Der Einfluss von fetaler Magnetresonanztomographie auf das emotionale und psychophysiologische Befinden von risikoschwangeren Frauen

Die zentrale Fragestellung der vorliegenden Diplomarbeit beinhaltete den Einfluss der fetalen MRT auf das emotionale und psychophysiologische Wohlbefinden risikoschwangerer Frauen. Die Auseinandersetzung mit Fragestellungen, welche das subjektive Erleben risikoschwangerer Patientinnen im Zusammenhang mit einer fetalen MRT thematisieren, ist deshalb von enormer Bedeutung, da in diesem Bereich erst wenige Studien publiziert wurden und somit dringender Forschungsbedarf besteht. Primäres Ziel dieser Studie war es, Faktoren ausfindig zu machen, welche es ermöglichen, die Untersuchungsbedingungen für die Patientinnen künftig angenehmer zu gestalten. Die Gesamtstichprobe umfasste 60 Teilnehmerinnen aus der Population risikoschwangerer Frauen im Alter von 17 bis 44 Jahren. Das emotionale Wohlbefinden wurde anhand standardisierter Verfahren erhoben (State-Trait-Angst Inventar; Positive and Negative Affect Schedule; Emotional Self Rating Scale; Beck-Depressions- Inventar). Das Stresserleben der Patientiennen während der MRT wurde mittels einer eigens für die Untersuchung entwickelten, MRT-tauglichen Fingerelektrode zur Ableitung des Hautleitwerts erhoben. Es gilt an dieser Stelle hervorzuheben, dass sich die Ableitung des Hautleitwerts als adäquate Methode zur Erfassung von Veränderungen im aktuellen Stressemfpinden herauskristallisierte. Ein weiterer psychophysiologischer Parameter, welcher als Bio-Marker für Stress fungiert – das Kortisol – wurde anhand von Speichelproben analysiert. Die Proben wurden zu zwei Zeitpunkten (vor und nach der fetalen MRT) erhoben um, zusätzlich zum aktuellen Stressempfinden während der Untersuchung, jenes vor und nach der MRT vergleichen zu können. Ein weiterer innovativer Aspekt vorliegender Studie bestand in der Erfassung der Ausprägung der individuellen Stressverarbeitungsstrategien, welche anhand des Stressverarbeitungsfragebogens (SVF-120) operationalisiert wurden. Darüber hinaus wurde der Einfluss der allgemeinen Selbstwertschätzung, erhoben mittels Frankfurter Selbstkonzeptskalen (FSKN), auf die im Rahmen der Untersuchung festgelegten abhängigen Variablen Stressempfinden, Angstausprägung und Stimmungsveränderung ermittelt. Als präventive Maßnahme zur Stressreduktion kann den Patientinnen künftig empfohlen werden, sich von dem Lebenspartner oder einer anderen Person zur Untersuchung begleiten zu lassen. Die Anwesenheit einer Begleitperson übt während der fetalen MRT eine beruhigende Wirkung auf die Patientinnen aus. Sollte es der Patientin nicht möglich sein, sich begleiten zu lassen, so besteht alternativ die Möglichkeit, sich von medizinischem Personal Unterstützung einzuholen. Die indiviuell ausgeprägte Stressverarbeitungsstrategie übt ebenfalls einen signifikanten Einfluss auf das Stressempfinden der Patientinnen während der MRT aus. Frauen mit überdurchschnittlichen Copingstrategien konnten sich am besten entspannen. Neben dem Stressempfinden zeigt sich auch die Ausprägung der depressiven Symptomatik von der Stressverarbeitungsstrategie beeinflusst. Frauen mit überdurchschnittlich positiver Stressverarbeitungstaktik zeigen die niedrigsten BDI-Scores, was als Indikator dafür steht, dass eine sehr positive Taktik das Entstehen depressiver Symptomatik vermeidet bzw. reduziert. Auch die positive Selbstwertschätzung wirkt dem Auftreten depressiver Symptomatik entgegen. Frauen mit sehr hoher allgemeiner Selbstwertschätzung zeigen im Vergleich zu jenen mit durchschnittlicher niedrigere Scores. Eine weitere Variable, die durch die Selbstwertschätzung beeinflusst wird, ist die Angstausprägung. Dabei ließ sich beobachten, dass die Höhe der Selbstwertschätzung positive Auswirkungen sowohl auf das momentane Angstempfinden als auch die habituelle Angst hat. Neben den signifikanten Ergebnissen konnten auch deutliche Trends beobachtet werden. Einerseits, dass Frauen mit der Zuweisungsdiagnose „Keine Pathologie, aber bestehendes Risiko“ während der fetalen MRT am deutlichsten entspannen konnten, andererseits, dass Frauen mit der schwerwiegendsten Zuweisungsdiagnose die höchsten Werte hinsichtlich der Ausprägung der depressiven Symptomatik aufzeigten. Aufgrund der Tatsache, dass zahlreiche innovative Faktoren sowie Instrumente in dieser Studie zur Überprüfung des Einflusses auf das subjektive Empfinden risikoschwangerer Patientinnen herangezogen wurden, sollten weitere Folgestudien durchgeführt werden, um die Ergebnisse zusätzlich zu bestätigen.Concerning the influence of fetal magnetic resonance imaging (MRI) on the emotional well-being of high-risk-pregnancy women, only a few studies investigated the psychological consequences related to this procedure. Leithner et al. (2008) for example found that women undergoing fetal MRI showed significantly higher levels of state-anxiety before the MRI, compared to the female norm population. After the MR examination the levels significantly decreased, even though the patients were not informed about the results of the investigation. The same study draws the conclusion that the severity of the referral diagnosis affects the anxiety level before MRI. The aim of the present study was to investigate patient’s perception of fetal MRT, more precisely the emotional and psychophysiological reactions. For this purpose standardized inventories to gather anxiety levels, mood variation and stress levels were used before and after the fetal MRI. Furthermore, the influence of self-esteem was appropriately taken into consideration. Cortisol levels were measured as a direct hormonal stress marker before and after MRI. Continuous stress levels were recorded using skin conductance measures during the MRI exam. Groups, based on their sociodemographic variables, were built to discover possible differences among them. Sixty women (60 f, 17-44 ys), assigned for a fetal MRI, were included. Affective state was assessed by standardized measures of anxiety, mood and depressive symptoms (State-Trait-Anxiety Inventory; Positive and Negative Affect Schedule; Emotional Self Rating; Beck Depression Inventory). Stress manifestation was elevated by skin conductance level during and salivary cortisol immediately before and after fetal MRI. Furthermore questionnaires acquiring stress-strategies (Stressverarbeitungs-fragebogen; SVF-120) and self-concept (Frankfurter Selbstkonzeptskalen; FSKN) were given. Analysis of fast (skin conductance) and slow (cortisol levels) stress measures revealed significant differences between women with and without a supporting person accompanying them to the MRI examination. For skin conductance levels, lower levels of stress during the MRI emerged in supported women. Moreover, women with well-marked stress-coping-strategies experienced lower levels of stress during the MRI examination as obtained with skin conductance measures. Although fast and slow stress measures before and after the MRI examination did not show significant correlations, a significant difference of skin conductance levels pre and post examination was clearly detectable, as well as a trend of decreased cortisol levels for both time points. Furthermore, the results indicate better stress-strategies in women with higher self-esteem, in combination with a lower presence of depressive symptoms. The results imply that the elevation of skin conductance level is an accurate instrument to assess fast stress alterations in patients during fetal MRI. Stress coping plays an important role in the experience of anxiety and depressive symptoms, especially in patients with high-risk-pregnancies to improve patient care. Further investigations on examination parameters, such as room temperature and a better understanding of environmental influences will help to understand the needs of this sensitive patient group

