Visual Dominance Effect upon Passing the Central Bottleneck of Information Processing / 中华医学杂志(英文版)

Background@#In the classical psychological refractory period (PRP) paradigm, two stimuli are presented in brief succession, and participants are asked to make separate speeded responses to both stimuli. Due to a central cognitive bottleneck, responses to the second stimulus are delayed, especially at short stimulus-onset asynchrony (SOA) between the two stimuli. Although the mechanisms of dual-task interference in the classical PRP paradigm have been extensively investigated, specific mechanisms underlying the cross-modal PRP paradigm are not well understood. In particular, it remains unknown whether the dominance of vision over audition manifests in the cross-modal PRP tasks. The present study aimed to investigate whether the visual dominance effect manifests in the cross-modal PRP paradigm.@*Methods@#We adapted the classical PRP paradigm by manipulating the order of a visual and an auditory task: the visual task could either precede the auditory task or vice versa, at either short or long SOAs. Twenty-five healthy participants took part in Experiment 1, and thirty-three new participants took part in Experiment 2. Reaction time and accuracy data were calculated and further analyzed by repeated-measures analysis of variance.@*Results@#The results showed that visual precedence in the Visual-Auditory condition caused larger impairments to the subsequent auditory processing than vice versa in the Auditory-Visual condition: a larger delay of second response was revealed in the Visual-Auditory condition (135 ± 10 ms) than the Auditory-Visual condition (88 ± 9 ms). This effect was found only at the short SOAs under the existence of the central bottleneck, but not at the long SOAs. Moreover, this effect occurred both when the single visual and the single auditory task were of equal difficulty in Experiment 1 and when the single auditory task was more difficult than the single visual task in Experiment 2.@*Conclusion@#Results of the two experiments suggested that the visual dominance effect occurred under the central bottleneck of cognitive processing.

Treatment of refractory left sided ulcerative colitis : lessons from the sages IBD registry

Background: Left sided ulcerative colitis is often a severe disease which requires aggressive medical therapy. Rarely, it can result in colectomy. Moreover, it can progress and extent to involve the entire colon. Method: Retrospective analysis of patient data on the SAGES IBD database. Patient data with severe left sided ulcerative colitis requiring anti-TNF therapy for the period between September 2016 to August 2017. Patient consent was obtained. Results: A total of 149 requests for biologic therapy were received during this period of which 13 had left sided ulcerative colitis. Seven (53.4%) were male and the mean age at diagnosis 33.3 years. Mean age at commencement of biologic therapy was 40.9 years. There were no smokers. One (7.7%) had ulcerative proctitis, 7 (53.8%) had proctosigmoiditis and 5 (38.4%) had left sided colitis. No patient was receiving topical steroids and 2 (15.4%) patients had exposure to topical 5-aminosalicylic acid. All patients had exposure to oral 5-aminosalicylic acid and 9 (69.2%) were receiving ongoing treatment. Ten (76.9%) received azathioprine or 6-mercaptopurine and 5 (38.5%) received methotrexate. Of the 12 patients on immunomodulator therapy, 10 (76.9) were concurrently on 5-aminosalicylic acid. Seven (53.8%) patients received infliximab and 9 (69.2%) patients received adalimumab. No one received golimumab or vedolizumab. All patients received standard dose anti-TNF therapy except 1 (7.7%) patient who received double dose infliximab. Biologic therapy was well tolerated with good clinical outcome and no side-effects. Conclusion: The incidence of severe left sided ulcerative colitis was low in this cohort. Severe left sided disease is associated with a high medication burden and cost. Response to biologic therapy was excellent

Neuropsychological Correlates for Obsessive Slowness.

Aim : To assess the cognitive functioning of a group of patients with OCD and a group of matched normal controls. Method : Patients of OCD were screened for selection criteria. They were assessed on Wisconson Card Sorting Test (WCST) and Continuous Performance Test (CPT) for neuro-cognitive impairments and compared the same with matched controls. Conclusions : On WCST, clinical group performed poorly, which is statistically significant. On CPT, the patient groups made significantly more wrong responses, more missed responses and took more time to respond, which is statistically significant.

Aspectos clínicos y terapéuticos del trastorno obsesivo compulsivo refractario al tratamiento antidepresivo / Clinical and therapeutic aspects of refractory obsessive compulsive syndrome

The obsessive compulsive disorder (TOC) is a clinical disorder which represents a challenge for therapists, since not only the acute clinical state but also its evolution shows difficulties in its treatment , with high figures of little response or frequent relapses. Antidepressants have been considered as the drugs of choice, using other biological techniques or psychotherapy in parallel form to the antidepressants or because of deficient response to the drugs. The optimization of treatment depends on the correct use of drugs, for the adequate time or the use of a combination of antidepressants. There has been use of antipsychotics, studies which require a longer space of time in order to establish a clinical answer. In actuality these states, together with others, have been incorporated to the concept specter of obsessive-compulsiveness, which in conjunction with new therapeutic procedures with more mythological evidence could be of help to these syndromes.

