Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study

Introduction: The multiorgan impact of moderate to severe coronavirus infections in the post-acute phase is still poorly understood. We aimed to evaluate the excess burden of multiorgan abnormalities after hospitalisation with COVID-19, evaluate their determinants, and explore associations with patient-related outcome measures. Methods: In a prospective, UK-wide, multicentre MRI follow-up study (C-MORE), adults (aged ≥18 years) discharged from hospital following COVID-19 who were included in Tier 2 of the Post-hospitalisation COVID-19 study (PHOSP-COVID) and contemporary controls with no evidence of previous COVID-19 (SARS-CoV-2 nucleocapsid antibody negative) underwent multiorgan MRI (lungs, heart, brain, liver, and kidneys) with quantitative and qualitative assessment of images and clinical adjudication when relevant. Individuals with end-stage renal failure or contraindications to MRI were excluded. Participants also underwent detailed recording of symptoms, and physiological and biochemical tests. The primary outcome was the excess burden of multiorgan abnormalities (two or more organs) relative to controls, with further adjustments for potential confounders. The C-MORE study is ongoing and is registered with ClinicalTrials.gov, NCT04510025. Findings: Of 2710 participants in Tier 2 of PHOSP-COVID, 531 were recruited across 13 UK-wide C-MORE sites. After exclusions, 259 C-MORE patients (mean age 57 years [SD 12]; 158 [61%] male and 101 [39%] female) who were discharged from hospital with PCR-confirmed or clinically diagnosed COVID-19 between March 1, 2020, and Nov 1, 2021, and 52 non-COVID-19 controls from the community (mean age 49 years [SD 14]; 30 [58%] male and 22 [42%] female) were included in the analysis. Patients were assessed at a median of 5·0 months (IQR 4·2–6·3) after hospital discharge. Compared with non-COVID-19 controls, patients were older, living with more obesity, and had more comorbidities. Multiorgan abnormalities on MRI were more frequent in patients than in controls (157 [61%] of 259 vs 14 [27%] of 52; p<0·0001) and independently associated with COVID-19 status (odds ratio [OR] 2·9 [95% CI 1·5–5·8]; padjusted=0·0023) after adjusting for relevant confounders. Compared with controls, patients were more likely to have MRI evidence of lung abnormalities (p=0·0001; parenchymal abnormalities), brain abnormalities (p<0·0001; more white matter hyperintensities and regional brain volume reduction), and kidney abnormalities (p=0·014; lower medullary T1 and loss of corticomedullary differentiation), whereas cardiac and liver MRI abnormalities were similar between patients and controls. Patients with multiorgan abnormalities were older (difference in mean age 7 years [95% CI 4–10]; mean age of 59·8 years [SD 11·7] with multiorgan abnormalities vs mean age of 52·8 years [11·9] without multiorgan abnormalities; p<0·0001), more likely to have three or more comorbidities (OR 2·47 [1·32–4·82]; padjusted=0·0059), and more likely to have a more severe acute infection (acute CRP >5mg/L, OR 3·55 [1·23–11·88]; padjusted=0·025) than those without multiorgan abnormalities. Presence of lung MRI abnormalities was associated with a two-fold higher risk of chest tightness, and multiorgan MRI abnormalities were associated with severe and very severe persistent physical and mental health impairment (PHOSP-COVID symptom clusters) after hospitalisation. Interpretation: After hospitalisation for COVID-19, people are at risk of multiorgan abnormalities in the medium term. Our findings emphasise the need for proactive multidisciplinary care pathways, with the potential for imaging to guide surveillance frequency and therapeutic stratification

Cerebral blood flow, metabolic, receptor, and transporter changes in bipolar disorder: The role of PET and SPECT studies

