45 research outputs found
Different Types of Decision Making Impairments in Anorexia Nervosa
Research on neurocognitive aspects in Anorexia Nervosa (AN) has outlined a cognitive profile characterized by deficiency in the ability to set-shifting (cognitive flexibility) and weak central coherence. A smaller agreement emerges in relation to the compromission of decisional profiles frequently observed in patients with AN since both the complexity of the pathology and the executive function itself make it unclear the nature of these alterations and its relationships with specific or independent clinical and enviornmental variables.
The aim of this study was: to investigate different types of decision-making (DM) ability, veridical and adaptive, in a sample of patients with AN using the Iowa Gambling Task and the Cognitive Bias Task; to analyze test performance using a specific cognitive model for the Iowa Gambling Task (Expectancy Valence Learning Model), and to study the relationship with clinical features, focusing on their relationship with neuropsychological profiles and clinical variables; to explore the neural correlations of the two tasks with functional connectivity; to observe the the impact of the genetic profile on different types of DM. Materials and Methods:
The sample, consisting of 310 female subjects with AN lifetime and 301 female subjects without diagnosis of lifetime eating disorders, was tested in relation to DM abilities through the Iowa Gambling Task and cognitive Bias Task. All of the participants completed a baseline assessment including the Structured Clinical Interview (SCID) for the DSM-IV, section for eating disorders, and neuropsychological tests including the Wisconsin Card Sorting Test, and Trail Making Test for assessing abilities of abstraction and cognitive flexibility; 10 "and 30" interference memory test for evaluation of working memory, Stop Signal Task for evaluation of inibitory control. The Expectancy Valence Model (EVM) was used to analyze the results obtained in IGT. A genotyping was performed to evaluate the impact of the major polymorphisms implicated in decision-making (158 Val â Met) of the COMT gene and single nucleotide A / G polymorphism (SNP rs25531) of the serotonin carrier gene 5 - HTTLPR.
In a smaller subgroup of 35 AN and 34 Healthy control seed based resting state Functional connectivity was explored.
Compared to the group of healthy subjects, the decision-making profile of patients suffering from AN was worse in both Iowa Gambling Task (IGT), which evaluates veridical DM, and Cognitive Bias Task (Cbias), which evaluates adaptive DM, regardless of the diagnostic subtype (restrictive vs. binging/purging), psychopathology severity, scholarity, manual 3 dominance or outcome specific treatment. However in IGT the affective decision-making seems to be independent of IMC, conversely in Cbias the adaptive decisional profile was influenced by underweight. Both types of decision-making in patients were not affected by neurocognitive or clinical variables considered. The unfavorable geotype in AN resulted the homozygous for the met allele of the Comt gene and for the short variant of the serotonin transporter gene. The resting functional connectivity explored on the seeds of interest (executive network, orbitofrontal cortex, accumbens and amygdala) in a subgroup of patients and controls showed significantly different patterns of correlation with the scores of IGt and Cbias. In addition, different resting neural patterns appear to be involved in the two different tasks considered. Only in the AN group a positive correlation between the scores on IGT and the activity of the amygdala resulted. In AN group an higher coactivation within the executive, accumbens and orbitofrontal networks was linked to higher context-independency decisional style assessed with CBias, whereas for the executive network the opposite was true for healthy women.
In summary our results confirm an impairment of different types of decision making in AN and highlitght the importance of assessing decisional processes with different specific tasks in clinical sample. In particular different maladaptative strategies are associated with ineffective decisional profiles in AN, consisting in a âmyopia for the futureâ and âanxiety inhibitionâ in veridical situations and in a difficulty to update/review oneâs own mindset according to new environmental stimuli (context indipendent reasoning strategies) in adaptive decisional framework. The severity of malnurishment seems to influence adaptive decisional style conferring a bias toward a context indipent reasoning, suggesting the need of metacognitive approach to help patients to be more aware of their tendency to automatically use selection bias in DM contexts. Genetic polimorphysms may in part account for the impaired decision making observed in AN patients, with a negative impact of met Comt allele and the short variant of 5HTTLPR polymorphism. Functional connectivity suggests the presence of different dysfunctional decision making networks in AN patients in the two decisional framework, confirming the importance of emotion and anxiety on decisional performance in AN.
