La depresión con ideas suicidas presenta disfunciones corticales prefrontales que favorecen significativamente el intento suicida / Depression with suicidal ideas presents prefrontal cortical dysfunctions that significantly favor suicidal intent

Se realiza una revisión de estudios de resonancia magnética integral y funcional, así como estudios bioquímicos en pacientes con y sin ideas suicidas. Estos estudios en pacientes con alto riesgo de suicidio presentan una disminución de volúmenes corticales en la corteza prefrontal dorso y ventrolateral. Lo importante de estos estudios es que resultan de la comparación con pacientes deprimidos con bajo riesgo de suicidio. Los estudios de resonancia magnética funcional mostraron una hipofuncionalidad del lóbulo prefrontal en los pacientes depresivos con ideas suicidas severas, que se observa como una disminución del flujo sanguíneo cerebral en las áreas lateral y ventral. Se observa una disminución del metabolismo de serotonina, en clara relación con la severidad de las ideas de muerte, también con un foco en la región lateroventral prefrontal. Dado que las funciones de la corteza prefrontal afirman al individuo en su perspectiva vital, disfunciones como las descritas debilitan la coordinación y organización del apego a la vida, quedando, por el contrario, la posibilidad de la búsqueda de la muerte. Se concluye que los pacientes depresivos con ideas suicidas tienen una alta vulnerabilidad para el intento de suicidio por la afectación de las zonas prefrontales.

A review of functional integral magnetic resonance and biochemical data from patients with and without suicidal ideation is presented. Patients with high suicidal risk show a decrease in cortical volume in ventrolateral and dorsal prefrontal cortex. These studies are compared to those of depressed patients with low suicidal risk. Functional magnetic resonance in depressed patients with severe suicidal ideation show an hypo functional prefrontal lobe, seen as a decrease in blood flow in lateral and ventral areas. There is a decrease in serotonin metabolism, clearly related to the severity of suicidal ideation, also in ventrolateral prefrontal cortex. As prefrontal cortex functions enhance vital perspectives, such dysfunctions weaken coordination and organization of attachment to life, making search for death a possibility. Authors conclude that depressed patients with suicidal ideation have a high vulnerability for suicidal intent due to changes in prefrontal areas.

Transcranial magnetic stimulation of the medial prefrontal cortex for psychiatric disorders: a systematic review

Objective: The medial prefrontal cortex (mPFC) is a highly connected cortical region that acts as a hub in major large-scale brain networks. Its dysfunction is associated with a number of psychiatric disorders, such as schizophrenia, autism, depression, substance use disorder (SUD), obsessive-compulsive disorder (OCD), and anxiety disorders. Repetitive transcranial magnetic stimulation (rTMS) studies targeting the mPFC indicate that it may be a useful therapeutic resource in psychiatry due to its selective modulation of this area and connected regions. Methods: This review examines six mPFC rTMS trials selected from 697 initial search results. We discuss the main results, technical and methodological details, safety, tolerability, and localization strategies. Results: Six different protocols were identified, including inhibitory (1 Hz) and excitatory (5, 10, and 20 Hz) frequencies applied therapeutically to patient populations diagnosed with major depressive disorder, OCD, autistic spectrum disorder, SUD, specific phobia, and post-traumatic stress disorder (PTSD). In the OCD and acrophobia trials, rTMS significantly reduced symptoms compared to placebo. Conclusion: These protocols were considered safe and add interesting new evidence to the growing body of mPFC rTMS literature. However, the small number and low methodological quality of the studies indicate the need for further research.

