Reliability of an fMRI paradigm for emotional processing in a multisite longitudinal study

Multisite neuroimaging studies can facilitate the investigation of brain‐related changes in many contexts, including patient groups that are relatively rare in the general population. Though multisite studies have characterized the reliability of brain activation during working memory and motor functional magnetic resonance imaging tasks, emotion processing tasks, pertinent to many clinical populations, remain less explored. A traveling participants study was conducted with eight healthy volunteers scanned twice on consecutive days at each of the eight North American Longitudinal Prodrome Study sites. Tests derived from generalizability theory showed excellent reliability in the amygdala ( = 0.82), inferior frontal gyrus (IFG; = 0.83), anterior cingulate cortex (ACC; = 0.76), insula ( = 0.85), and fusiform gyrus ( = 0.91) for maximum activation and fair to excellent reliability in the amygdala ( = 0.44), IFG ( = 0.48), ACC ( = 0.55), insula ( = 0.42), and fusiform gyrus ( = 0.83) for mean activation across sites and test days. For the amygdala, habituation ( = 0.71) was more stable than mean activation. In a second investigation, data from 111 healthy individuals across sites were aggregated in a voxelwise, quantitative meta‐analysis. When compared with a mixed effects model controlling for site, both approaches identified robust activation in regions consistent with expected results based on prior single‐site research. Overall, regions central to emotion processing showed strong reliability in the traveling participants study and robust activation in the aggregation study. These results support the reliability of blood oxygen level‐dependent signal in emotion processing areas across different sites and scanners and may inform future efforts to increase efficiency and enhance knowledge of rare conditions in the population through multisite neuroimaging paradigms. Hum Brain Mapp 36:2558–2579, 2015. © 2015 Wiley Periodicals, Inc .     

Optic nerve sheath diameter on computed tomography is correlated with simultaneously measured intracranial pressure in patients with severe traumatic brain injury

Purpose

Assess the relationship between optic nerve sheath diameter (ONSD) measured on bedside portable computed tomography (CT) scans and simultaneously measured intracranial pressure (ICP) in patients with severe traumatic brain injury.

Methods

Retrospective cohort study of 57 patients admitted between 2009 and 2013. Linear and logistic regression were used to model the correlation and discrimination between ONSD and ICP or intracranial hypertension, respectively.

Results

The cohort had a mean age of 40 years (SD 16) and a median admission Glasgow coma score of 7 (IQR 4–10). The between-rater agreement by intraclass coefficient was 0.89 (95 % CI 0.83–0.93, P < 0.001). The mean ONSD was 6.7 mm (SD 0.75) and the mean ICP during CT was 21.3 mmHg (SD 8.4). Using linear regression, there was a strong correlation between ICP and ONSD (r = 0.74, P < 0.001). ONSD had an area under the curve to discriminate elevated ICP (≥20 mmHg vs. <20 mmHg) of 0.83 (95 % CI 0.73–0.94). Using a cutoff of 6.0 mm, ONSD had a sensitivity of 97 %, specificity of 42 %, positive predictive value of 67 %, and a negative predictive value of 92 %. Comparing linear regression models, ONSD was a much stronger predictor of ICP (R ² of 0.56) compared to other CT features (R ² of 0.21).

Conclusions

Simultaneous measurement of ONSD on CT and ICP were strongly correlated and ONSD was discriminative for intracranial hypertension. ONSD was much more predictive of ICP than other CT features. There was excellent agreement between raters in measuring ONSD.     

Narcissistic, antisocial, and noncomorbid subgroups of borderline disorder. Are they distinct entities by long-term clinical profile?

This study evaluates the influence of narcissistic and antisocial features on the long-term functioning of individuals with borderline personality disorder. Borderline patients discharged from Chestnut Lodge Hospital, an inpatient residential treatment facility, were followed up an average of 15 years later to assess longitudinal clinical profile. Despite differences in baseline psychopathology, members of Narcissistic, Antisocial, and Noncomorbid Borderline subgroups turned out to be roughly equivalent on almost all long-term course and outcome dimensions. The implications of these results for the nosology and treatment of personality disorders are discussed.     

Psychotherapeutic models and the treatment of schizophrenia: the records of three successive psychotherapists with one patient at Chestnut Lodge for 18 years

Miss Jane Cole was 26 years old when admitted to Chestnut Lodge with a diagnosis of schizophrenia in 1949. She remained an inpatient and day patient for 18 years, and engaged in treatments that were primarily psychotherapeutically oriented, with three different therapists. She ultimately recovered sufficiently to live on her own while remaining in private treatment with her last Chestnut Lodge therapist. Her extended psychotherapeutic encounters at this institution are richly documented, with about 400 pages of transcribed annual treatment case conferences, allowing us to reconstruct her course in some detail. We offer her narrative as uniquely instructive about the utility of different psychotherapeutic models and styles in the treatment of people with long-term, severe, psychotic disorders.     

Testing four diagnostic systems for schizophrenia

Four diagnostic systems for schizophrenia--New Haven, Feighner et al, Research Diagnostic Criteria, and DSM-III--were tested for reliability, comprehensiveness, concordance with established clinical use, specificity, and predictive validity. The sample consisted of 400 patients admitted to Chestnut Lodge, Rockville, Md, 330 of whom received long-term follow-up assessment by interview an average of 15 years after discharge. Diagnostic system criteria were applied retrospectively to abstracted medical records. Findings replicated recent studies on schizophrenia diagnosis and extended the generalizability of current nosologic systems to chronically ill patients. Results also indirectly supported the validity of applying these systems to medical records. This study demonstrated advantages and disadvantages of each system.     

A comparison of DSM-III and DSM-III-R schizophrenia

The authors compared DSM-III and DSM-III-R definitions of schizophrenia among 532 inpatients treated in a long-term residential setting and reevaluated an average of 15 years later. Largely by excluding those with nonbizarre delusions (somatic, grandiose, or religious) without hallucinations, DSM-III-R reduced the number of patients diagnosed with schizophrenia by 10%. With the exception of the sign and symptom variables used to define them, the DSM-III schizophrenic patients included (N = 164) and excluded (N = 18) by DSM-III-R did not differ with respect to demographic, premorbid, or long-term outcome characteristics. The authors argue that frequent changes in diagnostic schemes in the absence of evidence of improved validity are likely to impede progress in research.