Since the cross sectional design of our study, further and longitudinal studies with recovered and at risk subjects are necessary to confirm our results
The Brief Negative Symptom Scale (BNSS): Independent validation in a large sample of Italian patients with schizophrenia
BACKGROUND:
The Brief Negative Symptom Scale (BNSS) was developed to address the main limitations of the existing scales for the assessment of negative symptoms of schizophrenia. The initial validation of the scale by the group involved in its development demonstrated good convergent and discriminant validity, and a factor structure confirming the two domains of negative symptoms (reduced emotional/verbal expression and anhedonia/asociality/avolition). However, only relatively small samples of patients with schizophrenia were investigated. Further independent validation in large clinical samples might be instrumental to the broad diffusion of the scale in clinical research.
METHODS:
The present study aimed to examine the BNSS inter-rater reliability, convergent/discriminant validity and factor structure in a large Italian sample of outpatients with schizophrenia.
RESULTS:
Our results confirmed the excellent inter-rater reliability of the BNSS (the intraclass correlation coefficient ranged from 0.81 to 0.98 for individual items and was 0.98 for the total score). The convergent validity measures had r values from 0.62 to 0.77, while the divergent validity measures had r values from 0.20 to 0.28 in the main sample (n=912) and in a subsample without clinically significant levels of depression and extrapyramidal symptoms (n=496). The BNSS factor structure was supported in both groups.
CONCLUSIONS:
The study confirms that the BNSS is a promising measure for quantifying negative symptoms of schizophrenia in large multicenter clinical studies
Social cognition in people with schizophrenia: A cluster-analytic approach
Background The study aimed to subtype patients with schizophrenia on the basis of social cognition (SC), and to identify cut-offs that best discriminate among subtypes in 809 out-patients recruited in the context of the Italian Network for Research on Psychoses. Method A two-step cluster analysis of The Awareness of Social Inference Test (TASIT), the Facial Emotion Identification Test and Mayer-Salovey-Caruso Emotional Intelligence Test scores was performed. Classification and regression tree analysis was used to identify the cut-offs of variables that best discriminated among clusters. Results We identified three clusters, characterized by unimpaired (42%), impaired (50.4%) and very impaired (7.5%) SC. Three theory-of-mind domains were more important for the cluster definition as compared with emotion perception and emotional intelligence. Patients more able to understand simple sarcasm (14 for TASIT-SS) were very likely to belong to the unimpaired SC cluster. Compared with patients in the impaired SC cluster, those in the very impaired SC cluster performed significantly worse in lie scenes (TASIT-LI <10), but not in simple sarcasm. Moreover, functioning, neurocognition, disorganization and SC had a linear relationship across the three clusters, while positive symptoms were significantly lower in patients with unimpaired SC as compared with patients with impaired and very impaired SC. On the other hand, negative symptoms were highest in patients with impaired levels of SC. Conclusions If replicated, the identification of such subtypes in clinical practice may help in tailoring rehabilitation efforts to the person's strengths to gain more benefit to the person
Social cognition in people with schizophrenia: A cluster-analytic approach
Background The study aimed to subtype patients with schizophrenia on the basis of social cognition (SC), and to identify cut-offs that best discriminate among subtypes in 809 out-patients recruited in the context of the Italian Network for Research on Psychoses. Method A two-step cluster analysis of The Awareness of Social Inference Test (TASIT), the Facial Emotion Identification Test and Mayer-Salovey-Caruso Emotional Intelligence Test scores was performed. Classification and regression tree analysis was used to identify the cut-offs of variables that best discriminated among clusters. Results We identified three clusters, characterized by unimpaired (42%), impaired (50.4%) and very impaired (7.5%) SC. Three theory-of-mind domains were more important for the cluster definition as compared with emotion perception and emotional intelligence. Patients more able to understand simple sarcasm (14 for TASIT-SS) were very likely to belong to the unimpaired SC cluster. Compared with patients in the impaired SC cluster, those in the very impaired SC cluster performed significantly worse in lie scenes (TASIT-LI <10), but not in simple sarcasm. Moreover, functioning, neurocognition, disorganization and SC had a linear relationship across the three clusters, while positive symptoms were significantly lower in patients with unimpaired SC as compared with patients with impaired and very impaired SC. On the other hand, negative symptoms were highest in patients with impaired levels of SC. Conclusions If replicated, the identification of such subtypes in clinical practice may help in tailoring rehabilitation efforts to the person's strengths to gain more benefit to the person