Intermittent theta-burst transcranial magnetic stimulation for autism spectrum disorder: an open-label pilot study

Objective: Theta-burst stimulation (TBS) modulates synaptic plasticity more efficiently than standard repetitive transcranial magnetic stimulation delivery and may be a promising modality for neuropsychiatric disorders such as autism spectrum disorder (ASD). At present there are few effective interventions for prefrontal cortex dysfunction in ASD. We report on an open-label, pilot study of intermittent TBS (iTBS) to target executive function deficits and restricted, repetitive behaviors in male children and adolescents with ASD. Methods: Ten right-handed, male participants, aged 9-17 years with ASD were enrolled in an open-label trial of iTBS treatment. Fifteen sessions of neuronavigated iTBS at 100% motor threshold targeting the right dorsolateral prefrontal cortex were delivered over 3 weeks. Results: Parent report scores on the Repetitive Behavior Scale Revised and the Yale-Brown Obsessive Compulsive Scale demonstrated improvements with iTBS treatment. Participants demonstrated improvements in perseverative errors on the Wisconsin Card Sorting Test and total time for the Stroop test. The iTBS treatments were well tolerated with no serious adverse effects. Conclusion: These preliminary results suggest that further controlled interventional studies of iTBS for ASD are warranted.

Transcranial magnetic stimulation and transcranial direct current stimulation appear to be safe neuromodulatory techniques useful in the treatment of anxiety disorders and other neuropsychiatric disorders / Uso clínico da estimulação magnética transcraniana e da estimulação transcraniana por corrente direta em transtornos de ansiedade e de transtornos neuropsiquiátricos

ABSTRACT Transcranial magnetic stimulation (TMS) has recently been investigated as a possible adjuvant treatment for many neuropsychiatric disorders, and has already been approved for the treatment of drug-resistant depression in the United States and in Brazil, among other countries. Although its use in other neuropsychiatric disorders is still largely experimental, many physicians have been using it as an off-label add-on therapy for various disorders. More recently, another technique, transcranial direct current stimulation (tDCS), has also become available as a much cheaper and portable alternative to TMS, although its mechanisms of action are different from those of TMS. The use of off-label therapeutic TMS or tDCS tends to occur in the setting of diseases that are notoriously resistant to other treatment modalities. Here we discuss the case of anxiety disorders, namely panic and post-traumatic stress disorders, highlighting the uncertainties and potential problems and benefits of the clinical use of these neuromodulatory techniques at the current stage of knowledge.

RESUMO A estimulação magnética transcraniana (TMS) foi recentemente proposta como um possível tratamento adjuvante para muitos distúrbios neuropsiquiátricos, e já foi aprovada para o tratamento de depressão fármaco-resistente nos Estados Unidos e no Brasil, entre outros países. Apesar do fato de que seu uso em outros transtornos neuropsiquiátricos ainda é em grande parte experimental, muitos médicos têm utilizado essas técnicas como uma terapia off-label em várias doenças. Mais recentemente, uma outra técnica, a estimulação transcraniana por corrente contínua (ETCC), tornou-se também disponível como uma alternativa muito mais barata e portátil do que a TMS, embora os seus mecanismos de ação sejam diferentes daqueles da TMS. O uso off-label de TMS ou ETCC tende a ocorrer no caso de doenças que são notoriamente resistentes a outras modalidades terapêuticas. Aqui nós discutimos o caso dos transtornos de ansiedade, ou seja, transtorno do pânico e estresse pós-traumático, destacando as incertezas, benefícios e problemas potenciais inerentes ao uso clínico dessas técnicas neuromoduladoras no atual estágio do conhecimento.

Análisis psicométrico del inventario de sintomatología prefrontal en sujetos adictos y no adictos / Psychometric analysis inventory prefrontal symptoms addicted and non-addicted subjetcs

