Rational approaches to the neurobiologic study of youth at risk for bipolar disorder and suicide

Objectives:  The aims of this paper are to provide an overview of neuroimaging findings specific to bipolar disorder and suicide, and to consider rational approaches to the design of future in vivo studies in youth at risk.
Methods:  Neuroimaging and related neurobiological literature pertaining to bipolar disorder and suicide in adult and pediatric samples was reviewed in a non-quantitative manner.
Results:  Specific structural and functional brain findings in bipolar disorder are described, where possible in the context of relevant current neurobiological theories of etiology. Diagnostic and prognostic implications are discussed.
Conclusions:  The simultaneous use of complementary neurobiological approaches may be a powerful way of identifying and validating factors reliably associated with bipolar disorder and suicide. A profile of neurobiological markers with which to screen for bipolar disorder and suicide risk may provide for earlier and more accurate diagnosis, perhaps even in the pre- or subsyndromal stages in high-risk youth.     

Neurobiology of Bipolar Illness: Implications for Future Study and Therapeutics

Many findings implicating prefrontal cortical and limbic areas of the brain and endocrine systems in the neuropathology and pathophysiology of bipolar illness have greatly increased our understanding of the neurobiology of the illness. New imaging techniques such as PET, MRI, SPECT, and MRS have detailed more evidence of specific regional alterations in the brains of bipolar patients than was thought possible just 20 years ago. These methods are beginning to be used to help predict response to treatment. Examining the mechanisms of action of mood stabilizers (such as lithium, carbamazepine, and valproate) has provided clues to potential underlying neurobiological abnormalities in the illness. Recent studies of postmortem brain tissue have begun to confirm prefrontal cortical and limbic neurochemical and microstructural alterations in patients with bipolar illness compared with controls. It is postulated that it is the balance between primary pathological versus secondary adaptive alterations in gene expression in the illness and their enhancement or dampening by pharmacotherapy, that may determine the episodic course of mood fluctuations and remissions. Further examination of the pathophysiology and neurobiology of bipolar illness should lead to both more effective treatments and, potentially, secondary and even primary episode prevention.     

The dance/movement therapy group in a psychiatric outpatient clinic: explorations in body image and interaction

The clinical experiences gained in the practice of dance/movement therapy group at the Psychiatric Clinic of Tampere are discussed. The clinical work was built on the tradition of DMT and it has been informed by the practice of mindfulness and the recent findings in interpersonal neurobiology. The experiences of the bodily, true self are dominantly processed in right hemisphere of the brain. Neurobiology also informs us that the right hemisphere is essentially involved in emotional processes, nonverbal communications, attachment, subjectivity and intersubjectivity, in empathy, in the processing of non-conscious self images, threat detection, bodily-based stress regulation and survival. Intersubjective relationships are essentially dependent upon the information processing in the right hemisphere. The quality of interpersonal interactions and relationships is influenced by nonverbal, kinesthetic behaviour and the sensitivity to it. DMT work, promoting movement experiences, internal attunement and enhancing the body-self, allows a creative method to explore and integrate the contents of the right hemisphere.     

Fractal description and quantitative analysis of normal brain development in infants

We examined the fractal pattern of cerebral computerized tomography images in 158 normal infants, aged 0-3 years, based on the quantitative analysis of chaotic theory. Results showed that the fractal dimension of cerebral computerized tomography images in normal infants remained stable from 1.86-1.91. The normal distribution range in the neonatal period, 1-2 months old infants, 1-2 year old infants, and of 2-3 year old infants was 1.88-1.90 (mean: 1.891 3 ± 0.006 4), 1.89-1.90 (mean: 1.892 7 ± 0.004 5), 1.86-1.90 (mean: 1.886 3 ± 0.008 5), and 1.88-1.91 (mean: 1.895 8 ± 0.008 3), respectively. The spectrum width of the multifractal spectrum (△α) in normal infants was 1.4618. These data suggest that the spectral width parameters of the multifractal spectrum and the fractal dimension criteria in normal children may be useful as a practical specific parameter for assessing the fractal mode of brain development in normal infants.     

Biological Conceptualizations of Mental Disorders Among Affected Individuals: A Review of Correlates and Consequences

Psychopathology is increasingly conceptualized as a biological phenomenon. The consequences of this conceptual shift for the general public's beliefs and attitudes regarding mental illness have been the subject of considerable study, but effects among individuals who suffer from mental disorders have received less attention. This review considers recent observational and experimental studies of the beliefs, attitudes, and behaviors associated with biological conceptions of psychopathology among affected individuals. Included in the review is research that has examined the implications of such conceptualizations for prognostic beliefs, internalization of stigmatizing attitudes, treatment usage and other behaviors and intentions, and perspectives on the use of biomedical technologies in mental health. Potential conclusions, limitations of the existing literature, and considerations for future studies are discussed.     

Research,Curriculum, and Diversity

The ideal psychoanalytic institute will prepare outstanding clinicians of varied backgrounds, who can exchange insights about how each culture produces different conditions for mental health. The ideal institute will also do clinical outcome research, to insure the survival of the psychoanalytic field. Candidates would not only learn psychoanalytic ideas, but also see them in the context of findings from other fields, including experimental psychology, neuroscience, anthropology, sociology, philosophy, sexology, and literature.     

Independent component analysis of resting state activity in pediatric obsessive‐compulsive disorder

Obsessive‐compulsive disorder (OCD) is an often severely disabling illness with onset generally in childhood or adolescence. Little is known, however, regarding the pattern of brain resting state activity in OCD early in the course of illness. We therefore examined differences in brain resting state activity in patients with pediatric OCD compared with healthy volunteers and their clinical correlates. Twenty‐three pediatric OCD patients and 23 healthy volunteers (age range 9–17), matched for sex, age, handedness, and IQ completed a resting state functional magnetic resonance imaging exam at 3T. Patients completed the Children's Yale Brown Obsessive Scale. Data were decomposed into 36 functional networks using spatial group independent component analysis (ICA) and logistic regression was used to identify the components that yielded maximum group separation. Using ICA we identified three components that maximally separated the groups: a middle frontal/dorsal anterior cingulate network, an anterior/posterior cingulate network, and a visual network yielding an overall group classification of 76.1% (sensitivity = 78.3% and specificity = 73.9%). Independent component expression scores were significantly higher in patients compared with healthy volunteers in the middle frontal/dorsal anterior cingulate and the anterior/posterior cingulate networks, but lower in patients within the visual network. Higher expression scores in the anterior/posterior cingulate network correlated with greater severity of compulsions among patients. These findings implicate resting state fMRI abnormalities within the cingulate cortex and related control regions in the pathogenesis and phenomenology of OCD early in the course of the disorder and prior to extensive pharmacologic intervention. Hum Brain Mapp 35:5306–5315, 2014. © 2014 Wiley Periodicals, Inc.     

Relations among Delay Discounting,Addictions, and Money Mismanagement: Implications and Future Directions

Background: Delay discounting is a reduction in the subjective value of a delayed outcome. Elevated delay discounting is a type of impulsivity that is associated with harmful behaviors, including substance abuse and financial mismanagement. Methods: Elevated delay discounting as related to addiction and financial mismanagement was reviewed from psychological, neurobiological, and behavioral economic perspectives. Results: Addiction and financial mismanagement frequently co-occur, and elevated delay discounting may be a common mechanism contributing to both of these problematic behaviors. Conclusions: Future research on the relationships between delay discounting, substance abuse, and financial mismanagement can provide important insights for developing improved prevention and treatment strategies.