Social cognition in people with schizophrenia: A cluster-analytic approach
Background The study aimed to subtype patients with schizophrenia on the basis of social cognition (SC), and to identify cut-offs that best discriminate among subtypes in 809 out-patients recruited in the context of the Italian Network for Research on Psychoses. Method A two-step cluster analysis of The Awareness of Social Inference Test (TASIT), the Facial Emotion Identification Test and Mayer-Salovey-Caruso Emotional Intelligence Test scores was performed. Classification and regression tree analysis was used to identify the cut-offs of variables that best discriminated among clusters. Results We identified three clusters, characterized by unimpaired (42%), impaired (50.4%) and very impaired (7.5%) SC. Three theory-of-mind domains were more important for the cluster definition as compared with emotion perception and emotional intelligence. Patients more able to understand simple sarcasm (14 for TASIT-SS) were very likely to belong to the unimpaired SC cluster. Compared with patients in the impaired SC cluster, those in the very impaired SC cluster performed significantly worse in lie scenes (TASIT-LI <10), but not in simple sarcasm. Moreover, functioning, neurocognition, disorganization and SC had a linear relationship across the three clusters, while positive symptoms were significantly lower in patients with unimpaired SC as compared with patients with impaired and very impaired SC. On the other hand, negative symptoms were highest in patients with impaired levels of SC. Conclusions If replicated, the identification of such subtypes in clinical practice may help in tailoring rehabilitation efforts to the person's strengths to gain more benefit to the person
Different Types of Decision Making Impairments in Anorexia Nervosa
Research on neurocognitive aspects in Anorexia Nervosa (AN) has outlined a cognitive profile characterized by deficiency in the ability to set-shifting (cognitive flexibility) and weak central coherence. A smaller agreement emerges in relation to the compromission of decisional profiles frequently observed in patients with AN since both the complexity of the pathology and the executive function itself make it unclear the nature of these alterations and its relationships with specific or independent clinical and enviornmental variables.
The aim of this study was: to investigate different types of decision-making (DM) ability, veridical and adaptive, in a sample of patients with AN using the Iowa Gambling Task and the Cognitive Bias Task; to analyze test performance using a specific cognitive model for the Iowa Gambling Task (Expectancy Valence Learning Model), and to study the relationship with clinical features, focusing on their relationship with neuropsychological profiles and clinical variables; to explore the neural correlations of the two tasks with functional connectivity; to observe the the impact of the genetic profile on different types of DM. Materials and Methods:
The sample, consisting of 310 female subjects with AN lifetime and 301 female subjects without diagnosis of lifetime eating disorders, was tested in relation to DM abilities through the Iowa Gambling Task and cognitive Bias Task. All of the participants completed a baseline assessment including the Structured Clinical Interview (SCID) for the DSM-IV, section for eating disorders, and neuropsychological tests including the Wisconsin Card Sorting Test, and Trail Making Test for assessing abilities of abstraction and cognitive flexibility; 10 "and 30" interference memory test for evaluation of working memory, Stop Signal Task for evaluation of inibitory control. The Expectancy Valence Model (EVM) was used to analyze the results obtained in IGT. A genotyping was performed to evaluate the impact of the major polymorphisms implicated in decision-making (158 Val â Met) of the COMT gene and single nucleotide A / G polymorphism (SNP rs25531) of the serotonin carrier gene 5 - HTTLPR.
