In this study we intended to analyse if the REF Scale is a good indicator to differentiate the two subtypes of paranoia “Bad Me” and “Poor Me” (Trower & Chadwick, 1995).

Participants: We analyzed data from a different sample of previous studies with 326 participants (64.11% women, mean age 30.8, SD = 10.84), of whom 212 were patients.

Design, materials and procedure: We used the REF-scale (Lenzenweger et al., 1997) adapted to Spanish language, of which we deleted two items because of psychometric criteria, resulting 32 dichotomic items. We used SPSS 15.0 to conduct a principal-components factor analysis with a varimax and oblimin rotation, retaining two factors.

Two factors explained 31.32% of the variance (rotated solution). We interpreted factor through factor loadings higher than .42. Factor 1 accounted for 18.28% of the variance and it's associated with referential laughter, commentaries and guilt. Factor 2 accounted for 13.05% of the variance and it's associated with referential concerns related to the media.

Since the inter-factor correlation is moderate (.44) and there are no relevant clinical differences about the content between the two factors, the REF scale is a one-dimensional measure. Therefore, two big factors don’t emerge from the REF scale related to referential concerns about laughter-commentaries and guilt that correspond to “Poor Me” and “Bad Me”, respectively.

This instrumental work aims to replicate the exploratory factor analysis about the Referential Thinking Scale (REF scale) already developed by Lenzenweger et al. (1997) to examine its multidimensionality.

Participants: The analyzed sample consisted of 193 participants (67.36% women, mean 28.36 years old, SD = 10.35), of whom 131 were patients.

Design, materials and procedure: We used the REF-scale (Lenzenweger et al., 1997) adapted to Spanish language. This questionnaire consists of 34 items that assess the frequency of referential thinking on a dichotomic scale (true/false). We used SPSS 15.0 to conduct a principal-components factor analysis with a varimax and oblimin rotation.

The principal-components factor analysis method led to 5 factors that explain 37.35% of variance for the rotated solution. Because of inter-factors correlations are small, we considered these factors as being independent. The five factors were labeled as: Laughter, Commentaries (it accounted for 8.92% of variance); Guilt (it accounted for 8.77% of variance); Causal Explanations (it accounted for 7.17% of variance); Songs, Newspapers, Books (it accounted for 6.44% of variance); and Attention, Appearance (it accounted for 6.04% of variance).

It's obtained the five factors isolated in previous studies (Lenzenweger et al., 1997; Rodríguez-Testal et al., 2001). However, the multidimensionality of the REF scale must be viewed with caution because of a small percentage of explained variance.

Affective temperaments (measured by the TEMPS-A) have been proved to be associated with major mood disorders, implying that these temperament types represent the subclinical manifestations of affective disorders and an increased vulnerability to pathological mood regulation. However, less attention was paid to the association of affective temperaments with trait impulsivity, which is commonly associated with clinical picture of bipolar mood disorder. The aim of our study was to assess the associations between affective temperaments and impulsivity among healthy volunteers and remitted bipolar outpatients.

1096 students, 31 euthymic bipolar outpatients and 31 healthy controls were self assessed with Barratt Impulsivity Scale and Slovenian version of TEMPS-A questionnaire.

Our data revealed positive correlation between impulsivity and cyclothymic and irritable temperament and negative correlation between impulsive behaviour and hyperthymic temperament. Depressive and anxious temperament proved to be positively linked with attentional and negatively with motor and nonplanning impulsivity. Furthermore, mean scores on depressive, cyclothymic, irritable and anxious temperament subscales as well as on attentional and motor impulsiveness and general impulsive score were significantly higher in the group of bipolar outpatients.

Our results are in agreement with several studies where authors emphasized that elevated depressive, cyclothymic, irritable and anxious temperamental scores as well as impulsive behaviour could indicate a vulnerability to pathological mood regulation during the remission phase of bipolar disorder. The results also brought to light some important connections between temperamental traits and impulsivity, indicating that both domains could be relevant in early diagnostic picture for affective disorders.

