The volition, the mode of movement selection and the readiness potential.

A growing body of evidence suggests that the mode of movement selection is relevant for the readiness potential, namely, internal (or free) selection of movements is associated with increased readiness potential amplitudes compared to predetermined or externally guided selection. It is little acknowledged, however, that this finding may be ascribed to the different expression of volition (i.e., conscious experience of choice) rather than to the mode of movement selection per se. To probe this issue, we conducted two experiments: in Experiment 1, a mental task was employed to distract sixteen volunteers from the selection and performance of incidental movements, which consisted of pressing one of two buttons according to either free or externally guided modes of movement selection; in Experiment 2, another sixteen individuals performed the same motor task, however, they were encouraged to attend to their intention to act. As result, the increased readiness potential amplitude before freely selected movements was found exclusively in Experiment 2. More detailed analysis suggested that the attention to the initiation of movements was associated with greater readiness potential in its medial and late portion, while the attention to the movement selection, with more global increase of the component. The study suggests that much of the higher demands on motor preparatory activities ascribed to the internal selection of movements in previous studies actually depends on individual's attention and, thus, probably corresponds to volitional processes.

The effect of conscious intention to act on the Bereitschaftspotential.

The current study investigated the effect of conscious intention to act on the Bereitschaftspotential. Situations in which the awareness of acting is minimally expressed were generated by asking 16 participants to press a button after performing a mental imagery task based on animal pictures (automatic condition). The affective responses induced by the pictures were controlled by selecting the animals according to different valences, threatening and neutral. The Bereitschaftspotential associated with the button presses was compared to the observed when similar movements were performed under the basic instructions of the self-paced movement paradigm (willed condition). Enhanced Bereitschaftspotential amplitudes were observed in the willed condition with respect to the automatic condition. This effect was manifested as a negative slope at medial frontocentral sites during the last 500 ms before movement onset. The valence of the pictures did not affect the motor preparatory potentials. The results suggest that significant part of the NS' subcomponent of the readiness potential is associated with the attention to-and, presumably, awareness of-intention to move, possibly reflecting cortical activation from supplementary motor areas. Secondarily, our findings supports that the feeling of threat does not influence the Bereitschaftspotential associated with automatic movements. Regarding methodological issues, the behavioural model of spontaneous voluntary movements proposed in automatic condition can benefit investigations on purely motor (or non-cognitive) subcomponents of the Bereitschaftspotential.

Obsessive-Compulsive Disorder.

PURPOSE OF REVIEW: This article reviews current knowledge regarding diagnosis, pathophysiology, and treatment trends in obsessive-compulsive disorder (OCD), a severe, underrecognized, and chronic condition frequently encountered in neurologic practice. RECENT FINDINGS: With a lifetime prevalence estimated at 2.5%, OCD is a common condition that can also present comorbidly with neurologic disease. The core symptoms of OCD are obsessions and compulsions. Obsessions are intrusive repetitive thoughts, urges, images, or impulses that trigger anxiety and that the individual is not able to suppress. Compulsions are repetitive behaviors or mental acts occurring in response to an obsession with the intention of reducing the distress caused by obsessions. Neuroimaging, neuropsychological, and pharmacologic studies suggest that the expression of OCD symptoms is associated with dysfunction in a cortico-striato-thalamo-cortical circuit. Evidence-based treatments for OCD comprise pharmacotherapy and cognitive-behavioral therapy. Selective serotonin reuptake inhibitors (SSRIs) are the first-line drugs recommended for OCD, but significant differences exist in their use for OCD compared to their use for other mood and anxiety conditions, including the need for higher dosage, longer trials necessitated by a longer lag for therapeutic response, and typically lower response rates. Cognitive-behavioral therapy, based on the principles of exposure and response prevention, shows results superior to pharmacologic treatments with lower relapse rates on long-term follow-up and thus should be considered in the treatment plan of every patient with OCD. SUMMARY: OCD and obsessive-compulsive symptoms are frequently encountered in the neurologic clinic setting and require a high index of suspicion to effectively screen for them and an illness-specific therapeutic approach.

