in a sample of borderline (BPD) and anti-social personality disorder (ASPD) patients using brain perfusion single photon emission computed tomography (SPECT).nnnMETHODSnA brain perfusion SPECT study was performed in 37 patients with BPD or ASPD (and no Axis I diagnosis) and 34 healthy control participants. Data were acquired on a triple head Toshiba gamma camera. Scatter and attenuation correction was done. Reconstructed SPECT images were analyzed by Statistical Parametrical Mapping (SPM99).nnnRESULTSnThere were no significant differences in age and gender distributions between the patients and the healthy controls. With regard to the functional imaging results, patients were characterized by a reduced regional cerebral blood flow (rCBF) in right temporal and prefrontal brain areas, including the right lateral temporal cortex (BA 21), the right frontopolar cortex (BA 10) and the right ventrolateral prefontal cortex (BA 47).nnnCONCLUSIONSnPatients with BPD and ASPD who showed impulsive behaviour have diminished rCBF in areas of the right prefrontal and temporal cortex.

Depression and anxiety during isolation and radionuclide therapy

Summary The combination of a diagnosis of malignancy and hospitalization, isolation and radioactivity of a radionuclide therapy may have an important effect on the psychological equilibrium of patients and may hamper compliance and acceptability. We performed a psychiatric evaluation in order to study psychopathological manifestations and underlying personality related vulnerabilities. During radioisolation, 48 patients (24 male, 24 female; mean age 57.8 years) with a malignant (n = 26) or non‐malignant (n = 22) pathology who needed isolation for radionuclide therapy, completed a series of questionnaires in order to assess anxiety (Spielberger State and Trait Anxiety Inventory; STAI), depression (Beck Depression Inventory; BDI), hopelessness (Beck Hopelessness Scale; BHS), personality characteristics (Temperament and Character Inventory; TCI) and coping strategies (Utrechts Coping List; UCL). Compared to patients with low state anxiety, patients who experienced a high level of state anxiety showed higher levels of depression (t = ‐2.10; P = 0.04) and hopelessness (t = ‐4.20; P = < 0.001). Their personality was characterized by significantly higher scores on harm avoidance (t = ‐2.78; P = 0.008) and lower scores on self‐directedness (t = 3.12; P = 0.003). Coping strategies were more passive (t = ‐2.43; P = 0.02), avoiding (t = ‐2.15; P = 0.04) and less well aimed (t = 2.64; P = 0.01). Surprisingly, the nature of disease (malignant versus non‐malignant) did not influence these results, nor was there a difference between males and females, age, years of education, having a relationship or not, or the duration of hospitalization. Thus, contrary to what may be expected in isolation with radionuclide therapy, subgroups such as women, elderly, cancer patients or lower educated people do not, a priori, exhibit a higher state anxiety level. Our study shows these levels to be closely related to individual personality traits and coping strategies that are inadequate for the situation. Screening for trait anxiety before admission can be easily done and may guide interventions aimed at increasing patient comfort and acceptability.

Eating Style and Weight Concerns in Young Females

Abstract In this study, attitudes towards eating among adolescent schoolgirls were compared to those among fashion models and eating disorder patients. The results clearly demonstrate a preoccupation with body weight, even in schoolgirls. A majority of the girls indicated a wish to lose weight, even when their current Body Mass Index (BMI) was between 20 and 25. Eating disorder patients more commonly reported premorbid overweight. Furthermore, fashion models tended to have an eating style that was comparable to that of patients with eating disorders. The finding that the mean current body weight was lower than before suggests that many girls developed a restrained eating style. Vomiting, the use of anorectic drugs and laxatives, eating alone, and counting calories were reported by a substantial proportion of the adolescent girls. Moreover, a substantial proportion of the girls experienced a loss of control over eating. The combination of this eating style and being overweight, can be considered as risk factor for the development of eating disorders.

Self-directedness: An indicator for clinical response to the HF-rTMS treatment in refractory melancholic depression

Although well-defined predictors of response are still unclear, clinicians refer a variety of depressed patients for a repetitive Transcranial Magnetic Stimulation (rTMS) treatment. It has been suggested that personality features such as Harm Avoidance (HA) and self-directedness (SD) might provide some guidance for a classical antidepressant treatment outcome. However, to date no such research has been performed in rTMS treatment paradigms. In this open study, we wanted to examine whether these temperament and character scores in particular would predict clinical outcome in refractory unipolar depressed patients when a typical high-frequency (HF)-rTMS treatment protocol is applied. Thirty six unipolar right-handed antidepressant-free treatment resistant depressed (TRD) patients, all of the melancholic subtype, received 10 HF-rTMS sessions applied to the left dorsolateral prefrontal cortex (DLPFC). All patients were classified as at least stage III TRD and were assessed with the Temperament and Character Inventory (TCI) before a HF-rTMS treatment. Only the individual scores on SD predicted clinical outcome. No other personality scales were found to be a predictor of this kind of application. Our results suggest that refractory MDD patients who score higher on the character scale SD may be more responsive to the HF-rTMS treatment.

Nuclear Brain Imaging in Eating Disorders

Eating disorders have always been a rarity within the domain of psychiatry and its disorders. Eating is a basic behaviour in order to preserve and maintain one’s own physical and mental integrity. Therefore, disturbances of this life-saving habit and the often distressing clinical presentation that results have always drawn the specific attention of physicians. Within the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR, American Psychiatric Association 2000), anorexia nervosa and bulimia nervosa are the two major pathological entities that are outlined. Furthermore, all eating disturbances that do not meet criteria of the aforementioned pathologies are grouped separately into a single category: eating disorders not otherwise specified. Besides anorexia nervosa and bulimia nervosa, a section is addressed to the binge-eating disorder and another to the problem of obesity. Obesity is considered one of the principal pathologies that medicine will have to deal with in the near future. Many obese patients are probably suffering from a binge-eating disorder, but this is certainly not always objectified and is even overlooked. An overview of nuclear functional brain imaging and receptor studies, together with a discussion on the presented literature, is provided here.