正常人安静和催眠状态下脑葡萄糖代谢的自身对照研究

目的 研究健康正常人催眠静息状态和清醒安静状态下脑内葡萄糖代谢的差异,初步探索催眠状态的神经生理基础。方法 正常人在清醒安静状态下行^18F—FDG PET扫描。隔日后,采用凝视法将受试者诱导进入催眠状态,再次行^18F—FDG PET扫描。两种状态皆应采用3D模式进行PET脑显像,应用SPM分析对催眠静息状态和清醒安静状态^18F—FDG PET图像进行组间体元统计,统计所得到的一系列数值构成了统计参数地图（SPM）。比较催眠静息状态和清醒安静状态脑局部糖代谢的变化,根据变化差异显著（P〈0．001）区域的Talariach坐标值确定其部位。结果 SPM分析显示催眠静息状态较清醒安静状态右侧枕叶（BA17,18）、左侧枕叶（BA17,18）、左侧顶叶（BA40,）、左侧颞上回（BA22）、右侧尾状核、右侧小脑后叶、右侧额叶（BA6）、左侧额中回（BA8,9）和右侧丘脑葡萄糖代谢明显降低（P〈0．001）。结论 催眠静息状态脑葡萄糖代谢不同于清醒安静状态,催眠静息状态存在神经生理基础。     

催眠状态的功能影像学研究进展

多年来,催眠状态是否存在,或者说它是否是一种意识状态,一直是对催眠有关争论的核心内容;但持两种相反态度的双方都不能拿出令人信服的证据来说服对方;同时,对催眠状态的判定存在着一定的主观性,这种主观性主要体现在不同的催眠师在同一种催眠状态下对同一个被催眠者的感觉可能不同;另外．在某种催眠状态,同一被试者对不同催眠师可能会有不同的反应,有时会出现戏剧性的变化;许多被催眠者会完成在正常状态下不能完成的任务。因此,催眠术自从产生以来,它就带有一种神秘的色彩。     

正常成人处于气功态和催眠态脑诱发电位实验研究

目的　观察 4 9例正常成人处于“正常态”、“气功入静态”和“催眠状态”的脑诱发电位 ,分析气功发功和催眠诱导对大脑生理过程的不同效应。方法　观察视觉诱发电位 (VEP)、听觉诱发电位(AEP)、听觉脑干诱发电位 (ABR)、关联性负变 (CNV)和P3 0 0 的潜伏期和波幅。结果　催眠状态下P3 0 0(T P3 )波幅降低 ,与正常态相比有极显著差异 (P <0 .0 1) ;AEP(P2 ) ,CNV(M2 )波幅降低 ,与正常态和气功入静态相比均存在显著差异 (P <0 .0 5 ) ;VEP(P2 、P3 )波幅降低 ,与正常态或气功入静态相比分别存在显著差异 (P <0 .0 5 )。结论　催眠诱导对大脑生理过程的影响与气功发功存在差别。     

催眠状态脑机制的研究进展

1摘要本文回顾了近年来运用神经心理学、脑电图、事件相关电位和功能性脑影像研究催眠过程脑机制的最新进展。2引言催眠到底是什么?有人提出,催眠既不是清醒状态也不同于睡眠状态,而是一种特殊的意识改变状态,“(催眠)以对暗示的高度依从和注意呈焦点性集中为特征,伴随对周围觉     

