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INTRODUCTION: Suicide is a tragic outcome with devastating consequences. In 2018, Scotland experienced a 15% increase in suicide from 680 to 784 deaths. This was marked among young people, with an increase of 53% in those aged 15-24, the highest since 2007. Early intervention in those most at risk is key, but identification of individuals at risk is complex, and efforts remain largely targeted towards universal suicide prevention strategies with little evidence of effectiveness.Recent evidence suggests childhood adversity is a predictor of subsequent poor social and health outcomes, including suicide. This protocol reports on methodology for harmonising lifespan hospital contacts for childhood adversity, mental health, and suicidal behaviour. This will inform where to 1) focus interventions, 2) prioritise trauma-informed approaches, and 3) adapt support avenues earlier in life for those most at risk. METHODS: This study will follow a case-control design. Scottish hospital data (physical health SMR01; mental health SMR04; maternity/birth record SMR02; mother's linked data SMR01, SMR04, death records) from 1981 to as recent as available will be extracted for people who died by suicide aged 10-34, and linked on Community Health Index unique identifier. A randomly selected control population matched on age and geography at death will be extracted in a 1:10 ratio. International Classification of Disease (ICD) codes will be harmonised between ICD9-CM, ICD9, ICD10-CM and ICD10 for childhood adversity, mental health, and suicidal behaviour. RESULTS: ICD codes for childhood adversity from four key studies are reported in two categories, 1) Maltreatment or violence-related codes, and 2) Codes suggestive of maltreatment. 'Clinical Classifications Software' ICD codes to operationalise mental health codes are also reported. Harmonised lifespan ICD categories were achieved semi-automatically, but required labour-intensive supplementary manual coding. Cross-mapped codes are reported. CONCLUSION: There is a dearth of evidence about touchpoints prior to suicide. This study reports methods and harmonised ICD codes along the lifespan to understand hospital contact patterns for childhood adversity, which come to the attention of hospital practitioners. KEY WORDS: Childhood Adversity, Adverse Childhood Experiences, Mental Health, Self-harm, Suicide, Suicidality, Violence, Hospital episodes, Routine Data, Data Linkage, Study Protocol.
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OBJECTIVE: Patient activation can be measured using the Patient Activation Measure (PAM) developed by Hibbard et al., however, little is known about the uses of the PAM in research and in practice. This study aims to explore its differing utility in four UK exemplar sites. METHODS: Data from four exemplars in a range of health settings with people living with long-term conditions (i.e. stroke or COPD) were evaluated. PAM scores were described and explored in relation to clinical and sociodemographic variables and outcome measures. RESULTS: PAM scores illustrated that most with COPD or stroke reported PAM levels of 3 or 4, indicating that they are engaging, but may need help to sustain their scores. The exemplars illustrate the utility of, and potential issues involved in, using PAM as a process/outcome measure to predict activation and the effectiveness of interventions, and as a tool to inform tailoring of targeted interventions. CONCLUSIONS: The PAM tool has been shown to be useful as an outcome measure, a screening tool to tailor education, or a quality indicator for delivery of care. PRACTICE IMPLICATIONS: However good demographic and patient history are needed to substantiate PAM scores. Further work is needed to monitor PAM prospectively.
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Evaluación del Resultado de la Atención al Paciente , Participación del Paciente/métodos , Psicometría/instrumentación , Enfermedad Pulmonar Obstructiva Crónica/terapia , Autocuidado/psicología , Encuestas y Cuestionarios/estadística & datos numéricos , Enfermedad Crónica , Estudios Transversales , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Participación del Paciente/psicología , Atención Dirigida al Paciente , Estudios Prospectivos , Calidad de Vida , Reproducibilidad de los Resultados , Estudios Retrospectivos , Encuestas y Cuestionarios/normas , Reino UnidoRESUMEN
PURPOSE: To examine the impact of severity of global cognitive impairment on SPECT-neuropsychology correlations, we correlated a verbal memory test with brain perfusion in patients with very mild Alzheimer's disease (AD), taking into account the Mini-Mental State Examination (MMSE) score as an index of global cognitive impairment. METHODS: Twenty-nine outpatients (mean age 78.2+/-5.5 years) affected by very mild, probable AD underwent brain SPECT with 99mTc-ethylcysteinate dimer and a word list learning test. SPM99 was used for voxel-based correlation analysis after normalisation to mean cerebellar counts (height threshold: p<0.01). In a first analysis, only age and years of education were inserted as nuisance covariates, while in a second analysis the MMSE score was inserted as well. RESULTS: In the first analysis, two clusters of significant correlation were found in both hemispheres, mainly including regions of the right hemisphere, such as the inferior parietal lobule, the middle temporal gyrus and the posterior cingulate. Significant correlation in the left hemisphere was observed in the lingual lobule, the parietal precuneus and the posterior cingulate. After taking into consideration the MMSE, the largest cluster of correlation was found in the left hemisphere, including the parietal gyrus angularis, the posterior cingulate and the middle temporal gyrus. CONCLUSION: The wide differences observed between the correlations achieved with and without taking into account the MMSE score indicate that severity of global cognitive impairment should be considered when searching for brain perfusion-neuropsychology correlations. In the present case, this strategy resulted in correlations that more closely matched neuropsychological models of verbal memory deficit.