El objetivo de la presente investigación fue estudiar las propiedades psicométricas en términos de confiabilidad y validez del Inventario de Sintomatología Prefrontal (ISP) en una muestra de pacientes adictos y no adictos venezolanos. Para ello, se aplicaron el ISP y la Escala de comportamiento de sistemas frontales (FrSBe-Sp) en una muestra de 689 personas, de las cuales 338 eran adictas y 351 no adictas, con edades comprendidas entre 17 y 70 añosde edad. Se realizó una adaptación lingüística a los ítems que conforman el test que resultó adecuada. En cuanto a la confiabilidad utilizando el coeficiente Alpha de Cronbach se obtuvo un alfa=0.93 para el Totalde la prueba y para cada una de las dimensiones. En lo que respecta a la validez de constructo,por medio de un Análisis Factorial con-firmatorio se obtuvo una estructuratrifactorial que explica el 33.5 por ciento de la varianza total. En referencia a la diferenciación de grupos, se encontró una diferencia significativa entre el grupo de adictos y el grupo de no adictos para el total del test (t(337)11.70; p=0.000)y cada una de sus dimensiones, resultando medias mayores para el primero. Asimismo, en lo que respecta a la validez de criterio se encontraron amplias correlaciones entre el ISP y el FrSBe-Sp (r=0.204 -0,484). Los datos obtenidos sugieren que el ISP, es una herramienta útil y con adecuadas propiedades psicométricas para evaluar la sintomatología prefrontal en indivi-duos adictos a distintas sustancias psicotrópicas.

The objective of this research was studying the psychometric properties in terms of reliability and validity of the Prefrontal Symptoms Inventory(PSI)in a sample of addicted and non-addicted Venezuelan patients. For this, the PSI and the frontal systems behavior scale (FrSBe-Sp) were applied to a sample of 689 people, 338 of which were addicted and 351 non-addicted, with ages between 17 and 70 years old. A linguistic adaptation was realized to the items that form the test that resulted adequate. As for the reliability using the Cronbach Alpha factor, it was obtained an alpha= 0.93 for the total of the test and for each of its dimen-sions. Regarding the construct validity, by a confirmatory factorial analysis it was obtained one three-factor structure that explains 33.5 percent of the total variance. Referring to the group differentiation, it was found a significant difference between the addicted group and the non-addicted group for the total of the test (t 11.70; p = 0.000) and each of its dimensions, resulting in larger averages for the first one. Also, regarding the criterion validity, broad correlations between the PSI and FrSBe-Sp (-0.484 r = 0.204) were found. The data obtained suggest that the PSI is a useful tool and it has adequate psychometric properties to assess the prefrontal symptoms in addicted individuals to various psychoactive substances.

Disentangling the effects of insomnia and night work on cardiovascular diseases: a study in nursing professionals

Cardiovascular diseases (CVDs) are known to be associated with poor sleep quality in general populations, but they have not been consistently associated with specific work schedules. Studies of CVD generally do not simultaneously consider sleep and work schedules, but that approach could help to disentangle their effects. We investigated the association between insomnia and a self-reported physician diagnosis of CVD in day and night workers, considering all sleep episodes during nocturnal and diurnal sleep. A cross-sectional study was conducted in 1307 female nursing professionals from 3 public hospitals, using baseline data from the “Health and Work in Nursing - a Cohort Study.” Participants were divided into two groups: i) day workers with no previous experience in night shifts (n=281) and whose data on insomnia were related to nocturnal sleep and ii) those who worked exclusively at night (n=340) and had data on both nocturnal and diurnal sleep episodes, as they often sleep at daytime. Multiple logistic regression analysis was performed. Among day workers, insomnia complaints increased the odds of CVD 2.79-fold (95% CI=1.01-6.71) compared with workers who had no complaints. Among night workers, reports of insomnia during both nocturnal and diurnal sleep increased the odds of reported CVD 3.07-fold (95% CI=1.30-7.24). Workers with insomnia had similar probabilities of reporting CVD regardless of their work schedule, suggesting a relationship to insomnia and not to night work per se. The results also highlighted the importance of including evaluation of all sleep episodes (diurnal plus nocturnal sleep) for night workers.

Mente desorganizada y reacción catastrófica: regulación emocional intrínseca y extrínseca en sobrevivientes de lesión cerebral adquirida / Disorganized mind and catastrophic reaction: intrinsic and extrinsic emotion regulation in acquired brain injury survivors

La experiencia de tener una mente desorganiza es un fenómeno común luego de lesiones a la corteza frontal. Si bien en las últimas décadas existe un mayor conocimiento respecto a los mecanismos neuropsicológicos que colapsan en una mente desorganizada, las consecuencias emocionales de dicho problema han sido escasamente descritas. Este artículo sugiere que uno de los resultados más importantes de experimentar una mente desorganizada es la imposibilidad de utilizar dicha mente como fuente de autorregulación emocional. Además, propone que en situaciones de desorganización mental, los sobrevivientes de lesión cerebral tienden a utilizar las mentes-cerebros de otros como fuente de regulación afectiva, proceso conocido como regulación extrínseca. Por medio de la descripción de un caso clínico se intenta además demostrar como los procesos de regulación intrínseca y extrínseca se encuentran íntimamente relacionados...