Individual topographic variability is inherent to cortical physiology but task-related differences may be noise.

The observation of highly variable sets of association neocortical areas across individuals, containing the estimated generators of Slow Potentials (SPs) and beta oscillations, lead to the persistence in individual analyses. This brought to notice an unexpected within individual topographic similarity between task conditions, despite our original interest in task-related differences. A recent related work explored the quantification of the similarity in beta topography between largely differing tasks. In this article, we used Independent Component Analysis (ICA) for the decomposition of beta activity from a visual attention task, and compared it with quiet resting, recorded by 128-channel EEG in 62 subjects. We statistically tested whether each ICA component obtained in one condition could be explained by a linear regression model based on the topographic patterns from the other condition, in each individual. Results were coherent with the previous report, showing a high topographic similarity between conditions. From an average of 12 beta component maps obtained for each task, over 80% were satisfactorily explained by the complementary task. Once more, the component maps including those considered unexplained, putatively "task-specific", had their scalp distribution and estimated cortical sources highly variable across subjects. These findings are discussed along with other studies based on individual data and the present fMRI results, reinforcing the increasingly accepted view that individual variability in sets of active neocortical association areas is not noise, but intrinsic to cortical physiology. Actual 'noise', mainly stemming from group "brain averaging" and the emphasis on statistical differences as opposed to similarities, may explain the overall hardship in replication of the vast literature on supposed task-specific forms of activity, and the ever inconclusive status of a universal functional mapping of cortical association areas. A new hypothesis, that individuals may use the same idiosyncratic sets of areas, at least by their fraction of activity in the sub-delta and beta range, in various non-sensory-motor forms of conscious activities, is a corollary of the discussed variability.

The concepts of representation and information in explanatory theories of human behavior.

Focusing in experimental study of human behavior, this article discusses the concepts of information and mental representation aiming the integration of their biological, computational, and semantic aspects. Assuming that the objective of any communication process is ultimately to modify the receiver's state, the term correlational information is proposed as a measure of how changes occurring in external world correlate with changes occurring inside an individual. Mental representations are conceptualized as a special case of information processing in which correlational information is received, recorded, but also modified by a complex emergent process of associating new elements. In humans, the acquisition of information and creation of mental representations occurs in a two-step process. First, a sufficiently complex brain structure is necessary to establishing internal states capable to co-vary with external events. Second, the validity or meaning of these representations must be gradually achieved by confronting them with the environment. This contextualization can be considered as part of the process of ascribing meaning to information and representations. The hypothesis introduced here is that the sophisticated psychological constructs classically associated with the concept of mental representation are essentially of the same nature of simple interactive behaviors. The capacity of generating elaborated mental phenomena like beliefs and desires emerges gradually during evolution and, in a given individual, by learning and social interaction.

Lack of systematic topographic difference between attention and reasoning beta correlates.

Based on previous evidence for individual-specific sets of cortical areas active during simple attention tasks, in this work we intended to perform within individual comparisons of task-induced beta oscillations between visual attention and a reasoning task. Since beta induced oscillations are not time-locked to task events and were first observed by Fourier transforms, in order to analyze the cortical topography of attention induced beta activity, we have previously computed corrected-latency averages based on spontaneous peaks of band-pass filtered epochs. We then used Independent Component Analysis (ICA) only to single out the significant portion of averaged data, above noise levels. In the present work ICA served as the main, exhaustive means for decomposing beta activity in both tasks, using 128-channel EEG data from 24 subjects. Given the previous observed similarity between tasks by visual inspection and by simple descriptive statistics, we now intended another approach: to quantify how much each ICA component obtained in one task could be explained by a linear combination of the topographic patterns from the other task in each individual. Our hypothesis was that the major psychological difference between tasks would not be reflected as important topographic differences within individuals. Results confirmed the high topographic similarity between attention and reasoning beta correlates in that few components in each individual were not satisfactorily explained by the complementary task, and if those could be considered "task-specific", their scalp distribution and estimated cortical sources were not common across subjects. These findings, along with those from fMRI studies preserving individual data and conventional neuropsychological and neurosurgical observations, are discussed in support of a new functional localization hypothesis: individuals use largely different sets of cortical association areas to perform a given task, but those individual sets do not change importantly across tasks that differ in major psychological processes.

