A combined VBM and DTI study of schizophrenia: bilateral decreased insula volume and cerebral white matter disintegrity corresponding to subinsular white matter projections unlinked to clinical symptomatology

PURPOSE:Grey matter and white matter changes within the brain are well defined in schizophrenia. However, most studies focused on either grey matter changes or white matter integrity separately; only in limited number of studies these changes were interpreted in the same frame. In addition, the relationship of these findings with clinical variables is not clearly established. Here, we aimed to investigate the grey matter and white matter changes in schizophrenia patients and exhibit the relation of these imaging findings with clinical variables.METHODS:A total of 20 schizophrenia patients and 16 matched healthy controls underwent magnetic resonance imaging to investigate the grey matter and white matter alterations that occur in schizophrenia patients using voxel-based morphometry (VBM) and whole brain voxel-wise analysis of diffusion tensor imaging (DTI) parameters with SPM8, respectively. While the preprocessing steps of VBM were performed with the default parameters of VBM8 toolbox, the preprocessing steps of DTI were carried out using FSL. Additionally, VBM results were correlated with clinical variables.RESULTS:Bilateral insula showed decreased grey matter volume in schizophrenia patients compared with healthy controls (P < 0.01). The opposite contrast did not show a significant difference. Psychiatric scores, duration of illness, and age were not correlated with the decreased grey matter volume of insula in schizophrenia patients. DTI analysis revealed a significant increase in mean, radial, and axial diffusivity, mainly of the fibers of bilateral anterior thalamic radiation and superior longitudinal fasciculus with left predominance, which intersected with bilateral subinsular white matter (P < 0.05).CONCLUSION:Our findings suggest that insula may be the main affected brain region in schizophrenia, which is also well supported by the literature. Our results were independent of disease duration and schizophrenia symptoms. White matter alterations were observed within bilateral anterior thalamic radiation and superior longitudinal fasciculus that intersects with subinsular white matter. Studies with larger sample sizes and more detailed clinical assessments are required to understand the function of insula in the neurobiology of schizophrenia

Psikolojik Stres İle Kortikal Yayılan Depresyon Uyarılma Eşiği İlişkisi ve İlgili Mekanizmaları

Migraine is suggested to belinked to cortical spreading depression (CSD), thus CSD is used to model migraine inexperimental animals. Migraine is frequently comorbid with depression and anxiety,two disorders that are associated with chronic stress; moreover migraine headache canbe triggered by stress. Glucocorticoids or noradrenaline can mediate the effect ofstress. In this study, we aimed to define the effects of psychological stress on CSDinduction threshold, and its relevant mechanisms. CSD induction threshold wasdetected by placing a cotton ball soaked with increasing KCl concentrations between0.05 to 0.15 M on the dura with 5 minutes intervals. Two electrodes were placed onthe parietal bone in order to record DC potential.Migren aurasının kortikal yayılan depresyon (KYD) ile ilişkili olduğubilinmektedir, bu nedenle KYD deney hayvanlarında migreni modellemek içinkullanılmaktadır. Migren, hem kronik stresle ilişkili olan depresyon ve anksiyetebozuklukları gibi hastalıklarla sıklıkla eş tanı almakta hem de stres iletetiklenebilmektedir. Stresin bu etkilerine glukokortikoidler veya noradrenalinaracılık edebilir. Bu çalışmada psikolojik stresin KYD uyarılma eşiği üzerineetkisinin ve bu etkinin mekanizmalarının araştırılması amaçlanmıştır. Kortikalyayılan depresyon eşiği, 0.05 M ile 0.15 M aralığındaki derişimlerde potasyumklorür emdirilmiş pamukların 5 dakika ara ile frontal bölgede açılan kranial pencereüzerine konulması ile saptanmıştır. Parietal bölgeye yerleştiren iki elektrot ile DCpotansiyel kaydı alınmıştır

Evaluation of the determinants and neuroanatomical associations of the depression that is comorbid with idiopathic parkinson's disease