The experience of a disorganized mind is a common phenomenon after pre-frontal cortex lesions. Even though during the last decades there has been a better understanding of the neuropsychological mechanisms that are often compromised in a disorganized mind, its emotional consequences have been scarcely described. This article suggests that a main problem of having a disorganized mind is the difficulty of using that same mind to self-regulate emotional states. In addition, this paper also proposes that in situations where the mind is in a state of disorganization, patients tend to use other’s people’s minds-brains as a source of affective regulation, a process commonly known as extrinsic regulation. Finally, the relationship between intrinsic and extrinsic regulatory processes is addressed through the description of a clinical case...

Alteración de la memoria de trabajo en la esquizofrenia / The Alteration of Working Memory in Schizophrenia

La memoria de trabajo o working memory es un constructo teórico que se refiere a las estructuras y procesos usados para el almacenamiento temporal (memoria a corto plazo) y la manipulación de la información, con una naturaleza activa, creadora o transformadora de la memoria. El rol de la corteza prefrontal en la memoria de trabajo es fundamental adaptativas en base a la información on line. Permite mantener activada una cantidad limitada de información necesaria para guiar la conducta. El sujeto necesita disponer de una representación mental tanto del objetivo como de la información relevante, no sólo acerca actual sino también en relación a la situación futura. La esquizofrenia es una enfermedad que presenta alteraciones que clínicamente abarcan las dimensiones de síntomas positivos, negativos y cognitivos. Los síntomas cognitivos presentan alteraciones en las funciones ejecutivas, atención, memoria declarativa verbal y espacial y la memoria de trabajo. La patofisiología de la esquizofrenia se puede entender como un complejo entramado entre factores genéticos y ambientales que generan alteraciones del neurodesarrollo y neurodegenerativos. Las hipótesis de la enfermedad conducen a una disregulación de los circuitos dopaminérgicos, glutamatérgicos, gabaérgicos, serotonérgico y colinérgicos, involucrando a las áreas corticales, hipocampo, ganglios de la base y tronco del encéfalo, en la fisiopatología de la enfermedad. La neurobiología de la enfermedad permite un acercamiento a la comprensión de esta patología y evaluar de manera racional, posibles abordajes psicofarmacológicos y psicosociales...

Working memory is a theoretical construct that refers to the structures and processes used for the temporary storage (short-term memory) and the manipulation of informations, with an active, creative or transformative nature of memory. The role of the prefrontal cortex in working memory is essential to establish a space of ordering, plannign, and sequencing. Filtered as irrelevant and build adaptive responses based on the on-line information. Keeps activated a limited amount of information needed to guide the behavior. The subject needs to have a mental representation both the objective and relevant information not only about the current state but also in relation to the future situation. Schizophrenia is a disease that presents disorders that clinically encompass the dimensions of positive, negative and cognitive symptoms present alterations in executive functions, attention and declarative memory spatial and verbal working memory. The pathophysiology of schizophrenia can be understoood as a complex network between genetic and environmetal factores that generate neurodegenerative and neurodevelopmental alterations. The hypothesis of the disease leading to a dysregulation of the circuits dopaminergic, glutamatergics, serotonergic and GABAergic, involving the cortical areas, hippocampus, basal ganglia and brainstem in the pathphysiology of the disease. The Neurobiology of disease allows an approach to the understanding of this desease and evaluate in a rational way, possible approaches psychopharmacologic and psychosocial...

