Objective Assessments in Diagnoses and Treatment: A Proposed Change in Paradigm.

For patients with psychiatric disorders, current diagnostic and treatment approaches are far from optimal. The clinical interview drives the standard approach-matching symptoms to diagnostic criteria-and results in standardized pharmacological and behavioral treatments, often, with inadequate outcome; but now, recent imaging advances can correlate behavioral assessments with brain function and measure them against normative databases to provide data critical for the reevaluation of patient diagnosis and treatment. This article addresses the data that support a redefinition of our current paradigm. We believe a neurobehavioral approach provides for more personalized treatment approaches unbound from classically defined diagnostic biases.

[Benefits of Iris Claw lens implantation among present methods of surgical correction of aphakia with insufficient capsular support]. / Korzysci wszczepu soczewki Iris Claw w swietle wspólczesnych meted chirurgicznej korekcji bezsoczewkowosci wobec braku odpowiedniego podparcia torebkowego.

Both anatomical and functional benefits associated with the implantation of intraocular lenses are the basis for the use of multiple surgical methods in intraocular lens surgery. To achieve adequate stability of the intraocular lens in cases of insufficient capsular support one may choose angle-supported anterior chamber intraocular lenses, iris-fixated intraocular lenses, iris-sutured or transsclerally sutured posterior chamber intraocular lenses. The transscleral IOL stabilization, most commonly used in clinical practice, seems particularly valuable in eyes with decreased corneal endothelial cell density, shallow anterior chamber, anatomical abnormalities of the iris and iridocorneal angle and uncontrolled glaucoma. Angle-supported anterior chamber IOLs, although easy to implant, can result in excessive endothelial cell loss or secondary glaucoma. Fixated to the midperipherial iris the Iris Claw lens seems to be an interesting and increasingly more popular alternative to other surgical methods used for cases of insufficient capsular support. The paper discusses some aspects of clinical and technical Iris Claw lens implantation in the correction of aphakia.

Preliminary Findings of Single- and Multifocused Epileptiform Discharges in Nonepileptic Psychiatric Patients.

Epileptiform discharges (EDs) in nonepileptic populations remain controversial as to their role in psychopathology. Previous studies have unsuccessfully attempted to correlate specific waveforms of EDs, defined by duration and morphology, with broad diagnostic categories such as depression and anxiety. These diagnostic categories often include heterogeneous patient populations, with potentially divergent biological underpinnings of clinical presentation. This study examined epileptiform activities as a single phenomenon, identifying the relationships between distribution patterns of EDs and endorsement of clinical symptoms across affective, cognitive, and somatic domains. In a sample of 71 nonepileptic psychiatric patients, those with EDs appearing in homologous electrode pairs endorsed significantly fewer symptoms related to affective deregulation. These patients were also significantly less likely to endorse a history of severe symptomatology, including suicidal ideation/previous attempt, self-injurious behavior, psychoses or dissociation, and previous psychiatric hospitalization. Conversely, patients with isolated EDs focused to a single brain region endorsed greater affective deregulation and severe clinical symptoms. These findings offer new possibilities regarding the potentially protective role that EDs may play when distributed across hemispheres, particularly in light of recent theories exploring functional connectivity of neuronal networks.

Conscious attention, meditation, and bilateral information transfer.

Recent findings indicate that conscious attention is related to large-scale information integration of various brain regions, including both hemispheres, that enables integration of parallel distributed modalities of processed information. There is also evidence that the level of information transference related to integration or splitting among brain regions, and between hemispheres, establishes a certain level of efficiency of the information processing. The level of information transference also may have modulatory influences on attentional capacity that are closely linked to the emotional arousal and autonomic response related to a stimulus. These findings suggest a hypothesis that changes in conscious attention, specifically during meditation could be reflected in the autonomic activity as the left-right information transference calculated from bilateral electrodermal activity (EDA). With the aim to compare conscious attention during meditation with other attentional states (resting state, Stroop task, and memory task), we performed bilateral EDA measurement in 7 healthy persons during resting state, Stroop task, neurofeedback memory test, and meditation. The results indicate that the information transference (ie, transinformation) is able to distinguish those attentional states, and that the highest level of the transinformation has been found during attentional processing related to meditation, indicating higher level of connectivity between left and right sides. Calculations other than pointwise transinformation (PTI) performed on EDA records, such as mean skin conductance level or laterality index, were not able to distinguish attentional states. The results suggest that PTI may present an interesting method useful for the assessment of information flow, related to neural functioning, that in the case of meditation may reflect typical integrative changes in the autonomic nervous system related to brain functions and focused attentional processing.

