Demonstration of chewing-related areas in the brain via functional magnetic resonance imaging.

Purpose: To localize and identify chewing-related areas and their connections with other centres in the human brain using functional magnetic resonance imaging (fMRI). Material and methods: The paradigm of the present study was block designed. Spontaneous and controlled chewing with sugar-free gum was used as the main task in a 3-Tesla fMRI unit with a 32-channel birdcage coil. Our study popu-lation comprised 32 healthy volunteers. To determine possible intersections, we also put the rosary pulling (silent tell one's beads) movement in the fMRI protocol. The data analyses were performed with the Statistical Parametric Mapping (SPM) toolbox integrated into the Matlab platform. Results: The superomedial part of the right cerebellum was activated during either pulling rosary beads or spontaneous chewing. This region, however, was not activated during controlled chewing. We did not find statistically significant activation or connection related to the brain stem. Conclusion: We have confirmed that the cerebellum plays an important role in chewing. However, we could not find a definite central pattern generator (CPG) in the brain stem, which has been hypothesized to underlie spontaneous chewing.

The importance of mentalization, coping mechanisms, and perceived stress in the prediction of resilience of healthcare workers.

Resilience is the process of overcoming stressors. Being able to examine the effect of the Covid epidemic on healthcare workers (HCWs) has provided us a unique opportunity to understand the impact of trauma on resilience. We aimed to investigate the relationship between stress, mentalization, and an individual's coping capacity against a real risk (Covid-19) and evaluate the predictors of resilience. 302 HCWs have enrolled in the study and completed an online questionnaire assessing demographics, perceived stress, resilience, coping, and mentalization. We utilized statistical analysis together with a Random Forest classifier to analyze the interaction between these factors extensively. We applied ten times ten-fold cross-validation and plotted Receiver Operator Characteristic (ROC) with the calculated Area Under the Curve(AUC) score and identify the most important features. Our experiments showed that the Perceived stress scale has the strongest relationship with resilience. The subject's awareness level of emotional states is an important factor that determines the level of resilience. Coping styles such as the decision of giving up is also a crucial indicator. We conclude that being aware of the risks and the mental states are the dominant factors behind the resilience levels of healthcare workers under pandemic conditions.

Functional connectivity in rumination: a systematic review of magnetic resonance imaging studies.

INTRODUCTION: Rumination, defined as intrusive and repetitive thoughts in response to negative emotions, uncertainty, and inconsistency between goal and current situation, is a significant risk factor for depressive disorders. The rumination literature presents diverse findings on functional connectivity and shows heterogeneity in research methods. This systematic review seeks to integrate these findings and provide readers diverse perspectives. METHOD: For this purpose, the literature on functional connectivity in rumination was reviewed according to the PRISMA guidelines. Regional connectivity and network connectivity results were scrutinized according to the presence of depression, research methods, and type of rumination. After screening 492 articles, a total of 36 studies were included. RESULTS: The results showed that increased connectivity of the default mode network (DMN) was consistently reported. Other important findings include alterations in the connectivity between the DMN and the frontoparietal network and the salience network (SN) and impaired regulatory function of the SN. Region-level connectivity studies consistently show that increased connectivity between the posterior cingulate cortex and the prefrontal cortex is associated with rumination, which may cause the loss of control of the frontoparietal network over self-referential processes. We have seen that the number of studies examining brooding and reflective rumination as separate dimensions are relatively limited. Although there are overlaps between the connectivity patterns of the two types of rumination in these studies, it can be thought that reflective rumination is more associated with more increased functional connectivity of the prefrontal cortex. CONCLUSIONS: Although there are many consistent functional connectivity outcomes associated with trait rumination, less is known about connectivity changes during state rumination. Relatively few studies have taken into account the subjective aspect of this thinking style. In order to better explain the relationship between rumination and depression, rumination induction studies during episode and remission periods of depression are needed.

Obsessive-Compulsive Disorder from an Embodied Cognition Perspective.