Stress matters! Psychophysiological and emotional loadings of pregnant women undergoing fetal magnetic resonance imaging

Background While the application of fetal MRI in high-risk pregnant women is steadily rising, little is known about the psychological consequences of this procedure. The aim of the present study was to investigate emotional and psychophysiological reactions of females undergoing fetal MRI. Methods Sixty women (1744 ys), assigned for fetal MRI, were included. Affective state was assessed by standardized measures of anxiety, emotional states and depressive symptoms. Stress coping strategies were assessed using a self-report questionnaire. Stress responses were determined using skin conductance levels (SCL) during fetal MRI as well as measurement of salivary cortisol levels immediately before and after fetal MRI. Results Analysis of fast and slow physiological stress measures revealed significant differences between women with and without a supporting person accompanying them to the examination. For SCLs, lower levels of stress during MRI emerged in accompanied women. Women with well-marked stress-coping-strategies experienced lower levels of stress during the examination. Although fast and slow stress measures before and after MRI did not show significant correlations, a significant difference of SCLs pre and post examination was clearly detectable, as well as a trend of decreased cortisol levels for both time points. Conclusions The results imply that the elevation of SCLs is an accurate instrument to assess fast stress alterations in patients during fetal MRI. Stress coping strategies and whether women are accompanied or not play an important role in the experience of anxiety and depressive symptoms. These factors should be considered especially in patients with high-risk-pregnancies to improve patient care.(VLID)486401

