A psicopatia e o criminoso nato: a modernização do positivismo criminológico / Psychopathy and the born criminal: the modernization of criminological positivism / Psicopatía y el criminal nato: la modernización del positivismo criminológico

O conceito de psicopatia é habitualmente associado a uma psicopatologia caracterizada pela falta de empatia, manipulação, agressividade, impulsividade, egocentrismo, crueldade e criminalidade. Já amplamente aceito pela comunidade científica, o conceito costuma ser utilizado em contextos jurídico-penais na validação de seu funcionamento punitivo. Dentre as concepções que alicerçaram o surgimento histórico desse conceito, destaca-se o papel do criminoso nato de Lombroso. Nesse sentido, este estudo buscou evidenciar como o conceito contemporâneo de psicopatia se firma enquanto modernização das concepções lombrosianas acerca do criminoso nato. Para isso, nos apoiamos na psicopatolologia para realizar um estudo comparativo entre as produções de Lombroso e as pesquisas contemporâneas acerca da psicopatia. Dentre as principais similaridades, destacamos a ênfase atribuída à suposta natureza criminal, etiologicamente decorrente de sua configuração orgânica. No mais, tais concepções também se assemelham no destaque de um déficit afetivo e moral, assim como na descrição da tendência a ser canhoto, egoísta, mentiroso, resistente à dor, narcisista, impulsivo, promíscuo, cruel, maléfico e inapto ao trabalho. Assim como fez Lombroso, as pesquisas acerca da psicopatia costumam ser realizadas com sujeitos já previamente criminalizados; condicionando uma seletividade étnico-racial e de classe. Descritos como sujeitos perigosos, incuráveis e intratáveis, ambas as concepções promovem a defesa do acirramento da punição jurídico-penal. Concluímos que a criminalidade nata de Lombroso continua a ser expressa no conceito de psicopatia, visto que as funções jurídico-penais e socioeconômicas de sua definição exercem o mesmo papel na legitimação científica da violência de Estado, encarceramento em massa e racismo estrutural.(AU)

Psychopathy is usually associated with a psychopathology characterized by a lack of empathy, manipulation, aggressiveness, impulsivity, egocentrism, cruelty, and criminality. Widely accepted by the scientific community, this concept is often used in legal and criminal contexts to validate its punitive functioning. Among the conceptions that underpinned the historical emergence of psychopathy, Lombroso's born criminal stands out. Hence, this study analyzes how the contemporary concept of psychopathy updates Lombrosian conceptions about the born criminal. To do so, we rely on psychopathology to conduct a comparative study between Lombroso's work and contemporary research on psychopathy. Among the main similarities, we highlight the emphasis given to the supposed criminal nature, etiologically arising from its organic configuration. Moreover, such conceptions emphasize an affective and moral deficit, and describe a tendency toward left-handedness, selfishness, lying, pain-resistance, narcissism, impulsivity, promiscuousness, cruelty, maliciousness and unfitness for work. As did Lombroso, research on psychopathy is usually conducted with individuals who have already been criminalized, conditioning an ethnic-racial and class selectivity. By describing these subjects as dangerous, incurable and intractable, both conceptions advocate for increased legal and penal punishment. In conclusion, Lombroso's natural criminality continues to underpin the concept of psychopathy, since its legal-criminal and socioeconomic functions play the same role in scientifically legitimizing state violence, mass incarceration, and structural racism.(AU)

La psicopatía es un concepto generalmente asociado a una psicopatología que se caracteriza por la falta de empatía, la manipulación, agresividad, impulsividad, egocentrismo, crueldad y criminalidad. Ya ampliamente aceptado por la comunidad científica, este concepto se utiliza a menudo en contextos legales para validar su funcionamiento punitivo. Entre los conceptos que fundamentaron el surgimiento histórico de este concepto, destaca el papel del criminal nato de Lombroso. En este contexto, este estudio buscó mostrar cómo el concepto contemporáneo de psicopatía se establece como la modernización de las concepciones lombrosianas sobre el criminal nato. Para eso, se utiliza la psicopatología para realizar un estudio comparativo entre las producciones de Lombroso y la investigación contemporánea sobre psicopatía. Entre las principales similitudes, destaca el énfasis atribuido a su supuesta naturaleza criminal, resultado etiológico de su configuración orgánica. Además, estas concepciones también son similares al resaltar un déficit afectivo y moral, así como al describir la tendencia a ser zurdo, egoísta, mentiroso, resistente al dolor, narcisista, impulsivo, promiscuo, cruel, malévolo e inadecuado para el trabajo. Como hizo Lombroso, los estudios sobre psicopatía se suelen realizar con sujetos que ya han sido criminalizados; condicionando una selectividad étnica, racial y de clase. Calificados como sujetos peligrosos, incurables e intratables, ambas concepciones promueven la defensa del aumento de la pena legal. Se concluye que la criminalidad nata de Lombroso continúa expresándose en el concepto de psicopatía, ya que las funciones penales y socioeconómicas de su definición juegan el mismo papel en la legitimación científica de la violencia estatal, encarcelamiento masivo y racismo estructural.(AU)