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Enfermedad de Alzheimer/diagnóstico , Trastornos del Conocimiento/diagnóstico , Trastornos de la Memoria/diagnóstico , Pruebas Neuropsicológicas , Tomografía Computarizada de Emisión de Fotón Único/métodos , Anciano , Anciano de 80 o más Años , Enfermedad de Alzheimer/clasificación , Enfermedad de Alzheimer/complicaciones , Enfermedad de Alzheimer/psicología , Trastornos del Conocimiento/etiología , Trastornos del Conocimiento/psicología , Femenino , Humanos , Masculino , Trastornos de la Memoria/etiología , Trastornos de la Memoria/psicología , Índice de Severidad de la Enfermedad , Estadística como AsuntoRESUMEN
Telithromycin was the first ketolide to be approved in Europe and is in the approval process in the United States. It is structurally related to the macrolides; it has a keto group in the C3 position rather than cladinose. A carbamate group is also present at C11-C12. As a result, it has a reduced induction of the MLSB resistance mechanism (erm gene), it is not affected by the flux mechanism (mef gene), it has higher stability at low pH and has increased intrinsic activity compared with clarithromycin and azithromycin. Phase III studies have shown telithromycin to be effective in the treatment of community-acquired upper and lower respiratory tract infections. Its long half-life allows for oral once-daily dosing. From a pharmacokinetic point of view, its activity has been shown to be AUC(24h)/MIC dependent. It is active against bacteria involved in atypical pneumonia. The aim of our study was to determine the activity of telithromycin in isolates with defined resistance phenotypes obtained from community-acquired respiratory tract infections. Twelve centers in Argentina, Chile, Paraguay and Uruguay participated in the study. Each center collected three strains of the following species and resistance patterns: S. pyogenes, S. pneumoniae with resistance or intermediate resistance to oxacillin, erythromycin-resistant S. pneumoniae, clindamycin-resistant S. pneumoniae, oxacillin-susceptible S. aureus, erythromycin-resistant S. aureus, ampicillin-susceptible and -resistant M. catarrhalis and H. influenzae. Agar diffusion susceptibility tests with NeoSensitabs tablets (Rosco, Denmark) were carried out at each center. Isolates were sent to the coordinating center, where MICs were determined using agar microdilution and the Seppala test was used to determine the resistance mechanism to macrolides. The 327 isolates received were susceptible to telithromycin. Eighty percent of the erythromycin-resistant S. pneumoniae isolates were likely resistant due to a flux mechanism, and all those resistant to clindamycin were resistant due to the erm inducible mechanism. Only 20 out of 36 strains of clindamycin-resistant S. pneumoniae and 25 of the 36 ampicillin-resistant H. influenzae strains could be collected, thereby showing that these resistance patterns are less common in the participating South American countries than in other areas. The in vitro activity of telithromycin suggests that it is a promising antibacterial drug for the treatment of community-acquired respiratory tract infections.
