Emotional disorders in patients with cerebellar damage : case studies

Aim. Growing number of research shows the role of the cerebellum in the regulation of affect. Lesions of the cerebellum can lead to emotional disregulation, a significant part of the Cerebellar Cognitive Affective Syndrome. The aim of this article is to analyze the most recent studies concerning the cerebellar participation in emotional reactions and to present three cases: two female and one male who suffered from cerebellar damage and presented post-traumatic affective and personality change. Method. The patients’ neuropsychological examination was performed with Raven’s Progressive Matrices Test – standard version, Trial Making Test, Wisconsin Card Sorting Test, Auditory Verbal Learning Test by Łuria, Benton Visual Retention Test, Verbal Fluency Test, Stroop Interference Test, Attention and Perceptivity Test (Test Uwagi i Spostrzegawczości TUS), Frontal Behavioral Inventory (FBI). Results. The review of the literature suggest cerebellar participation, especially teh vermis and paravermial regions, in the detection, integration and filtration of emotional information and in regulation of autonomic emotional responses. In the described patients we observed: oversensitivity, irritability, impulsivity and self-neglect. The man and the woman with right-sided lesions presented similar symptoms: rigidity of thought, stubbornness, lack of criticism, jocular and inappropriate behavior. The woman with left-sided cerebellar lesion was adynamic, apathic and passive, she presented emotional blunting, social isolation, lack of interests and motivation, general cognitive slowdown. Conclusions. Both the analyzed research and the described cases indicate the connection between the cerebellum and emotion regulation. The symptoms presented by the described patients were most probably a consequence of damaged cerebellar projections to subcortical structures (the limbic system) and frontal areas. The diversification of symptoms depending on the localization of lesions had not been described yet and seems to indicate an interesting direction for future research

Burnout, neurotic symptoms and coping strategies in medical students

the early stages of a medical career - as early as in medical college. Medical studies are considered one of the most stressful majors, leading to early burnout and other related symptoms such as neurotic symptoms. Our aim was to examine this topic by assessing burnout and neurotic symptoms as well as strategies of coping with stress experienced during each year of studies. Method: We used a web-based questionnaire, consisting of the Maslach Burnout Inventory-Student Survey (MBI-SS), Coping Inventory for Stressful Situations (CISS) and Symptom Checklist S-III, and invited medical students at various stages of a 6-year medical course to fill it in online. Questionnaire was filled by 781 students in total. Results: Statistical analysis revealed an interesting pattern of symptoms severity in students, with highest scores at the beginning and at the end of the medical course and the lowest score during the 3rd year of studies. This pattern was clearly visible for MBI-SS Exhaustion, and somewhat less pronounced for MBI-SS Cynicism and S-III scores, where only the decrease of symptoms was significant. Coping strategies seemed to be similar for all medical students with a higher score for the Distraction scale among the 3rd - year students compared with the 2nd-year students. Discussion: These results, however unexpected, seem to be consistent with available literature, emphasizing higher levels of stress experienced during great changes regarding expectations in students at the beginning of their course and in soon-to-be doctors. Conclusions: The results prompt to reflect on ways of countering emerging symptoms of burnout not only in experienced students, but also among those starting medical college

Psychiatric disorders and the cerebellar structure and functions — an overview of the latest research

W artykule przedstawiono przegląd najnowszych badań dotyczących roli móżdżku w niektórych zaburzeniach psychicznych. Szczegółowej analizie poddane zostały: schizofrenia, zaburzenia afektywne jedno- i dwubiegunowe, autyzm oraz zaburzenia lękowe, ze szczególnym uwzględnieniem zespołu stresu pourazowego (PTSD). Móżdżek, dzięki swoim licznym połączeniom ze strukturami korowymi i podkorowymi, w zróżnicowany sposób uczestniczy w opisanych zaburzeniach, zarówno pod względem strukturalnym (zmiany w strukturach móżdżku wykazano we wszystkich analizowanych chorobach), jak i funkcjonalnym (liczne dane neuroobrazowe ujawniają specyficzne wzorce aktywacji móżdżku w analizowanych zaburzeniach). Nadal jednak wnioski z analizowanych badań nie są konkluzywne i określenie dokładnej relacji pomiędzy móżdżkiem a zaburzeniami psychicznymi na ten moment jest niemożliwe. Przeprowadzanie większej liczby badań na temat móżdżkowych korelatów zaburzeń psychicznych jest konieczne dla dogłębnego poznania tego zagadnienia.The article provides an overview of the latest studies concerning the role of the cerebellum in certain psychiatric diseases. We analyzed in detail the following disorders: schizophrenia, depression, bipolar disorder, autism and anxiety disorders with a main focus on PTSD. Thanks to its numerous connections with cortical and subcortical structures, the cerebellum participates in psychiatric disorders in various ways, both in the terms of structure: changes in cerebellar structures were noted in all analyzed diseases; and function: numerous neuroimaging data indicates a abnormal activation patterns in analyzed disorders. Still the results of the studies are hardly conclusive and the clear description of the relationship between the cerebellum and psychiatric disorders is at this moment impossible. More research is needed to provide unequivocal conclusions concerning this subject

