Post-traumatic stress disorder: a right temporal lobe syndrome?

In a recent paper (Georgopoulos et al 2010 J. Neural Eng. 7 016011) we reported on the power of the magnetoencephalography (MEG)-based synchronous neural interactions (SNI) test to differentiate post-traumatic stress disorder (PTSD) subjects from healthy control subjects and to classify them with a high degree of accuracy. Here we show that the main differences in cortical communication circuitry between these two groups lie in the miscommunication of temporal and parietal and/or parieto-occipital right hemispheric areas with other brain areas. This lateralized temporal-posterior pattern of miscommunication was very similar but was attenuated in patients with PTSD in remission. These findings are consistent with observations (Penfield 1958 Proc. Natl Acad. Sci. USA 44 51-66, Penfield and Perot 1963 Brain 86 595-696, Gloor 1990 Brain 113 1673-94, Banceaud et al 1994 Brain 117 71-90, Fried 1997 J. Neuropsychiatry Clin. Neurosci. 9 420-8) that electrical stimulation of the temporal cortex in awake human subjects, mostly in the right hemisphere, can elicit the re-enactment and re-living of past experiences. Based on these facts, we attribute our findings to the re-experiencing component of PTSD and hypothesize that it reflects an involuntarily persistent activation of interacting neural networks involved in experiential consolidation.

The synchronous neural interactions test as a functional neuromarker for post-traumatic stress disorder (PTSD): a robust classification method based on the bootstrap.

Traumatic experiences can produce post-traumatic stress disorder (PTSD) which is a debilitating condition and for which no biomarker currently exists (Institute of Medicine (US) 2006 Posttraumatic Stress Disorder: Diagnosis and Assessment (Washington, DC: National Academies)). Here we show that the synchronous neural interactions (SNI) test which assesses the functional interactions among neural populations derived from magnetoencephalographic (MEG) recordings (Georgopoulos A P et al 2007 J. Neural Eng. 4 349-55) can successfully differentiate PTSD patients from healthy control subjects. Externally cross-validated, bootstrap-based analyses yielded >90% overall accuracy of classification. In addition, all but one of 18 patients who were not receiving medications for their disease were correctly classified. Altogether, these findings document robust differences in brain function between the PTSD and control groups that can be used for differential diagnosis and which possess the potential for assessing and monitoring disease progression and effects of therapy.

Transmission of electric and magnetic foetal cardiac signals in a case of ectopia cordis: the dominant role of the vernix. caseosa.

Foetal electrocardiograms (fECGs) and foetal magnetocardiograms (fMCGs) were recorded in the 26th, 29th and 31st weeks of gestation from a foetus with ectopia cordis-a rare condition in which the heart lies outside the chest wall. This provided an opportunity to study foetal cardiograms uninfluenced by the insulating effects of the foetal skin and vernix caseosa. The fECG of the ectopia cordis foetus was striking. Unlike recordings from age-matched normal foetuses, recordings from this subject had very high signal-to-noise ratio and showed no anomalous signal transmission properties. In contrast, fMCGs recorded from the ectopia cordis foetus and normal foetuses were largely similar. Both showed high signal-to-noise ratio and signal transmission properties consistent with volume conduction. The findings corroborate the hypothesis that high foetal skin resistance due primarily to the vernix caseosa is responsible for the low amplitude and anomalous transmission properties of the normal fECG, and demonstrate that the fMCG is relatively insensitive to conductivity inhomogeneities.

Assessment of fetal rhythm in complete congenital heart block by magnetocardiography.

We report high precision assessment of fetal rhythm in utero in a case of isolated congenital complete heart block using fetal magnetocardiography. The recordings reveal a remarkably strong tendency for the atria and ventricles to synchronize, which is manifested by the continual presence of ventriculophasic sinus arrhythmia and frequent episodes of accrochage and isorhythmic AV dissociation.

[School climate and psychological symptoms--correlations between school stress, sense of coherence and physical-psychological impairment in high school students]. / Unterrichtsklima und Symptombildungen. Zusammenhänge zwischen Schulstress, Kohärenzgefühl und physischen/psychischen Beschwerden von Gymnasiasten.

