Shaping the future for primary care education and training project. Finding the evidence for education & training to deliver integrated health and social care: the primary care workforce perspective

This report is one of a series of outputs from the Shaping the Future in Primary Care Education and Training project (www.pcet.org.uk) funded by the North West Development Agency (NWDA). It is the result of a collaborative initiative between the NWDA, the North West Universities Association and seven Higher Education Institutions in the North West of England. The report presents an evidence base drawn from the analysis of the experiences and aspirations of integrated health and social care, as reported by members of the current primary health and social care workforce working in or with Primary Care Trusts (PCTs) in the North West region

Are Bipolar Disorder and Schizophrenia Neuroanatomically Distinct? An Anatomical Likelihood Meta-analysis

Objective: There is renewed debate on whether modern diagnostic classification should adopt a dichotomous or dimensional approach to schizophrenia and bipolar disorder. This study synthesizes data from voxel-based studies of schizophrenia and bipolar disorder to estimate the extent to which these conditions have a common neuroanatomical phenotype. Methods: A post-hoc meta-analytic estimation of the extent to which bipolar disorder, schizophrenia, or both conditions contribute to brain gray matter differences compared to controls was achieved using a novel application of the conventional anatomical likelihood estimation (ALE) method. 19 schizophrenia studies (651 patients and 693 controls) were matched as closely as possible to 19 bipolar studies (540 patients and 745 controls). Result: Substantial overlaps in the regions affected by schizophrenia and bipolar disorder included regions in prefrontal cortex, thalamus, left caudate, left medial temporal lobe, and right insula. Bipolar disorder and schizophrenia jointly contributed to clusters in the right hemisphere, but schizophrenia was almost exclusively associated with additional gray matter deficits (left insula and amygdala) in the left hemisphere. Limitation: The current meta-analytic method has a number of constraints. Importantly, only studies identifying differences between controls and patient groups could be included in this analysis. Conclusion: Bipolar disorder shares many of the same brain regions as schizophrenia. However, relative to neurotypical controls, lower gray matter volume in schizophrenia is more extensive and includes the amygdala. This fresh application of ALE accommodates multiple studies in a relatively unbiased comparison. Common biological mechanisms may explain the neuroanatomical overlap between these major disorders, but explaining why brain differences are more extensive in schizophrenia remains challenging

Spatiotemporal dipole source localization of face processing ERPs in adolescents: a preliminary study

<p>Abstract</p> <p>Background</p> <p>Despite extensive investigation of the neural systems for face perception and emotion recognition in adults and young children in the past, the precise temporal activation of brain sources specific to the processing of emotional facial expressions in older children and adolescents is not well known. This preliminary study aims to trace the spatiotemporal dynamics of facial emotion processing during adolescence and provide a basis for future developmental studies and comparisons with patient populations that have social-emotional deficits such as autism.</p> <p>Methods</p> <p>We presented pictures showing happy, angry, fearful, or neutral facial expressions to healthy adolescents (aged 10–16 years) and recorded 128-channel event-related potentials (ERPs) while they performed an emotion discrimination task. ERP components were analyzed for effects of age and emotion on amplitude and latency. The underlying cortical sources of scalp ERP activity were modeled as multiple equivalent current dipoles using Brain Electrical Source Analysis (BESA).</p> <p>Results</p> <p>Initial global/holistic processing of faces (P1) took place in the visual association cortex (lingual gyrus) around 120 ms post-stimulus. Next, structural encoding of facial features (N170) occurred between 160–200 ms in the inferior temporal/fusiform region, and perhaps early emotion processing (Vertex Positive Potential or VPP) in the amygdala and orbitofrontal cortex. Finally, cognitive analysis of facial expressions (P2) in the prefrontal cortex and emotional reactions in somatosensory areas were observed from about 230 ms onwards. The temporal sequence of cortical source activation in response to facial emotion processing was occipital, prefrontal, fusiform, parietal for young adolescents and occipital, limbic, inferior temporal, and prefrontal for older adolescents.</p> <p>Conclusion</p> <p>This is a first report of high-density ERP dipole source analysis in healthy adolescents which traces the sequence of neural activity within the first 500 ms of categorizing emotion from faces. Our spatio-temporal brain source models showed the presence of adult-like cortical networks for face processing in adolescents, whose functional specificity to different emotions appear to be not yet fully mature. Age-related differences in brain activation patterns illustrate the continued development and maturation of distinct neural systems for processing facial expressions during adolescence and possible changes in emotion perception, experience, and reaction with age.</p

Prenatal exposure to valproic acid induces a dose dependent impairment in sensorimotor gating in a mouse model of autism

Poster Sessionspublished_or_final_versionThe 27th World Congress of the International College of Neuro-Psychopahrmacology (CINP), Hong Kong, 6–10 June 2010. In International Journal of Neuropsychopharmacology, 2010, v. 13, suppl. S1, p. 68, abstract no. P-02.03

Autistic Disorders and Schizophrenia: Related or Remote? An Anatomical Likelihood Estimation

