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J Neurol Neurosurg Psychiatry 2004;75:593-599. doi: 10.1136/jnnp.2002.006403 Background: The human amygdala is implicated in the formation of emotional memories and the perception of emotional stimuli--particularly fear--across various modalities. Objectives: To [...]

Introduction: Despite their efficacy, antipsychotic drugs appear to be associated with metabolic side effects such as impaired lipid metabolism and an increased risk for developing metabolic syndrome. Investigating the association between individual antipsychotics, exposure durations and mean changes in complete lipid profile has not yet been the focus of a meta-analysis. Objectives: The aim is to conduct a meta-analysis of randomized controlled trials (RCTs) examining the association between changes in lipid profile in adults using an antipsychotic drug. Methods: This meta-analysis follows the PRISMA guidelines and a protocol has been published in PROSPERO. A systematic search was performed using the databases PubMed, EMBASE, Cochrane, and PsycINFO. Eligible RCTs were identified and no restriction was made regarding diagnosis or publication date. Statistical analysis will be conducted using a random effects model. Results are separated in four exposure categories, namely < 6 weeks, 6-16 weeks, 16-38 weeks, and ≥ 38 weeks. Outcome measures include mean change in total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol and triglyceride levels. Results: The search strategy identified 1144 citations. Of these, 746 abstracts were excluded as being off-topic. Atotal of 399 fulltext articles were assessed for eligibility and 202 articles met inclusion criteria. Data extraction and analysis are currently underway. Results will be presented at the EPA Congress 2020. Conclusions: We expect the findings of this study to be of clinical relevance in the management and monitoring of antipsychotic treatment. The knowledge of whether duration of exposure is associated with different lipid changes could provide interesting results benefiting individualised choices. [ABSTRACT FROM AUTHOR]

Introduction: Intravesical injections with botulinum toxin A (BoNT-A) is an established treatment for patients with overactive bladder (OAB) symptoms. However, most studies have evaluated the efficacy of this treatment in women and report short-term results. In this study, we evaluated the long-term compliance of BoNT-A in a heterogeneous group of male patients., Materials and Methods: This is a retrospective, single-centre study. We evaluated all male patients who have been treated with BoNT-A from 2004 until 2010 in a large teaching hospital. Patients received 100-300 U of onabotulinum toxin-A in 20 intravescial injections. Some patients received dose adjustment with repeated injections., Results: In total, 88 male patients were included. The mean follow-up was almost 6 years (69 months). Of all patients, 22 (25%) continued BoNT-A treatment at last follow-up (success). Of the patients who discontinued treatment, 35 had insufficient effect and 27 had tolerability issues (eg, urinary retention, self-catheterisation, voiding LUTS). Four patients abandoned treatment due to other reasons that were not related to BoNT-A. Of all patients, 24% had to use intermittent catheterisation (de novo) or indwelling catheters at some point during the follow-up., Discussion: In this real-life, heterogeneous cohort of men, the long-term compliance with BoNT-A was 25%. Patients with neurogenic OAB symptoms appear to have the best results in our study with 36% of patients who were still on active treatment during last follow-up. Intravesical BoNT-A can be an effective treatment for men with OAB symptoms. In our study, only 25% of patients continued treatment during long-term follow-up. Larger, prospective trials are needed to confirm these results., (© 2017 Wiley Periodicals, Inc.)

Purpose: Patients with temporal lobe epilepsy (TLE) often present mood disturbances, which may either exacerbate or remit following surgery. The objective of the study was to investigate the relationship between post-operative depressive/anxiety symptoms and hippocampal/amygdala volumes following anterior temporal lobectomy., Methods: Thirty-five patients operated for TLE were assessed for mood disturbances by the Beck depression inventory (BDI) and Beck anxiety inventory (BAI). Post-operative MRI data were collected and volumetric analysis of the hippocampi (HV) and amygdala (AV) was performed. Correlations between volumetric data, measures of mood, and demographic and clinical data were calculated., Results: BDI scores significantly correlated with the intact HV (p=0.029) as well as the absolute difference between the intact and remnant HV (p=0.021). This was evident in left-side resections (p=0.049); in right-side resections the correlation was marginally non- significant (p=0.057). Depressed patients also had smaller remnant AV (p=0.002). Furthermore, BAI was negatively correlated with the HV remnant in left-side resections (p=0.038). No other significant associations between post-operative mood disturbances and various demographic and clinical variables were observed., Conclusion: The severity of depressive symptomatology in operated epilepsy patients correlates with the extent of hippocampal and amygdala resection; this association appears to be more evident in left-side resections.

