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Psychosurgery, the neurosurgical treatment for psychiatric disorders, has a long and controversial history. The review introduces the birth of psychosurgery, the rise and fall of the frontal lobotomy and the transition to the modern era of psychosurgery, due to the development of the stereotactic instruments, and the different psychosurgical procedures. Today, recent advances in neuromodulation may provide an opportunity for psychosurgery to become a more attractive option for the treatment of psychiatric diseases. Current states in China and prospects of psychosurgery are also discussed.
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Amisulpride,a kind of the second generation antipsychotics,was marketed in China in 2010.A series of clinical research and experience before and after listed,especially the data based on Chinese population,provided evidence for the generalization and application of amisulpride.In order to optimize the clinical application of amisulpride,and improve the prognosis of patients,Expert Advice on the Practical Use of Amisulpride in the Treatment of Schizophrenia is presented here.This advice is based on the recent evidence and clinical experience,for guiding the clinical medication of amisulpride.
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Objective To better understand the role of CREB signaling pathway in chronic mild stress (CMS), we investigated the alteration of CREB and p-CREB in CMS rats with and without fluoxetine hydrochloride. Methods Fifty adult male Sprague-Dawley rats were randomly divided into three groups:CMS group (26), fluoxtine group (12) and con-trol group (12). The rats in CMS group and fluoxtine group received 8 weeks of chronic mild stress. Rats in fluoxtine group were administered daily injections of fluoxetine 10mg/kg I.P. Sucrose preference tests and open-field test were car-ried out after the 8th week. Based on endpoint sucrose-intake, animals were further divided into 4 groups:CMS sensitive group, CMS resilient group, fluoxtine group and control group. Western blot was used to detect the expression levels of CREB and p-CREB in the hippocampus and prefrontal cortex. Results The sucrose consumption was significantly de-creased in CMS resilience group compared to sensitive group, control group and fluoxetine-intervention group (all P<0.05). Similarly, the numbers in total arm entries, percentage of entries into open arms and time spent in open arms was significantly lower in CMS resilience group compared to control group(all P<0.05), but not different compared to CMS sensitive group(all P<0.05). The p-CREB in the hippocampus was significantly lower in CMS sensitive rat compared to CMS resilience group, control group and fluoxetine-intervention group(all P<0.05), but CREB was not dfferent among the four groups(all P<0.05). Conclusions The elevated phosphorylation of CREB in the hippocampus and prefrontal cortex of resilience CMS rats may contribute to the mood alteration induced by stress.
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Objective To explore the role of default mode network (DMN) in the pathophysiology of depression and the correlations between the functional connectivity (FC) of DMN and the clinical characteristics of depression through the resting-state fMRI scan in depressed patients. Methods Sixteen medication-na?ve patients with major depressive disorder and 15 healthy controls were recruited and underwent the resting-state MRI scan. Hamiliton depression rating scale (HAMD) was used to evaluate patients’symptom. The FC of DMN and its correlations with clinical features of pa-tients were analyzed. Results Compared with healthy controls, the FC within DMN in depressed patients is disturbed. There were negative correlations between the left mPFC-left hippocampus FC and HAMD total scores (r=-0.569, P=0.021) and subscale scores for sluggishness (r=-0.498, P=0.050). The left mPFC-right hippocampus FC in patients was negatively correlated with HAMD scores (r=-0.508, P=0.045). There were negative correlations between FC in the hippo-campus and HAMD subscale scores for cognitive impairment (r=-0.509, P=0.044). Conclusions The results suggest that there is abnormal FC within DMN in drug-na?ve patients with depression during resting state and some abnormal altera-tions of FC may be correlated with the clinical characteristics in depression.