Obsessive Compulsive Disorder (OCD) is characterized by problems of control over behavior and cognition. Although almost all of the studies on pathogenesis of OCD point out fronto-striatal dysfunction, it is still not possible to reveal mechanisms to explain the entire clinical course of OCD through these circuits. A more holistic explanation can be given through the Embodied Cognition (EC) perspective, which suggests that the alteration/dysfunction of low-level sensory-motor process may appear as a multifarious extent of dysfunction of high-level cognitive processes. Fronto-striatal circuits play fundamental role in behavioral control. These circuits also have a central role for the feed-forward motor control (FFMC). In FFMC, the internal model of movement is driven by efference copies as templates for motor behavior, without being adjusted by sensory information. If impairment of low-level sensory-motor processing is crucial to occurrence of compulsions, one possible hypothesis about this impairment is the problem which emerges from occurrence of efference copy in FFMC. On the other hand, the efference copy has also pivotal role for subject's feeling of the agency of an action. Therefore, there may be role of failure in successfully reproduction of the efference copy in the background of subjects' experience of losing control on compulsive behaviors. In this paper, we will discuss how the embodied cognition (EC) perspective which can be one of the biological bases of computationalism, which brings neuroscientific explanations on the functioning of nervous system to a more symbolic perspective, may contribute to our understanding of etiopathogenesis of OCD. In this perspective, our method will be to integrate the theoretical basis provided by EC perspective to the current models for OCD, rather than falsifying them.

Comparison of the Effects of Antidepressants with Different Mechanisms of Action on Efficacy, Cognitive Functions and Side Effects. / Farkli Etki Mekanizmasina Sahip Antidepresanlarin Etkinlik, Bilissel Islevler ve Yan Etki Açisindan Karsilastirilmasi.

OBJECTIVE: The aim of this study was to compare the effects of the agomelatine and selective serotonin reuptake inhibitors (SSRIs) on symptoms of depression, cognitive functions, impulsiveness, suicidal tendency, sleep pattern and side effects. METHOD: This study enrolled patients with depression started on SSRIs (n=30) or agomelatine (n=30) on an outpatient basis. All patients were evaluated with SCID-I and the Sociodemographic Questionnaire on the first day of the treatment. In order to assess the side effects of the treatments, the patients were assessed at the first and the fourth weeks with Hamilton Depression Scale (HAM-D), the Suicide Probability Scale (SPS), the UPSS Impulsive Behaviour Scale, the Epworth Sleepiness Scale (ESS), the UKU Side Effect Rating Scale, and the Stroop Test and the Trail Making Test for cognitive functions. . RESULTS: Patients on SSRIs showed better treatment response and remission rates at the end of the first month. Improvement in cognitive functions correlated with the decrease in depressive symptoms, but no difference was observed between the groups with respect to the improvement of the cognitive functions. SSRIs caused more autonomic and sexual side effects compared to agomelatine. Differences were not observed between the effects of the two medications on impulsivity, sleep pattern and suicidal tendency. CONCLUSION: In conclusion, treatment with SSRIs was significantly more associated with improvement in the clinical symptoms. Sexual side effects were more prevalent with SSRIs, but the effect on cognitive functions did not differ from agomelatine Despite the distinct, promising mechanism of action, agomelatine was not as effective as the SSRIs for the treatment of depression.

Cortical motor areas show different reorganizational changes in adult patients with brachial plexus birth injury (BPBI).

INTRODUCTION: Brachial plexus birth injury (BPBI) may cause permanent disability. It is recently thought to result from the (mal)adaptive reorganizational central nervous system problems. METHODS: In this study, adult patients with BPBI and age-matched healthy controls were compared for the cortical activity during action observation by functional magnetic resonance imaging (fMRI). RESULTS: The cortical activity in patients was significantly weaker than in the control group (p < .05). Areas of difference were middle temporal gyrus, premotor area, and inferior parietal lobule. The signal change in these areas was significantly lower in the patient group (p < .05). CONCLUSIONS: This study showed that the cortical activity in the associative motor regions was weaker in the patients while no primary region showed any difference. The results were concluded that there is a diversity in the neuroplastic changes between primary and associative motor areas. Clinically, neurorehabilitative interventions should be planned based on this diversity.

Investigation of the Processing of Noun and Verb Words with fMRI in Patients with Schizophrenia.