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Antibacterianos/farmacología , Cetólidos , Macrólidos , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Infecciones Comunitarias Adquiridas/tratamiento farmacológico , Farmacorresistencia Microbiana , Humanos , Pruebas de Sensibilidad Microbiana , Fenotipo , Infecciones del Sistema Respiratorio/microbiología , América del SurRESUMEN
La telitromicina es el primer cetólido aprobado en Europa y en vías de aprobación en Estados Unidos. Su estructura deriva de los macrólidos. Presenta en C3 un grupo ceto en lugar de cladinosa y un sustituyente unido a carbamato en C11-C12. Como consecuencia, tiene menor capacidad de inducción del mecanismo de resistencia MLSB (gen erm), no resulta afectado por el mecanismo de flujo (gen mef), tiene mayor estabilidad en el medio ácido gástrico y presenta una acción intrínseca aumentada en relación a claritromicina y azitromicina. La telitromicina ha demostrado su eficacia en estudios de fase III en infecciones respiratorias de vías altas y bajas adquiridas en la comunidad. Su larga vida media le permite ser administrada por vía oral en una sola dosis diaria. Bajo el punto de vista farmacodinámico se ha demostrado que su actividad es dependiente del cociente AUC24h/CMI. Tiene actividad frente a bacterias productoras de neumonías atípicas. Nuestro interés fue determinar su actividad en cepas seleccionadas según su fenotipo de resistencia, aisladas de infecciones respiratorias. El estudio incluyó 12 centros del Cono Sur Americano. Cada uno de ellos recolectó tres cepas de cada una de las siguientes especies y resistotipos: S. pyogenes, S. pneumoniae resistente o con resistencia intermedia a oxacilina, S. pneumoniae resistente a eritromicina, S. pneumoniae resistente a clindamicina, S. aureus sensible a oxacilina, S. aureus resistente a eritromicina, M. catarrhalis y H. influenzae sensible y resistente a ampicilina. En cada centro se determinó la sensibilidad a diversos antibacterianos por el método de difusión con tabletas NeoSensitabs (Rosco, Dinamarca), y en el Centro Coordinador se determinó la CMI por macrodilución en agar, así como el mecanismo de resistencia a macrólidos por el test de Seppala. Las 327 cepas recibidas fueron sensibles a telitromicina. El 80 por ciento de las cepas de S. pneumoniae resistentes a eritromicina fue resistente, probablemente debido al mecanismo de flujo, y todas las resistentes a la clindamicina lo fueron por erm inducible. Sólo 20 de 36 cepas de S. pneumoniae resistentes a clindamicina pudieron ser recuperadas, así como 25 de 36 H. influenzae resistentes a ampicilina, demostrando que estos resistotipos son menos frecuentes en el Cono Sur Americano que en otras áreas. La telitromicina se presenta como un antibacteriano prometedor para el tratamiento de las infecciones respiratorias adquiridas en la comunidad (AU)
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Humanos , Macrólidos , América del Sur , Infecciones Comunitarias Adquiridas , Fenotipo , Infecciones del Sistema Respiratorio , Antibacterianos , Farmacorresistencia Microbiana , Pruebas de Sensibilidad MicrobianaRESUMEN
BACKGROUND: the effect of single-dose and long-term cholinergic enhancement with tacrine on regional cerebral perfusion was examined in patients with Alzheimer's disease using single-photon emission tomography (SPET). METHOD: 23 patients with probable Alzheimer's disease (DSM-III-R and NINCDS-ADRDA criteria) were scanned before and after a single oral dose of tacrine at the start of the study and again after 12 weeks of randomized, double-blind treatment with tacrine or placebo, using high resolution (99m)Tc-Exametazime SPET. Patients also underwent neuropsychological testing with the CAMCOG, the Mini-Mental State Examination and the Rivermead Behavioural Memory Test before and after 12 weeks of treatment. RESULTS: occipital count ratios in all regions of interest declined by 3% over 12 weeks, indicating a progression of the disease. Acute tacrine challenge resulted in a 16% increase in the superior frontal and a 11% decrease in the anterior temporal cortex. The acute effects of tacrine were modified by 12 weeks of treatment, particularly in the medial frontal (cingulate) cortex where active treatment was associated with a reduced acute tacrine response. There were no changes in cognitive function associated with active treatment. CONCLUSION: the study demonstrates the sensitivity of cerebral perfusion measures to changes during acute and medium-term tacrine treatment.
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BACKGROUND: The detailed effects of mercury poisoning on cognitive function, brain anatomy and regional brain function are largely unknown. We report the case of a 38-year-old man who was exposed to toxic levels of inorganic mercury. METHOD: Four years after exposure, the patient was assessed using magnetic resonance imaging (MRI), single-photon emission computerised tomography (SPECT) and detailed neuropsychological evaluation. RESULTS: The patient developed a myriad of physical and psychiatric complaints, including stomatitis, muscle spasm, tremor, skin rash and the psychiatric syndrome known as 'erythism' (Mad Hatter's disease). Neuropsychological evaluation revealed marked and significant deficits of attention concentration, particularly when under time pressure. The MRI scan was unremarkable; however, SPECT revealed hypermetabolism of the posterior cingulate CONCLUSIONS: Mercury poisoning appeared to result in a dysregulation of posterior cingulate cortex, which was associated with attention/concentration deficits and marked anxiety/agitation.