Balance disturbances in asthmatic patients.

OBJECTIVE: The aim of this study was to investigate balance control in asthmatic patients. METHODS: Thirty subjects with controlled persistent asthma were compared with 30 non-asthmatic subjects who were matched by age and sex. Individuals who had received psychiatric treatment, demonstrated chronic musculoskeletal pain, had limited joint movements, or showed vestibular or other equilibrium disorders were excluded from both the groups to avoid biomechanical bias in the dynamic posturography. Balance control was evaluated with the subject standing still on a force platform under four different sensory test conditions. These conditions combined the subject's eyes being opened or closed with a fixed or mobile force platform. A mobile platform provides a somatosensory perturbation, and when associated with the eyes closed condition, only vestibular information is available to moderate balance control. Sensory manipulation provides a more sensitive condition to differentiate postural control between populations or pathologies. Data were sampled at 100 Hz in three 20-second trials and four postural conditions were assessed. The center of pressure (CoP) displacement values were used to calculate area and velocity in the medial-lateral and forward-backward directions. A two-factor analysis of variance with repeated measurements was applied to the data. RESULTS: In comparison to the control group, the asthma group demonstrated a greater area of CoP displacement in conditions using the mobile force platform (with eyes opened or closed) and a higher velocity in forward-backward direction on the mobile platform with the eyes closed. CONCLUSION: Asthmatic individuals presented a greater area for the CoP displacement under somatosensory perturbations and a higher velocity in the forward-backward direction when vestibular information only was made available. Our data suggest that balance needs to be evaluated in asthmatic patients.

Space and motion perception and discomfort in air travel.

INTRODUCTION: The perception of comfort during air trips is determined by several factors. External factors like cabin design and environmental parameters (temperature, humidity, air pressure, noise, and vibration) interact with individual characteristics (anxiety traits, fear of flying, and personality) from arrival at the airport to landing at the destination. In this study, we investigated the influence of space and motion discomfort (SMD), fear of heights, and anxiety on comfort perception during all phases of air travel. METHODS: We evaluated 51 frequent air travelers through a modified version of the Flight Anxiety Situations Questionnaire (FAS), in which new items were added and where the subjects were asked to report their level of discomfort or anxiety (not fear) for each phase of air travel (Chronbach's alpha = 0.974). Correlations were investigated among these scales: State-Trait Anxiety Inventory (STAI), Cohen's Acrophobia Questionnaire, and the Situational Characteristics Questionnaire (SitQ, designed to estimate SMD levels). RESULTS: Scores of SitQ correlated with discomfort in situations involving space and movement perception (Pearson's rho = 0.311), while discomfort was associated with cognitive mechanisms related to scores in the anxiety scales (Pearson's rho = 0.375). Anxiety traits were important determinants of comfort perception before and after flight, while the influence of SMD was more significant during the time spent in the aircraft cabin. DISCUSSION: SMD seems to be an important modulator of comfort perception in air travel. Its influence on physical well being and probably on cognitive performance, with possible effects on flight safety, deserves further investigation.

Minor and unsystematic cortical topographic changes of attention correlates between modalities.

In this study we analyzed the topography of induced cortical oscillations in 20 healthy individuals performing simple attention tasks. We were interested in qualitatively replicating our recent findings on the localization of attention-induced beta bands during a visual task [1], and verifying whether significant topographic changes would follow the change of attention to the auditory modality. We computed corrected latency averaging of each induced frequency bands, and modeled their generators by current density reconstruction with Lp-norm minimization. We quantified topographic similarity between conditions by an analysis of correlations, whereas the inter-modality significant differences in attention correlates were illustrated in each individual case. We replicated the qualitative result of highly idiosyncratic topography of attention-related activity to individuals, manifested both in the beta bands, and previously studied slow potential distributions [2]. Visual inspection of both scalp potentials and distribution of cortical currents showed minor changes in attention-related bands with respect to modality, as compared to the theta and delta bands, known to be major contributors to the sensory-related potentials. Quantitative results agreed with visual inspection, supporting to the conclusion that attention-related activity does not change much between modalities, and whatever individual changes do occur, they are not systematic in cortical localization across subjects. We discuss our results, combined with results from other studies that present individual data, with respect to the function of cortical association areas.