INTRODUCTION: Action naming is reported to be more damaged in patients with schizophrenia than object naming. Aim of this study is to understand the cortical mechanism underlying the negative symptoms seen in patients with schizophrenia such as inactivity, restricted behavioral repertoire, by using functional MRI (fMRI) to determine whether the action origin words have a different representation in the brain regions of patients with schizophrenia and healthy individuals. Our hypothesis is that restriction in the repertoire of movement and behavior and the failure of words of "action" than words of "object" are interrelated through the same cortical mechanisms. If this hypothesis is correct, the reason for not taking action in patients with schizophrenia may be improper definition of the action (verb). METHODS: fMRI study was conducted with 12 patients with schizophrenia and 12 healthy individuals. fMRI recording was performed after applying positive and negative syndrome (PANSS) scale, Calgary depression scale, hand preference scale to the participants. During the sessions, "lexical decision task" is applied by showing a total of 240 words (120 words - 60 verbs (words of action) and 60 nouns (words of object) - and 120 non-words) to the subjects. RESULTS: In fMRI findings, in the group main effect, which can also be expressed as the difference of the noun and verb words in the group of schizophrenia from the noun and verb words in the healthy control group, the activation of the anterior prefrontal cortex is found to be lower in patients with schizophrenia than in healthy individuals. When the brain areas which show the difference in verb words in schizophrenia group from both noun words in schizophrenia group and noun and verb words in healthy individuals are examined, inferior frontal gyrus pars triangularis (BA45) showed more activation in patients with schizophrenia than healthy individuals, but again for the same task, inferior frontal gyrus pars opercularis (BA44) and left primary sensory area showed less activation in patients with schizophrenia than healthy individuals. There is no difference between patients with schizophrenia and healthy volunteers in terms of correctly identified words and reaction time. CONCLUSION: Considering the lack of difference between the groups in terms of number of correctly identified words and reaction time, and BA 44's role in recognition and imitation of action and being a part of the mirror neuron system, the significant inverse correlation between PANSS negative score and BA40 can be seen as an effort to compensate for BA44 inadequate activity through BA40.

Does Generalized Linear Model Support Functional Default Mode Network Studies.

INTRODUCTION: A growing body of research has emerged on the resting state and the default mode of the brain. Functional connectivity studies, which lately dominate this research area, have confirmed that regions such as the cortical mid-line structures, as well as parietal-temporal regions are tightly interconnected within the default mode network (DMN). However, little is known about the activity patterns of resting state related brain regions detected in fMRI studies using the generalized linear model (GLM) in a whole brain analysis. The aim of the current study was to investigate the activity changes among brain regions identified through GLM during the transition from task to rest and the prolongation of rest. METHODS: A picture imagination task, as a controlled thought content task, was used in order to minimize confounding factors such as a visual stimulus or a motor response. RESULTS: The present study revealed a consistent fluctuating activation pattern of the dorsal anterior cingulate cortex (dACC), the posterior cingulate cortex (PCC), thalamus, primer motor area (PMA), insula, brain stem and bilateral putamen during the transition from task to the early phase of the resting state and the prolongation of the resting state. All regions showed increased activation during the detachment from task. However, this increased activation was not sustained during the extension of rest, replaced with a decreased activation at the late phase of rest. The increased activation of resting state regions might help with the detachment from the current task. Among these regions dACC, insula and putamen were correlated in all conditions. CONCLUSION: These findings underline the importance of the activation increase of the cortical mid-line regions and insula in the transition from task to the resting state.

The effect of different types of honey on healing infected wounds.

OBJECTIVE:: To investigate the effects of treatments of 'mad honey', blossom honey and nitrofurazone on infected wound healing. METHOD:: Male albino Wistar rats were randomly divided into four groups: 'mad honey' (MH), blossom honey (BH), nitrofurazone (N) and control (C). All rats were anaesthetised intraperitoneally. A circular skin incision was made to the back regions. Grafts containing slime-producing Staphylococcus epidermidis were placed on the incision area and then sutured to the skin. Infection in the wound area was confirmed after 48 hours. Wounds were dressed twice daily with the various treatment materials. Rats were randomly euthanised on days 7 or 14, and tissue samples taken. Tissue samples were assessed for hydroxyproline (HP), tensile strength (TS) and macroscopic measurement (area and intensity). RESULTS:: HP levels were higher in the treatment groups (MH, BH, N) at days 7 and 14 compared with the control group. 'Group x day' interaction was found in the HP levels (p=0.015). Increases in HP levels in the MH and N groups between days 7 and 14 were significantly higher than those in the other groups (p<0.05). Intensity was significantly lower in the control group and significantly higher in group MH compared with the other groups. Significant 'group x day' interaction was observed in intensity (p=0.006). TS was significantly lower on day 7 than on day 14 (p=0.022). No marked difference was observed between the groups, nor any 'group x day' interaction, in terms of TS. CONCLUSION:: Honey administration successfully healed infected wounds. However, there was no significant difference between the effect of MH and that of N in terms of wound healing.