抗精神病药物对精神分裂症大鼠模型痛阈和运动行为的影响

背景既往研究提示精神分裂症患者的疼痛敏感性降低并且可以被抗精神病药物部分逆转。对这一假说的评价方法之一是检测精神分裂症模型。目的在显示出预期的行为学改变的氯胺酮诱导的精神分裂症大鼠模型中,检测是否出现痛闾升高,并且检测抗精神病药物预处理是否逆转这种痛阈升高。方法将30只雄性Wistar大鼠随机分为5组,其中3组先腹腔注射抗精神病药物预处理[利培N（o．3mg,／kg）、利培酮（0．9mg／kg）或氟哌啶醇（1mg／kg）],30min后再腹腔注射氯胺酮（100mg／kg）;1组先腹腔注射生理盐水,再腹腔注射氯胺酮;1个对照组接受2次生理盐水注射。测定大鼠在基线以及第二次注射后第5、15、30和45min的压痛和热痛阈值。另外的30只大鼠做同样处理,用旷场实验观测大鼠在第二次注射后120min内的行为改变。结果与对照组相比,在所有时间段内,氯胺酮组大鼠（未用抗精神病药物）出现压痛阈降低、热痛阈升高。在所有时间段内,氟哌啶醇预处理明显减轻了氯胺酮诱导的压痛降低,但高或低剂量的利培酮对压痛阈无明显影响。用低剂量利培酮预处理减轻了氯胺酮诱导的第5min时段的热痛阈升高,但不包括第15—45min时段。高剂量利培酮和氟哌啶醇对热痛阈无明显影响。在旷场实验中,抗精神病药物预处理的各组比仅用氯胺酮处理的一组有较少的直立行为（目标指向的行为）,较少的穿越格子行为（较低的高运动性）,较少的摇头和转圈运动。氟哌啶醇预处理组比氯胺酮组（无预处理）和2个利培酮预处理组相比,摔倒（即共济失调）更为常见。结论我们不能肯定先前所见的在精神分裂症大鼠模型中抗精神病药物对氯胺酮诱导的痛阈升高有抑制作用。氯胺酮引起的压痛阈明显降低可能与氯胺酮注射后增强的全身活动性有关（这使压痛阈检测难以可靠进行）。利培酮和氟哌啶醇有效减轻多方面的氯胺酮引起的拟精神病症状,而氟哌啶醇增强了氯胺酮引起的共济失调,利培酮降低了共济失调。这一资料与易于摔倒的老年患者有临床相关性。     

中枢神经系统一氧化氮对大鼠的痛觉调制作用

以钾离子透入引起大鼠甩尾的电流强度（ｍＡ）作为痛反应指标,采用侧脑室微量注射Ｌ－精氨酸（Ｌ－Ａｒｇ）、亚甲基蓝（ＭＢ）等,大鼠痛阈的变化,分析探讨中枢神经系统中一氧化氮（ＮＯ）对大鼠痛觉的调制作用,结果显示：大鼠侧脑室微量注射ＮＯ前体及供体物质Ｌ－Ａｒｇ和硝普钠（ＳＮＰ）均引起明显的痛敏效应。微量注射ＭＢ和Ｌ－ＮＡＭＥ后大鼠痛阈升高非常显著。侧脑室微量注射ＭＢ和Ｌ－Ａｒｇ混合液后,大鼠痛阈较单纯注     

基于功能磁共振成像的早发精神分裂症默认网络研究

目的：探讨早发精神分裂患者在静息状态下脑默认网络功能连接特点。方法：采用功能磁共振成像（fMRI）技术,对26例早发精神分裂症患者和28例正常对照进行静息状态下全脑的磁共振脑功能扫描。采用功能连接分析方法,提取静息状态下默认网络,在患者组和对照组中分别计算默认网络各脑区两两间的功能连接。结果：早发精神分裂症组在默认网络存在5条异常连接。其中3条连接表现为连接增强：腹侧前额叶内侧皮质-右侧颞下回（P=0.0078）,腹侧前额叶内侧皮质-左侧外侧顶叶（P=0.0091）、腹侧前额叶内侧皮质-背侧前额叶内侧皮质（P=0.0163）。2条连接表现为连接减弱：右侧外侧顶叶-小脑扁桃体（P=0.0223）,左侧额上回-右侧下半月小叶（P=0.0294）。结论：早发精神分裂症患者存在默认网络功能的异常。这些异常改变可能与精神分裂症的病理机制相关。     