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Intoxicación por Mercurio/psicología , Enfermedades Profesionales/inducido químicamente , Trastornos Relacionados con Sustancias/psicología , Adulto , Atención/efectos de los fármacos , Encéfalo/efectos de los fármacos , Encéfalo/patología , Metabolismo Energético/efectos de los fármacos , Fungicidas Industriales/envenenamiento , Giro del Cíngulo/efectos de los fármacos , Giro del Cíngulo/patología , Humanos , Imagen por Resonancia Magnética , Masculino , Recuerdo Mental/efectos de los fármacos , Intoxicación por Mercurio/diagnóstico , Examen Neurológico/efectos de los fármacos , Enfermedades Profesionales/diagnóstico , Enfermedades Profesionales/psicología , Compuestos de Fenilmercurio/envenenamiento , Trastornos Relacionados con Sustancias/diagnóstico , Tomografía Computarizada de Emisión de Fotón ÚnicoRESUMEN
Twelve patients with obsessive-compulsive disorder (OCD) were investigated at rest using single photon emission computerized tomography with 99mTc-exametazime. The uptake of 99mTc-exametazime was expressed relative to calcarine/occipital cortex. Patients were matched for drug treatment with 12 patients with a major depressive episode and the patient groups were compared with a control group. Significant bilateral decreases in tracer uptake were confined to basal ganglia in the OCD group. There was a paradoxical positive correlation between anxiety ratings and tracer uptake to basal ganglia in the OCD group. The findings confirm that the functional topography of OCD implicates altered function in the basal ganglia.
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Encéfalo/diagnóstico por imagen , Trastorno Depresivo/diagnóstico por imagen , Trastorno Obsesivo Compulsivo/diagnóstico por imagen , Tomografía Computarizada de Emisión de Fotón Único , Adulto , Trastornos de Ansiedad/diagnóstico por imagen , Trastornos de Ansiedad/tratamiento farmacológico , Trastornos de Ansiedad/fisiopatología , Nivel de Alerta/efectos de los fármacos , Nivel de Alerta/fisiología , Ganglios Basales/diagnóstico por imagen , Ganglios Basales/efectos de los fármacos , Ganglios Basales/fisiopatología , Encéfalo/efectos de los fármacos , Encéfalo/fisiopatología , Mapeo Encefálico , Corteza Cerebral/diagnóstico por imagen , Corteza Cerebral/efectos de los fármacos , Corteza Cerebral/fisiopatología , Trastorno Depresivo/tratamiento farmacológico , Trastorno Depresivo/fisiopatología , Dominancia Cerebral/efectos de los fármacos , Dominancia Cerebral/fisiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trastorno Obsesivo Compulsivo/tratamiento farmacológico , Trastorno Obsesivo Compulsivo/fisiopatología , Compuestos de Organotecnecio , Oximas , Psicotrópicos/uso terapéutico , Exametazima de Tecnecio Tc 99mRESUMEN
The effect of the paced auditory serial addition test (PASAT) on the regional uptake of 99mTc-exametazime was determined by single photon emission computed tomography. Twenty insulin-treated diabetic outpatients were scanned at rest and during the performance of the PASAT task using split-dose injection of tracer. When resting and activation scans were compared there were significant decreases in tracer uptake in the right anterior cingulate and left posterior cingulate areas during PASAT activation. The findings are compared with previous studies which had implicated the anterior cingulate area in the mechanisms of attention in humans and other animals. The potentially confounding role of anxiety during attentional tasks is discussed.