In a smaller subgroup of 35 AN and 34 Healthy control seed based resting state Functional connectivity was explored.
Compared to the group of healthy subjects, the decision-making profile of patients suffering from AN was worse in both Iowa Gambling Task (IGT), which evaluates veridical DM, and Cognitive Bias Task (Cbias), which evaluates adaptive DM, regardless of the diagnostic subtype (restrictive vs. binging/purging), psychopathology severity, scholarity, manual 3 dominance or outcome specific treatment. However in IGT the affective decision-making seems to be independent of IMC, conversely in Cbias the adaptive decisional profile was influenced by underweight. Both types of decision-making in patients were not affected by neurocognitive or clinical variables considered. The unfavorable geotype in AN resulted the homozygous for the met allele of the Comt gene and for the short variant of the serotonin transporter gene. The resting functional connectivity explored on the seeds of interest (executive network, orbitofrontal cortex, accumbens and amygdala) in a subgroup of patients and controls showed significantly different patterns of correlation with the scores of IGt and Cbias. In addition, different resting neural patterns appear to be involved in the two different tasks considered. Only in the AN group a positive correlation between the scores on IGT and the activity of the amygdala resulted. In AN group an higher coactivation within the executive, accumbens and orbitofrontal networks was linked to higher context-independency decisional style assessed with CBias, whereas for the executive network the opposite was true for healthy women.
In summary our results confirm an impairment of different types of decision making in AN and highlitght the importance of assessing decisional processes with different specific tasks in clinical sample. In particular different maladaptative strategies are associated with ineffective decisional profiles in AN, consisting in a âmyopia for the futureâ and âanxiety inhibitionâ in veridical situations and in a difficulty to update/review oneâs own mindset according to new environmental stimuli (context indipendent reasoning strategies) in adaptive decisional framework. The severity of malnurishment seems to influence adaptive decisional style conferring a bias toward a context indipent reasoning, suggesting the need of metacognitive approach to help patients to be more aware of their tendency to automatically use selection bias in DM contexts. Genetic polimorphysms may in part account for the impaired decision making observed in AN patients, with a negative impact of met Comt allele and the short variant of 5HTTLPR polymorphism. Functional connectivity suggests the presence of different dysfunctional decision making networks in AN patients in the two decisional framework, confirming the importance of emotion and anxiety on decisional performance in AN.
Since the cross sectional design of our study, further and longitudinal studies with recovered and at risk subjects are necessary to confirm our results.La ricerca sugli aspetti neurocognitivi nellâanoressia nervosa (AN) ha delineato un profilo cognitivo caratterizzato da deficit nellâabilitĂ di set-shifting (flessibilitĂ cognitiva) e da debole coerenza centrale. Un minor accordo emerge in relazione alla compromissione dei profili decisionali frequentemente osservata nelle pazienti con AN dal momento che la complessitĂ della patologia e della funzione esecutiva stessa rendono poco chiara la natura di tali alterazioni e le relazioni con aspetti clinici specifici della malattia o indipendenti da essa.
Il nostro studio si propone di valutare la capacitĂ decisionale di un campione di pazienti affette da AN utilizzando l'Iowa Gambling Task, e il Cognitive Bias Task, di analizzare le performance al test utilizzando un modello cognitivo specifico per lâIowa Gambling Task (Expectancy Valence model), e di studiare le relazioni tra i risultati ottenuti e le caratteristiche cliniche delle pazienti focalizzandoci nella loro relazione con aspetti caratteristici del profilo neuropsicologico e della presentazione della malattia come la precoce etĂ di esordio. Approfondire i correlati anatomici, di connettivitĂ strutturale e funzionale delle perfomance ai due task e lâimpatto dellâassetto genetico.