The research project "Health Promotion and School Culture" investigated associations between school climate, school stress, sense of coherence and physical/psychological symptoms in high school students. 565 students, aged 15 to 20 from two high schools (Gymnasium) in the canton of Zurich took part in the study. Assessment measures included questionnaires on school climate (FUK 7-10), school stress, sense of coherence (SOC-13), physical (GBB-24) and psychological symptomatology (SCL-90-R, ADS-K). 166 of the students also participated in a standardised psychiatric interview (DIA-X). Results revealed significant associations between 1. school climate and school stress, 2. biographical risk and protective factors and sense of coherence, 3. school stress and sense of coherence, and 4. school-stress and sense of coherence on the one side and symptomatology on the other. The results are discussed in terms of Karasek and Theorell's (1990) three dimensional stress model. Finally, the need for health promotion in school, especially in classes of high school, is addressed.

Noninvasive in utero assessment of PR and QRS intervals from the fetal magnetocardiogram.

Fetal cardiac waveform intervals were assessed from fetal magnetocardiogram (FMCG) recordings taken from 59 pregnant women at 17-41 weeks gestation. Beyond 27 weeks' gestation PR and QRS intervals, measured from averaged waveforms, could be obtained from all subjects; however, prior to 21 weeks' gestation the success rate was 50% or less due to low signal-to-noise ratio. QT interval could not be assessed accurately in most subjects. Weak, but statistically significant, correlations with gestational age were found for PR interval (n = 145, R2 = 0.033, P = 0.028) and QRS interval (n = 145, R2 = 0.140, P < 0.0005). Abnormal waveform morphology was documented in several patients with cardiac malformations.

Characteristics of psychiatric emergencies and the choice of intervention strategies.

The aim of this study was to describe the sociodemographic, contextual and clinical characteristics of a consecutive sample of 3611 psychiatric emergency visits to a Swiss university general hospital, and to investigate their associations with different intervention strategies. All consultations were documented by a questionnaire covering sociodemographic and diagnostic data as well as information about the consultation and the disposition decision. In a total of 1093 cases (30.3%) no further emergency intervention was required, in 1287 cases (35.6%) patients were offered out-patient crisis intervention, and in 1231 cases (34.1%) patients were hospitalized. Social integration and the presence of an easily recognizable precipitating stressor were associated with referral to out-patient crisis intervention. In logistic regression analyses, referral by the police or by health professionals (in contrast to self-referral or referral by relatives), current diagnosis of a psychotic disorder, and previous hospitalizations were the most powerful predictors of hospitalization. The presence of a precipitating stressor related to the patient's social network decreased the likelihood of hospitalization. The findings indicate a need for facilities offering brief admission, allowing for extended emergency assessments.

Atrial and ventricular fetal heart rate patterns in isolated congenital complete heart block detected by magnetocardiography.

Atrial and ventricular fetal heart rate tracings from a patient with isolated congenital complete heart block treated with dexamethasone showed a remarkable degree of correlation and greater reactivity for the ventricular than the atrial fetal heart rate. Ventriculophasic sinus arrhythmia was present continually in the atrial fetal heart rate tracings.

[Sexual dysfunctions with antidepressive drugs--results of a physician survey]. / Sexuelle Dysfunktionen unter Antidepressiva--Ergebnisse einer Arztebefragung.

In a survey throughout Switzerland 7.455 general practitioners and psychiatrists were mailed a questionnaire addressing topics in sexual medicine with regard to antidepressant medication, 940 completed questionnaires (response rate 12.5%) were evaluated. 77.6% of the responders agree that knowledge in sexual medicine is important or very important. Only one half of the physicians judge their competence in sexual medicine as fair or good. There are differences in sexual history taking between general practitioners and psychiatrists; the latter addressing more frequently sexual medicine related questions. Sexual dysfunction before and during therapy with antidepressants is observed less frequently than reported in other studies. Only half of the physicians counsel their patients when sexual dysfunction occur during therapy. Treatment strategies of antidepressant induced sexual side effects are rarely seen. The results emphasize the importance of knowledge and competence in sexual medicine for general practitioners and psychiatrists, both showing interest in continuing education on this topic.

