Reciprocity Of Human Corticolimbic Activity

The studies reviewed above delineate potential mechanisms of limbic-cortical interactions that may be crucial to understand how the human brain accomplishes the business of normal and abnormal emotion regulation. Emotional arousal accompanying the experience of intense subjective feelings in healthy subjects (Liotti et al., 2000a Damasio et al., 2000) or active episodes of major depression (Mayberg et al., 1999) as well the emotional arousal in the presence of basic drives such as air hunger,...

Neurotransmitter Imaging of the Dopamine System

The classical psychiatric disorder primarily affecting the dopaminergic system is schizophrenia. Beyond that, dopamine is also thought to play a mayor role in substance abuse and the neurobiology of addiction, as well as in Tourette syndrome. A comprehensive review summarizing the state of knowledge on the involvement of dopamine in psychiatric and neurologic disorders was recently published (Verhoeff, 1999) and, although missing the more recently acquired knowledge, it is recommended to...

References

Melatonin and the Mammalian Pineal Gland. Chapman and Hill London. Argiolas AM, Gessa GL (1991). Central Functions of Oxytocin. Neurosci Biobehav Revs 15 217-231. Bem DJ (2000). Exotic becomes erotic Interpreting the biological correlates of sexual orientation. Arch Sex Behav 29 531-548. Booth RJ, Cohen S, Cunningham A, et al. (2002). The state of the science The best evidence for the involvement of thoughts and feelings in physical health. Adv Mind-Body Med 17 2-59. Britton...

Cognitive Deficits

Cognitive impairments in depressed patients are common (Elliott, 1998). Most often affected are the domains of attention, memory, and psychomotor speed specific impairments in language, perception, and spatial abilities do not normally occur except as a secondary consequence of poor attention, motivation, or organizational abilities. Deficits are usually of moderate intensity but can become severe in prolonged or intractable depressions, adding to everyday...

Roughand Tumble PLAYJoy System

Among the genetically ingrained emotive systems of the mammalian brain, perhaps the most ignored has been the one that mediates playfulness. We can now be certain that certain mammals possess PLAY systems, largely subcortically situated, that encourage them to indulge in vigorous social engagements that probably promote socialization and the relevant forms of brain development (Panksepp, 1998a). It would be perplexing if the human brain did not contain psychobiological processes homologous to...

Neurodynamic Aspects Of Consciousness

Hebb's visionary notion in 1949 of reverberating cell assemblies was an important beginning point for a neurodynamic emphasis. Neurodynamics is thus a relatively new discipline, addressing how brain activation changes over time. The neurodynamic perspective is complementary to traditional perspectives that emphasize structures, connectivities, and neuromodulators in that it seeks to understand the time-dependent changes that occur in neuronal populations (neural network models, by comparison,...

Obsessive Compulsive Disorder

Adult OCD has been summarized in Chapter 13 of this volume. Herein we will address the childhood variant as an expression of vulnerability genes for TS and relevant brain imaging findings for this condition. All forms of OCD are characterized by recurrent, distressing, and intrusive thoughts, images, or urges to action, together with their repetitive behavioral counterparts. Usually, performance of the compulsion brings some degree of relief from the urge to action and from the anxiety...

Transcranial Magnetic Stimulation

Magnetic stimulators became commercially available in Sheffield (United Kingdom) in 1985. Transcranial magnetic stimulation (TMS) is currently an experimental technique and does not have an approved psychiatric indication. TMS is achieved by conducting a large current through a coil that is placed on the patient's scalp. A magnetic field is induced that passes freely though the skull and induces an electrical field in the cerebral cortex underlying the stimulating coil. TMS has been shown to...

Generating Emotional Feelings Through Upper Brainstemlimbic And Cortical Interactions

The combined body of evidence reported above supports a complex hierarchical view of how emotions are elaborated in the brain. For instance, the reciprocal relations in limbic and cortical regions during the imaging of emotions and cognitions in the human brain has prompted the formulation of a model of emotional regulation in which activity in neocortical regions plays an important role in the regulation of emotional states, including emotion generation, maintenance, and suppression (see Figs....

Neurotransmitter Correlates

Perhaps because many psychiatric medications affect a class of neurotransmitters called the biogenic amines (i.e., serotonin, dopamine, and norepinephrine), associations between biogenic amine function and personality disorders have received the most extensive characterization. However, a limited number of studies also address links between acetylcholinergic as well as peptidergic function and personality disorder symptoms. We review those findings below. Serotonin. The inverse relationship...