Il campione, costituito da 310 soggetti di sesso femminile con diagnosi lifetime di AN e 301 soggetti di sesso femminile senza diagnosi di sturbo del comportamento alimentare Ăš stato testato in relazione alle abilitĂ decisionali attraverso lâIowa Gambling Task.
Tutti i soggetti, previo consenso informato, hanno completato una valutazione sia clinica che semistrutturata mediante la somministrazione dellâIntervista Clinica Strutturata (SCID) per il DSM-IV, sezione per i disturbi del comportamento alimentare.
Eâ stata somministrata una batteria di valutazione neuropsicologica includente: the WCST Wisconsin Card Sorting Test and Trail Making Tet sper la valutazione dellâabilitĂ di astrazione e della flessibilitĂ cognitiva; test di Memoria con interferenza a 10" e 30" per la valutazione della memoria di lavoro; SSRT per la valutazione del controllo inibitorio. E' stato utilizzato inoltre uno specifico modello cognitivo (Expectancy Valence model) al fine di analizzare i risultati ottenuti all'IGT. Ă stata effettuata una genotipizzazione per valutare lâimpatto dei principali polimorfismi ritenuti implicati nelle performance decisionali (158 Val â Met del gene COMT, la variante corta e il polimorfismo a singolo nucleotide A/G (SNP rs25531) del gene del trasportatore della serotonina 5-HTTLPR.
Un sottogruppo di 35 soggetti affetti da AN e 34 controlli sani infine si Ăš sottoposto a risonanza magnetica funzionale a riposo. Eâ stata condotta unâanalisi della connettivitĂ funzionale basata su âseedâ in specifiche regioni di interesse (network esecutivo, corteccia orbitofrontale, network dellâaccumbens ed amigdala).
I risultati confermano la presenza di un peggior profilo decisionale allâ IGT nelle pazienti affette da Anoressia nervosa indipendentemente dallâetĂ del soggetto, tuttavia il deficit decisionale sembra essere indipendente dallâIMC nell IGT ma influenzato dal sotto peso nel Cbias. Entrambi i diversi tipi di decision making nelle pazienti non risentono dallâassetto neurocognitivo o dalle variabili cliniche prese in esame. Lâassetto genetico sfavorevole nelle pazienti sembrerebbe essere lâomozigosi per lâallele met del gene Comt e per la variante S del trasportatore della serotonina.
Rispetto al gruppo di soggetti sani, il profilo decisionale delle pazienti affette da Anoressia Nervosa Ăš risultato peggiore sia allo Iowa Gambling Task (IGT), che valuta le abilitĂ deciosionali di tipo veridico, che al Cognitive Bias Task (Cbias), che valuta le abilitĂ decisionali di tipo adattativo, indipendentemente dal sottotipo diagnostico (restrittivo vs bulumico purgativo), psicopatologia, scolaritĂ o dominanza manuale. La connettivitĂ funzionale a riposo esplorata sui seed di interesse (network esecutivo, corteccia orbitofrontale, accumbens e amigdala ) in un sottogruppo di pazienti e controlli ha mostrato nei due gruppi pattern significativamente diversi di correlazione con i punteggi allâIGt e al Cbias. Inoltre pattern neurali differenti a riposo sembrano essere coinvolti nei due diversi task considerati. Ă stata identificata solo nel gruppo di AN una correlazione positiva tra i punteggi allâIGT e lâattivitĂ dellâamigdala. Nelle pazienti una maggior coattivazione allâinterno del network esecutivo , orbitofrontale e dellâaccumbens Ăš legata a performance decisionali maggiormente indipendenti dal contesto al Cbias, mentre per il network esecutivo accade il contrario nei soggetti sani
Pica in an eating disordered woman with multiple sclerosis: Impulse dyscontrol, compulsive symptom or self-medication attempt?