Fear of heights: cognitive performance and postural control.

INTRODUCTION: Fear of heights, or acrophobia, is one of the most frequent subtypes of specific phobia frequently associated to depression and other anxiety disorders. Previous evidence suggests a correlation between acrophobia and abnormalities in balance control, particularly involving the use of visual information to keep postural stability. This study investigates the hypotheses that (1) abnormalities in balance control are more frequent in individuals with acrophobia even when not exposed to heights, that (2) acrophobic symptoms are associated to abnormalities in visual perception of movement; and that (3) individuals with acrophobia are more sensitive to balance-cognition interactions. METHOD: Thirty-one individuals with specific phobia of heights and thirty one non-phobic controls were compared using dynamic posturography and a manual tracking task. RESULTS: Acrophobics had poorer performance in both tasks, especially when carried out simultaneously. Previously described interference between posture control and cognitive activity seems to play a major role in these individuals. DISCUSSION: The presence of physiologic abnormalities is compatible with the hypothesis of a non-associative acquisition of fear of heights, i.e., not associated to previous traumatic events or other learning experiences. Clinically, this preliminary study corroborates the hypothesis that vestibular physical therapy can be particularly useful in treating individuals with fear of heights.

Interindividual variability in EEG correlates of attention and limits of functional mapping.

In this study, we analyzed the EEG oscillatory activity induced during a simple visual task, in search of spectral correlate(s) of attention. This task has been previously analyzed by conventional event-related potential (ERP) computation, and Slow Potentials (SPs) were seen to be highly variable across subjects in topography and generators [Basile LF, Brunetti EP, Pereira JF Jr, Ballester G, Amaro E Jr, Anghinah R, Ribeiro P, Piedade R, Gattaz WF. (2006) Complex slow potential generators in a simplified attention paradigm. Int J Psychophysiol. 61(2):149-57]. We obtained 124-channel EEG recordings from 12 individuals and computed latency-corrected peak averaging in oscillatory bursts. We used current-density reconstruction to model the generators of attention-related activity that would not be seen in ERPs, which are restricted to stimulus-locked activity. We intended to compare a possibly found spectral correlate of attention, in topographic variability, with stimulus-related activity. The main results were (1) the detection of two bands of attention-induced beta range oscillations (around 25 and 21 Hz), whose scalp topography and current density cortical distribution were complex multi-focal, and highly variable across subjects (topographic dispersion significantly higher than sensory-related visual theta induced band-power), including prefrontal and posterior cortical areas. Most interesting, however, was the observation that (2) the generators of task-induced oscillations are largely the same individual-specific sets of cortical areas active during the pre-stimulus baseline. We concluded that attention-related electrical cortical activity is highly individual-specific, and possibly, to a great extent already established during mere resting wakefulness. We discuss the critical implications of those results, in combination with results from other methods that present individual data, to functional mapping of cortical association areas.

Antidepressants and dizziness.

Despite several evidences supporting a close relationship between dizziness and anxiety symptoms, the role of antidepressants in the treatment of such conditions remains poorly explored. The high prevalence of dizziness during serotonin reuptake inhibitors discontinuation syndrome and the few reports suggesting efficacy of antidepressants in treating some vestibular disorders justify a careful investigation. Neurophysiologic studies suggest possible focus of investigation on mechanisms of drug action. Psychophysiologic studies also suggest a possible role of antidepressant drugs in improving balance control and cognitive functioning. Controlled studies involving antidepressants with selective action in different neurotransmitters systems are necessary to elucidate the complex pathophysiologic mechanisms involving emotional and balance control. For future researches, special attention must be paid to the methodology of balance evaluation and the interaction between posture control and cognitive functioning.