Relationship between neurological and cerebellar soft signs, and implicit motor learning in schizophrenia and bipolar disorder

Background: Schizophrenia (SZ) and bipolar disorder (BD) patients share deficits in motor functions in the form of neurological (NSS) and cerebellar soft signs (CSS), and implicit motor learning disturbances. Here, we use cluster analysis method to assess (1) the relationship between those abnormalities in SZ and BD and (2) the differences between those groups. Methods: 33 SZ patients, 33 BD patients as well as 31 healthy controls (HC) took part in the study. We assessed CSS with the International Cooperative Ataxia Rating Scale (ICARS) and NSS with the Neurological Evaluation Scale (NES). Implicit motor learning was evaluated with the Serial Reaction Time Task (SRTT). Participants were divided into clusters (Ward's method) based on the mean response time and mean error rate in SRTT. The difference in ICARS and NES scores, and SRTT variables between clusters were evaluated. We have measured associations between SRTT parameters and both ICARS and NES total scores and subscores. Results: Cluster analysis based on the SRTT parameters allowed to extract three clusters. Those were characterized by the increasing disruption of motor functioning (psychomotor retardation, the severity of NSS and CSS) regardless of the diagnosis. Cluster 1 covered almost all of HC and was characterized by faster reaction times and small number of errors. BD and SZ patients represented in cluster 1, although fully functional in performing the SRTT, showed higher rates of NSS and CSS. Patients with BD and SZ were set apart in clusters 2 and 3 in a similar proportion. Cluster 2 presented significantly slower reaction times but with the comparable number of errors to cluster 1. Cluster 3 consisted of participants with normal or decreased reaction time and significantly increased number of errors. None of the clusters were predominantly composed of the patients representing one psychiatric diagnosis. Conclusions: To our best knowledge, we are presenting the first data indicating the relationship between implicit motor learning and NSS and CSS in SZ and BD patients' groups. Lack of clusters predominantly represented by patients with the diagnosis of SZ or BD may refer to the model of schizophrenia-bipolar disorder boundary, pointing out the similarities between those two disorders

The biological rhythms interview of assessment in neuropsychiatry in patients with bipolar disorder : correlation with affective temperaments and schizotypy

Objective: To assess the relationship of biological rhythms, evaluated by the Biological Rhythms Interview of Assessment in Neuropsychiatry (BRIAN), with affective temperaments and schizotypy. Methods: The BRIAN assessment, along with the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego-Autoquestionnaire (TEMPS-A) and the Oxford-Liverpool Inventory for Feelings and Experiences (O-LIFE), was administered to 54 patients with remitted bipolar disorder (BD) and 54 healthy control (HC) subjects. Results: The TEMPS-A cyclothymic temperament correlated positively and the hyperthymic temperament correlated negatively with BRIAN scores in both the BD and HC groups, although the correlation was stronger in BD subjects. Depressive temperament was associated with BRIAN scores in BD but not in HC; conversely, the irritable temperament was associated with BRIAN scores in HC, but not in BD. Several positive correlations between BRIAN scores and the schizotypal dimensions of the O-LIFE were observed in both BD and HC subjects, especially with cognitive disorganization and less so with unusual experiences and impulsive nonconformity. A correlation with introversion/anhedonia was found only in BD subjects. Conclusion: Cyclothymic and depressive temperaments predispose to disturbances of biological rhythms in BD, while a hyperthymic temperament can be protective. Similar predispositions were also found for all schizotypal dimensions, mostly for cognitive disorganization

Mental rotation task in bipolar disorder

Aim. Bipolar disorder (BD) significantly affects level of cognitive and motor functioning. Studies on cognitive function in BD shows i.a. deficits in visuospatial processing and visuospatial memory. However, studies have not used Mental Rotation Task to evaluate these functions so far. Our aim is to introduce this method to assess abovementioned deficits in euthymic BD patients. Method. 31 euthymic BD patients and 27 healthy volunteers matched for age and years of education were recruited. All participants performed digital version of Mental Rotation Task. In this task, participants were asked to compare two figures rotated against each other and declare its similarity or difference indicating whether the figures are identical or whether they constitute their own mirror image.. Results. The test revealed significantly longer reaction times in the group of BD patients when images were rotated by – 90, – 45, 45, 90 degrees, or not rotated at all. There was no significant difference in condition of – 135, 135 or 180 degrees. The accuracy rate was significantly lower in the patient group than in the control group for the entire test and in each condition. The correlation between the average response time and the accuracy rate turned out to be insignificant. Conclusions. Our results are consistent with studies presenting visuospatial deficits in bipolar disorder. In this study we show for the first time that mental rotation deficits are present in euthymic state of BD patients