We report about a complex case of pica in comorbidity with multiple sclerosis and binge eating disorder. Pica is classified among the feeding and eating disorders of infancy and early childhood, but there is a debate in the literature about the psychopathology and classification of this behavior. Some authors emphasize the similarities with the obsessive-compulsive spectrum disorders, whereas others propose an interpretation of pica as an addiction or as an impulsive behavior. The clinical case that we describe provides a picture of impulsive and compulsive features that are very difficult to disentangle. It is noteworthy that hypercalcemia is reported to have a protective/therapeutic effect against multiple sclerosis and seems to increase the plasmatic levels of beta-endorphins. The nature, diagnostic classification, and functions of pica are a topic worthy of future investigation
DistracciĂłn Ăłsea de los rebordes alveolares
Fil: GIANNUNZIO, G. Universidad de Buenos Aires. Facultad de OdontologĂa. CĂĄtedra de CirugĂa y TraumatologĂa Bucomaxilofacial III; Argentina.Fil: STOLBIZER, F. Universidad de Buenos Aires. Facultad de OdontologĂa. CĂĄtedra de CirugĂa y TraumatologĂa Bucomaxilofacial III; Argentina.Fil: MAURIĂO, N. Universidad de Buenos Aires. Facultad de OdontologĂa. CĂĄtedra de CirugĂa y TraumatologĂa Bucomaxilofacial III; Argentina.Fil: FERRERĂA, J.L. Universidad de Buenos Aires. Facultad de OdontologĂa. CĂĄtedra de CirugĂa y TraumatologĂa Bucomaxilofacial III; Argentina.En pacientes parcial o totalmente desdentados la sustituciĂłn de las piezas dentarias ausentes puede lograrse mediante la confecciĂłn de prĂłtesis removibles, por medio de prĂłtesis fija dentosoportadas, o a travĂ©s de prĂłtesis implanto soportadas. Sin embargo, rebordes alveolares de altura y espesor insuficiente constituyen una dificultad para la colocaciĂłn de los implantes
Tumor odontogĂ©nico queratoquĂstico : presentaciĂłn de un caso clĂnico y revisiĂłn de la bibliografĂa
Fil: Attaguile, A. Universidad de Buenos Aires. Facultad de OdontologĂa. CĂĄtedra de CirugĂa y TraumatologĂa Bucomaxilofacial III; Argentina.Fil: Bianchi, M. Universidad de Buenos Aires. Facultad de OdontologĂa. CĂĄtedra de CirugĂa y TraumatologĂa Bucomaxilofacial III; Argentina.Fil: Benitez, J. Universidad de Buenos Aires. Facultad de OdontologĂa. CĂĄtedra de CirugĂa y TraumatologĂa Bucomaxilofacial III; Argentina.Fil: Zubillaga, Y. Universidad de Buenos Aires. Facultad de OdontologĂa. CĂĄtedra de CirugĂa y TraumatologĂa Bucomaxilofacial III; Argentina.Fil: Giannunzio, G. Universidad de Buenos Aires. Facultad de OdontologĂa. CĂĄtedra de CirugĂa y TraumatologĂa Bucomaxilofacial III; Argentina.El Tumor OdontogĂ©nico QueratoquĂstico (TOQ) es una entidad patolĂłgica benigna de origen odontogĂ©nico con tendencia a la recidiva y controversial tratamiento. Cerca del 75% se presentan en zona de rama ascen-dente y cuerpo mandibular, mientras que en zona sinfisaria no alcanzan el 10% de los casos. Se presenta un caso clĂnico con ubicaciĂłn en zona sinfisaria con diagnĂłstico de TOQ. Se realiza el trata-miento y seguimiento a distancia, revisando las caracterĂsticas clĂnicas y anatomopatolĂłgicas de la entidad