Hemispheric Lateralization in PTSD

Both Rauch et al. (1996) and Teicher and his group (2002) found marked hemispheric lateralization in PTSD subjects who were exposed either to a negative memory or to a personalized trauma script. This suggests that there is differential hemispheric involvement in the processing of traumatic memories. The right hemisphere, which developmentally comes on-line' earlier than the left hemisphere (Schore, 1994), is involved in the expression and comprehension of global nonverbal emotional...

Sleep Stress And The Restoration Of Brain And Mind Introductory Remarks

More research has been done on sleep mechanisms than any other state-control processes of the brain. We now know the locations of the major circuits that control slow-wave sleep (SWS) as well as those periodic arousals that are full of vivid emotional dreams and rapid eye movements (REM sleep). We know much about the neurophysiological changes that reflect these natural tides of the brain and the major neurochemistries that control these passages of consciousness, but rather little about the...

NE Receptor Antagonist

FDA approved for the treatment of depression in the summer of 1998, mirtazapine is unique among antidepressants by virtue of the fact that it does not inhibit the reuptake 5-HT, NE, or DA. Its primary mechanism of action relates to its potent antagonism of a2-adrenergic receptors and 5-HT2 receptors. It is also a potent antagonist of 5-HT3 and histamine H1 receptors, effects that influence its side effect profile. Mirtazapine has no effects on DA, cholinergic, or a1 -adrenergic...

Studies of Cerebral Metabolism and Blood Flow in Anxiety Disorders

A dysfunctional cortico-striato-thalamo-cortical circuitry may play an important role in this disorder (Rauch and Baxter, 1998 Rauch et al., 1998). According to this model, the primary pathology afflicts subcortical structures (striatum thalamus), which leads to inefficient gating and results in hyperactivity within the orbito-frontal cortex and also within the anterior cingu-late cortex. Compulsions are conceptualized as repetitive behaviors that are...

Psychodynamic Model of Panic Disorder

In the psychodynamic model of panic disorder, anxiety symptoms are believed to be triggered by unconscious fantasies and impulses that are experienced by the individual as unacceptable, and threaten to break through into consciousness. The anxiety also represents the failure of defense mechanisms to adequately protect against the emergence of these wishes in undisguised form. In addition, the physical symptoms of panic, as well as many other aspects of life, are a result of compromise...

Treatment Of Panic Disorder

Medications, including tricyclic antidepressants, selective serotonin reuptake inhibitors, monoamine oxidase inhibitors, and benzodiazepines, as well as cognitive-behavioral therapy (CBT) have demonstrated efficacy for treatment of panic disorder in multiple double-blind, placebo-controlled studies. Common concerns have also surfaced in some of these studies (Nagy et al., 1989 Noyes et al., 1989 1991 Pollack et al., 1993 Barlow et al., 2000). Because of the narrower definition of panic disorder...

Psychodynamic Psychotherapy for Panic Disorder

Systematic study of psychodynamic treatments for panic disorder is in its infancy. As described above, a significant minority of patients fail to respond to the more extensively empirically tested treatments, and many patients experience residual symptoms after pharmacological and cognitive-behavior treatments (Nagy et al., 1989 Noyes et al., 1989, 1991 Pollack et al., 1993 Barlow et al., 2000). Thus, attention to psychodynamic issues may potentially provide...

Longterm Outcome Of Treatment Trials For Panic Disorder

Patients with panic disorder are a highly symptomatic, help-seeking group who tend toward recurrent exacerbations of symptoms (Pollack and Otto 1997 Pollack and Marzol, 2000 Faravelli et al., 1995). It is therefore important to gauge not only the effectiveness of treatments over the short term but to ascertain their effectiveness over longer follow-up intervals. Useful data with regard to long-term outcome, however, has been limited thus far in the literature. In a review of follow-up studies...

Ultrapositivistic Psychopharmacology Era 1970present

Modern biological psychiatry started in 1952 when the French psychiatrists Jean Delay and Pierre Deniker first evaluated the efficacy of chlorpromazine (trade name Tho-razine) in a variety of psychiatric disorders and found it to be highly effective for ameliorating schizophrenic symptoms. This breakthrough was based on the recent discovery of surgeon Henri Laborit that such drugs were effective presurgical sedatives, and also potentially effective in controlling the agitation of various...

From Pathophysiology To Pathogenesis

A clear description of pathophysiological processes is essential for the generation of insights into underlying pathogenic processes. At one time, there was the hope that psychiatric disorders would turn out to be as simple as gout, where elevated uric acid levels lead to buildup at susceptible joints causing inflamed tissues and excruciating pain. Elimination of uric acid buildup (whether by blockade of synthesis with allopuri-nol or reduced ingestion of purine precursors) eliminates the...