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Nivel de Alerta/fisiología , Atención/fisiología , Giro del Cíngulo/irrigación sanguínea , Solución de Problemas/fisiología , Tomografía Computarizada de Emisión de Fotón Único , Adulto , Ansiedad/diagnóstico por imagen , Glucemia/metabolismo , Encéfalo/irrigación sanguínea , Encéfalo/diagnóstico por imagen , Mapeo Encefálico , Diabetes Mellitus Tipo 1/diagnóstico por imagen , Dominancia Cerebral/fisiología , Femenino , Giro del Cíngulo/diagnóstico por imagen , Humanos , Hipoglucemia/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Compuestos de Organotecnecio , Oximas , Tiempo de Reacción/fisiología , Flujo Sanguíneo Regional/fisiología , Aprendizaje Seriado/fisiología , Exametazima de Tecnecio Tc 99mRESUMEN
Sixteen patients with primary brain tumours were examined on average eight years after treatment with surgery or whole brain irradiation using standard clinical assessment, CT, a neuropsychological test battery, and single photon emission CT (SPECT) with 99mTc-exametazime. Seventeen lesions were discovered on inspection of SPECT images, 11 with x-ray CT. Quantitative assessment of tracer uptake compared with 16 matched healthy volunteers was consistent with the presence of lesions. Measurement of uptake in brain regions of the hemisphere not containing the primary tumour still showed significant reductions in patients. This may be due to remote direct effects of the tumour or, more likely, to the whole brain irradiation received. Psychometric performance on most tests was significantly impaired in the patient group and was correlated with abnormalities of tracer uptake to relevant brain regions.
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Encefalopatías/diagnóstico , Encefalopatías/etiología , Neoplasias Encefálicas/complicaciones , Neoplasias Encefálicas/terapia , Irradiación Craneana/efectos adversos , Tomografía Computarizada de Emisión de Fotón Único , Adulto , Cuidados Posteriores , Encefalopatías/fisiopatología , Encefalopatías/psicología , Neoplasias Encefálicas/mortalidad , Estudios de Casos y Controles , Craneotomía , Femenino , Humanos , Masculino , Análisis por Apareamiento , Persona de Mediana Edad , Pruebas Neuropsicológicas , Compuestos de Organotecnecio , Oximas , Psicometría , Desempeño Psicomotor , Sobrevivientes , Exametazima de Tecnecio Tc 99mRESUMEN
Chronic hyperglycaemia and recurrent severe hypoglycaemia have both been implicated as causing cerebral damage in patients with diabetes. Although cognitive dysfunction and intellectual impairment have been demonstrated in patients with recurrent severe hypoglycaemia, structural correlates have not been described, and it is not known whether specific functional changes occur in the brains of affected patients. Regional cerebral blood flow was estimated by SPECT with 99mTechnetium Exametazime in 20 patients with IDDM. Ten patients had never experienced severe hypoglycaemia and 10 had a history of recurrent severe hypoglycaemia. Patient results were compared with 20 age- and sex-matched healthy volunteers. We observed differences between the two patient groups and the control group. Tracer uptake was greater in diabetic patients in the superior pre-frontal cortex. This effect was particularly pronounced in the group who had a history of previous severe hypoglycaemia. Patients with a history of recurrent hypoglycaemia also had a relative reduction in tracer uptake to the calcarine cortex. This suggests an alteration in the pattern of baseline regional cerebral blood flow in diabetic patients with frontal excess and relative posterior reduction in cerebral blood flow.
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Circulación Cerebrovascular/fisiología , Diabetes Mellitus Tipo 1/fisiopatología , Hipoglucemia/fisiopatología , Adulto , Análisis de Varianza , Cognición/fisiología , Diabetes Mellitus Tipo 1/psicología , Femenino , Humanos , Hipoglucemia/psicología , Masculino , Persona de Mediana Edad , Compuestos de Organotecnecio , Oximas , Recurrencia , Exametazima de Tecnecio Tc 99m , Tomografía Computarizada de Emisión de Fotón ÚnicoRESUMEN
The effects upon regional brain function of infusing either saline or clonidine (1.5 microgram/kg) has been examined in 18 patients with alcoholic Korsakoff's psychosis using 99mTc-hexamethylpropyleneamineoxime (99mTc-HMPAO or 99mTc-Exametazime) and Single Photon Emission Tomography (SPET or SPECT). The hypothesis tested was that frontal lobe function would be increased by adrenoceptor stimulation. This was confirmed by an increase in the uptake of 99mTc-Exametazime into anterior cingulate regions of the frontal lobes. Patients were scanned before and after saline or clonidine infusion during performance of a verbal fluency task. There was a significantly increased performance of verbal fluency in patients given clonidine. This effect was variable and could not be unequivocably distinguished from increases in performance in the saline treated group. Nevertheless, the increase in neuropsychological performance was also correlated with increased function in left dorsolateral frontal cortex within the clonidine treated group. An exploratory examination of other brain areas suggested that relative increases in posterior cingulate cortex and changes in the symmetry of function within the thalamus may also be produced by acute infusion of clonidine in Korsakoff patients. The findings support the idea that adrenergic mechanisms may modulate cognitive performance by actions on attentional systems within the brain. These appear to be located primarily within limbic cortex. It is, of course, notable that this can occur in patients with profound and disabling amnesia.