The basic concepts of positron emission tomography (PET) and single photon emission computed tomography ( SPECT) scanning are introduced, and the two modalities are compared. Applications to bipolar disorder ( BD) are reviewed. Regional cerebral metabolic rate and blood flow, often used as surrogate measures of neuronal synaptic activity, are increased in the frontal lobes in both unipolar and bipolar depression. In mania, metabolism increases in the dorsal cingulate cortex, striatal regions, and the nucleus accumbens, as well as in limbic structures of the temporal lobes, but decreases in dorsolateral prefrontal cortex, possibly reflecting its loss of modulatory control over limbic structures. Specifically targeted PET radioligands are used to investigate neurotransmitter systems. D1 receptor binding potentials are reduced in frontal cortex, but striatal D2 receptor density is normal in all phases of non-psychotic BD. Psychotic BD patients show higher D2 receptor densities in the caudate, which correlate with the degree of psychosis but not mood symptoms. The serotonin transporter shows increased density in the thalamus, dorsal cingulate cortex, medial preftontal cortex, and insula of depressed BD patients. In the dorsal cingulate cortex and insula, it correlates with anxiety (and in the cingulate, with suicide attempts)

Diagnostic Neurophysiology in Neuropsychiatry

WOS:000550979600006[No Abstract Available

Rhythmic Oscillations in Quantitative EEG Measured During a Continuous Performance Task

The objective of the present investigation was to determine if cyclic variations in human performance recorded during a 30 min continuous performance task would parallel cyclic variations in right-hemisphere beta-wave activity. A fast fourier transformation was performed on the quantitative electroencephalogram (qEEG) and the performance record of each participant (N = 62), producing an individual periodogram for each outcome measure. An average periodogram was then produced for both qEEG and performance by combining (averaging) the amplitudes associated with each periodicity in the 62 original periodograms. Periodicities ranging from 1.00 to 2.00 min and from 4.70 to 5.70 min with amplitudes greater than would be expected due to chance were retained (Smith et al. 2003). The results of the present investigation validate the existence of cyclic variations in human performance that have been identified previously (Smith et al. 2003) and extend those findings by implicating right-hemisphere mediated arousal in the process (Arruda et al. 1996, 1999, 2007). Significant cyclic variations in left-hemisphere beta-wave activity were not observed. Taken together, the findings of the present investigation support a model of sustained attention that predicts cyclic changes in human performance that are the result of cyclic changes in right-hemisphere arousal. © 2008 Springer Science+Business Media, LLC

Rhythmic oscillations in quantitative EEG measured during a continuous performance task

The objective of the present investigation was to determine if cyclic variations in human performance recorded during a 30 min continuous performance task would parallel cyclic variations in right-hemisphere beta-wave activity. A fast fourier transformation was performed on the quantitative electroencephalogram (qEEG) and the performance record of each participant (N = 62), producing an individual periodogram for each outcome measure. An average periodogram was then produced for both qEEG and performance by combining (averaging) the amplitudes associated with each periodicity in the 62 original periodograms. Periodicities ranging from 1.00 to 2.00 min and from 4.70 to 5.70 min with amplitudes greater than would be expected due to chance were retained (Smith et al. 2003). The results of the present investigation validate the existence of cyclic variations in human performance that have been identified previously (Smith et al. 2003) and extend those findings by implicating right-hemisphere mediated arousal in the process (Arruda et al. 1996, 1999, 2007). Significant cyclic variations in left-hemisphere beta-wave activity were not observed. Taken together, the findings of the present investigation support a model of sustained attention that predicts cyclic changes in human performance that are the result of cyclic changes in right-hemisphere arousal. © 2008 Springer Science+Business Media, LLC

The relationship between childhood trauma, emotion recognition, and irritability in schizophrenia patients

WOS: 000399509400017PubMed ID: 28192770This study investigated the relationship between childhood trauma, irritability, and emotion recognition, in schizophrenia patients during a psychotic break. Thirty-six schizophrenia inpatients and 36 healthy controls were assessed with the Irritability Questionnaire (IRQ) and two facial emotion recognition tasks, the Emotion Discrimination Test (EDT) and Emotion Identification Test (EIT). Patients were further assessed with the Structured Clinical Interview for DSM IlI-R Axis II Disorders (SCID-II), the Positive and Negative Symptom Scale (PANSS), and the Childhood Trauma Questionnaire-28 (CTQ-28). EDT and EIT performance was significantly impaired in patients compared to healthy controls. Furthermore, patients tended to misidentify sad, surprised, or angry faces as showing fear, and this misidentification correlated with the patients' irritability. Childhood adversity increased irritability both directly and indirectly through emotion misidentification