Person-centered medicine versus personalized medicine: is it just a sophism? A view from chronic pain management.

The main aim of this brief overview is to explore the concepts of person-centered medicine and personalized medicine in the areas of chronic pain research and management. Through several definitions and paradigms of pain, the authors introduce the complexity of pain phenomenology in order to establish the challenge of person-centered and personalized medicine in everyday practice. By providing deeper insight into fibromyalgia, its presentation, biology and treatment, several questions are addressed, ranging from person-centered diagnosis to personalizing the various processes of the fibromyalgia spectrum complex. By reviewing current treatment options and evaluating treatment pitfalls derived from methodological flaws in current research, the authors discuss various possibilities of personalizing treatment and, therefore, propose how the use of these two paradigms could enhance outcomes in chronic pain management. If we wish to make comments about enhanced outcomes we need to talk about outcomes of pain treatments, we need to discuss what successful treatment is from the patient's point of view as well as in the reviewed models.

EEG complexity and attentional processes related to dissociative states.

Reported findings indicate that attentional narrowing is related to decreased complexity and increased inhibition of neural assemblies. These findings suggest that analysis of electroencephalogram (EEG) complexity could present a useful method for research of attentional changes related to dissociation. To examine this model we used a case study to test the two hypotheses: (1) that successful anticonvulsant medication would result in dissociative symptom alleviation, improvement of inhibitory neural functions, and decreased EEG complexity, and (2) that cognitive conflict, related to aversive events in the patient's past experience, during reliving of a dissociative state would lead to greater allocation of attention and decreased EEG complexity. Three EEG studies recorded in the eyes closed non-drowsy state were performed: (1) at baseline, (2) post-induction of dissociative state, and (3) post-anticonvulsant medication following induction of dissociative state. A dissociative state was achieved following an interview regarding the patient's aversive past experiences through use of the Peritraumatic Dissociative Experiences Questionnaire (PDEQ). The patient's level of dissociation was measured using the Dissociative Experiences Scale-II (DES-II). The PDEQ interview and DES-II assessment were also used one hour following the oral consumption of an anticonvulsant medication (clonazepam 2mg). Analysis of the data revealed that complexity values (PD2) are significantly lower following the oral consumption of clonazepam (2mg) in the majority of EEG channels. Additionally, complexity during the reliving of a dissociative state was statistically significantly lower than both the baseline and post-medication conditions in all but two EEG channels. Results of the case study suggest that changes in attentional processes linked to dissociation are related to: (1) decreased complexity when attention is extremely focused because of attentional narrowing to the disturbing past experience, and (2) increased complexity during ordinary experiences when attention is less narrowly focused.

Frontal alpha power asymmetry in aggressive children and adolescents with mood and disruptive behavior disorders.

Building on prior research, which has suggested a relationship between aggression and left frontal activity, our study tested the hypothesis that proneness to impulsive aggression would be related to relative left frontal overactivation. EEG one-hertz resting alpha power frontal asymmetry was examined in 65 pediatric male psychiatric patients with a history of impulsive aggression and comorbid mood and disruptive behavior disorders. The strongest finding, which emerged from this analysis, was a finding of relative increases in left frontal activity compared with right frontal activity. The results also indicated that greater left frontal activity correlated positively with the severity of psychiatric disturbance. These findings suggest that relative increases in left frontal activity may be related to a locus of neurophysiological disruption associated with psychopathology characterized by behavioral and affective disinhibition. Results are discussed within a model of behavioral inhibition system-behavioral activation system theory.