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Trastorno Amnésico Alcohólico/diagnóstico , Clonidina/farmacología , Giro del Cíngulo/metabolismo , Cloruro de Sodio/farmacología , Compuestos de Tecnecio , Adulto , Anciano , Trastorno Amnésico Alcohólico/complicaciones , Trastorno Amnésico Alcohólico/metabolismo , Circulación Cerebrovascular , Trastornos del Conocimiento/diagnóstico , Trastornos del Conocimiento/etiología , Lóbulo Frontal/diagnóstico por imagen , Lóbulo Frontal/efectos de los fármacos , Lóbulo Frontal/metabolismo , Giro del Cíngulo/diagnóstico por imagen , Giro del Cíngulo/efectos de los fármacos , Humanos , Persona de Mediana Edad , Escalas de Valoración Psiquiátrica , Receptores Adrenérgicos/efectos de los fármacos , Método Simple Ciego , Compuestos de Tecnecio/farmacocinética , Tomografía Computarizada de Emisión de Fotón Único , Conducta Verbal/efectos de los fármacosRESUMEN
Fifteen patients with major depression who were being treated with bilateral electroconvulsive treatment (ECT) were investigated before and 45 min after a single ECT using split-dose Single Photon Emission Tomography (SPET or SPECT) with 99mTc-Exametazime. All patients suffered from unipolar depressive illness and were rated on the Newcastle scale and with the 17-item Hamilton scale. They completed tests of orientation and verbal memory on the day of ECT. For comparison, verbal memory was also tested on the preceding day. The uptake of 99mTc-Exametazime was expressed relative to calcarine/occipital cortex. Significant decreases in tracer uptake were confined to the inferior anterior cingulate cortex. The changes were correlated with the severity of depressive symptoms and more weakly with decrements of memory function produced by ECT; there was no significant correlation with stimulus intensity or electroencephalographic measures of seizure duration.
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Trastorno Depresivo/diagnóstico por imagen , Compuestos de Organotecnecio/farmacocinética , Oximas/farmacocinética , Tomografía Computarizada de Emisión de Fotón Único , Anciano , Mapeo Encefálico , Corteza Cerebral/diagnóstico por imagen , Trastorno Depresivo/terapia , Dominancia Cerebral/fisiología , Electroencefalografía , Femenino , Giro del Cíngulo/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Exametazima de Tecnecio Tc 99mRESUMEN
Twenty-eight patients with a major depressive episode previously investigated at rest using Single Photon Emission Tomography (SPET or SPECT) with 99mTc-exametazime, were followed up at an interval of 9-28 months with the same investigation after full recovery. All patients were unipolar and were rated on the Newcastle scale and with the 17-item Hamilton scale. The uptake of 99mTc-Exametazime was expressed relative to calcarine/occipital cortex. Sixteen patients were scanned when optimally matched for drug treatment (4) or on both occasions drug free (12). The other 12 patients were fully recovered but could not be matched for drug status; these patients showed significantly more retardation, diurnal mood variation and guilt at presentation. Significant bilateral increases in tracer uptake were confined to basal ganglia and inferior anterior cingulate cortex in the matched group, where there were additional increases in thalamus and posterior cingulate cortex on the right side. There were no statistically discernible changes in the neocortex in the matched sample. The unmatched sample yielded inconclusive evidence of increased tracer uptake in left temporal cortex. The findings give a potential focus to the neuropharmacological analysis of depressive illness because the topography of the state change in brain function implicates dopamine function.