PLOS One / Same Same but Different : Different Trigeminal Chemoreceptors Share the Same Central Pathway

Intranasal trigeminal sensations are important in everyday life of human beings, as they play a governing role in protecting the airways from harm. Trigeminal sensations arise from the binding of a ligand to various sub-types of transient receptor potential (TRP) channels located on mucosal branches of the trigeminal nerve. Which underlying neural networks are involved in the processing of various trigeminal inputs is still unknown. To target this unresolved question fourteen healthy human subjects were investigated by completing three functional magnetic resonance imaging (fMRI) scanning sessions during which three trigeminal substances, activating varying sub-types of chemoreceptors and evoking different sensations in the nose were presented: CO2, menthol and cinnamaldehyde. We identified similar functional networks responding to all stimuli: an olfactory network, a somatosensory network and an integrative network. The processing pathway of all three stimulants was represented by the same functional networks, although CO2 evokes painful but virtually odorless sensations, and the two other stimulants, menthol and cinnamaldehyde are perceived as mostly non painful with a clear olfactory percept. Therefore, our results suggest a common central processing pathway for trigeminal information regardless of the trigeminal chemoreceptor and sensation type.(VLID)491223

PLOS ONE / Neuronal correlates of cognitive function in patients with childhood cerebellar tumor lesions

While it has been shown that cerebellar tumor lesions have an impact on cognitive functions, the extent to which they shape distant neuronal pathways is still largely undescribed. Thus, the present neuroimaging study was designed to investigate different aspects of cognitive function and their neuronal correlates in patients after childhood cerebellar tumor surgery. An alertness task, a working memory task and an incompatibility task were performed by 11 patients after childhood cerebellar tumor surgery and 17 healthy controls. Neuronal correlates as reflected by alterations in functional networks during tasks were assessed using group independent component analysis. We were able to identify eight networks involved during task performance: default mode network, precuneus, anterior salience network, executive control network, visual network, auditory and sensorimotor network and a cerebellar network. For the most ‘basic cognitive tasks, a weaker task-modulation of default mode network, left executive control network and the cerebellar network was observed in patients compared to controls. Results for higher-order tasks are in line with a partial restoration of networks responsible for higher-order task execution. Our results provide tentative evidence that the synchronicity of brain activity in patients was at least partially restored in the course of neuroplastic reorganization, particularly for networks related to higher-order cognitive processes. The complex activation patterns underline the importance of testing several cognitive functions to assess the specificity of cognitive deficits and neuronal reorganization processes after brain lesions.(VLID)487281

Ratings of the three applied substances CO₂, menthol and cinnamaldehyde.

<p>^a Bonferroni corrected</p><p>^b High values indicate pleasant/ familiar stimuli</p><p>^c High values indicate painful stimuli</p><p>^d Percentage of subjects who were able to label the substance correctly</p><p>Ratings of the three applied substances CO₂, menthol and cinnamaldehyde.</p

Main brain regions comprised in the component maps.

<p>Top brain regions included in the component maps as classified by AAL (automatic anatomic labelling) atlas (<a href="http://www.gin.cnrs.fr/AAL?lang=en" target="_blank">http://www.gin.cnrs.fr/AAL?lang=en</a>) [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0180200#pone.0180200.ref036" target="_blank">36</a>]. Labelling was conducted on binary masks consisting of the overlapping regions of the three tasks (component maps of each task FDR-thresholded at p_FDR < .001, <i>k</i> = 100). Please note that therefore no voxel intensity information is provided.</p

Spatially overlapping networks identified in the three cognitive tasks (part 2).

<p>MNI coordinates in brackets. CM = component map, WM = working memory task, AL = alertness task, IC = incompatibility task. CM overlap = areas which were included in the component maps of 2 [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0180200#pone.0180200.ref003" target="_blank">3</a>] tasks. * = network comprising parts of the cerebellum, not identified in [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0180200#pone.0180200.ref039" target="_blank">39</a>].</p

Detailed description of patient sample including age, gender, lesion site, and time between surgery and experiment.

<p>Detailed description of patient sample including age, gender, lesion site, and time between surgery and experiment.</p

Beta weight values (<i>mean</i>(<i>SD</i>)) of the spatially matched components for each task.

<p>Beta weight values (<i>mean</i>(<i>SD</i>)) of the spatially matched components for each task.</p

Group comparisons of performance in the three cognitive tasks.

<p>Group comparisons of performance in the three cognitive tasks.</p