This study examines emotional memory effects in primary depersonalization disorder (DPD). A core complaint of DPD sufferers is the dulling of emotional responses, and previous work has shown that, in response to aversive stimuli, DPD patients do not show activation of brain regions involved in normal emotional processing. We hypothesized that DPD sufferers would not show the normal emotional enhancement of memory, and that they would not show activation of brain regions concerned with emotional processing during encoding and recognition of emotional verbal material. Using fMRI, 10 DPD patients were compared with an age-matched healthy control group while performing a test of emotional verbal memory, comprising one encoding and two recognition memory tasks. DPD patients showed significantly enhanced recognition for overtly emotive words, but did not show enhancement of memory for neutral words encoded in an emotive context. In addition, patients did not show activation of emotional processing areas during encoding, and exhibited no substantial difference in their neural responses to emotional and neutral material in the encoding and emotional word recognition tasks. This study provides further evidence that patients with DPD do not process emotionally salient material in the same way as healthy controls, in accordance with their subjective descriptions of reduced or absent emotional responses.

It is now well established that emotion enhances episodic memory. However, it remains unclear whether the same neural processes underlie enhancement of memory for both emotional stimuli and neutral stimuli encoded in an emotive context. We designed an experiment that specifically attempted to separate these effects and that was validated on 30 participants. We then used functional magnetic resonance imaging (fMRI) to examine the neural correlates of encoding and retrieval of the two classes of stimuli in 12 healthy male volunteers. We predicted that aversive emotional context would enhance memory regardless of content and that activation of anterior cingulate would be inversely related to retrieval of aversive items. Both predictions were supported. Furthermore we demonstrated apparent asymmetrical lateralisation of activation in the hippocampal/parahippocampal complex during recognition of words from aversive sentences: more left-sided activation for neutral words from aversive contexts, and more right-sided activation for aversive content words. These findings, if applicable to the wider population, may have application in a range of psychiatric disorders where interactions between emotion and cognition are relevant.

Purpose: We carried out a pilot study of quantitative volumetric MRI of the amygdala in patients undergoing surgery for intractable temporal lobe epilepsy. We wished to explore whether amygdala volume correlated with pre-operative clinical variables and post-operative outcome., Methods: Ten patients had detailed volumetric measurements of their amygdala and hippocampus according to operationalised anatomical criteria from an optimised MRI imaging sequence. A ratio of volumes from the unoperated to operated side was calculated. Surgical specimens were examined histologically for astrocytosis., Results: The volumes of the amygdala and hippocampus on the operated side were significantly smaller than on the unoperated side. More severe astrocytosis appeared to go along with smaller volume ratios but the relationship was not significant. There were few significant correlations between volumes measures and clinical or outcome variables., Conclusion: Reductions in amygdala volume in the to-be-operated temporal lobe in patients with medically intractable epilepsy can be reliably detected using volumetric MRI. Accurate amygdala volume measures do not appear to exert a significant effect on clinical presentation and outcome in the presence of hippocampal volumes reductions, but may be useful in confirming bilateral pathology. Larger studies examining clinico-pathological correlations are recommended.

Recall is typically better for emotional than for neutral stimuli. This enhancement is believed to rely on limbic regions. Memory is also better for neutral stimuli embedded in an emotional context. The neural substrate supporting this effect has not been thoroughly investigated but may include frontal lobe, as well as limbic circuits. Alzheimer's disease (AD) results in atrophy of limbic structures, whereas normal aging relatively spares limbic regions but affects prefrontal areas. The authors hypothesized that AD would reduce all enhancement effects, whereas aging would disproportionately affect enhancement based on emotional context. The results confirmed the authors' hypotheses: Young and older adults, but not AD patients, showed better memory for emotional versus neutral pictures and words. Older adults and AD patients showed no benefit from emotional context, whereas young adults remembered more items embedded in an emotional versus neutral context.

The structure and function of the human amygdala is attracting increasing attention in the scientific literature, particularly since the advent of high resolution magnetic resonance imaging (MRI). We carried out a systematic review of the published literature reporting left and right amygdala volumes from MRI in non-clinical subjects. Our aim was to estimate the normal range of the volume of the amygdala and to account for heterogeneity of the measures. The factors we considered included the detail given regarding various subject factors, the plane of scan acquisition, slice thickness and contiguity, magnet strength, positional and volume correction, and the reliability of measurement. Thirty-nine studies with 51 data sets fulfilled selection criteria. The mean+/-95% confidence interval for the left amygdala volume was 1726.7 mm(3)+/-35.1, and right was 1691.7 mm(3)+/-37.2. The left-right difference did not reach statistical significance. The overall range of reported volumes was 1050 mm(3) to 3880 mm(3). The amygdala is significantly larger in men and shows an inverse correlation with age. The main methodological factor found to influence amygdala measurement was anatomical definition. Studies using 'Watson's criteria' (Neurology 42 (1992) 1743) produced significantly larger volumes than the remainder. An index of study quality revealed an inverse relationship with volume-the higher the quality the smaller the volume. This reflected such factors as slice thickness, correction for brain volume, positional correction and number of subjects. We conclude by putting forward a detailed operationalized anatomical delineation of the amygdala, based on Watson's criteria. This work should guide future research in obtaining accurate and reliable amygdala volume measures which in turn will aid comparisons with clinical groups and the specification of structural-functional relationships.