To evaluate the subjective well-being of a group of patients who were hospitalized at the Institute of Psychiatry (Novara), compared to the severity of illness.

Patients are evaluated at admission and discharge through self-administration of the SWN (Subjective Well-being under Neuroleptics) scale, which contains five subscales (emotional regulation; self-control; mental functioning; social integration and physical functioning) assessing patients’ psychophysical and emotional well-being, calculating a value for each subscale and a total score. The clinician fills in the CGI (Clinical Global Impression) for each patient, which provides a global judgement in three areas: severity of illness, global improvement and therapeutic effectiveness.

From June 2009, 51 patients were evaluated at admission and discharge: 26 diagnosed with psychosis and 25 diagnosed with personality disorders. Preliminary data suggest a meaningful improvement of the physical functioning in the psychotic group, a tendency to improvement of the social integration area in the personality disorders group. Among the psychotic group, the schizophrenic patients (n°=14) have shown an improvement in the self-control subscale.

Literature suggests that a high SWN score is associated with a better compliance and an early improvement of subjective well-being is a major predictor of the chance of remission. This study will allow to compare the subjective well-being evaluated by SWN with the clinical judgment of the CGI and above all if this can represent a predictor index for the compliance and the chance of remission.

The extent of working memory (WM) impairment has rarely been studied in patients with amnestic mild cognitive impairment (aMCI). The aim of the present study was to evaluate the cortical activation in these patients compared to healthy controls while performing a visuo-spatial WM task.

Functional magnetic resonance imaging (fMRI) with a 3-Tesla head scanner (Allegra, Siemens) was used to investigate the neural correlates of WM in 25 aMCI subjects and 12 matched controls while performing a visual-spatial n-back task (2-back). Both groups were pretested to ensure that all participants were able to understand and perform the task.

In comparison to the healthy subjects, a random-effects analysis revealed that patients with aMCI showed less cortical activation especially in the left superior parietal cortex and left inferior frontal cortex. These areas are known to be involved in the control of attention and visuo-spatial WM.

Our findings suggest that attenuated cortical activation during working memory tasks may provide an early marker for aMCI.

Following consensus on a fronto-striato-thalamo-frontal dysfunction as the neuronal basis of the pathogenesis of obsessive-compulsive disorder, neurobiological psychotherapy research is concentrating increasingly on recording the neuronal modification mechanisms induced by psychotherapeutic intervention.

A systematic literature search was used to identify original papers that studied the effects of psychotherapy on the neuronal activation patterns correlating with obsessive-compulsive disorder.

As a consistent result in patients with obsessive-compulsive disorder, a reduction in activity in the caudate nucleus was measured after a successful response to behavioural therapy in those studies that did not use any psychological simulation test. Moreover there is evidence of an altered correlation between the orbitofrontal cortex (OFC), the caudate nucleus and the thalamus after a symptom improvement induced by psychotherapy, and also an improved recruitment capability by those cortex areas that play an important role in cognitive processes, such as the cerebellum and the dorsolateral prefrontal cortex (DLPFC).

It can be shown that neuronal activation patterns in the brain are modifiable by psychotherapeutic interventions. It is unclear why these changes in the case of obsessive-compulsive disorder are similar to those produced by pharmacological treatment whereas in the case of depression, for example, heterogeneous results are observed in this respect. Furthermore, the methodological background of the neuro-imaging methods is critically analysed and future research strategies for neuroscientifically oriented psychotherapy research are indicated.

Many research groups have used neuroimaging techniques in order to investigate brain abnormalities in patients with Anorexia Nervosa (AN). The results of structural studies, which utilised CT scan and MRI, have revealed both global brain abnormalities and region-specific brain abnormalities. The central disturbance in AN is that of a distorted body image and food refusal. The purpose of the present study was to analyze structural neuroimaging studies in order to revel the possible existence of a neural basis of AN symptoms.