不同思维状态下脑电近似熵的变化规律*

背景：近似熵是一种描述信号复杂性和规律性的非线性动力学方法,只需较少数据就能度量信号的复杂性。 目的：探讨不同思维状态下脑电近似熵的变化规律,以及近似熵在认知过程中的作用。 方法：用近似熵对20名健康成年人在安静闭眼、安静睁眼、闭眼记忆、闭眼心算和图片识别 5 种状态下的脑电数据进行分析。 结果与结论：近似熵值在闭眼计算和闭眼记忆思维状态高于安静闭眼状态,在图片识别状态下高于安静睁眼状态(P < 0.01);近似熵在安静闭眼和安静睁眼状态下各导联处于较低水平,在闭眼心算和闭眼记忆思维状态下各导联处明显增加。说明不同思维状态和不同导联部位对近似熵均有影响;近似熵在认知作业过程下较安静状态增高,并且不同思维状态下大脑功能活动的复杂性不同。因此脑电近似熵分析适用于认知过程脑功能活动变化规律研究,有助于了解大脑的工作机制。 关键词：近似熵;脑电;认知功能;思维状态;数字化医学     

大学生特质应对方式与抑郁、焦虑的关系

目的探讨大学生特质应对方式与抑郁、焦虑的关系。方法用特质应对方式问卷（TCSQ）、状态-特质焦虑问卷（STAI）、贝克抑郁测验（BDI）对120名大学生施测。结果消极应对与状态焦虑（r=0.296,P〈0.01）、特质焦虑（r=0.447,P〈0.001）及抑郁（r=0.227,P〈0.05）存在显著的正相关;积极应对与特质焦虑（r=-0.360,P〈0.001）及抑郁（r=0.227,P〈0.05）存在显著的负相关;抑郁与状态焦虑（r=0.447,P〈0.001）及特质焦虑（r=0.574,P〈0.001）之间也存在显著的正相关。特质焦虑能预测抑郁（P〈0.001）;抑郁、消极应对、状态焦虑和积极应对能预测特质焦虑（P〈0.001）;特质焦虑和积极应对能预测状态焦虑（P〈0.001）。结论特质应对方式对状态-特质焦虑和抑郁有影响。     

轻型缺血性卒中后认知障碍与脑动态功能连接状态改变的功能磁共振成像研究

目的 探索轻型缺血性卒中后有认知障碍（cognitive impairment,CI）患者和无认知障碍（no cognitive impairment,NCI）患者脑动态功能连接（functional connectivity,FC）状态的变化。 方法 选择2014年12月1日-2016年5月31日首都医科大学附属北京天坛医院神经病学中心就诊的 轻型急性缺血性卒中患者为研究对象,对所有患者进行神经心理学评估和多模态MRI检查,分为CI 组（15例）和NCI组（11例）,同时招募年龄、性别均匹配的志愿者作为健康对照（healthy control,HC）组 （29例）。基于静息态功能头颅MRI影像,利用动态功能网络连接方法构建一系列随时间变化的FC网络, 然后通过聚类方法划分为多个具有代表性的动态FC状态（分别为模块化连接状态、强连接状态、局 部连接状态和稀疏连接状态）,比较HC组、CI组与NCI组的FC动态特征（各状态的时间比例、驻留时间 及各状态间的转换次数）差异,并在两个时间点（基线和3个月随访期）探索CI组与NCI组动态FC状态 的变化。 结果 HC组、CI组和NCI组在基线和随访期各连接状态的时间比例差异均无统计学意义。基线CI组 和NCI组在稀疏连接状态的驻留时间比HC组更低,三组差异有统计学意义（P =0.035）,但两两比较 的结果均未通过Bonferroni校正;而在随访期,各连接状态的驻留时间差异均无统计学意义。纵向比 较中,与基线相比,CI组随访期在模块化连接状态的时间比例明显下降（P =0.035）,在稀疏连接状 态的时间比例明显上升（P =0.025）,在模块化连接状态的驻留时间明显降低（P =0.012）;而NCI 组 在两个时间点各连接状态的时间比例和驻留时间差异均无统计学意义。对于转换次数,所有组间的 差异均无统计学意义。 结论 轻型缺血性卒中患者急性期较对照人群有局部连接状态增多而稀疏连接状态减少的趋势, 但差异未达统计学意义;对于有认知障碍的轻型缺血性卒中患者,发病3个月时模块化连接状态和 稀疏连接状态均较急性期显著恢复;动态功能网络能够客观反映大脑功能的变化。     