Revisión de la relación entre estrés y tinnitus / Review of the relationship between stress and tinnitus

El tinnitus es un síntoma común y frecuente definido como una sensación de sonido que se produce en ausencia de cualquier fuente acústica externa. El tinnitus crónico no solo es aversivo, sino que también interfiere con las actividades de la vida diaria de las personas que lo perciben. Se realizó una revisión narrativa utilizando las palabras claves "tinnitus", "estrés", "acúfeno", "estresor" y "fisiología" en las bases de datos Scielo,Medline, Embase, Ovid y PubMed. Los modelos fisiopatológicos actuales relacionan la aparición y el mantenimiento del tinnitus con el estrés; esta activación implica un conjunto de reacciones conductuales y fisiológicas (neuronales, metabólicas y neuroendocrinas) que permiten responder al estresor de la manera más adaptada posible. Esta respuesta depende tanto de la magnitud del estresante que en este caso es el tinnitus como del aprendizaje, autoestima, sentido de dominio y control, apoyo social y emocional de la persona que presenta el síntoma. Dado que los sistemas auditivo y límbico están interconectados, el tinnitus puede afectar las propiedades emocionales y cognitivas y a su vez, el sistema límbico puede desempeñar un papel esencial para la generación o estabilización del tinnitus. Este artículo recoge la evidencia reciente que demuestra la relación fisiológica y psicológica del tinnitus con el estrés para poner de manifiesto la importancia de que sea un factor a tener en cuenta en la evaluación y manejo de esta población

Tinnitus is a common and frequent symptom defined as a sound sensation that occurs in the absence of an external acoustic source. Chronic tinnitus is not only aversive but also interferes with the activities of the daily life of people who perceive it. A narrative review was carried out using the keywords "tinnitus", "stress", "stressor" and "physiology" in the Scielo, Medline, Embase, Ovid, and PubMed databases. Current pathophysiological models relate to the onset and maintenance of tinnitus to stress. This appearance of stress implies a set of behavioral and physiological reactions (neuronal, metabolic, and neuroendocrine) that allow responding to the stressor in the most adapted way possible. This response depends on the magnitude of the stressor that, in this case, it is tinnitus as well as learning, self-esteem, sense of dominance and control, social and emotional support of the person presenting the symptom. Since the auditory and limbic systems are interconnected, tinnitus can affect emotional and cognitive properties. In turn, the limbic system can play an essential role in the generation or stabilization of tinnitus. This article gathers recent evidence that demonstrates the physiological and psychological relationship of tinnitus with stress to highlight the importance of being a factor to consider in the evaluation and management of this population

Fear Network Model in Panic Disorder: The Past and the Future

The core concept for pathophysiology in panic disorder (PD) is the fear network model (FNM). The alterations in FNM might be linked with disturbances in the autonomic nervous system (ANS), which is a common phenomenon in PD. The traditional FNM included the frontal and limbic regions, which were dysregulated in the feedback mechanism for cognitive control of frontal lobe over the primitive response of limbic system. The exaggerated responses of limbic system are also associated with dysregulation in the neurotransmitter system. The neuroimaging studies also corresponded to FNM concept. However, more extended areas of FNM have been discovered in recent imaging studies, such as sensory regions of occipital, parietal cortex and temporal cortex and insula. The insula might integrate the filtered sensory information via thalamus from the visuospatial and other sensory modalities related to occipital, parietal and temporal lobes. In this review article, the traditional and advanced FNM would be discussed. I would also focus on the current evidences of insula, temporal, parietal and occipital lobes in the pathophysiology. In addition, the white matter and functional connectome studies would be reviewed to support the concept of advanced FNM. An emerging dysregulation model of fronto-limbic-insula and temporooccipito-parietal areas might be revealed according to the combined results of recent neuroimaging studies. The future delineation of advanced FNM model can be beneficial from more extensive and advanced studies focusing on the additional sensory regions of occipital, parietal and temporal cortex to confirm the role of advanced FNM in the pathophysiology of PD.