The effect of temperament on the treatment adherence of bipolar disorder type I.

BACKGROUND AND AIMS: Treatment adherence is one of the most important factors that may determine treatment response in patients with bipolar disorders (BD). Many factors have been described to be associated with treatment adherence in BD. Temperament that can influence the course of BD will have an impact on treatment adherence. The aim of this study is to investigate temperament effect on treatment adherence in euthymic patients with BD-I. METHODS: Eighty patients with BD-I participated in the study. A psychiatrist used the Structured Clinical Interview for DSM-IV Axis-I Disorders to determine the diagnosis and co-morbidities. Hamilton Depression and Young Mania Rating Scale were used to detect the remission. We used the Temperament Evaluation of Memphis, Pisa, Paris, San Diego Autoquestionnaire and the 4-item Morisky Medication Adherence Scale to evaluate temperament and treatment adherence, respectively. The study group was divided into two groups as "treatment adherent" and "treatment non-adherent". RESULTS: The cyclothymic and anxious temperament scores of the treatment non-adherent patients with BD-I were significantly higher than those of the treatment adherent group (p < 0.001, p = 0.006, respectively). Multiple linear regression analysis determined that cyclothymic temperament predicted treatment non-adherence (p = 0.009). CONCLUSION: It should be kept in mind that BD-I patients with cyclothymic temperament may be treatment non-adherent and future studies should explore whether temperament characteristics deteriorate BD-I course by disrupting treatment adherence.

Magical ideation associated social cognition in adolescents: signs of a negative facial affect recognition deficit.

BACKGROUND: Studies provide evidence for impaired social cognition in schizotypy and its association with negative symptoms. Cognitive features related to magical ideation - a component of the positive dimension of schizotypy - have been less investigated. We aimed to assess social cognitive functioning among adolescents with high magical ideation scores, mainly focusing on face and emotion recognition. METHODS: 22 subjects with magical ideation scale scores above the cut off level and 22 controls with lowest scores from among 250 students screened with this scale were included in the study. A face and emotion recognition n-back test, the empathy quotient, theory of mind tests and the Physical Anhedonia Scale were applied to both magical ideation and control groups. RESULTS: The magical ideation group performed significantly worse than controls on both face and emotion recognition tests. Emotion recognition performance was found to be affected by memory load, with sadness, among emotions, revealing a difference between the two groups. Empathy and theory of mind tests did not distinguish the magical ideation group from controls. CONCLUSION: Our findings provide evidence for a deficit in negative emotion recognition affected by memory load associated with magical ideation in adolescents.

Effects of comorbid anxiety disorders on the course of bipolar disorder-I.

BACKGROUND AND AIMS: Although comorbid anxiety disorders (AD) are quite frequent in bipolar disorders (BD), data on how this comorbidity affects BD are limited. In the present study, we aimed to investigate the frequency of comorbid AD in Turkish patients with bipolar disorder-I (BD-I) and the effects of comorbid AD on the course of BD-I. METHODS: 114 patients with BD-I were included in the study. All patients were diagnosed by a psychiatrist. The patients were divided into two groups as BD-I patients with lifetime comorbid AD (BDI-CAD) or those without comorbid AD (BDI). RESULTS: 37 (32.46%) patients had one or more comorbid lifetime AD. The numbers of admissions to the outpatient clinic within calendar year 2013 (P = 0.014), the number of lifetime mood episodes (P = 0.019) and the duration of BD (P = 0.007) were higher in the BDI-CAD group compared with the BDI group. There was a strong relationship between the duration of the disorder and the number of episodes (r = 0.583, P < 0.001). Partial correlation analyses showed that the number of admission to the outpatient clinic correlated significantly with the frequency of episodes (P = 0.007, r = 0.282). CONCLUSION: We found that the patients with BDI-CAD use the healthcare system more frequently than the BDI patients. This suggests that AD comorbidity may have a negative influence on the course of BD-I and it is a factor that should be considered in the clinical follow-up.