The effects of hypnotic and nonhypnotic imaginative suggestion on pain

Background: Few studies have compared placebo and suggested pain reduction.Purpose: Hypnotic and nonhypnotic imaginative analgesia suggestions were compared against a placebo in reducing experimental pain. The mediator role of response expectancies and the moderator role of hypnotic and nonhypnotic imaginative suggestibility were evaluated.Methods: Sixty participants previously assessed for hypnotic and nonhypnotic imaginative suggestibility were assigned to one of two experimental conditions or a no-treatment control condition. In the “placebo first” condition, participants received placebo, followed by imaginative and then hypnotic analgesia suggestions. In the “placebo last” condition, participants received imaginative and then hypnotic suggestions, followed by placebo.Results: Imaginative and hypnotic suggestions did not differ significantly and were more effective than no treatment in reducing pain. The placebo was no different from the analgesia suggestions and was more effective than no treatment, but only when administered after the suggestions. Pain reduction was mediated by expectancy but was not significantly related to suggestibility or hypnotizability, the latter operationalized as hypnotic suggestibility with imaginative suggestibility statistically controlled.Conclusions: In the general population, nonhypnotic imaginative suggestions may be as effective as hypnotic suggestions in reducing pain. Response expectancies would seem to be an important mechanism of placebo and suggested pain reduction. We most gratefully acknowledge the dedicated assistance of Amanda Breen, Gina Carosella, Stephanie Hays, Tracy Poppe, Catherine Sullivan, and Casey Webster in the completion of this study. We thank Mary Alice Mills-Baxter for her helpful comments on a previous version of this article.     

The effect of duloxetine on primary pain symptoms in Parkinson disease

OBJECTIVES: To study the effect of duloxetine (Cymbalta), a selective serotonin and norepinephrine reuptake inhibitor, on pain symptoms in Parkinson Disease (PD). METHODS/PATIENTS: Twenty-three patients with PD with painful phenomena were treated with duloxetine for 6 weeks in an open-label design. Assessments were performed before and at treatment completion and consisted of a Visual Analogue Scale, the Brief Pain Inventory, Short-Form McGill Pain Questionnaire, Parkinson Disease Quality of Life Questionnaire-39-item version, and motor part of the Unified Parkinson Disease Rating Scale. Pain threshold was assessed by quantitative sensory tests. RESULTS: Thirteen of the 20 patients who completed the study reported varying degrees of pain relief. The mean Visual Analogue Scale, Brief Pain Inventory, and Short-Form McGill Pain Questionnaire scores decreased significantly. There was no change in pain threshold after treatment. CONCLUSIONS: Duloxetine seems to be effective for the treatment of central pain in PD.     

Reaction to pain stimulus before and during hypnosis measured by pupillary reaction

The aim of this study was to investigate the analgesic effects of hypnotic pain control on experimental pain by measuring pupil reactions as an objective psycho-physiologic parameter. Twenty-two healthy volunteers (11 female and 11 male) aged between 22 and 35 years participated in the study. Pupil diameter was measured as baseline measurement (i.e., static measurement) in the non-hypnotic and in the hypnotic state. Pupil diameter changes to a standardized pain stimulus were measured in the non-hypnotic and hypnotic state and compared. Additionally, a Fourier analysis of pupil oscillations reflecting central nervous activation during the static measurement (25.6 sec) was calculated. During the hypnotic state the pain related pupil dilation was significantly smaller than during the non-hypnotic state. Pupil oscillations were significantly reduced during hypnosis.     