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Objective To explore the feature of functional connectivity of default mode network (DMN) and salience network (SN) in unmedicated schizophrenia patients during a resting state by functional magnetic resonance imaging (fM-RI). Methods The SPM8 and DPARSFA softwares combined with independent component analysis (ICA) were used to in-vestigate functional connectivity (FC) of the DMN and SN in 27 unmedicated patients with schizophrenia and 27 age-and gender-matched healthy controls. Results Concerning the DMN, patients with schizophrenia showed decreased FC in right inferior frontal gyrus , right precuneus(unadjusted P<0.05)and increased FC in right middle cingulate gyrus, left middle frontal gyrus(unadjusted P<0.05). With regard to the SN, patients showed reduced connectivity in left inferior frontal gyrus, right inferior frontal gyrus, left anterior cingulate, left postcentral gyrus(unadjusted P<0.05)and increased connectivity in left superior temporal gyrus(unadjusted P<0.05). Correlation analyses showed that the increased FC of left superior temporal gyrus significantly correlated with PANSS-positive symptoms(r=0.568,P=0.002)and decreased FC of right precuneus significantly negatively correlated with delusion symptom(r=-0.458,P=0.016). Conclusion This study provides evidence for resting state functional abnormalities of DMN and SN in unmedicated schizophrenia patients. These aberrant function connectivities in some brain regions of the two networks could be a source of abnormal introspectively-oriented mental actives.
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ObjectiveTo explore gamma resonance signals in acute medication-free schizophrenics,and the effects of antipsychotics on gamma activity.MethodsSchizophrenia patients( n=56) and normal controls ( n =18 ) underwent auditory steady-state event-related potential testing and were evaluated of their psychopathic syndromes with the positive and negative syndrome scale (PANSS) before and after 8 weeks of medication with oral chlorpromazine or clozapine.Click trains varying in rate of stimulation 40 Hz were presented; EEG-evoked power and intertrial phase synchronization were obtained in response to stimulation frequency.ResultsSchizophrenic patients showed reduced evoked power( Fz:( 5.08 ± 1.48) μV2 vs (6.91 ± 1.64) μV2 ; Cz:(4.70 ± 2.03 ) μV2 vs ( 6.93 ± 1.43 ) μV2 ; P ＜ 0.01 ) and a tendency of reduction in phase synchronization ( Fz:0.14 ± 0.04 vs 0.13 ± 0.04,P =0.051 ; Cz:0.18 ± 0.06 vs 0.17 ± 0.06,P =0.056) in response to 40 Hz stimulation.However significant correlations were not observed between oscillatory responses and clinical parameters in schizophrenic patients.There were no significant differences of gamma power and ITC in patients before and after chlorpromazine or clozapine administered.ConclusionSchizophrenia patients have deficits in the power and coherent of gamma oscillations,and can not be normalized by medication with antipsychotics.
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Objective: To explore the cognitive function of chronic schizophrenic patients with tardive dyskinesia(TD).Methods: 82 chronic schizophrenic patients with TD,70 chronic schizophrenic patients without TD were accepted 3 neuropsychological tests including WMS,WCST and TMT.Results: Compared with non-TD group in WCST,TD group had poorer performance in the number of error responses,the selective error rate,error thinking time,the number of perservation of responses and the rate of conceptualization responses.Additionally,TD group had poorer performance in TMT-PartB.Conclusion: Chronic schizophrenic patients with TD had significantly cognitive impairment,involving the frontal cortex.