La fisiología vista desde un sistema nervioso autónomo ampliado y circadianamente organizado Bases para un enfoque Bio-Psico-Social-Ecológico de la salud y la enfermedad / THE PHYSIOLOGY OBSERVED SINCE AN AMPLIED AND CIRCADIANILLY ORGANIZED AUTONOMIC NERVOUS SYSTEM. BASIS FOR A BIO-PSICHO-SOCIAL-ECOLOGICAL APPROACH DURING HEALTH AND DISEASE

El sistema nervioso autónomo (SNA) es un componente fundamental del sistema nervioso cuya función es mantener la homeostasis y reaccionar de forma adaptativa a los cambios en el medio externo e interno. Participa en la regulación de la respiración, la circulación, la digestión, el metabolismo y el medio interno, la secreción exocrina y endocrina, las respuestas inmunes, la temperatura corporal y la reproducción. En este trabajo se analizará cómo la organización del SNA se construye en 4 niveles jerárquicos, a partir de un periodo de diferenciación crítico neonatal en el cual el medio ambiente y el vínculo afectivo con la madre juega un rol predominante. A continuación, se discutirá cómo la función del SNA cambia en las tres configuraciones corporales (vigilia, sueño de ondas lentas, sueño de movimientos oculares rápidos, REM) que se suceden durante un ciclo de 24 horas. Por último, se discutirá la aplicación de estos conceptos en la Unidad Neurofisiología del Curso de Fisiología para alumnos de 2º año de la Facultad de Ciencias Médicas, UCA, enfatizando los aspectos instrumentales destinados a aumentar la participación de los alumnos en el proceso de enseñanza

The autonomic nervous system (ANS) is a fundamental component of the nervous system whose function is to maintain homeostasis and react adaptively to changes in the external and internal environment. It participates in the regulation of respiration, circulation, digestion, metabolism and internal environment, exocrine and endocrine secretion, immune response, body temperature and reproduction. In this review article I will analyze how the organization of the ANS is built on 4 hierarchical levels, starting from a period of critical neonatal differentiation in which the environment and the affective bond with the mother plays a predominant role. Next, I will discuss how the ANS function changes in the three body configurations (wakefulness, slow wave sleep, fast eye movement, REM) that occur during a 24 hour cycle. Finally, the application of these concepts to teaching Neurophysiology at the Physiology Course for 2nd year medical students of the Faculty of Medical Sciences, Pontificia Universidad Católica Argentina, emphasizing the instrumental aspects intended to increase the participation of students in the teaching process is discussed.

Which Neural Tract Plays a Major Role in Memory Impairment After Multiple Cerebral Infarcts? A Case Report

Injury to the thalamocortical tract (one in the Papez circuit) that leads to memory impairment following brain injury is very rare. In this study, we present a case of partial injury to the thalamocortical tract that causes memory impairment after concurrent thalamic and hippocampal infarct. A 20-year-old male complained of memory impairment 1 month after partial injury to the thalamocortical tract. Using a probabilistic diffusing tensor tractography, it was found that the right thalamocortical tract was thinner than the left thalamocortical tract. However, all other neural tracts including the fornix, cingulum, and mammillothalamic tract were intact on both hemispheres. Therefore, the memory impairment in this patient was considered as being due to thalamic infarct based on the observation that the fornix from hippocampal infarct was intact. This case suggests that the assessment of lesions in the neural tracts of the Papez circuit might be useful for understanding the mechanism of memory impairment following cerebral infarction.

Social instigation and repeated aggressive confrontations in male Swiss mice: analysis of plasma corticosterone, CRF and BDNF levels in limbic brain areas / Instigação social e confrontos agressivos repetidos em camundongos Swiss machos: análise de corticosterona plasmática e dos níveis de CRF e BDNF em áreas cerebrais límbicas

Abstract Introduction: Agonistic behaviors help to ensure survival, provide advantage in competition, and communicate social status. The resident-intruder paradigm, an animal model based on male intraspecific confrontations, can be an ethologically relevant tool to investigate the neurobiology of aggressive behavior. Objectives: To examine behavioral and neurobiological mechanisms of aggressive behavior in male Swiss mice exposed to repeated confrontations in the resident intruder paradigm. Methods: Behavioral analysis was performed in association with measurements of plasma corticosterone of mice repeatedly exposed to a potential rival nearby, but inaccessible (social instigation), or to 10 sessions of social instigation followed by direct aggressive encounters. Moreover, corticotropin-releasing factor (CRF) and brain-derived neurotrophic factor (BNDF) were measured in the brain of these animals. Control mice were exposed to neither social instigation nor aggressive confrontations. Results: Mice exposed to aggressive confrontations exhibited a similar pattern of species-typical aggressive and non-aggressive behaviors on the first and the last session. Moreover, in contrast to social instigation only, repeated aggressive confrontations promoted an increase in plasma corticosterone. After 10 aggressive confrontation sessions, mice presented a non-significant trend toward reducing hippocampal levels of CRF, which inversely correlated with plasma corticosterone levels. Conversely, repeated sessions of social instigation or aggressive confrontation did not alter BDNF concentrations at the prefrontal cortex and hippocampus. Conclusion: Exposure to repeated episodes of aggressive encounters did not promote habituation over time. Additionally, CRF seems to be involved in physiological responses to social stressors.