Segregated Limbic Cortical Pathways

The available evidence suggests that limbic-cortical pathways are sufficiently segregated among different emotional systems, with some overlap in regions such as medial prefrontal cortex, insula, and cerebellar vermis (Phan et al., 2002 Damasio et al., 2000 Liotti et al., 2000a), possibly subserving common dimensions of emotion (such as arousal). The task of identifying such segregated pathways is complicated by the frequent coexistence of different basic emotions in both normal feelings and...

Framework for Origin and Neural Elaboration of Human Consciousness

Another construct that benefits from such an integrated model of limbic-cortical function emphasizing vertical control is the problem of where basic conscious awareness is represented and how it may have originated. Several lines of evidence suggest that periconscious, affective processing of emotion takes place subcortically, in areas such as the brainstem, hypothalamus, and amygdala, while cognitive appraisal of emotions takes place in the prefrontal cortex and the anterior cingulate cortex....

Dilemma Of Psychiatric Diagnostics Dsms And Beyond

Some mental disorders arise through stressful life circumstances. Others emerge more from constitutional infirmities. Nature-nurture arguments do not help us much in unraveling such intertwined complexities, unless discrete genetic differences can be discovered, as in fragile X and Williams syndrome (Chapter 14). Ultimately psychiatric thought must continue to be guided by a careful appreciation of the evolving stories of selves in action on the stage of life. Neither the brainless psychiatry...

Studies of Cerebral Metabolism and Blood Flow in Dementia

Studies with FDG PET in Alzheimer's patients revealed a typical hypometabolism in neocortical structures, mainly the parietal, frontal, and posterior temporal association cortices, that is the same areas where neuronal as well as synaptic degenerations are most severe in postmortem studies. In addition to the regional abnormalities, these patients also exhibit a global reduction of cerebral glucose metabolism. Metabolic decrease in the parieto-temporal association cortex has been recognized as...

Fragile X

Fragile X, a relatively common form of mental retardation caused by a single mutation in the long arm of the X chromosome, occurs once in every 2000 to 4000 live births. Approximately 20 percent of such children exhibit autistic symptoms. Conversely, 8 percent of males and 6 percent of females diagnosed with autism carry the fragile X abnormality. The mutation alters brain development and produces a distinctive physical, cognitive, and neuropsychiatric phenotype. Clinical symptoms are...

Restorative Effects of Sleep

As mentioned above, sleep problems are common in psychiatric disorders. Again, the most prominent example is the tendency of depressed individuals to sustain sleep poorly and to wake in the middle of the night, partly because their pituitary adrenal stress waking alarm system become active much earlier than normal (Kryger et al., 2000). Other features include an excessively rapid entry into the REM phase after sleep onset. Since sleep recruits endogenous antistress mechanisms and depression...

Prognostic Markers

In light of the described differences between responders and nonresponders with treatment, an obvious related question is whether baseline findings predict eventual treatment outcomes. Several studies have found that pretreatment metabolic activity in the rostral (pregenual) cingulate uniquely distinguishes medication responders from nonresponders (Mayberg et al., 1997), a pattern replicated in Parkinson's disease and other unipolar depressed cohorts (Kennedy et al., 2001...

Monoamine Reuptake Inhibitors

Monoamine reuptake inhibition is the most common mechanism by which antidepres-sant drugs work. Drugs with this pharmacological action include the old TCAs, the selective 5-HT reuptake inhibitors (SSRIs), and several newer drugs such as venlafax-ine, duloxetine, and reboxetine. The older drugs in this group (such as imipramine, desipramine, and amitriptyline) tend to be relatively nonselective and frequently have many active metabolites. The newer drugs tend to be highly selective for reuptake...

Loss of Arousal Regulation

Elementary self-regulation involves an interconnected collection of neural patterns that maintain bodily processes and that represent, moment by moment, the state of the organism (Damasio, 1999). The immediate response to a traumatic experience involves dysregulation of arousal, with (a) exaggerated startle response, (b) over- or under-aroused physiological and emotional responses, (c) difficulty falling or staying asleep, and (d) dysregulation of eating, with lack of attention to needs for...

How Can Disordered Personality Be Treated

Studies of physiological correlates of personality disorder symptoms cannot establish causality. They leave open the question of whether the physiological correlate leads to symptoms, whether the symptoms perturb the physiological correlate, or both. Causal evidence for a physiological effect on personality disorder symptoms might come from double-blind studies in which neurotransmitter function is selectively manipulated and changes in specific symptoms are monitored. A few relevant studies...

Hypericum and Other Alternatives

In the mid-1990s there was considerable interest in the possible use of Hypericum perforatum (St. John's Wort) as a new treatment for major depression. Numerous European studies had suggested that Hypericum had equal efficacy to standard antidepressant drugs but was safer and more tolerable (Whiskey et al., 2001). Unfortunately, two well-designed large placebo-controlled U.S. studies failed to support the efficacy of Hypericum for the treatment of major depression (Shelton et al., 2001...