Majör Depresyon, İdiopatik Parkinson Hastalığı na (İPH) sıklıkla eşlik etmektedir ve bu birlikteliğin psikososyal ve nörobiyolojik yönleri iyi bilinmemektedir. Bu çalışmada, 55 İPH hastası, depresyon sıklığı ve ilişkili faktörlerin değerlendirilmesi amacı ile SCID-I, sosyodemografik veri formu ve diğer klinik ölçekler ile değerlendirilmiştir. Değerlendirme sonrasında yaş, cinsiyet, eğitim durumu, UPDRS III puanları ve İPH süresi açısından depresyonu olan ve depresyonu olmayan 7 İPH hastası eşleştirilmiş ve depresyonun nöroanatomik ilişkisini incelemek amacı ile, iki grup, voksel temelli morfometri analizi ile gri ve beyaz cevher hacimleri, duygusal stroop fonksiyonel manyetik rezonans görüntüleme ile görev ilişkili aktivasyonları açısından karşılaştırılmıştır. İPH da hayat boyu depresyon (% 45.5), son bir ayda depresyon (% 25.5) ve İPH öncesinde depresyon öyküsünün (% 20) sık olduğu, depresyon için en belirleyici faktörlerin erken İPH başlangıç yaşı ve genç hasta yaşı olduğu bulunmuştur. Majör depresyonu olan ve depresyonu olmayan İPH hastalarının frontal girus ve temporal girustaki bazı gri ve beyaz cevher bölgeleri açısından anlamlı farklılık gösterdiği, striatal yapılar ve anterior singulat açısından gruplar arasında fark olmadığı tespit edilmiştir. Majör depresyonu olan hastalarda, sağ medial frontal kortekste hem gri cevher haciminde azalma hem de duygusal stroop görevi sırasında daha zayıf aktivasyon sinyalleri mevcuttur. Bu çalışma, İPH ya majör depresyonun sıklıkla eşlik ettiğini ve depresyonun genel populasyonda saptanan depresyondan farklı nörobiyolojik ilişkileri olabileceğini göstermektedir. Bu çalışmanın sonuçlarının tekrarlanabilmesi için, daha geniş örneklemli ileri çalışmalara ihtiyaç vardır.Major depression is frequently comorbid with Idiopathic Parkinson's disease (IPD) and the psychosocial and neurobiologic aspects of this comorbidity are not well-known. In this study, 55 IPD patients were evaluated wıth SCID-I, sociodemographic data form and other clinical scales, in order to measure depression frequency and its related factors. After the evaluation, 7 IPD patients that had a comorbid depression were matched with 7 IPD patients that did not have a comorbid depression, for age, gender, educational status, UPDRS III scores and duration of IPD symptoms and in order to examine the neuroanatomical relationship of depression, two groups were compared for gray and white matter volumes using voxel based morphometry analysis and for task related activations using emotional stroop functional magnetic resonance imaging. It has been found that the diagnosis of life time depression (% 45.5), depression in the last month (%25.5) and depression before IPD diagnosis is common and the major determinants of having a depression diagnosis are early IPD onset and young patient age. Compared to IPD patients that did not have a comorbid depression, IPD patients that had a comorbid depression showed significant differences in gray and white matter of several frontal gyrus and temporal gyrus regions, but no difference in striatal structures and anterior cingulate were found. In IPD patients that had a comorbid depression, right medial frontal cortex had both decreased gray matter volume and decreased activation during emotional stroop task. This study points out that depression is frequently comorbid in IPD and that depression in IPD may have different neurobiological correlates compared to the depression in the general population. Further studies with larger sample sizes are needed to replicate the results of this stud

Reliability and Validity of Beliefs about Substance Use (BSU) Questionnaire in Alcohol Dependent Patients.