Topical anesthetic before microneurography decreases pain without affecting sympathetic traffic

Pain associated with the microneurography procedure varies among human research volunteers, and may influence baseline sympathetic neural activity. The purpose of this study was to evaluate the efficacy and effects of applying a topical anesthetic prior to microneurography. Ten volunteers underwent microneurography twice, separated by a minimum of 4 weeks. Using a single-blind, randomized cross-over design, EMLA cream (2.5% lidocaine and 2.5% prilocaine in oil emulsion) or an aqueous placebo cream was applied 2 h prior to each session. Subjects rated pain on a scale from 0 (no pain) to 4 (extreme pain). The electrocardiogram, and efferent sympathetic nerve traffic from peroneal nerve muscle fascicles at the popliteal fossa were recorded during a 10-min supine rest period. EMLA cream significantly reduced perception of pain (P < 0.05), but did not affect burst reflex latencies from preceding R-waves or total muscle sympathetic nerve traffic (P > 0.05). These data show that use of EMLA cream prior to microneurography is innocuous, and do not support the hypothesis that baseline sympathetic traffic is increased by pain or discomfort associated with microneurography.     

Quality of life in major depressive disorder: the role of pain and pain catastrophizing cognition

ObjectivePain symptoms are frequent complaints in patients with major depressive disorder (MDD). Although it is known that pain intensity and pain-related cognition predict quality of life (QOL) in patients with chronic pain, limited studies have examined their roles in MDD. The study aimed to determine whether pain and pain catastrophizing were independent predictors of QOL in MDD after accounting for the impact of anxiety and depression.MethodsThis is a prospective, naturalistic follow-up study. Ninety-one Chinese patients were enrolled during an acute episode of MDD, 82 of them were reassessed 3 months later using the same assessment on pain, anxiety, depression, and QOL. Pain intensity was evaluated using a verbal rating scale and a visual analog scale. Quality of life was assessed using the 36-item Short Form Health Survey. Pain-related cognition was assessed at baseline with the Pain Catastrophizing Scale.ResultsThere was significant improvement in pain, anxiety, depression, and QOL from baseline to 3-month follow-up. Hierarchical regression analyses showed that pain intensity was significantly associated with QOL at baseline and 3 months. Pain complaint was more important than anxiety and depressive symptoms in predicting changes in both physical and psychosocial domains of QOL. After controlling for the severity of pain, anxiety, and depression, Pain Catastrophizing Scale score was independently associated with QOL in MDD.ConclusionThe study supports the specific role of pain and pain-related cognition in predicting QOL in depressed patients. Further studies targeting pain-related cognition for improving the outcome of MDD are necessary.     

A learning assessment procedure as a test supplement for monitoring progress with two post-coma persons with a diagnosis of vegetative state

Objective: Evaluating a learning assessment procedure for monitoring progress with two post-coma adults with a diagnosis of vegetative state.

Method: ABABCBCB and ABABCB designs were used for the two participants, with A representing baseline, B intervention and C control conditions. Participants’ activation of an optic microswitch by eyelid closure produced stimulation during B phases.

Results: One participant increased responding during B phases and decreased it during the C condition, suggesting a non-reflective minimal level of consciousness. She showed P300 and mismatch negativity responses and scored at the vegetative level on the Coma Recovery Scale-Revised (CRS-R). The other participant increased responding during the initial B phases without decline during the first (viable) part of the C condition, suggesting a pre-conscious level. He showed indistinct P300 and mismatch negativity responses and vegetative-level scores on the CRS-R.

Conclusion: Learning data seemed reconcilable with neurophysiological measures and more positive than CRS-R scores.     

Gabapentin in painful HIV-related neuropathy: a report of 19 patients, preliminary observations

The objective of this study was to assess the efficacy and safety of Gabapentin as the sole analgesic in patients with HIV-related painful neuropathy. Nineteen patients with HIV-related painful neuropathy were administered Gabapentin. Efficacy was evaluated with two 100-mm Visual Analogue Scales (VAS) (0: no symptom; 100: worst symptom), rating pain and interference of pain with sleep, performed at baseline and monthly intervals. Main Pain VAS score decreased from a baseline of 55.7 +/- 19.1 mm to a final 14.7 +/- 18.6 mm (ANOVA P = 0.0001) and mean Sleep Interference VAS score decreased from a baseline of 60.4 +/- 31.9 mm to a final 15.5 +/- 27.7 mm (ANOVA P = 0.0001). Gabapentin provided significant pain relief in our patients with HIV-associated painful sensory neuropathy.     