Hormonal Response in Posttraumatic Stress Disorder

In a well-functioning person, stress produces rapid and pronounced hormonal responses. However, chronic and persistent stress inhibits the effectiveness of the stress response and induces desensitization. PTSD develops following exposure to events that overwhelm the individual's capacity to reestablish homeostasis. Instead of returning to baseline, there is a progressive kindling of the individual's stress response. Initially only intense stress is accompanied by the release of endogenous,...

Neuroimaging of Sadness

A large number of imaging studies have reported neural correlates of the internal experience of sadness provoked in healthy individuals. This work has been largely motivated by its relevance for understanding clinical depression. Considerable variability in the findings can be explained by the use of widely different induction methods (externally driven or internally driven, Reiman et al., 1997) and the cognitive demands associated with the generation of the emotional state (Liotti et al.,...

Sexual Urges Regrets and Remedies

The different gender identities of the brain, engraved during fetal development, are activated by maturing gonadal steroid secretions during puberty. To have a male brain means many things. The enlarged SDN-POA nuclei of males promotes male-typical sexual urges via the activational effects of T, and experimental damage to those brain areas diminishes male sexual behavior more than that of females. In contrast, female receptivity is dependent much more on circuits within the ventromedial...

Case Study 32 Bilateral ILN LesionA Progressive Walk Through of the Taxonomy of Disorders of Consciousness1

Www Ant Commissure

This patient was a male in his middle forties brought to the hospital after he could not be woken up normally in the morning. He was in a low-grade coma, with double incontinence, punctuated by brief periods of restlessness. His clinical and laboratory examinations were generally unremarkable with a blood pressure of 150 90, normal electrocardiogram, and normal metabolic studies. On neurological exam he had narrow pupils nonreactive to light, with the eyes remaining in midposition. Reactions to...

Hippocampus in PTSD

The hippocampus plays a significant role in the capacity to consciously recall a previous life event, that is, in declarative memory. Its role in emotion and affective style has only recently started to be explored. The hippocampus plays a significant role in context-dependent memory (O'Keefe and Nadel Fanselow, 2000). When an animal is exposed to a cue-conditioning procedure, where a discrete cue is paired with an aversive outcome, the animal also learns to associate the context in which the...

Side Effects of Antidepressants

The pharmacological properties that underlie the side effects of antidepressants have been better characterized than the properties responsible for the therapeutic effects. While newer antidepressants have provided little additional therapeutic efficacy compared to older drugs, they are unequivocally safer and much better tolerated. In general, side effects can be divided into those that occur early in the course of treatment and those that emerge gradually over continuous use. Frequently...

Limbic Cortical Dysregulation Model of Depression

Frontal And Posterior Cortical Network

In an attempt to synthesize the findings described in the previous sections, regions with known anatomical interconnections that also show consistent changes across studies are summarized in a simplified schematic model illustrated in Fig. 7.5 (updated from Mayberg, 1997). Failure of this regional network is hypothesized to explain Figure 7.5. Limbic-cortical dysregulation model. Cortical compartment limbic compartment subcortical compartment Arrows relevant anatomical connections. Numbers...

Disintegration of Experience Accompanying PTSD

In a series of studies we demonstrated that memories of trauma initially tend to have few autobiographical elements When PTSD patients have their flashbacks, the trauma is relived as isolated sensory, emotional, and motoric imprints, without much of a storyline. We have shown this in victims of childhood abuse (van der Kolk and Fisler, 1995), assaults, and accidents in adulthood (van der Kolk et al., 1997) and in patients who gained awareness during surgical procedures (van der Kolk et al.,...

Attention Deficit Hyperactivity Disorder

The validity of ADHD as a clinical diagnosis has long excited debate and controversy in both lay and scientific circles. An expert panel convened and sponsored by the National Institutes of Health recently reviewed and documented extensively within a Consensus Statement the validity of ADHD as a clinical disorder, its public health importance for children and families, and the effectiveness of its treatments (NIH, 2000). Among their many conclusions, the conference panelists concurred that ADHD...

Basic Models Of The Etiology Of Panic Disorder Neurophysiological Models

Several lines of evidence suggest a neurophysiological basis for panic disorder, including genetic studies. The illness's medication responsiveness discussed in the treatment section below has been interpreted to imply a neurophysiological etiology. Evidence for a genetic basis for panic disorder has also been derived from studies of twins that demonstrate a higher rate of concordance for panic in monozygotic than dizygotic twins Torgersen, 1983, Kendler et al., 1993 Skre et al., 1993 ....