Resumo Introdução: Comportamentos agonísticos ajudam a garantir a sobrevivência, oferecem vantagem na competição e comunicam status social. O paradigma residente-intruso, modelo animal baseado em confrontos intraespecíficos entre machos, pode ser uma ferramenta etológica relevante para investigar a neurobiologia do comportamento agressivo. Objetivos: Analisar os mecanismos comportamentais e neurobiológicos do comportamento agressivo em camundongos Swiss machos expostos a confrontos repetidos no paradigma residente-intruso. Métodos: A análise comportamental foi realizada em associação com medidas de corticosterona plasmática em camundongos expostos repetidamente a um rival em potencial próximo, porém inacessível (instigação social), ou a 10 sessões de instigação social seguidas de encontros agressivos diretos. Além disso, o fator de liberação de corticotrofina (CRF) e o fator neurotrófico derivado do cérebro (BNDF) foram medidos no encéfalo desses animais. Camundongos controles não foram expostos à instigação social ou confrontos agressivos. Resultados: Os camundongos expostos a confrontos agressivos exibiram um padrão semelhante de comportamentos agressivos e não agressivos típicos da espécie na primeira e na última sessão. Em contraste com instigação social apenas, confrontos agressivos repetidos promoveram aumento na corticosterona plasmática. Após 10 sessões de confrontos agressivos, os camundongos apresentaram uma tendência não significativa de redução dos níveis de CRF no hipocampo, que se correlacionaram inversamente com os níveis plasmáticos de corticosterona. Por outro lado, sessões repetidas de instigação social ou confronto agressivo não alteraram as concentrações de BDNF no córtex pré-frontal e hipocampo. Conclusão: A exposição a episódios repetidos de encontros agressivos não promoveu habituação ao longo do tempo. Adicionalmente, o CRF parece estar envolvido nas respostas fisiológicas aos estressores sociais.

Decreased White Matter Structural Connectivity in Psychotropic Drug-Naïve Adolescent Patients with First Onset Major Depressive Disorder / 정신신체의학

OBJECTIVES: Recent neuroimaging studies focus on dysfunctions in connectivity between cognitive circuits and emotional circuits: anterior cingulate cortex that connects dorsolateral orbitofrontal cortex and prefrontal cortex to limbic system. Previous studies on pediatric depression using DTI have reported decreased neural connectivity in several brain regions, including the amygdala, anterior cingulate cortex, superior longitudinal fasciculus. We compared the neural connectivity of psychotropic drug naïve adolescent patients with a first onset of major depressive episode with healthy controls using DTI. METHODS: Adolescent psychotropic drug naïve patients(n=26, 10 men, 16 women; age range, 13–18 years) who visited the Korea University Guro Hospital and were diagnosed with first onset major depressive disorder were registered. Healthy controls(n=27, 5 males, 22 females; age range, 12–17 years) were recruited. Psychiatric interviews, complete psychometrics including IQ and HAM-D, MRI including diffusion weighted image acquisition were conducted prior to antidepressant administration to the patients. Fractional anisotropy(FA), radial, mean, and axial diffusivity were estimated using DTI. FMRIB Software Library-Tract Based Spatial Statistics was used for statistical analysis. RESULTS: We did not observe any significant difference in whole brain analysis. However, ROI analysis on right superior longitudinal fasciculus resulted in 3 clusters with significant decrease of FA in patients group. CONCLUSIONS: The patients with adolescent major depressive disorder showed statistically significant FA decrease in the DTI-based structure compared with healthy control. Therefore we suppose DTI can be used as a biomarker in psychotropic drug-naïve adolescent patients with first onset major depressive disorder.

Origins of Addiction Predictably Embedded in Childhood Trauma: A Neurobiological Review

The seeds of addiction are typically sown years prior to the onset of addictive substance use or engagement in addictive behaviors, due to the priming of the reward pathway (RewP) by alterations in the mechanism of stress-signaling from the hypothalamic-pituitary-adrenal axis (HPA) and related pathways. Excessive stress from a single-event and/or cumulative life experiences during childhood, such as those documented in the Adverse Childhood Experiences Study, is translated into neurobiological toxicity that alters the set-point of the HPA axis and limbic system homeostasis [suggested new term: regulation pathway (RegP)]. The resultant alteration of the RegP not only increases the risk for psychiatric and physical illness, but also that for early onset and chronic addictions by dysregulating the RewP. This paper reviews the interface of these symbiotic pathways that result in the phenotypic pathology of emotional dysregulation, cognitive impairment, and compulsive behaviors, as well as morbidity and shorter life expectancy when dysregulated by chronic stress.