Modulation of electrically induced pain by paired pulse transcranial magnetic stimulation of the medial frontal cortex.

OBJECTIVE: Aim of this study was to investigate whether paired pulse transcranial magnetic stimulation (ppTMS) applied over the medial frontal cortex (MFC) affects acute Adelta fiber-mediated electrically induced pain. In addition, we investigated whether this effect depends on the time course of the stimulation, on the noxious stimulus intensity or on the ppTMS intensity. METHODS: For painful stimulation, the electrical stimulus for the nociceptive flexion reflex (NFR) was used. PpTMS (ISI: 50 ms) was applied over the medial frontal cortex at different intervals ranging from 0 to 1,000 ms following the previous elicited NFR in 10 healthy volunteers. Three sequences at 3 different NFR stimulus intensities (at NFR threshold, 1.3 x and 1.6 x NFR threshold) with a ppTMS stimulus intensity at 1.2 x resting motor threshold (RMT) and one sequence with elevated ppTMS at 1.6 x RMT stimulus intensity were performed. Pain intensity and pain unpleasantness were assessed by visual analogue scales. RESULTS: Pain ratings differed in dependence of the interstimulus interval between NFR and ppTMS. Post-hoc t-tests revealed an increased verbal pain report within interstimulus intervals from 25 to 75 ms at NFR threshold as well as for 25 ms at 1.3 x NFR threshold when ppTMS was applied at 1.2 x RMT and from 0 to 75 ms at 1.6 x NFR threshold when ppTMS was applied at 1.6 x RMT. CONCLUSIONS: The present data suggest that ppTMS over MFC-applied in a certain time window-can enhance pain perception of acute Adelta fiber-mediated electrically induced pain. We hypothesize that the increase of pain is due to interference between ppTMS and the incoming nociceptive input. Further pain processing might be modulated by direct effects on MFC or indirect effects on anterior cingulate cortex (ACC) or spinal nociception. SIGNIFICANCE: Brain areas involved in cognitive and emotional adaptation to pain can be used, in place of primary motor areas, as cortical targets in TMS trials of experimental or ongoing pain.     

How positive and negative expectations shape the experience of visceral pain: an experimental pilot study in healthy women

Background In order to elucidate placebo and nocebo effects in visceral pain, we analyzed the effects of positive and negative expectations on rectal pain perception, rectal pain thresholds, state anxiety and cortisol responses in healthy women. Methods Painful rectal distensions were delivered at baseline, following application of an inert substance combined with either positive instructions of pain relief (placebo group, N = 15), negative instructions of pain increase (nocebo group, N = 17), or neutral instructions (control, N = 15). Perceived pain intensity, unpleasantness/aversion and urge‐to‐defecate, state anxiety and serum cortisol were determined at baseline, immediately following group‐specific instructions and on a second study day after the same instructions (test day). Rectal pain thresholds were determined at baseline and on the test day. Key Results Whereas perceived pain intensity was significantly decreased in the placebo group, the nocebo group revealed significantly increased pain intensity ratings, along with significantly greater anticipatory anxiety on the test day (all P < 0.05 vs controls). Cortisol concentrations were significantly increased in the nocebo group following treatment but not on the test day. Conclusions & Inferences The experience of abdominal pain can be experimentally increased or decreased by inducing positive or negative expectations. Nocebo effects involve a psychological stress response, characterized by increased anticipatory anxiety. These findings further underscore the role of cognitive and emotional factors in the experience of visceral pain, which has implications for the pathophysiology and treatment of patients with chronic abdominal complaints.