Published reports from refereed journals of the last twenty years are collected, analyzed and synthesized into a summary of the most significant neuroimaging findings. We used as keywords “anorexia”, “neuroimaging”, “MRI”, “CT”, “manual measurement”, “voxel based morphometry” differently matched together.

Structural studies have showed total decreases in both gray matter (GM) and white matter (WM), with an increase in cerebrospinal fluid (CSF). Several structural follow-up studies reported that GM, WM and CSF abnormalities are fully reversible after recovery, whilst other authors reported that GM decreases persists after recovery. Region-specific structural studies have principally revealed a decrease in extrastriate body area, precuneus, parietal lobe and, following recovery, the anterior cingulate cortex.

These results showed a global GM vulnerability in AN patients and that the specific GM regions affected are principally involved in the processing of body-image and mental images, and in the regulation of hunger and satiation. Although these results are still under debate, findings suggest that AN symptoms could have a neural substrate.

To assess the frequency of silent brain infarcts and cerebral cortical atrophy in male alcohol dependant psychiatric patients in post war Bosnia and Herzegovina (BH).

We analyzed twenty male alcohol dependant patients who were treated in the Department of Psychiatry in University Clinical Centre Tuzla during one year period (July 2007-July 2008), and to whom Computerized Tomography (CT) scan of neuro-cranium were done, according to age, war engagement, brain trauma, employment, smoking and presence of silent strokes and cerebral cortical atrophy. The results were analyzed using descriptive statistics.

Average age of the group of patients studied was 48.8±6.0 years, and 13/20 was hospitalized for the first time. Eleven of 20 were engaged as soldiers during the 1992-95 war in BH. Four of them were wounded and two of them had air-blast injury and head stroke without concussion. Fourteen of twenty were unemployed, and two of them were retired. Only one was admitted with alcoholic delirium. Eleven of twenty were cigarette smokers. Half of them had CT objectified silent stroke, and sixteen of twenty had generalized brain cortical atrophy. Brain cortical atrophy was significantly negatively associated with war engagement, while silent stroke were positively associated with age of patients.

Brain cortical atrophy and silent brain stroke are frequent findings in computerized tomography of the brain in psychiatric patients with alcohol dependency.

The aim of the study was to assess the frontal cortex functioning in schizophrenics and patients with paraphilia using CNV analysis in antisaccade paradigm.

9 paranoid schizophrenics, 13 patients with stereotyped forms of paraphilia, and 10 healthy subjects performed horizontal antisaccades. All participants were right-handed males. EEG was recorded from 19 sites. Mean amplitudes of slow negative potentials time-locked to peripheral target (CNV) were analyzed over two intervals: 1000-800 ms (early CNV), and 200-0 ms (late CNV) before peripheral target. Fixation period was 1200-1400 ms.

Significant increase of errors was revealed in patients with schizophrenia (13,6±4,4%) and parafilia (12,4±2,8%) compared to controls (4,1±1,0%). The significant between-group differences were obtained for the amplitude of early CNV, related to cognitive aspects of preparatory set. Bilateral frontal-central-parietal distribution of early CNV with a maximal amplitude at the saggital sites (Fz, Cz) was observed in control subjects. Significant decline of the CNV amplitude most pronounced in the saggital frontal region (Fz) was found in schizophrenics compared to controls. In patients with paraphilia the negativity zone didn't include central and parietal regions, but CNV amplitude at frontal sites didn't differ from control values.

The obtained results demonstrate that poor antisaccade performance was associated with different neural mechanisms in patients with schizophrenia and paraphilia.

The deficit of frontal activation was found in schizophrenic patients. Lack of the activation of central-parietal region in paraphilia group may reflect dysturbed interaction between cortical and subcortical systems involved in the executive regulation of behavior.

We wished to examine whether patterns of neural engagement during emotional processing could distinguish patients with Bipolar Disorder (BD) from their relatives with Major Depressive Disorder (MDD) and their psychiatrically healthy relatives.