El Trastorno obsesivo compulsivo (TOC) es un cuadro clínico que representa un desafío para los terapeutas, pues tanto el cuadro clínico agudo como su evolución muestra dificultades en su tratamiento, con cifras altas de escasa respuesta o recaídas frecuentes. Los antidepresivos han sido considerados como los fármacos de primera elección, empleándose otras técnicas biológicas o psicoterapéuticas ya sea en forma paralela al uso de antidepresivos o bien luego de la falta de respuesta a estos fármacos. La optimización del tratamiento depende del correcto uso de los fármacos, por tiempos adecuados o el uso de combinaciones de antidepresivos. Se han utilizado antipsicóticos, estudios que requieren un plazo más prolongado para establecer su respuesta clínica. En la actualidad estos cuadros junto a otros han sido incorporados bajo el concepto de espectro obsesivo-compulsivo, que junto a nuevos procedimientos terapéuticos con mayor evidencia metodológica podrán ser de ayuda en estos trastornos.

Transtornos de humor refratários a tratamento / Treatment-resistant mood disorders

OBJETIVOS E MÉTODO: Os transtornos de humor estão entre os transtornos psiquiátricos mais prevalentes. Apesar de novas descobertas e avanços no estudo das bases neurobiológicas e abordagens terapêuticas no transtorno bipolar e depressão recorrente, elevadas taxas de recorrência, sintomas subsindrômicos persistentes e refratariedade terapêutica são aspectos clínicos desafiadores e precisam ser abordados. O objetivo desta revisão da literatura é o de avaliar os conceitos e critérios de resistência e refratariedade ao tratamento, e evidenciar as principais alternativas terapêuticas para transtornos do humor resistentes aos tratamentos disponíveis. RESULTADOS: Fatores genéticos, erro diagnóstico e de tratamento, não-aderência, e estressores biológicos e psicossociais podem levar à perda de mecanismos regulatórios e ao aumento na prevalência de casos de refratariedade nos transtornos de humor. Com relação aos tratamentos disponíveis, o uso de doses apropriadas, seguido por associação com um segundo ou terceiro fármaco, e após, se indicado, a troca de medicação, são etapas necessárias na busca de melhor eficácia. Entretanto, no paradigma de refratariedade terapêutica, tratamentos atuando em sistemas já conhecidos, especialmente monoaminas, freqüentemente apresentam limitada eficácia. Assim, a busca por tratamentos mais eficazes para os transtornos de humor torna-se um aspecto chave para diminuir sua morbidade. CONCLUSÃO: Estratégias focadas na regulação de vias ativadoras de neuroplasticidade, incluindo agentes antiglutamatérgicos, antagonistas de receptor glucocorticóide e neuropeptídeos, podem representar opções terapêuticas promissoras.

OBJECTIVE AND METHOD: Mood disorders are the most prevalent psychiatric disorders. Despite new insights and advances on the neurobiological basis and therapeutic approaches for bipolar disorders and recurrent depression, elevated prevalence of recurrence, persistent sub-syndromal symptoms and treatment resistance are challenging aspects and need to be urgently addressed. The objective of this literature review is to evaluate the current concepts of treatment resistance and refractoriness in mood disorders. RESULTS: Genetic factors, misdiagnosis, use of inappropriate pharmacological approaches, non-compliance and biological/psychosocial stressors account for dysfunctions in mood regulation, thus increasing the prevalence of refractory mood disorders. Regarding available treatments, the use of effective doses during an adequate period followed by augmentation with a second and/or third agent, and finally switching to other agent are steps frequently necessary to optimize efficacy. However, in the treatment-resistant paradigm, drugs mimicking standard strategies, which target preferentially the monoaminergic system, can present reduced therapeutic effects. Thus, the search for new effective treatments for mood disorders is critical to decreasing the overall morbidity secondary to treatment resistance. CONCLUSION: Emerging strategies targeting brain plasticity pathways or 'plasticity enhancers', including antiglutamatergic drugs, glucocorticoid receptor antagonists and neuropeptides, have been considered promising therapeutic options for difficult-to-treat mood disorders.

Clozapina no transtorno bipolar refratario / Clozapine in refractory bipolar disorder

Os autores relatam o caso de um paciente de 36 anos, portador de transtorno bipolar tipo I, com predominio de episodios maniacos, refratario a varios esquemas terapeuticos ha mais de uma decada. Com a introducao da clozapina em associacao com valproato de sodio, houve remissao do quadro de humor e foi possivel reduzir a sua politerapia farmacologica a apenas duas medicacoes. Uma revisao de literatura sobre o papel da clozapina no transtorno bipolar...