Association of fetal junctional rhythm and respiratory arrhythmia detected by magnetocardiography.

Magnetocardiographic recordings from a fetus at 34 weeks' gestation with a complex heart malformation revealed an unusual fetal arrhythmia, where the rhythm was observed to alternate between extended periods of sinus and junctional rhythms. Fetal heart rate measurement showed that the junctional rhythm was strongly associated with respiratory arrhythmia. We hypothesize that changes in autonomic balance due to the onset and cessation of fetal breathing movements were largely responsible for the rhythm alternations. To our knowledge this is the first report of a fetal junction rhythm and the first observation of fetal respiratory arrhythmia during nonsinus rhythm.

Reference to psychiatric consultation in the discharge letter of general hospital inpatients.

OBJECTIVE: The consultation-liaison psychiatrist is frequently confronted with the consultees' lack of adherence to the consultants' recommendations. The aim of this study was to investigate the question if and how the C-L psychiatrist's diagnoses and recommendations are mentioned in the consultee's final medical report and thus communicated to the physician responsible for the aftercare. METHOD: Psychiatric consult reports of a consecutive sample of 144 patients of the departments of neurology, internal medicine, and gynecology and obstetrics at the University Hospital of Zurich were compared to the content of the respective discharge letters. RESULTS: Some kind of information about the psychiatric consultation was found in 84 percent of the discharge letters (consultation as such: 71.5%; psychiatric diagnosis: 66.7%; recommendations: 76.2%. Length of stay, timing of the consultation, length of the consult report and type of recommendation correlated significantly with the mention of psychiatric aspects in the final medical report. Psychotropic medication and psychiatric hospitalization were the recommendations most reliably mentioned. CONCLUSIONS: Psychiatric consultation seems to be taken seriously by attending physicians and is communicated in a high percentage to the physicians responsible for the aftercare. Nevertheless, in patients where active post-discharge management is needed the C-L psychiatrist should actively manage referral to outpatient settings and/or instruct primary care providers.

Fetal auditory evoked responses detected by magnetoencephalography.

Magnetoencephalography was used to noninvasively record auditory evoked responses from fetuses in utero at 34 to 37 weeks' gestation. The recordings were similar to auditory evoked responses from neonates at age 7 to 14 days.

Foetal magnetocardiogram amplitude oscillations associated with respiratory sinus arrhythmia.

We show that oscillations at foetal breathing frequencies observed in foetal heart rate (FHR) tracings obtained from foetal magnetocardiogram (FMCG) recordings are often accompanied by synchronous modulation of FMCG signal amplitude. This implies an association between the FHR oscillations and foetal chest wall movements, corroborating the hypothesis that the oscillations are due to respiratory sinus arrhythmia.

[The Swiss population and drug problems: perception of the problems and proposals for solutions]. / Die Schweizer Bevölkerung und das Drogenproblem: Problemsicht und Lösungsvorschläge.

The aim of this study is to investigate which problems in relation with drug abuse are considered to be the most important by the Swiss population and which measures do they support to reduce them. Base for this study are the results of a representative telephone survey realized in october 1991 with 1004 Swiss residents. People are mostly concerned with problems related to the danger for youth and those concerning public order but also with the human condition of addicts. Drug addicts are considered as people who have lost the sense of live, as sick but also as dangerous and less truthful. Supported are overall prevention, offers for therapies, the repression of trafficking and money-laundering but not of drug users as well as measures going in the direction of harm-minimisation (shooting rooms, medical prescription of drugs). Younger people, those with higher education and the german-speaking population have a more positive view of drug addicts and support measures in the sense of harm-minimisation. Elder people and the french-speaking population have a rather negative view of drug addicts and don't favour measures for harm-minimisation.