Functional magnetic resonance imaging (fMRI) data were collected during a sad facial affect recognition task from 41 remitted BD patients, 40 of their first degree relatives (15 of whom had MDD) and 51 healthy controls. Data were analysed in SPM5.

1. A) Compared to controls, all individuals with genetic predisposition to BD showed increased activation in temporal lobe regions.

2. B) Compared to BD patients, MDD relatives had reduced activation in the left posterior cingulate (BA31) and the orbitofrontal cortex (BA11)

3. C) Compared to their healthy relatives, BD patients showed increased activation in somatosensory cortices bilaterally (BA3 and BA5) and in the posterior cingulate gyrus (BA30) on the left and reduced activation in the right cerebellum and the right inferior frontal gyrus (BA47).

4. D) Compared to their healthy relatives, MDD relatives showed reduced activation in the left superior frontal gyrus (BA10).

Our results suggest that:

1. (a) genetic predisposition to BD was associated with increased activation in distal nodes of the ventral visual pathway within the temporal lobe

2. (b) disease expression for mood disorders was associated with reduced neural responses in the PFC

3. (c) resilience in healthy relatives was associated with enhanced PFC engagement

4. (d) loci identified showed partial specificity for different clinical phenotypes indicative of partially segregated processes underpinning disease and resilience for mood disorders.

It is well known that brain activity associated with Go/NoGo tasks differed for normal children and those with ADHD, anxiety disorders, etc. Here, EEG mapping is used to study brain activity associated with Go/NoGo tasks in two populations of young healthy Brazilian (Fig. 1A) and German (Fig. 1B) children (4-6 year old).

Children (N=30) performed a child-oriented go-nogo task at the computer. We determined the entropy of the correlations between the EEG signal recorded by each electrode (10/20 system in Brazil, extended 10/20 system in Germany) as proposed elsewhere (Rocha et al. 2005) for 1000 ms epochs after the beginning of each trial.

Fig. 1

Factor Brain Mappings associated with solving Go/NoGo tasks in Brazilian (A) and German (B) children

Factor Analysis showed that the calculated entropy covaried among the frontal electrodes (Pattern F1); centro-temporal electrodes (Pattern F2) and the parieto-occiptal electrodes (Pattern F2) covariation in the two populations despite the different EEG recording systems.

Our spatial EEG approach revealed a Go/NoGo brain activity pattern similar to that recorded by adults in fMRI. In addition, the results were similar for two different populations of children and for two different recording systems. The EEG technology demonstrated here reliabl, cross cultural and cross technical robustness, when investigating young children from different cultures.

Attention is hypothesized to increase the brain's functional connectivity measured as EEG coherence between brain areas. Is this true for different types of attention compared to no-task resting?

In 25 healthy, meditation-naïve, right-handed, male students 58-channel EEG was recorded during three conditions of 5 minutes each with closed eyes in randomized order: (1) resting [3 runs], (2) mental arithmetic [2 runs], and (3) breath counting, a meditation initiation technique [2 runs]. For the 8 EEG frequency bands, the artifacted EEG was recomputed into sLORETA intracerebral current densities. To avoid localization ambiguities, we computed EEG coherence between sLORETA areas. To avoid effects of volume conduction, we computed intracerebral `lagged coherence' connectivity between sLORETA current densities in 19 areas. Averaged resting runs were compared to those breath counting and arithmetic runs of which participants post-hoc reported that their concentration was best.

Paired t-tests between conditions yielded differences of coherence at p< 0.1 (corrected for multiple testing) for 5 EEG frequency bands (delta, theta, alpha1, alpha2, beta3) [number of connections in brackets]: coherence was lower in breath counting than arithmetic (delta, beta3 [1,1]). Coherence was lower in resting than arithmetic (alpha2 [1]), but higher in resting than breath counting (theta, alpha1, alpha2, beta3 [2,1,1,1]).