Alteraciones de la Corteza Prefrontal en la esquizofrenia (Tercera parte) / Alterations in the Prefrontal Cortex in Schizophrenia (Third Part)

La Corteza Prefrontal (CPF) y específicamente la Corteza Prefrontal Dorso Lateral es una corteza de asociación heteromodal, particular y selectivamente alterada en la esquizofrenia. La CPFDL (Corteza Prefrontal Dorso Lateral) presenta disminución selectiva de su conectividad sináptica, con disminución del neuropilo y del tamaño de los somas neuronales, con aumento de la densidad neuronal. Hay disminución de las aferencias provenientes del ATV (área tegmental ventral) en las capas medias y de las provenientes del NDM (núcleo dorso medial) del Tálamo en las medias y profundas, con disminución del volumen del mismo. Las alteraciones se agravan con el podado fisiológico en la adolescencia, produciendo fallas en los circuitos córtico-talámicos, córtico-estrio-tálamo-corticales y córtico-tálamo-cerebelares, con fallas en la regulación del filtro talámico y estados de hiperdopaminergia subcortical secundaria, relacionados con los síntomas positivos de la enfermedad. Esta revisión será presentada en tres partes. En la primera y segunda parte del trabajo se desarrollaron las alteraciones cognitivas descriptas en la esquizofrenia, específicamente la Memoria de Trabajo y la circuitería de la Corteza Prefrontal. En la tercera parte se tratará la importancia de la neurotransmisión dopaminérgica y neurofisiopatología de la CPF en la esquizofrenia.

The Prefrontal Cortex (PFC), and specifically, the Dorsolateral Prefrontal Cortex is a heteromodal association cortex, which is particularly and selectively altered in schizophrenia. The DLPC (Dorsolateral Prefrontal Cortex) displays a selective decrease of its synaptic connectivity, with a reduction of the neuropile as well as the size of neural somas, with an increased neural density. There is a decrease in the afferents of the ventral tegmental area (VTA), in the medium layers and the layers of the MDN (medial dorsal nucleus) of the Thalamus, in the medium and deep layers, with a reduction of its volume. Alterations become worse with physiological crop in adolescence, leading to impairments of the corticothalamic, cortico-striatal-thalamic-cortical and cortico-thalamic-cerebellar circuits, with impairments in the regulation of the thalamic filter, and states of secondary subcortical hyperdopaminergia, associated with the pisitive symptoms of the disease. This review will be divided in three parts. The first and the second part consist in the cognitive alterations described in schizophrenia, specifically, the Working Memory as well as the Prefrontal Cortex circuitry. The Third part deals with the importance of dopaminergic neurotransmission and the neurophysiopathology of the PFC in schizophrenia.

Neurobiology of apathy in Alzheimer's disease / Neurobiologia da apatia na doença de Alzheimer

Apathy is considered the most frequent neuropsychiatric disturbance in dementia and its outcome is generally deleterious. Apathy can be related to a dysfunction of the anatomical-system that supports the generation of voluntary actions, namely the prefrontal cortex and/or the prefrontal-subcortical circuits. In Alzheimer's disease, pathological and neuroimaging data indicate that apathy is likely due to a dysfunction of the medial prefrontal cortex. Accordingly, in this review article, we propose a pathophysiological model to explain apathetic behavior in Alzheimer's disease, combining data from neuroimaging, neuropathology and experimental research on the role of orbito-frontal cortex, anterior cingulate cortex, basal ganglia and dopamine in decision-making neurobiology.

Apatia é considerada a alteração neuropsiquiátrica mais freqüente nas demências e suas conseqüências são habitualmente deletérias. Apatia pode ser relacionada à disfunção do sistema anatômico responsável pela geração de ações voluntárias, conhecido com córtex pré-frontal e/ou circuitos pré-frontais-subcorticais. Na doença de Alzheimer, evidências neuropatológicas e de neuroimagem funcional indicam que a apatia é provavelmente decorrente da disfunção do córtex pré-frontal medial. Assim, neste artigo de revisão, apresentamos uma proposta de um modelo fisiopatológico para explicar o comportamento apático na doença de Alzheimer, combinando dados de neuropatologia, neuroimagem e experimentação animal sobre o papel do córtex órbito-frontal, cíngulo anterior, núcleos da base e dopamina na neurobiologia da tomada de decisão.