Ruptura del paradigma subcortical en los procesos emocionales / Rupture of the subcortical paradigm in the emotional processes

El estudio de las emociones, su desarrollo, procesamiento y comprensión, se ha limitado a la funcionalidad de estructuras subcorticales; sin embargo, recientemente se han propiciado investigaciones que reorientan y amplían el campo de estudio del procesamiento emocional hacia vínculos con regiones corticales del cerebro. Pese a lo anterior, no se había planteado claramente la importancia de eliminar el sesgo localizacionista en los procesos emocionales; este artículo realiza un recorrido por los inicios griegos con tendencia científica en el abordaje y estudio de las emociones, y la evolución que estos preconceptos y resultados han tenido a lo largo del último par de siglos donde se ha intensificado la comprensión de la actividad cerebral, así como las limitantes que han logrado trascender a lo largo del último siglo y que presentan perspectivas parciales del funcionamiento y procesamiento emocional en los circuitos biológicos del cerebro. De igual forma, se hace pertinente resaltar la importancia de las emociones en regiones corticales, que intervienen en la actividad cognitiva y motora que allí se suscita, y cómo éstas pueden afectar o favorecer su funcionalidad.

The study of emotions, development, processing and understanding has been limited to the functionality of subcortical structures; however, recently been reoriented led reearch and expand the field of study of emotional processing to links with cortical regions of the brain. Despite this, they had not clearly stated the importance of eliminating the bias localizationist emotional processes; This article takes a journey through the Greek incios with scientific trend in the approach and study of emotions, and the evolution of these preconceptions and results have had over the last couple of centuries where there is increased understanding of brain activity, as well as the limitations that have managed to transcend throughout the last century and have partial perspectives of functioning and emotional processing in biological brain circuits. Similarly, it is pertinent to highlight the importance of emotions in cortical regions involved in cognitive and motor activity that arises there, and how they can affect or favor their functionality.

Relationship between Gyrus Rectus Resection and Cognitive Impairment after Surgery for Ruptured Anterior Communicating Artery Aneurysms

OBJECTIVE: The gyrus rectus (GR) is known as a non-functional gyrus; hence, its resection is agreed to be a safe procedure frequently practiced to achieve a better surgical view during specific surgeries. This study aimed at comparing the cognitive outcomes following GR resection in patients who underwent surgery for ruptured anterior communicating artery (ACoA) aneurysms. MATERIALS AND METHODS: From 2012 to 2015, 39 patients underwent surgical clipping for ruptured ACoA aneurysms. Mini-mental state examinations (MMSE) were performed in 2 different periods. The statistical relationship between GR resection and MMSE results was evaluated, and further analysis of MMSE subgroup was performed. RESULTS: Twenty-five out of the 39 patients (64.19%) underwent GR resection. Mean initial and final MMSE scores in the GR resection group were 16.3 ± 9.8 and 20.8 ± 7.3, respectively. In the non-resection group, the mean initial and final MMSE scores were 17.1 ± 8.6 and 21.9 ± 4.5, respectively. Neither group's scores showed a significant change. Subgroup analysis of initial MMSE showed a significant difference in memory recall and language (p = 0.02) but not in the final MMSE scores. CONCLUSION: There was no significant relationship between the GR resection and cognitive outcomes in terms of total MMSE scores after surgery for ruptured ACoA aneurysm. However, subgroup analysis revealed a temporary negative effect of GR resection in the categories of language and memory recall. This study suggests that GR resection should be executed superficially, owing to its close anatomical relationship with the limbic system.

A Short Review on the Current Understanding of Autism Spectrum Disorders

Autism spectrum disorder (ASD) is a set of neurodevelopmental disorders characterized by a deficit in social behaviors and nonverbal interactions such as reduced eye contact, facial expression, and body gestures in the first 3 years of life. It is not a single disorder, and it is broadly considered to be a multi-factorial disorder resulting from genetic and non-genetic risk factors and their interaction. Genetic studies of ASD have identified mutations that interfere with typical neurodevelopment in utero through childhood. These complexes of genes have been involved in synaptogenesis and axon motility. Recent developments in neuroimaging studies have provided many important insights into the pathological changes that occur in the brain of patients with ASD in vivo. Especially, the role of amygdala, a major component of the limbic system and the affective loop of the cortico-striatothalamo-cortical circuit, in cognition and ASD has been proved in numerous neuropathological and neuroimaging studies. Besides the amygdala, the nucleus accumbens is also considered as the key structure which is related with the social reward response in ASD. Although educational and behavioral treatments have been the mainstay of the management of ASD, pharmacological and interventional treatments have also shown some benefit in subjects with ASD. Also, there have been reports about few patients who experienced improvement after deep brain stimulation, one of the interventional treatments. The key architecture of ASD development which could be a target for treatment is still an uncharted territory. Further work is needed to broaden the horizons on the understanding of ASD.

