Search

Background It remains unknown whether the presence of coronary microcirculatory dysfunction (CMD) correlates with its equivalent conditionin the brain, cerebral small vessel disease (CSVD). The cerebral-coronary connection (C3), a prospective blinded study, investigatedthe prevalence of CMD in patients with coronary artery disease (CAD) and its association with CSVD and cognitive function. Methodsand results Patients with documented CAD fulfilling inclusion criteria underwent physiological assessment of epicardial vessels and the microcirculation using intracoronary pressure and Doppler. Coronary microcirculation-related indices included coronary flow reserve (CFR) and hyperaemic microvascular resistance. Brain magnetic resonance imaging, transcranial Doppler (TCD), and neurocognitive examination were performed. Overall, 67 patients were included in the study (mean age 66 years, 73% female). Patients with abnormal CFR (<2.0) (55.2%) showed higher burden of white-matter hyperintensities: 43.2 vs. 20.0% (P=0.044). After statistical adjustment, low CFR was associated with lower grey matter volume (P=0.024) and with parameters of white-matter microstructural damage in diffusion-tensor imaging (lower fractional anisotropy and higher mean diffusivity, P=0.029 and P=0.032, respectively). Low CFR was associated with higher resistive (P=0.027) and pulsatility (P=0.043) values on TCD, and worse neurocognitive test scores (lower mini mental state examination, P=0.025, and slower Trail Making Test A, P=0.034). Conclusions Coronary microcirculatory dysfunction is frequent in patients with CAD and correlates with CSVD, abnormal cerebral flow haemodynamics, and significant cognitive impairment. These findings support the hypothesis that microvascular dysfunction in the heart and the brain are part of a single pathological process affecting microcirculation in patients with CAD., Depto. de Psicobiología y Metodología en Ciencias del Comportamiento, Fac. de Psicología, TRUE, pub

Background: Obsessive-compulsive disorder (OCD) has consistently been linked to abnormal frontostriatal activity. The electrophysiological disruption in this circuit, however, remains to be characterized. Objective/hypothesis: The primary goal of this study was to investigate the neuronal synchronization in OCD patients. We predicted aberrant oscillatory activity in frontal regions compared to healthy control subjects, which would be alleviated by deep brain stimulation (DBS) of the nucleus accumbens (NAc). Methods: We compared scalp EEG recordings from nine patients with OCD treated with NAc-DBS with recordings from healthy controls, matched for age and gender. Within the patient group, EEG activity was compared with DBS turned off vs. stimulation at typical clinical settings (3.5 V, frequency of stimulation 130 Hz, pulse width 60 ms). In addition, intracranial EEG was recorded directly from depth macro electrodes in the NAc in four OCD patients. Results: Cross-frequency coupling between the phase of alpha/low beta oscillations and amplitude of high gamma was significantly increased over midline frontal and parietal electrodes in patients when stimulation was turned off, compared to controls. Critically, in patients, beta (16-25 Hz)-gamma (110-166 Hz) phase amplitude coupling source localized to the ventromedial prefrontal cortex, and was reduced when NAc-DBS was active. In contrast, intracranial EEG recordings showed no beta-gamma phase amplitude coupling. The contribution of non-sinusoidal beta waveforms to this coupling are reported. Conclusion: We reveal an increased beta-gamma phase amplitude coupling in fronto-central scalp sensors in patients suffering from OCD, compared to healthy controls, which may derive from ventromedial prefrontal regions implicated in OCD and is normalized by DBS of the nucleus accumbens. This aberrant cross-frequency coupling could represent a biomarker of OCD, as well as a target for novel therapeutic approaches. (C) 2021 The Author

En este estudio se ha pretendido poner de manifiesto la importancia de la conciencia en los procesos psíquicos. Tras definir su concepto, hemos comprobado que la función cerebral denominada conciencia puede alterarse dando lugar a unos estados excepcionales de conciencia que se manifiestan en gran parte de los trastornos psiquiátricos. También, más allá de la clínica, se han analizado las condiciones psicosociales que llevan a una modulación de las conciencias, constatando el poderoso influjo que ejercen a tal fin los factores pedagógicos, jurídicos y religiosos. Igualmente, en las causas clínicas como en las psicosociales encontramos un elemento de gran importancia para la génesis de diversas alteraciones, la culpa hipertrofiada. La importancia de la conciencia, tanto en la cerebralización como en nuestra evolución, es esencial para entender la vida humana y los procesos de pensamiento. La investigación puede resumirse en las siguientes conclusiones, 1. La conciencia es una función cerebral configurada socialmente. 2. Existe una relación recíproca entre alteraciones psíquicas y de conciencia. 3. Las denominadas enfermedades mentales se desencadenan a partir de la aparición filogenética de la conciencia. 4. La sugestión y la culpa, separadamente o asociadas, juegan un papel fundamental en algunos estados excepcionales de conciencia. 5. Los éxtasis místicos, las visiones y las posesiones. A.Implican estados excepcionales de conciencia, B.En su inmensa mayoría pueden ser explicados y tratados por la psicología médica y la psiquiatría como, entre otros, trastornos de trance y posesión o de ideas delirantes inducidas. 6. Un mayor conocimiento sobre los estados excepcionales de conciencia podrá incidir en una mejora de la salud mental.