The Role of Hippocampus in the Pathophysiology of Depression

Hippocampus, as a part of the limbic cortex, has a variety of functions ranging from mating behavior to memory besides its role in the regulation of emotions. The hippocampus has reciprocal interactions of with other brain regions which act in the pathophysiology of major depressive disorder (MDD). Moreover, since the hippocampus is a scene for the neurogenesis, which can be seen as a response to antidepressant treatment, the hippocampus became a focus of attention in neuroimaging studies of MDD. It has been shown that brain derived neurotrophic factor (BDNF), that is responsible from the neurogenesis, is associated with the response to the antidepressants and antidepressant drugs are ineffective if neurogenesis is hindered.Hippocampal atrophy is expected with the decrease of neurogenesis as a result of the lower BDNF levels with the deleterious effects of glucocorticoids in depression. Recurrent and severe depression seems to cause such a volume reduction though first episode MDD subjects do not differ from healthy individuals in respect to their hippocampal volumes (HCVs) measured by magnetic resonance imaging methods. One may argue regarding these findings that the atrophy in the hippocampus may be observed in the long term and the decrease in BDNF levels may predispose the volume reduction. Although it has been postulated that smaller HCV as a result of genetic and environmental factors and prior to the illness, may cause a vulnerability to MDD, sufficient evidence has not been accumulated yet and the view that HCV loss develops as depression progresses is widely accepted. Findings that serum BDNF (sBDNF) is lower in MDD patients though HCVs of patients do not differ from healthy individuals and the positive correlation of sBDNF with HCV seen only in the patient group support this view. It can be assumed that depressed patients have sensitivity for the fluctuations in BDNF levels. Follow-up studies which consider effects of hipotalamo-pituiter-adrenal axis dysregulation and monoamine systems are needed to further elucidate the role of BDNF in the pathogenesis of MDD. Results of these studies may lead the way for the treatment of resistant or recurrent depressive disorder

Maintenance Electroconvulsive Therapy

Since the other treatment options did not meet the expectations in treatment resistant patients, maintenance electroconvulsive therapy (m-ECT) recently regained interest as a treatment option . Although it has long been applied as a treatment, studies of m-ECT lacks strong evidence for effectiveness, safety and the choice of application method because of problems regarding methodology, small sample sizes and scarcity of randomized, double-blind, controlled trials. Besides several points about treatment remains uncertain. Some of these troubled points are the selection of patients that will receive m-ECT, schedule and procedure of the application, the duration of the treatment, the assessment and follow-up of side effects and concomitant medication with drugs. Therefore, some guidelines recommended it for a particular group of patients and some rejected its application with a cautious consideration. The terminology, applications and rationales in different disorders, possible side effects and concomitant drug use are discussed in this review. Further studies with broader samples are needed to clarify the issues of effectiveness and adverse events in m-ECT

Comparison of Alcohol Attentional Bias and Alcohol Craving Among Alcohol Abusers and Non-Abusers

The aim of this research is to investigate implicit cognitive process underlying alcohol craving and relationship between alcohol attentional bias and alcohol craving by using visual probe task. Current study examined whether alcohol abusers show attentional bias toward alcohol related task compared with non- abusers and causal relationship between alcohol attentional bias and alcohol craving. Firstly, participants were divided two groups (non abusers- abusers) and they were completed alcohol craving scale to determinate their alcohol craving level. Then, participants alcohol attentional bias was investigated using the visual probe task. In this task, images (alcohol-related and neutral) were presented for 500 ms on a computer screen. After that, probe (*, asterisk) was presented. Participants were asked to decide the place of the probe place by using keyboard keys within 1500 ms. Participants reaction time and number of correct and incorrect answers during the test. According to results, alcohol abuser group’s reaction times were faster than non-abuser when probe was associated with alcohol picture but not in neutral trials. These results suggested that, alcohol abusers showed significantly greater attentional bias to alcohol related pictures than non- abusers. From this point, investigation of alcohol attentional bias might be important component of alcohol dependence in terms of the alcohol relapse risk and determination of the alcohol craving

Cerebellar Cognitive Affective Syndrome

Scientific BACKGROUND: For the last two decades the traditional role of cerebellum that is dedicated exclusively to motor control and coordination has been evolved as recent findings demonstrate its contribution to cognitive processing and emotional regulation. There is a growing body of evidence of the impact of cerebellar lesions on emotional and cognitive, especially fronto-executive functions. OBJECTIVE: We aimed in this article to mention contribution of the cerebellum to cognitive and behavioral processes. CASE: We report a 46 years old patient with an acute onset and permanent frontal-executive disturbance, psychomotor slowing, emotional instability and forgetfulness following a head trauma. Cranial MRI revealed extensive left cerebellar hemispheric lesions. Deficits of attention, executive function, affect and memory suggest a "cerebellar cognitive affective syndrome" CONCLUSION: Clinical findings of this case are consistent with the role of the cerebellum as a modulator of mental functions. The cognitive deficits resulting from cerebellar pathology may be related to the disruption of cerebello-cortical connections involving a complex network which includes the prefrontal region, suggesting that the cerebellum may process cortical information coming from different brain areas linked with the control of cognitio