Anti-Ma2-Associated Encephalitis Presenting as Hypersomnia

Anti-Ma2-associated encephalitis is one of the paraneoplastic neurological syndromes. It has been shown to be associated with various neoplasms, mainly testicular, lung, and breast cancers. Most patients with anti-Ma2-associated encephalitis present limbic-diencephalic-brainstem dysfunctions such as seizure, mood disorder, excessive daytime sleepiness, and ophthalmoparesis. Some patients develop symptoms indicating the multifocal involvement of the limbic system, diencephalon, or brainstem. However, there are few case studies of anti-Ma2-associated encephalitis presenting as isolated hypersomnia. We report a case of anti-Ma2-associated encephalitis presenting as hypersomnia.

Functional Imaging of Tinnitus / 한양의대학술지

Tinnitus is an auditory phantom characterized by the perception of sound without the presence of an external acoustical source. The peripheral auditory system is considered to contribute to the initiation of tinnitus but only explains the severity and distress level to a limited degree. The neuropsychological models of tinnitus have been developed to explain the pathophysiology of tinnitus as a malfunctioning feedforward/feedback signal in the central neural system including the auditory brainstem, limbic system, auditory cortices, and other anatomical features. Functional neuroimaging techniques have been introduced in recent decades and have provided non-invasive tools to assess the working human brain in vivo. Researchers have found these techniques valuable in examining the neural correlates of tinnitus and have been able to not only support the neuropsychological model but to expand it. Though neuroimaging studies on tinnitus only began in 1990s, they have been increasing exponentially in number. In this review, we investigate the current state of functional neuroimaging studies on tinnitus in humans. The characteristics of commonly used functional neuroimaging techniques including positron emission tomography (PET), functional magnetic resonance imaging (fMRI), electroencephalography (EEG) and magnetoencephalography (MEG) are also discussed. We briefly review recent studies on the tinnitus-brain relationship that have used those research tools.

The Role of Psychological Factors in Tinnitus / 한양의대학술지

Based on the limitation of biomedical model of tinnitus, more attention has been paid to personalities or psychological aspects. Depressive disorder, anxiety disorder, and sleep disturbance were comorbid illnesses of tinnitus and research showed that neurobiological mechanisms such as dysfunction of limbic system or HPA axis were common in tinnitus and affective disorders and that comorbid psychiatric disorders enhanced the negative outcome of tinnitus. Recently, more attention is being paid to the relation of tinnitus with personality and the role of stress. Although the causal relation of personality and tinnitus is unclear, stress in itself showed that it can be a trigger in the development of tinnitus, and stress of tinnitus can cause adverse effects. Since the effect of fear-related cognition such as catastrophic thought about tinnitus was revealed more recently, its therapeutic implication should be explored. This review will describe the product of previous research and discuss future direction about psychological factors related to tinnitus.

Tinnitus Retraining Therapy / 한양의대학술지

According to the Jastreboff's neurophysiological model of tinnitus, if negative associations are attached to the tinnitus signal, tinnitus is perceived to be a threat or a danger and it activates the autonomic nervous and limbic systems. Consequently patient's awareness of tinnitus is heightened and so patient perceives it to be louder and more persistent. Jastreboff and Hazell started tinnitus retraining therapy (TRT) based on the neurophysiological model of tinnitus. The purpose of TRT is blocking tinnitus from activating the sympathetic nervous and limbic systems (habituation of reaction) and from reaching the cerebral cortex (habituation of perception). TRT is composed of two components directive counseling that tries to reclassify tinnitus into the meaningless stimuli and sound therapy that decreases the relative strength of the tinnitus signal. Physicians try to put patient's tinnitus into the territory of meaningless stimuli through retraining the brain (habituation of reaction). Because the brain habituates all unimportant stimuli, if habituation of reaction is fully achieved, habituation of perception will follow automatically. In most clinical results, clinical success rates of TRT approach or exceed 80% improvement. Early improvement can be achieved during the first few months, followed by additional progressive improvement. It should be recommended that the patient continue treatment at least 18 months.

Tinnitus neural mechanisms and structural changes in the brain: the contribution of neuroimaging research

Introduction Tinnitus is an abnormal perception of sound in the absence of an external stimulus. Chronic tinnitus usually has a high impact in many aspects of patients' lives, such as emotional stress, sleep disturbance, concentration difficulties, and so on. These strong reactions are usually attributed to central nervous system involvement. Neuroimaging has revealed the implication of brain structures in the auditory system. Objective This systematic review points out neuroimaging studies that contribute to identifying the structures involved in the pathophysiological mechanism of generation and persistence of various forms of tinnitus. Data Synthesis Functional imaging research reveals that tinnitus perception is associated with the involvement of the nonauditory brain areas, including the front parietal area; the limbic system, which consists of the anterior cingulate cortex, anterior insula, and amygdala; and the hippocampal and parahippocampal area. Conclusion The neuroimaging research confirms the involvement of the mechanisms of memory and cognition in the persistence of perception, anxiety, distress, and suffering associated with tinnitus.