Reduced NAA levels in the dorsolateral prefrontal cortex of young bipolar patients.

OBJECTIVE: Converging evidence implicates prefrontal circuits in the pathophysiology of bipolar disorder. Proton spectroscopy studies performed in adult bipolar patients assessing prefrontal regions have suggested decreased levels of N-acetylaspartate (NAA), a putative marker of neuronal integrity. In order to examine whether such abnormalities would also be found in younger patients, a 1H spectroscopy study was conducted that focused on the dorsolateral prefrontal cortex of children and adolescents with bipolar disorder. METHOD: The authors examined the levels of NAA, creatine plus phosphocreatine, and choline-containing molecules in the left dorsolateral prefrontal cortex of 14 bipolar disorder patients (mean age=15.5 years, SD=3, eight female) and 18 healthy comparison subjects (mean age=17.3, SD=3.7, seven female) using short echo time, single-voxel in vivo 1H spectroscopy. Absolute metabolite levels were determined using the water signal as an internal reference. RESULTS: Bipolar patients presented significantly lower NAA levels and a significant inverse correlation between choline-containing molecules and number of previous affective episodes. No differences were found for other metabolites. CONCLUSIONS: These findings suggest that young bipolar patients have decreased NAA levels in the dorsolateral prefrontal cortex, similar to what was previously reported in adult patients. Such changes may reflect an underdevelopment of dendritic arborizations and synaptic connections. These neuronal abnormalities in the dorsolateral prefrontal cortex of bipolar disorder youth are unlikely to represent long-term degenerative processes, at least in the subgroup of patients where the illness had relatively early onset.

O processo diagnóstico nos transtornos ansiosos / The diagnostic process in anxiety disorders

A eficácia de entrevistas rápidas na correta avaliação de pacientes com transtornos de ansiedade foi avaliada em 95 atendimentos iniciais feitos por um grupo especializado no tratamento de transtornos ansiosos. As impressões diagnósticas assim obtidas foram comparadas com entrevistas longas e cuidadosas realizadas até 30 dias após a avaliação inicial. Transtorno de pânico com ou sem agorafobia foi o diagnóstico mais frequente, realizado de forma segura em 53 pacientes já na primeira entrevista. A entrevista breve, no entanto, mostrou-se ineficaz na identificação correta de sintomas depressivos, que apareceram com grande frequência na segunda consulta, sugerindo que, mesmo que o diagnóstico de transtorno ansioso pareça claro num primeiro contato rápido com o paciente, sintomas depressivos sejam especificamente explorados, mesmo que isto demande maior tempo de entrevista

O processo diagnostico nos transtornos ansiosos

A eficacia de entrevistas rapidas na correta avaliacao de pacientes com transtornos de ansiedade foi avaliadas em 95 atendimentos iniciais feitos por um grupo especializado no tratamento de transtornos ansiosos. As impressoes diagnosticas assim obtidos foram comparadas com entrevistas longas e cuidadosas realizadas ate 30 dias apos a avaliacao inicial. Transtorno de panico com ou sem agorafobia foi o diagnostico mais frequente, realizado de forma segura em 53 pacientes ja na primeira entrevista. A entrevista breve, no entanto, mostrou-se ineficaz na identificacao correta de sintomas depressivos, que apareceram com grande frequencia na segunda consulta, sugerindo que, mesmo que o diagnostico de transtorno ansioso pareca claro num primeiro contato rapido com o paciente, sintomas depressivos sejam especificamente explorados, mesmo que isto demande maior tempo de entrevistas.

Estudo eletroencefalográfico em pacientes com trastorno de pânico

Alteraçöes eletroencefalográficas foram pesquisadas em 27 pacientes com diagnóstico de transtorno do pânico e agorafobia com ataques de pânico, dad a semelhanca sisntomatológica entre ataques de pânico e certas formas de epilepsia, em especial as do lobo temporal. Näo foram encontradas alteraçöes nos registros eletroencefalográficos obtidos com a privaçäo de sono, fotoestimulaçäo e hiperventilaçäo