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<p><b>OBJECTIVE</b>To investigate the features of regional cerebral metabolic rate of glucose (rCMRglc) in patients with mild cognitive impairment (MCI) by positron emission-tomography and its relationship with neuropsychological test.</p><p><b>METHODS</b>Positron emission tomography, mini-mental state examination and Wechsler memory scale were applied in 10 patients with MCI and 10 healthy volunteers as the control group.</p><p><b>RESULTS</b>Scores of mini-mental state examination and Wechsler memory scale in MCI patients were lower than those in the control group (P < 0.01). rCMRglc of the left orbital gyrus, right middle temporal gyrus and right putamen was lower in the MCI group than in the control group (P < 0.05). Correlation analysis in the MCI group indicated that rCMRglc of many brain regions such as the orbital gyrus, putamen, left hippocampus and parahippocampal gyrus, cingulate gyrus, left amygdaloid body, precentral gyrus, postcentral gyrus, and medial occipitotemporal gyrus in MCI patients, were correlated negatively with age; while the rCMRglc of many parts of the brain such as the left putamen, temporal lobe, anterior cingulate gyrus, left insular lobe, amygdaloid body, precentral gyrus, postcentral gyrus and medial occipitotemporal gyrus were correlated positively with mini-mental state examination; and rCMRglc of the left putamen, temporal lobe, left insular lobe, precentral gyrus and postcentral gyrus were correlated positively with Wechsler memory scale. The right putamen, the right inferior temporal gyrus, precentral gyrus, and left postcentral gyrus were correlated positively with the length of education. However, only rCMRglc of the left amygdaloid body were correlated positively with gender.</p><p><b>CONCLUSION</b>The rCMRglc was lower in the orbital gyrus and putamen of MCI patients. Their rCMRglc were correlated with their cognitive impairment severity, age, length of education and sex.</p>
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Aged , Female , Humans , Male , Middle Aged , Brain , Metabolism , Cognition Disorders , Metabolism , Psychology , Glucose , Metabolism , Neuropsychological Tests , Tomography, Emission-ComputedABSTRACT
Objective To study the feature of regional cerebral metabolism rate of glucose (rCMRglc) in patients with Alzheimer’s disease (AD) and the value of positron emission tomography (PET) scanning in diagnosis of AD. Methods 13 AD patients and 13 health controls ,Who matched in age,sex and education years,were scanned with PET. Results (1) Watching by naked eyes,there was mild decreasing of rCMRglc at parietal lobe in healthy elders. While in AD patients,there was widely decreasing of cerebral metabolism rate of glucose. The most significant region was parietal lobe, the next was temporal lobe,and the last was frontal lobe. (2) Detecting with PET and dealing with statistical parametric mapping (SPM) of 99 software,there was more significant decreasing of rCMRglc in regions 7,23,30,31 of cingulate gyrus,region 39 and 40 of pario-occipital lobe,region 20 of temporal lobe and region 6,8,9 of frontal lobe in AD group( P
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Objective To investigate the effect of risperidone on regional cerebral blood flow (rCBF) and the relationship between efficacy and rCBF ratio. Methods Twenty four naive schizophrenic patients (diagnosed according to the ICD 10) completed 8 weeks treatment with risperidone. Ten patients were male and 14 were female. Twenty six healthy controls were enrolled as control group. The treatment dose of risperidone was 3～6 mg/d. After 8 weeks treatment, brain imaging was conducted again. Results Before treatment with risperidone, compared to the control group, the baseline rCBF ratios of left and right inferior posterior temporal of patients were higher and the cognitive activated rCBF ratios of left mid-lateral frontal was lower. After treatment, the baseline state rCBF ratios of right lateral temporal, left and right superior posterior temporal were significantly decreased. The cognitive activated rCBF ratios of left and right inferior medial frontal, left inferior lateral frontal, left superior fronto temporal and left superior lateral fronal significantly increased. The efficacy was correlated with changes of the baseline rCBF ratio in some RIOs. Conclusions Risperidone could change the blood perfusion in some ROIs. It suggested that the perfusion in these ROIs could be useful for predicting treatment efficacy.
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Objective:To explore the relationship between DRD2 - 141C Ins/Del polymorphism and heroin craving. Methods:380 heroin addicts who were under abstinence were given the cue- elicited heroin craving experiment. And then we detected the polymorphism of DRD2- 141CIns/Del for them by using PCR- RFLP. We compared the relationship between genotypes of DRD2- 141CIns/Del and heroin craving before and after cue exposure. Results:No significant differ- ence has been found between heroin craving before and after cue- exposure in three genotypes of DRD2- 141CIns/Del. Conclusion:D2 receptor gene - 141CIns/Del polymorphisms may have no association with the susceptibility of heroin crav- ing.