Objective: In this study, it is aimed to evaluate the validity and reliability of the Beliefs About Substance Use Questionnaire (BSU) which was originally developed by Wright (1993). Method: Seventy alcohol addicted inpatients, who were admitted to Ankara Dışkapı Yıldırım Beyazıt Education and Research Hospital Psychiatry Clinic, 31 healthy volunteers who had never used alcohol and 33 social drinkers were evaluated. For all groups, BSU and Craving Beliefs Questionnaire (CBQ), for the patient groups, Beck Anxiety Inventory (BAI), Clinical Institute Withdrawal Assessment (CIWA), Dysfunctional Attitudes Questionnaire (DAS) and Automatic Thoughts Questionnaire (ATQ) were used as the assessment tools. The correlations and differences between the questionnaires were studied. Results: Mean age of the addicted patients, healthy controls and social drinkers were 42,3± 7,0, 33,5± 9,9 and 33,2± 8,9, respectively. In patient group, mean BSU score was 46,4 ± 21,2. For alcohol addicts, internal reliability of BSU was found to be adequate (Cronbach alfa=0.91) and item-total score correlations were between 0.33 and 0.69. Basic component analysis showed one basic factor. A positive correlation has been found between BSU and CBQ, and ATQ scores. No correlations have been found between total and subscale scores of DAS and total scores of CIWA, BAI and BSU. In evaluation of validity, BSU mean scores of alcohol addicts were found to be significantly higher than healthy controls and social drinkers. Conclusion: Our findings support that Turkish version of BSU is an adequate tool that can be used to evaluate alcohol addicted patients` cognitive believes about alcohol us

Madde Kullanımı ile İlgili İnançlar Ölçeği (MKİÖ) Türkçe Uyarlamasının Alkol BağımlılarındaGeçerlik ve Güvenilirliği

Amaç: Bu çalışmada özgün formu Wrigt (1993) tarafından geliştirilen Madde Kullanımı ile İlgili İnançlar Ölçeği (MKİÖ) Türkçe uyarlamasının geçerlik ve güvenilirliğinin değerlendirilmesi amaçlanmıştır. Yöntem: Ankara Dışkapı Yıldırım Beyazıt Eğitim ve Araştırma Hastanesi kliniğine yatırılarak tedavi edilen 70 alkol bağımlısı hasta, 31 hiç alkol kullanmayan sağlıklı gönüllü ve 33 sosyal alkol kullanıcısı incelenmiştir. Bütün gruplarda Madde Kullanımı ile İlgili İnançlar Ölçeği (MKİÖ) ve Alkol Kullanma İsteği ile İlgili İnançlar Ölçeği (AKİÖ), hasta grubunda Beck Anksiyete Envanteri (BAE), Alkol Çekilme Değerlendirme Skalası (AÇDS), Fonksiyonel Olmayan Tutumlar Ölçeği (FOTÖ) ve Otomatik Düşünce Ölçeği (ODÖ) değerlendirme araçları olarak kullanılmıştır. Ölçekler arasındaki bağıntılar ve farklılıklar incelenmiştir.Bulgular: Hasta grubunun, sağlıklı kontrol grubunun ve sosyal alkol kullanıcılarının yaş ortalamaları sırasıyla 42,37,0, 33,59,9 ve 33,28,9 idi. Hasta grubunda BSU ortalama puanı 46,4 21,2 idi. Alkol bağımlıları için MKİÖ içtutarlılığı yeterli düzeyde bulundu (Cronbach alfa0.89) ve madde-toplam puan bağıntıları 0.33 ile 0.69 arasındaydı. Temel eleman analizleri tek bir ana faktörü gösterdi. MKİÖ, AKİÖ ve ODÖ arasında pozitif bağıntı bulundu. FOTÖ toplam puanları ya da alt ölçekleri, AÇDS, BAÖ ve MKİÖ toplam puanları arasında bağıntı bulunmadı. Geçerlilik incelemesinde MKİÖ ortalama puanları, alkol bağımlılarında sağlıklı kontrol grubuna ve sosyal alkol kullanıcılarına göre anlamlı olarak yüksek bulundu.Sonuç: Bulgularımız MKİÖ'nün Türkçe uyarlamasının alkol bağımlısı hastalarda madde kullanımıyla ilgili inançların değerlendirilmesi için yeterli bir araç olduğunu desteklemektedirObjective: In this study, it is aimed to evaluate the validity and reliability of the Beliefs About Substance Use Questionnaire (BSU) which was originally developed by Wright (1993). Method: Seventy alcohol addicted inpatients, who were admitted to Ankara Dışkapı Yıldırım Beyazıt Education and Research Hospital Psychiatry Clinic, 31 healthy volunteers who had never used alcohol and 33 social drinkers were evaluated. For all groups, BSU and Craving Beliefs Questionnaire (CBQ), for the patient groups, Beck Anxiety Inventory (BAI), Clinical Institute Withdrawal Assessment (CIWA), Dysfunctional Attitudes Questionnaire (DAS) and Automatic Thoughts Questionnaire (ATQ) were used as the assessment tools. The correlations and differences between the questionnaires were studied. Results: Mean age of the addicted patients, healthy controls and social drinkers were 42,3&plusmn; 7,0, 33,5&plusmn; 9,9 and 33,2&plusmn; 8,9, respectively. In patient group, mean BSU score was 46,4 &plusmn; 21,2. For alcohol addicts, internal reliability of BSU was found to be adequate (Cronbach alfa0.91) and item-total score correlations were between 0.33 and 0.69. Basic component analysis showed one basic factor. A positive correlation has been found between BSU and CBQ, and ATQ scores. No correlations have been found between total and subscale scores of DAS and total scores of CIWA, BAI and BSU. In evaluation of validity, BSU mean scores of alcohol addicts were found to be significantly higher than healthy controls and social drinkers. Conclusion: Our findings support that Turkish version of BSU is an adequate tool that can be used to evaluate alcohol addicted patients cognitive believes about alcohol use