Abnormal electrophysiological activation in schizophrenics during a personal traits attribution task

Changes in personal identity have been described as a major component in the expression of schizophrenia. Considering current evidence that relates the cortical structures of the medial line with the self, we hypothesize that there are differences in the frontomedial electrophysiological activation in schizophrenics when compared to normal subjects during tasks that require this function. In an experimental design, 9 schizophrenic and 7 normal subjects participated in a personal traits attribution task regarding the attribution of the self, another person and a simple reading. Electric brain activity was recorded with a dense array of 128 electrodes, with evoked brain potentials being obtained for the three conditions. Considering the evoked potential morphology, repeated measures ANO VA were performed on the adaptive mean for the 180-230 ms time window (P200) in the frontomedial electrodes, with a group effect being found (F=5.352; p=0.038). Comparisons of the groups show that the schizophrenics presented less voltage in the seZ/condition (t=2.386; p=0.033). Although the results are not consistent with the hypothesis, it can be suggested that the early modulation of word-related meaning formation in a self-referential context could be affected in schizophrenia.

Neuro-cognitive functions in patients of major depression.

Earlier studies have shown conflicting results regarding impairment of executive functions in patients of major depression. In the present study, subjects were divided into following groups-Group 1 (19 Males & 11 females, age 18-45 years) consisting of patients of major depression diagnosed on the basis of DSM IV criteria and Group 2 (20 Males & 10 females, age 18-45 years) consisting of healthy subjects who had been screened for any sub-psychiatric illness by standardized hindi version of Goldberg's General Health Questionnaire (G.H.Q.). All the Group 1 & Group 2 subjects were rated on Hamilton Rating Scale for Depression (HAM-D) and then administered Neuro-cognitive test battery consisting of Letter Cancellation test, Trail Making test 'A' & 'B', Ruff Figural Fluency test, Forward & Reverse Digit Span test for assessing following cognitive domains: Attention span, visuo-motor scanning, short term memory and executive functions like working memory, information manipulation, set-shifting strategy analysis etc. Results showed significant impairment on all the studied neuro-cognitive parameters in Group 1 subjects as compared to Group 2 subjects, which demonstrate significant impairment of attention, visuomotor speed, immediate verbal memory, short-term retentive capacity and executive functions (strategic planning, attentional set shifting and working memory) in patients of major depression. It may probably be due to the disruption of dorso-lateral prefrontal cortex (dlpfc) and orbito-frontal networks in patients of major depression.

Asimetrías funcionales frontales en el trastorno depresivo mayor / Functional frontal asymmetries in the depressive mayor disorder

Introducción: Las asimetrías funcionales de la corteza prefrontal son un importante parámetro predictor del estilo afectivo. Consecuentemente, diversos trastornos del afecto se asocian a diferencias individuales en dicho índice. En ese contexto, el trastorno depresivo mayor puede ser caracterizado por patrones anormales de activación de la corteza prefrontal izquierda. Material y métodos: Apoyados en los datos experimentales relevantes se presentan los fundamentos de un modelo del trastorno depresivo mayor que enfatiza los aspectos funcionales de la corteza cerebral. Conclusiones: Tanto el diagnóstico, como el tratamiento de la depresión dependen de nociones adecuadas de su etiología. Dada la heterogeneidad del paciente depresivo, así como los múltiples factores psicofisiológicos asociados, se propone una estrategia de investigación que considera marcadores objetivos para guiar el desarrollo de nuevos métodos de diagnóstico.