Attention to breath counting showed lowest, to arithmetic highest demands on intracerebral functional connectivity. Breath counting and mental arithmetic induce mental states whose inter-area connectivity differs in opposite directions from resting. The results do not support a global hypothesis of increased coherence during attention.

Cocaine use is related to several cardiovascular conditions. Vasoconstriction seems to be particularly harmful to the brain.

To evaluate the relationship between the pattern of cocaine use and cerebral perfusion among cocaine addicts.

A sample of 30 cocaine addicts was studied using 99 m-Tc-HMPAO SPECT (single photon emission computed tomography with injection of 99 m-Tc-hexametilpropilenoamina-oxime). Their cerebral perfusion pattern was then compared with their pattern of cocaine use.

Eighty percent of the sample presented some degree of impairment in brain perfusion, either focal or diffuse. There was no difference between sniffers and crack smokers regarding their perfusion patterns. No relationship could be established between the severity of SPECT abnormalities and the amount of drug consumption or the duration of abstinence. However, duration of cocaine use did correlate with the severity of cerebral perfusion (Spearman correlation coefficient: r = 0.45, p < 0.05).

This study documents the high frequency of cerebral functional impairment in cocaine addicts and establishes the relationship between duration of cocaine exposure and severity of perfusion abnormalities.

Diffusion tensor imaging (DTI) is a relatively new imaging technique that is being increasingly used in different types of psychiatric patologies to characterize white matter microstructural organization in this kind of disorders. In the present study we use DTI to explore the structure of the white matter of borderline personality disorder (BPD) patients, using a novel voxel-based approach, tract-based spatial statistics (TBSS), to analyze the data.

DTI was performed in a 1.5T MRI unit in 9 young male patients with a DSM-IV defined BPD and 14 healthy male control subjects (no significant age difference between groups).Voxel wise analysis was performed using TBSS (diffusion toolbox of FSL- functional MRI Software Library) to localize regions of white matter showing significant changes of fractional anisotropy (FA). Additional high resolution three dimensional datasets were also acquired and normalised white matter volume was estimated with SIENAX (part of FSL).

The TBSS analysis revealed a statistically significant decrease in FA at the anterior part of the body and the genu of the corpus callosum and frontal white matter. This finding is consistent with previously reported findings of subtle prefrontal white matter abnormalities in BPD.

Significant white matter tract alterations in patients with BPD where observed in frontal regions involved in emotional, behavioural and cognitive regulation, and these abnormalities may be linked to key aspects of psychopatology in these patients.

Continuous arterial spin labelling (cASL) is a non-invasive magnetic resonance imaging method increasingly used to study human brain function and perfusion physiology.

In this study, we investigated distinct patterns of cerebral blood flow (CBF) in MDD patients by means of resting state cASL.

11 healthy controls and 11 patients with MDD according to DSM-IV criteria were included. The individual cASL images underwent data preprocessing steps including the generation of perfusion-weighted images, followed by conversion to quantified CBF. An analysis of temporally coherent CBF patterns was performed using a spatial Independent Component Analysis.

Both groups showed distinct blood flow patterns in a medial frontoparietal and lateral temporal component (“default mode” network), a medial temporal and anterior cingulate component (“limbic” network) and bilateral prefrontal and parietal component (“cognitive” network). Within the “limbic” network, MDD patients showed a pattern of increased CBF in the bilateral ventrolateral prefrontal, cingulate, striatal and hippocampal regions. Within the “cognitive” network, MDD patients showed a pattern of increased CBF in left dorsolateral prefrontal and the inferior parietal areas. Decreased perfusion in MDD patients was found in the right precuneus, the right inferior parietal cortex, the left posterior cingulate and the left lateral temporal cortex.

These preliminary data demonstrate the sensitivity of cASL techniques for detecting resting state CBF changes in MDD patients. Thus, cASL studies in MDD could provide valuable information with regard to neurobiologically characterized endophenotypes, while resting state CBF measures could serve as objective predictors of treatment response in future studies.