Shared genetic and environmental risk factors have been identified for autistic spectrum disorders (ASD) and schizophrenia. Social interaction, communication, emotion processing, sensorimotor gating and executive function are disrupted in both, stimulating debate about whether these are related conditions. Brain imaging studies constitute an informative and expanding resource to determine whether brain structural phenotype of these disorders is distinct or overlapping. We aimed to synthesize existing datasets characterizing ASD and schizophrenia within a common framework, to quantify their structural similarities. In a novel modification of Anatomical Likelihood Estimation (ALE), 313 foci were extracted from 25 voxel-based studies comprising 660 participants (308 ASD, 352 first-episode schizophrenia) and 801 controls. The results revealed that, compared to controls, lower grey matter volumes within limbic-striato-thalamic circuitry were common to ASD and schizophrenia. Unique features of each disorder included lower grey matter volume in amygdala, caudate, frontal and medial gyrus for schizophrenia and putamen for autism. Thus, in terms of brain volumetrics, ASD and schizophrenia have a clear degree of overlap that may reflect shared etiological mechanisms. However, the distinctive neuroanatomy also mapped in each condition raises the question about how this is arrived in the context of common etiological pressures

Ketamine abuse and apoptosis in the cortex in monkeys and mice

International Journal of Neuropsychopharmacology, 2008, v. 11, suppl. 1, p. 236-237, abstract no. P-06.11published_or_final_versionThe 26th CINP Congress, Munich, Germany, 13-17 July 2008

Neural Acupuncture Unit: A New Concept for Interpreting Effects and Mechanisms of Acupuncture

When an acupuncture needle is inserted into a designated point on the body and mechanical or electrical stimulation is delivered, various neural and neuroactive components are activated. The collection of the activated neural and neuroactive components distributed in the skin, muscle, and connective tissues surrounding the inserted needle is defined as a neural acupuncture unit (NAU). The traditionally defined acupoints represent an anatomical landmark system that indicates local sites where NAUs may contain relatively dense and concentrated neural and neuroactive components, upon which acupuncture stimulation would elicit a more efficient therapeutic response. The NAU-based local mechanisms of biochemical and biophysical reactions play an important role in acupuncture-induced analgesia. Different properties of NAUs are associated with different components of needling sensation. There exist several central pathways to convey NAU-induced acupuncture signals, Electroacupuncture (EA) frequency-specific neurochemical effects are related to different peripheral and central pathways transmitting afferent signals from different frequency of NAU stimulation. More widespread and intense neuroimaging responses of brain regions to acupuncture may be a consequence of more efficient NAU stimulation modes. The introduction of the conception of NAU provides a new theoretical approach to interpreting effects and mechanisms of acupuncture in modern biomedical knowledge framework

Magnetic resonance spectroscopy reveals N-acetylaspartate reduction in hippocampus and cingulate cortex after fear conditioning

The fear conditioning in rodents provides a valuable translational tool to investigate the neural basis of learning and memory and potentially the neurobiology of post-traumatic stress disorder (PTSD). Neurobiological changes induced by fear conditioning have largely been examined ex vivo while progressive 'real-time' changes in vivo remain under-explored. Single voxel proton magnetic resonance spectroscopy (1H MRS) of the hippocampus, cingulate cortex and thalamus of adult male C57BL/6N mice (N=12) was performed at 1 day before, 1 day and 1 week after, fear conditioning training using a 7T scanner. N-acetylaspartate (NAA), a marker for neuronal integrity and viability, significantly decreased in the hippocampus at 1 day and 1 week post-conditioning. Significant NAA reduction was also observed in the cingulate cortex at 1 day post-conditioning. These findings of hippocampal NAA decrease indicate reduced neuronal dysfunction and/or neuronal integrity, contributing to the trauma-related PTSD-like symptoms. The neurochemical changes characterized by 1H MRS can shed light on the biochemical mechanisms of learning and memory. Moreover, such information can potentially facilitate prompt intervention for patients with psychiatric disorders. © 2012 Elsevier Ireland Ltd.postprin

Women, Work and Well-Being : An Evaluation of Women's Management of Occupational Pressure

The purpose of the present study was to examine the relationship between women’s coping activities and their mental and physical health. A large group of women managers (n = 302) were surveyed to assess their experience of occupational and domestic pressure and stress-related symptoms. Based on this data two groups, a “distressed” (i.e. “High Stress”: high pressure/high distress) and a “non-distressed” group (i.e. “Low Stress” : high pressure/low distress), were identified. Using a semi-structured interview and questionnaires, “High Stress” and “Low Stress” managers were again assessed with respect to (i) coping repertoire, i.e. range and type of coping strategies; (ii) coping style, described within an approach-avoidance model; (iii) self-control/learned resourcefulness and (iv) gender-role orientation. Participants’ experience of work and family stressors was also explored. The importance of an emotion-focused coping approach was observed in relation to both physical and psychological health outcome. A non-traditional gender orientation and a high level of self-control or resourcefulness was also found to be significant in the maintenance of psychological, though not physical, health. Coping style, coping range and the use of problem-focused strategies showed no association with participants’ mental or physical health. Additionally, the stressor factors, Domestic Responsibilities and Relationship with the Line Manager, were observed to be associated with both mental and physical health such that higher reported levels of either of these pressures was predictive of greater mental and physical distress. These findings were discussed in relation to the particular pressures encountered by women managers in a traditionally male organisation. It was proposed that given the intractable nature of the wider organisational challenges likely to be encountered by working women, an emotion-focused approach may be an appropriate and, therefore, adaptive coping response

X-chromosome trinucleotide repeats: effects on brain structure (British Human Genetics Conference, Abstract 4.12)

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