The relationship between pain, and freezing of gait and falls in Parkinson's Disease

INTRODUCTION: To investigate the relationship between pain, freezing of gait (FOG) and falls in Parkinson's Disease (PD). METHODS: The study included 110 PD patients. The Unified PD Rating Scale (UPDRS) and Hoehn and Yahr Scale were used to evaluate disease severity. The patients self-reported occurrence of FOG and falls, and the FOG Questionnaire was administered to evaluate the severity of FOG. A visual analog scale (VAS) was used to measure the severity of pain and pain localization was self-reported by the patients. RESULTS: Fifty-eight of the patients had FOG and 43 experienced falls. Among the patients, 42 had no pain, whereas 35 had lower extremity pain. Higher UPDRS motor and FOG scores, and advanced-stage disease were noted in significantly more of the patients with FOG and falls. VAS scores were not affected by the presence of FOG or falls. There was a positive correlation between the severity of FOG and VAS score in the male patients (r=0.308; p=0.010). More patients with falls had lower extremity pain than those without falls (r=0.308; p=0.010). DISCUSSION: Patients with FOG and falls had more severe motor findings. Pain is correlated with both FOG and falls. Further investigations should be done to understand the mechanism of this relationship to prevent the motor complications in advanced PD

The modulatory role of pre-SMA in speed-accuracy tradeoff: A bi-directional TMS study

Many perceptual decisions are inevitably subject to the tradeoff between speed and accuracy of choices (SAT). Sequential sampling models attribute this ubiquitous relation to random noise in the sensory evidence accumulation process, and assume that SAT is adaptively modulated by altering the decision thresholds at which the level of integrated evidence should reach for making a choice. Although, neuroimaging studies have shown a relationship between right presupplementary motor area (pre-SMA) activity and threshold setting, only a limited number of brain stimulation studies aimed at establishing the causal link, results of which were inconsistent. Additionally, these studies were limited in scope as they only examined the effect of pre-SMA activity unidirectionally through experimentally inhibiting the neural activity in this region. The current study aims to investigate the predictions of the striatal theory of SAT by experimentally assessing the modulatory effect of right pre-SMA on threshold setting bi-directionally. To this end, we applied both offline inhibition and excitation to the right pre-SMA utilizing transcranial magnetic stimulation in a within-subjects design and tested participants on a Random Dot Motion Task. Decision thresholds were estimated using the Hierarchical Drift Diffusion Model. Findings of our planned comparisons showed that right pre-SMA inhibition leads to significantly higher, whereas right pre-SMA excitation leads to significantly lower thresholds without showing any effects on the evidence integration process itself