Cognitive control of a simple mental image in patients with obsessive--compulsive disorder.

The nature of obsessions has led researchers to try to determine if the main problem in obsessive-compulsive disorder (OCD) is impaired inhibitory control. Previous studies report that the effort to suppress is one of the factors that increase the frequency of obsessive thoughts. Based on these results and those of the present study that suggest inferior parietal lobe (IPL) abnormality in OCD and findings of a recent study that reported the importance of the right posterior parietal cortex in cognitive control of a simple mental image, the present cognitive control paradigm study aimed to determine whether there is a difference in brain dynamics between OCD patients and non-obsessive controls while performing tasks that necessitate cognitive control of a simple mental image, and whether the right posterior parietal region is one of the regions in which a difference in activity between the OCD patients and controls would be observed. Functional brain imaging was performed while the participants attempted to suppress, imagine, or manipulate a mental image. The general linear model showed that there was a main effect of group and main effect of task. Accordingly, in all contrasts (suppression minus free-imagination, erasing minus free-imagination, and imagination minus free-imagination), the right IPL, right posterior cingulate cortex, and right superior frontal gyrus activity were lower in the OCD patients than in the healthy controls. These results and the observed correlations between activity levels, and symptom and subjective performance scores are discussed. In conclusion, the results of the present study and those of previous studies suggest that the main problem in OCD might be difficulty activating the right frontoparietal networks during tasks that require cognitive control, which might result in the intrusiveness of obsessive thoughts.

[A mourning case that referred with sexual identity disorder secondary to a general medical condition]. / Genel Tibbi Duruma Ikincil Cinsel Kimlik Bozuklugu Ile Basvuran Yas Olgusu.

D.G. was a 59-year-old male patient who was retired and married, and had 3 children. He reported no psychopathology prior to a myocardial infarction he had in 1996. Following bypass surgery he had erectile dysfunction. Subsequently, gynecomastia developed as a side effect of spironolactone and digoxin treatment. After a long period of depression he claimed was caused by non-adaptation to the changes in his body, he realized differences about himself; he began to feel like a woman. Upon referral to our clinic, he said that he had decided to continue his life as a woman and wished to get pink colored (as opposed to blue for male) identity card issued by the Turkish Government for female Turkish citizens. He reported that his wish was to learn how to become a woman. This is the first case in the medical literature defined as sexual identity disorder secondary to a general medical condition. The case is discussed in terms of pathological grief reaction.

How is cognitive control of a simple mental image achieved? An fMRI study.

The aim of this study was to determine the brain regions associated with suppressing the image of an object. We used functional magnetic resonance imaging (fMRI) during five mental tasks (imagining, suppressing, erasing, free thinking and resting) performed by the subjects. The analysis showed that the suppressing, erasing and imagining conditions all activated the parietal and prefrontal regions to a different extent. These results suggest that the regions associated with cognitive control were also activated while a simple mental process was performed. Additionally, the results showed that the parietal lobe is the key region for the suppression of a mental image.

Assessment of the autonomic nervous system is an appropriate biological marker for the well-being in erectile dysfunction.

AIM: To investigate whether the autonomic nervous system (ANS) components are suitable biological markers for representing well-being in patients with erectile dysfunction (ED). METHODS: The present study included 74 male patients who had applied for check-ups in the cardiology outpatient clinic at Kirikkale University (Kirikkale, Turkey) and who had been diagnosed as having hyperlipidemia. Of these patients, 26 had an additional diagnosis of ED and made up the patient group. The remaining 48 patients formed the control group. Well-being was assessed with short-form 36 (SF-36). The International Index of Erectile Function (IIEF) was used as a measure of libido and erectile function. Quantitative assessment of the ANS was made based on the analysis of heart rate variability by means of 24-h holter monitorization. RESULTS: Comparisons between the ED and control groups showed significant differences only in energy scale of SF-36. The ED group also had significantly higher values of sympathetic activity. Except for the general health score of SF-36, which was found to be correlated with parasympathetic activity only in ED group, there were similar correlation patterns within the groups. Although well-being and sympathetic activity were correlated negatively, parasympathetic activity and well-being were correlated positively. CONCLUSION: Quantitative assessment of the ANS by heart rate variability analysis might be a suitable marker for well-being of patients with ED.