Bruxismo do sono e o padrão neurocomportamental – proposta de protocolo de biofeedback multimodal / Sleep bruxism and its neurobehavioral pattern – a proposal of a multimodal biofeedback protocol

O bruxismo do sono (BS) é uma manifestação intensa da atividade muscular mastigatória rítmica, caracterizado pelo ranger e apertar dos dentes durante o sono. Sua etiologia ainda não foi definida, o que dificulta o diagnóstico e, consequentemente, o plano de tratamento. As abordagens terapêuticas convencionais são o uso de placas e fármacos, questionadas por serem padronizadas, sem abordagem individualizada e com efeitos colaterais adversos. Conforme revisões da literatura, hipóteses etiológicas apontam a participação expressiva do sistema nervoso central (SNC), especialmente do sistema límbico (SL), sistema nervoso autônomo (SNA) e do reflexo vago-trigeminal, na origem do BS. Um postulado consistente relaciona o BS como um ajuste para o estresse. Estudos demonstram que o BS pode ser um mecanismo fisiológico de autorregulação do sistema autonômico, como resposta para estabelecer alostasia do sistema corporal frente a ocorrências noturnas de taquicardias decorrentes da atividade cerebral, quando ocorrem microdespertares fisiológicos de sentinela, durante o sono. Este estudo apresentou um protocolo com instrumentos para coleta e retroalimentação de sinais biológicos, com a finalidade de identificar alterações fisiológicas que sejam compatíveis ou não com alterações emocionais, que possam desencadear o bruxismo. Esses instrumentos possibilitam a autorregulação dos eventos psicofisiológicos e o desenvolvimento de habilidades pelo próprio indivíduo, permitindo o controle de suas emoções e comportamento. Esse processo terapêutico é conhecido como biofeedback (BF). O treinamento com o BF permite regularizar rítmos internos, propiciando desaceleração das funções neurofisiológicas, atenuando os efeitos desta atividade não funcional...

Sleep bruxism (SB) is a severe manifestation of rhythmic masticatory muscle activity characterized by grinding and clenching of teeth during sleep. Its etiology has not been set yet which complicates the diagnosis and therefore the treatment plan. The more conventional therapeutic approaches are the use of intra oral plates and drugs, that are being questioned for being a standardized approach and not individualized, with adverse side effects. Describe in the literature, etiological hypotheses suggest significant participation of the central nervous system (CNS), especially the limbic system (LS), autonomous nervous system (ANS) and the vague-trigeminal reflex, in the SB source. A consistent postulate relates SB to a mechanism for adjustment to stress. Some studies show that BS may be a physiological mechanism of self-regulation of the autonomic system, as a response to establish body system alostasia when tachycardia occurs during sleep associated to physiological sentinel microarousals. This work is meant to provide information to assist health professionals to assess the behavioral and emotional relation with BS. Furthermore, this study presents a protocol with instruments to collect and feedback data related to biological signals, in order to identify physiological changes which are compatible or not with emotional changes that may trigger bruxism. These instruments, allow self-regulation of psychophysiological events by the individual and the development of habilities that enables to control of emotions and behavior. This therapeutic process is known as Biofeedback (BF). Training with the BF allows to regularize the heart and respiratory rate, providing deceleration of neurophysiological functions, mitigating the effects of this nonfunctional activity...

Somatic and cognitive-affective depressive symptoms among patients with heart disease: differences by sex and age / Sintomas depressivos somáticos e cognitivo-afetivos entre pacientes com doença cardíaca: diferenças por sexo e idade / Síntomas depresivos somáticos y cognitivo-afectivos entre pacientes con enfermedad cardíaca: diferencias por sexo y edad

OBJECTIVE: this study investigated the association of somatic and cognitive-affective symptoms with sex and age, among patients hospitalized with heart disease. METHOD: this study was a secondary analysis of two previous observational studies totaling 531 patients with heart disease, hospitalized from 2005 to 2011 in two public hospitals in Ribeirão Preto, state of São Paulo, Brazil. Somatic and cognitive-affective symptoms were assessed using the subscales of the Beck Depression Inventory - I (BDI-I). RESULTS: of 531 participants, 62.7% were male, with a mean age 57.3 years (SD= 13.0) for males and 56.2 years (SD= 12.1) for females. Analyses of variance showed an effect of sex (p<0.001 for somatic and p=0.005 for cognitive-affective symptoms), but no effect of age. Women presented with higher mean values than men in both BDI-I subscales: 7.1 (4.5) vs. 5.4 (4.3) for somatic, and 8.3 (7.9) vs. 6.7 (7.2) for cognitive-affective symptoms. There were no differences by age for somatic (p=0.84) or cognitive-affective symptoms (p=0.84). CONCLUSION: women hospitalized with heart disease had more somatic and cognitive-affective symptoms than men. We found no association of somatic and cognitive-affective symptoms with age. Future research for these patients could reveal whether these differences according to sex continue throughout the rehabilitation process. .