Frontal and anterior cingulate activation during overt verbal fluency in patients with first episode psychosis

OBJETIVO: Estudos de neuroimagem funcional empregando tarefa de fluência verbal fonológica têm permitido a avaliacão dos circuitos neurais relevantes à neuropsicologia das psicoses. Pacientes com esquizofrenia crônica apresentam diferenca nos padrões de ativacão em córtex pré-frontal e giro do cíngulo anterior em relacão a controles normais. Essas regiões cerebrais foram avaliadas por ressonância magnética funcional, durante tarefa de fluência verbal fonológica, em pacientes com psicose funcional de início recente. MÉTODOS: Sete pacientes com psicose funcional (3 esquizofreniformes, 4 afetivos) e nove controles saudáveis foram estudados. Foram comparadas as imagens de ressonância magnética funcional adquiridas durante a articulacão de palavras que comecassem com letras classificadas como "fáceis" para a producão de palavras em Português. Comparacões estatísticas foram obtidas com métodos não-paramétricos. RESULTADOS: Os grupos não diferiram em relacão ao desempenho da tarefa. Os controles apresentaram maior ativacão em cíngulo anterior rostral esquerdo e em córtex pré-frontal inferior direito, enquanto os pacientes mostraram maior ativacão em uma região mais dorsal do cíngulo anterior bilateralmente e em uma porcão mais superior do córtex pré-frontal direito. CONCLUSAO: Nossos resultados preliminares são consistentes com estudos prévios e demonstram menor ativacão em córtex pré-frontal e cíngulo anterior em pacientes com psicose de início recente durante tarefa de fluência verbal fonológica. A maior ativacão em outras partes do cíngulo anterior e do córtex pré-frontal em pacientes pode estar relacionada a uma resposta compensatória necessária para a manutencão do desempenho normal da tarefa e sugere que uma alteracão do padrão de atividade das diversas unidades funcionais do cíngulo anterior está associada aos transtornos psicóticos.

Regulación emocional y psicopatología: el modelo de vulnerabilidad/resiliencia / Emotion regulation and psychopathology: the vulnerability/resilience approach

La regulación emocional es un elemento clave de la conducta emocional. Más aun, los estudios de la neurociencia afectiva y la psicología del desarrollo han develado que la habilidad de regulación emocional es una fuente importante de psicopatología. Sin embargo, se hace necesaria una aproximación integradora entre aquellos programa de investigación. Material y métodos: Apoyados en los datos experimentales relevantes presentamos los fundamentos de un modelo acerca de la psicopatología. Conclusiones: Considerando variables psicobiológicas (asimetrías cerebrales tónicas) y conductuales (habilidades de mentalización) proponemos un modelo de la vulnerabilidad/resiliencia.

Córtex prefrontal y trastornos del comportamiento: modelos explicativos y métodos de evaluación / Prefrontal cortex and behavioral disorders: theoretical framework and neuropsychological evaluation

Los trastornos del córtex prefrontal (CPF) permiten explicar la sintomatología de importantes cuadros neurológicos y psiquiátricos, tales como las secuelas de traumatismos encéfalo-craneanos y las esquizofrenias. Sin embargo, y a pesar de la gran importancia de sus funciones, su estudio se ha visto dificultado por razones teóricas, experimentales y clínicas. Recientemente han surgido dos nuevos modelos que intentan explicar los mecanismos a la base del funcionamiento del CPF. Presentamos una revisión de las principales manifestaciones clínicas ante su disfunción, los modelos explicativos postulados tradicionalmente, además de las dos propuestas recientes de Koechlin y Mesulam, para finalizar con una revisión de los instrumentos más utilizados en el ámbito clínico para la evaluación de las funciones propias de esta región, denominadas funciones ejecutivas y de autorregulación del comportamiento.

Dysfunction of prefrontal cortex explains the symptoms of many neurological and psychiatric disorders, such as the consequences of cerebral trauma and schizophrenia. Although the importance of frontal lobe functions in complex cognition has long been recognized, systematic research efforts to specify the nature, organization and roles of these functions have been difficult for theoretical, experimental and clinical reasons. Recently, two new theoretical frameworks have been proposed to explain the role of prefrontal cortex. In this paper, we present a revision of the main clinical manifestations secondary to prefrontal dysfunction, the frameworks proposed by Mesulam and Koechlin to explain the role of prefrontal cortex in behavior and the principal instruments available to evaluate executive and strategic self-regulation functions.