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Antidepresivos/uso terapéutico , Encéfalo/irrigación sanguínea , Trastorno Depresivo/tratamiento farmacológico , Tomografía Computarizada de Emisión de Fotón Único , Adulto , Encéfalo/diagnóstico por imagen , Encéfalo/efectos de los fármacos , Mapeo Encefálico , Corteza Cerebral/irrigación sanguínea , Corteza Cerebral/diagnóstico por imagen , Corteza Cerebral/efectos de los fármacos , Trastorno Depresivo/diagnóstico por imagen , Trastorno Depresivo/psicología , Dopamina/fisiología , Metabolismo Energético/efectos de los fármacos , Metabolismo Energético/fisiología , Femenino , Estudios de Seguimiento , Humanos , Cuidados a Largo Plazo , Masculino , Persona de Mediana Edad , Compuestos de Organotecnecio , Oximas , Inventario de Personalidad , Flujo Sanguíneo Regional/efectos de los fármacos , Flujo Sanguíneo Regional/fisiología , Exametazima de Tecnecio Tc 99mRESUMEN
The uptake, at rest, of 99mTc-exametazime into different brain regions was compared using SPECT for 20 elderly subjects with major depressive disorder, 20 with Alzheimer-type dementia, and 30 age-matched normal volunteers. Uptake was referred to calcarine-occipital cortex as a reference sensory area. Cross-sectional differences between the three groups were highly statistically significant, but reflected primarily the reductions in cortical uptake in the Alzheimer group. A detailed comparison of depressed patients and controls identified decrements in anterior cingulate, temporal and frontal cortex and in caudate and thalamus in men only. These decrements were correlated with impairment of performance on a trail-making task, but were also associated with continuing treatment with antidepressants or benzodiazepines. However, most depressed patients had quantitatively normal scans for posterior parietal association cortex, and this suggests that SPECT may find a limited role in the differential diagnosis of depression and dementia. The reduced brain function in some depressed patients may parallel the findings from studies of brain structure in elderly depressives; there was between good outcome at 6-18 months and increased tracer uptake in subcortical areas.
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Enfermedad de Alzheimer/diagnóstico por imagen , Encéfalo/diagnóstico por imagen , Demencia/diagnóstico por imagen , Trastorno Depresivo/diagnóstico por imagen , Compuestos de Organotecnecio , Oximas , Tomografía Computarizada de Emisión de Fotón Único , Edad de Inicio , Anciano , Anciano de 80 o más Años , Enfermedad de Alzheimer/complicaciones , Análisis de Varianza , Trastornos del Conocimiento/complicaciones , Trastorno Depresivo/complicaciones , Trastorno Depresivo/etiología , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores Sexuales , Exametazima de Tecnecio Tc 99mRESUMEN
Ten patients with Alzheimer-type dementia and nine age-matched normal controls were examined with SPECT, using split-dose 99mTc-labelled exametazime. The baseline condition involved repetition of the word 'yes' or 'no'. The activation condition involved recognition (indicated by a 'yes' or 'no') of words from a previously learned list presented along with distractor words. Patients who performed this task successfully were selected, and efforts were made to match the patients with controls according to their performance on the task, although this was not fully achieved. Uptake of 99mTc-exametazime was estimated at baseline and during the word-recognition task for predetermined regions of interest drawn from a standard neuroanatomical atlas. The baseline task appeared to normalise tracer uptake for frontal, temporal and parietal cortex in the patient group. However, during the recognition task, controls but not patients showed activation effects. These were most prominent in dorsolateral frontal cortex and adjacent anterior cingulate cortex. Among patients, successful performance was correlated with activation of dorsolateral frontal and parietal cortex on the left side. The results confirm the central role of frontal mechanisms in a recognition memory task. The study highlights some of the difficulties of using cognitive challenge tests in clinical groups.
Asunto(s)
Enfermedad de Alzheimer/diagnóstico por imagen , Corteza Cerebral/diagnóstico por imagen , Trastornos de la Memoria/diagnóstico por imagen , Memoria , Tomografía Computarizada de Emisión de Fotón Único , Estimulación Acústica , Anciano , Enfermedad de Alzheimer/psicología , Análisis de Varianza , Femenino , Humanos , MasculinoRESUMEN
Ten patients suffering from DSM-III-R simple phobia were studied under two conditions: (a) while listening to a 4 min relaxation tape, and (b) while listening to a 4 min audio tape describing exposure to the phobic stimulus. During each condition, subjects were injected with 99mTc-Exametazime, a marker of regional cerebral blood flow. Subjective and psychophysiological measures indicated a marked effect of the anxiety induction procedure. Ratio analysis of the SPET data revealed reductions in tracer uptake largely confined to posterior cerebral regions bilaterally. Analysis of brain regions of interest normalised to the whole brain slice showed reductions confined to right temporal/occipital regions. In general there was no clear association between subjective and physiological variables and changes in regional uptake of tracer as a consequence of the anxiety induction procedure. The changes in tracer uptake were dissimilar to those previously reported for other cognitive activation paradigms, providing some reassurance that those functional brain changes were not artefacts of non-specific changes in state anxiety. These posterior brain changes may reflect alterations in activation of the GABA/benzodiazepine complex.