Vergence eye movements in bipolar disorder

Aim. With respect to bipolar disorder (BD), previous research have demonstrated saccadic eye movements abnormalities, manifested mainly as an increase in reaction time (latency) in both prosaccadic and antisaccadic task. So far, there were no studies related to vergence eye movements in subjects with BD. Our primary aim was to evaluate vergence tracking performance in this clinical group.  Methods. 30 patients with BD in remission and 23 healthy controls were enrolled. Subjects underwent optometric examination where near point of convergence was measured by the use of Wolff Wand. Instrumented convergence measurements were performed using infrared eye tracker and dedicated vergence stimuli generator. Results. BD patients presented significantly higher average error between eyes’ convergence and convergence required to fixate the target and higher number of saccadic intrusions compared with healthy controls group. Principal component analysis performed on oculometric parameters revealed differences between BD patients and healthy controls. Significant correlations between the vergence disturbances and saccadic intrusions were found. Conclusions. BD patients showed the alterations of the vergence eye movements similar to the disturbances of eye movements in the fronto-parallel plane. While the abnormalities of vergence eye movements in some mental disorders have been reported, we have for the first time objectively measured this phenomenon in BD

Executive functions and delusion-proneness in healthy population

Podatność urojeniowa to pojęcie opisujące kontinuum objawów urojeniowych i urojeniopodobnych. Osoby deklarujące doświadczenia doświadczenia podobne do urojeń wykazują większe ryzyko rozwoju zaburzeń psychotycznych. Wspólne neurokorelaty podatności urojeniowej i zaburzeń psychotycznych oraz innych zaburzeń z towarzyszącymi urojeniami umacniają przekonanie o podatności urojeniowej jako części kontinuumpsychozy. Ze względu na obecność istotnych zmian w stanach klinicznych w obszarze płatów czołowych oraz odpowiadających tym obszarom dysfunkcji wykonawczych, istnieją przypuszczenia, że subtelne deficyty funkcji wykonawczych można również wykazać w stanach subklinicznych. Celem niniejszej pracy jest określenie zależności między podatnością urojeniową a funkcjami wykonawczymi. W badaniu zastosowano Skalę Urojeń Peters et al. (PDI) do oceny podatności urojeniowej oraz testy funkcji wykonawczych: Testu Sortowania Kart Berg (BCST) do oceny funkcji przerzutności, Zadanie Stroopa do oceny funkcji hamowania oraz Zadanie N-Wstecz do oceny funkcji odświeżania. Analiza korelacyjna wykazała istotną ujemną zależność podskali dystresu PDI z odsetkiem błędównieperseweracyjnych BCST. W przypadku testu N-Wstecz, nie wykazano istotnych zależności. W teście Stroopa zarówno wynik ogólny, jak i wszystkie podskale PDI korelują ujemnie z sumaryczną liczbą błędów oraz dodatnio z poprawnością wykonania w warunku niespójnym. Wyniki te sugerują istnienie związku podatności urojeniowej z funkcjami wykonawczymi, jednak związek ten ma charakter adaptacyjny.Delusion-proneness is a construct describing a continuum of delusional and delusion-like symptoms. Persons who experience delusional disorder have a higher risk of developing psychotic disorders. Common neurocorrelates of delusion-proneness and psychotic disorders, reinforce the conviction of delusion-proneness as part of the psychosis continuum . Due to the presence of significant changes in the frontal lobes in psychotic disorders and the corresponding areas of executive functions, there is a possibility that subtle deficits in executive functions can also be demonstrated in subclinical states. The aim of this study is to assess the relationship between delusion-proneness and executive functions. The study used a Peters et al. Delusions Inventory (PDI) for delusion-proneness assessment and tests of executive functions: Berg’s Card Sorting Task (BCST) to evaluate shifting, Stroop task to evaluate inhibition and the N-Back task to assess updating. Correlation analysis showed a significant negative correlation of PDI distress subscale and BCST non-perseverative errors. Both the overall score and all PDI subscales correlate negatively with the Stroop task’s total number of errors and positively with the accuracy in incongruent variant. These results suggest the existence of adaptive relationship between delusion-proneness and executive functioning

Altered functional connectivity differences in salience network as a neuromarker of suicide risk in euthymic bipolar disorder patients

Objective: The occurrence of death by suicide in patients diagnosed with bipolar disorder is as much as 60 times greater than in the general population. Even during the state of euthymia patients are characterized by suicide risk. The aim of the study is to investigate the baseline brain activity in euthymic bipolar disorder patients in regard to suicide risk. We hypothesized that patients compared to healthy control group will demonstrate altered functional connectivity among resting state networks which will be directly related to current suicide risk. Method: 41 subjects were enrolled in the study consisting control group (n = 21) and euthymic bipolar disorder patients group (n = 20). Functional magnetic resonance imaging was used to evaluate resting state brain activity and ROI-ROI functional connectivity analysis was performed. Suicidal risk was estimated using The Suicide Behaviors Questionnaire-Revised. Results: A two sample t-test revealed decreased functional connectivity between regions involved in the salience network in patients compared to the control group. This decrease was negatively correlated with current suicide risk. Conclusion: Obtained results suggest the association between risk of suicide and activity of regions responsible for functions such as learning from mistakes, prospective thinking, and sensory integration