OBJETIVO: investigar a associação de sintomas somáticos e cognitivo-afetivos ao sexo e à idade de pacientes hospitalizados com doença cardíaca. MÉTODO: este estudo é resultado de uma análise secundária de dois estudos observacionais anteriores, totalizando 531 pacientes com doença cardíaca, internados de 2005 a 2011, em dois hospitais públicos em Ribeirão Preto, estado de São Paulo, Brasil. Os sintomas somáticos e cognitivo-afetivos foram avaliados utilizando-se as subescalas do Inventário de Depressão de Beck - I (IDB-I). RESULTADOS: dos 531 participantes, 62,7% são do sexo masculino, com média de idade de 57,3 anos (DP= 13,0) para os homens e 56,2 anos (DP = 12,1) para as mulheres. A análise da variância mostrou um efeito relacionado ao sexo do paciente (p<0,001 para sintomas somáticos e p=0,005 para os sintomas cognitivo-afetivos), mas nenhum efeito relacionado à idade. As mulheres apresentaram maiores escores do que os homens em ambas subescalas IDB-I: 7,1 (4,5) e 5,4 (4,3) para os sintomas somáticos, e 8,3 (7,9) e 6,7 (7,2) para os sintomas cognitivo-afetivos, respectivamente. Não houve diferenças referentes à idade para sintomas somáticos (p=0,84) ou sintomas cognitivo-afetivos (p=0,84). CONCLUSÃO: as mulheres internadas com doença cardíaca apresentaram mais sintomas somáticos e cognitivo-afetivos do que os homens. Não houve associação dos sintomas somáticos e cognitivo-afetivos com a idade. Pesquisas futuras desses pacientes poderiam revelar se essas diferenças de acordo com o sexo permanecem durante todo o processo de reabilitação. .

OBJETIVO: este estudio investigó la asociación de síntomas somáticos y cognitivo-afectivos con el sexo y la edad en pacientes hospitalizados con enfermedad cardíaca. MÉTODO: este estudio fue un análisis secundario de dos estudios observacionales anteriores, totalizando 531 pacientes con enfermedad cardíaca, internados de 2005 a 2011, en dos hospitales públicos en Ribeirão Preto, estado de São Paulo, Brasil. Los síntomas somáticos y cognitivo-afectivos fueron evaluados utilizándose las subescalas del Inventario Beck de Depresión - I (IBD-I). RESULTADOS: de los 531 participantes, 62,7% era del sexo masculino, con promedio de edad de 57,3 años (DE= 13,0) para los hombres y 56,2 años (DE = 12,1) para el sexo femenino. El análisis de variancia mostró un efecto del sexo (p<0,001 para síntomas somáticos y p=0,005 para los síntomas cognitivo-afectivos), pero ningún efecto de la edad. Las mujeres presentaron valores medios más altos que los hombres en ambas subescalas IBD-I: 7,1 (4,5) vs. 5.4 (4.3) para los síntomas somáticos, y 8,3 (7,9) vs. 6,7 (7,2) para los síntomas cognitivo-afectivos. No fueron encontradas diferencias por edad para síntomas somáticos (p=0,84) o síntomas cognitivo-afectivos (p=0,84). CONCLUSIÓN: las mujeres internadas con enfermedad cardíaca tenían más síntomas somáticos y cognitivo-afectivos que los hombres. No fue encontrada asociación de los síntomas somáticos y cognitivo-afectivos con la edad. Investigaciones futuras de esos pacientes podrían revelar si esas diferencias por sexo continúan durante todo el proceso de rehabilitación. .

Abnormal Activation of the Social Brain Network in Children with Autism Spectrum Disorder: An fMRI Study

OBJECTIVE: The aim of this study is to investigate abnormal findings of social brain network in Korean children with autism spectrum disorder (ASD) compared with typically developing children (TDC). METHODS: Functional magnetic resonance imaging (fMRI) was performed to examine brain activations during the processing of emotional faces (happy, fearful, and neutral) in 17 children with ASD, 24 TDC. RESULTS: When emotional face stimuli were given to children with ASD, various areas of the social brain relevant to social cognition showed reduced activation. Specifically, ASD children exhibited less activation in the right amygdala (AMY), right superior temporal sulcus (STS) and right inferior frontal gyrus (IFG) than TDC group when fearful faces were shown. Activation of left insular cortex and right IFG in response to happy faces was less in the ASD group. Similar findings were also found in left superior insular gyrus and right insula in case of neutral stimulation. CONCLUSION: These findings suggest that children with ASD have different processing of social and emotional experience at the neural level. In other words, the deficit of social cognition in ASD could be explained by the deterioration of the capacity for visual analysis of emotional faces, the subsequent inner imitation through mirror neuron system (MNS), and the ability to transmit it to the limbic system and to process the transmitted emotion.