Asunto(s)
Ansiedad/fisiopatología , Encéfalo/diagnóstico por imagen , Circulación Cerebrovascular , Compuestos de Organotecnecio , Oximas , Trastornos Fóbicos/fisiopatología , Tomografía Computarizada de Emisión de Fotón Único , Estimulación Acústica , Ansiedad/diagnóstico por imagen , Ansiedad/etiología , Encéfalo/fisiopatología , Femenino , Lateralidad Funcional , Humanos , Masculino , Persona de Mediana Edad , Lóbulo Occipital/irrigación sanguínea , Lóbulo Occipital/diagnóstico por imagen , Lóbulo Occipital/fisiopatología , Inventario de Personalidad , Trastornos Fóbicos/diagnóstico , Trastornos Fóbicos/diagnóstico por imagen , Escalas de Valoración Psiquiátrica , Exametazima de Tecnecio Tc 99m , Lóbulo Temporal/irrigación sanguínea , Lóbulo Temporal/diagnóstico por imagen , Lóbulo Temporal/fisiopatologíaRESUMEN
We examined 20 actively psychotic unmedicated schizophrenic patients and 20 matched control subjects by using single-photon emission, computed tomography (SPECT) with 99mtechnetium-exametazime. Patients showed a hyperfrontal pattern of tracer uptake with significant relative increases in superior prefrontal cortex. This abnormality was less pronounced in patients with higher symptom scores for psychomotor poverty. In addition, patients showed associations between certain schizophrenic syndrome scores, such as psychomotor poverty, disorganization, and reality distortion, and tracer uptake to a number of cortical and subcortical brain regions. This syndrome-related pattern of tracer uptake was, at least in part, consistent with similar associations previously reported in chronically medicated schizophrenic patients. SPECT therefore provides a readily available method to examine the relationship between symptom pattern and regional brain metabolism in psychotic patients. Any observed patterns of association will depend on the current mental and medication status of the patients examined.
Asunto(s)
Corteza Cerebral/irrigación sanguínea , Esquizofrenia/diagnóstico por imagen , Psicología del Esquizofrénico , Tomografía Computarizada de Emisión de Fotón Único , Adulto , Nivel de Alerta/fisiología , Dominancia Cerebral/fisiología , Femenino , Lóbulo Frontal/irrigación sanguínea , Humanos , Masculino , Persona de Mediana Edad , Compuestos de Organotecnecio , Oximas , Escalas de Valoración Psiquiátrica , Flujo Sanguíneo Regional/fisiología , Esquizofrenia/clasificación , Exametazima de Tecnecio Tc 99mRESUMEN
Forty patients with a major depressive episode were investigated at rest using Single Photon Emission Tomography (SPET or SPECT) with 99mTc-exametazime, an intravenous ligand taken into brain in proportion to regional cerebral blood flow, thereby providing an estimate of regional metabolism. All patients were unipolar and were rated on the Newcastle scale and with the 17-item Hamilton scale. They also completed a range of neuropsychological tests. They were compared with 20 control subjects matched for age, gender, premorbid intelligence and education. The uptake of 99mTc-exametazime was expressed for a range of anatomically defined regions of interest relative to calcarine/occipital cortex. The depressed group showed reduced uptake in the majority of cortical and sub-cortical regions examined, most significantly in temporal, inferior frontal and parietal areas. Unexpectedly, there was a strong positive association between uptake and scores on the Newcastle scale, especially in cingulate areas and frontal cortex. After removing the variance attributable to the Newcastle ratings, however, there emerged the expected negative association between Hamilton scores and anterior tracer uptake. The associations between neuropsychological impairment and regional brain uptake of tracer in part reflected the pattern seen with the Newcastle scale: for example, impairment of memory function correlated with higher uptake into posterior cingulate areas. We propose that depressive illness may be characterised by two processes. One leads to an overall reduction in anterior neocortical function, perhaps related to symptom severity. The other mechanism is manifest as relatively increased function, most notably within cingulate and frontal areas of the cerebral cortex in association with psychotic symptoms. The findings offer new understanding of the brain states underlying depressive illness and a potential focus to subsequent neuropharmacological analysis.