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Biomedical subjects

Paul Cosyns

Publications and source records attributed to Paul Cosyns.

9 recordsLinked to original sources
PubMed2006

Combined dexamethasone/CRF test in remitted outpatients with recurrent major depressive disorder.

BACKGROUND: Hyperactivity of the hypothalamic-pituitary-adrenal (HPA) axis is a prominent neurobiological finding during a major depressive episode, reflecting a state dependent factor. An issue under investigation is whether the dysfunction of the HPA axis has also a role to play as a state-independent or trait factor for major depressive disorder (MDD). In relation to this, it is important to examine HPA axis function in patients who are clinically remitted from depression. METHODS: Twenty-three remitted outpatients with recurrent MDD and 23 age- and gender-matched control individuals without a history of MDD participated in the sensitive combined dexamethasone/corticotropin-releasing factor (DEX/CRF) test. RESULTS: Free salivary cortisol responses were not significantly different between the two groups, although three patients (13%) displayed extremely elevated cortisol responses after CRF. LIMITATIONS: Limited sample size. All but one patient were under treatment with an antidepressant. CONCLUSIONS: This study shows no evidence for a disturbed DEX/CRF test as a state-independent factor in recurrent MDD on a group level. However, MDD is a complex and heterogenic disorder. Probably, there is a subgroup of patients who show a disturbed DEX/CRF test due to an inherited and/or acquired predisposition or as a biological scar after previous depressive episodes.

Adult↗
PubMed2006

A biopsychosocial model as a guide for psychoeducation and treatment of depression.

Effective treatment of severe or chronic unipolar depression requires the combination of pharmacological and psychotherapeutic interventions, and demands a theoretical paradigm integrating biological and psychosocial aspects of depression. Supported by recent research, we propose in our article a biopsychosocial diathesis-stress model of depression. Its basic aim is psychoeducational: to provide therapists, patients, and their environment a constructive conceptual framework to understand depressive complaints, vulnerability, and stress. The core of the model consists of the concept of psychobiological vulnerability, which is determined by risk factors-of a biogenetic, psychological, somatic, and societal nature-and by protective factors. Life events with an idiosyncratic, stress-inducing value interact with this vulnerability, triggering severe or chronic distress that affects the individual's resilience and leads to symptoms of depression. The pathogenesis of depression is symbolized by a negative downward loop, in which interactions among symptoms, vulnerability, and stressors drive the patient toward a depressive condition. Moreover, experiencing recurrent depression influences psychobiological vulnerability, the occurrence of stressors, and tremendously increases the risk of further relapse. The model stresses the self-evident integration of biological and psychological therapeutic interventions that need to focus on symptom reduction and on relapse prevention. Moreover, it offers the patient and therapist a psychoeducational context in which the individual's vulnerability and depressive symptoms can be treated. Finally, applications of the depression model as a therapeutic approach to severe depression in the phases of remoralization, symptom reduction, and relapse prevention are presented.

Cognitive Behavioral Therapy↗
PubMed2006

Metabolic imaging of anterior capsular stimulation in refractory obsessive-compulsive disorder: a key role for the subgenual anterior cingulate and ventral striatum.

UNLABELLED: High-frequency anterior capsular stimulation is a new, promising, and reversible neuromodulatory treatment in the research stage for patients with refractory obsessive-compulsive disorder (OCD). The mechanism of action is unknown but hypothesized to be secondary to interruption of the corticothalamostriatocortical circuit. METHODS: (18)F-FDG PET was performed on 6 consecutive OCD patients preoperatively and after stimulation. The results were compared with those of 20 age- and sex-matched healthy volunteers by using both a standardized volume-of-interest-based approach for subcortical areas and statistical parametric mapping. Correlations were investigated with Yale-Brown Obsessive Compulsive Scale scores (Y-BOCS) and Hamilton Depression Rating Scale scores (HAM-D). RESULTS: Chronic anterior capsular electrostimulation resulted in a further decrease of prefrontal metabolic activity, especially in the subgenual anterior cingulate (P < 0.001). Correlation analysis demonstrated that decreases in Y-BOCS and HAM-D with anterior capsular electrostimulation were inversely related to the metabolic activity changes in the left ventral striatum, left amygdala, and left hippocampus (P < 0.01). Preoperative resting metabolic activity in the subgenual anterior cingulate was predictive of therapeutic response (P = 0.001). CONCLUSION: These observations provide evidence that the subgenual anterior cingulate and ventral striatum have a key role in the neuronal circuitry involved in the pathophysiology of OCD with associated major depression and in the neuromodulatory mechanism of anterior capsular stimulation.

Adult↗
PubMed2006

Lower omega-3 polyunsaturated fatty acids and lower docosahexaenoic acid in men with pedophilia.

BACKGROUND: Previous studies have suggested that abnormalities in plasma phospholipid fatty acids may play a role in aggressive behavior. Recently, it was suggested that a dysfunctional serotonergic turnover in the brain may be involved in the etiopathology of pedophilia. Depletion of n-3 polyunsaturated fatty acids (PUFA) may cause alterations in the serotonergic system that may be related to pedophilia and aggression. METHODS: This study examines the serum phospholipid n-3 and n-6 PUFA fractions in pedophilia. Twenty-seven pedophilic men and eighteen healthy volunteers participated in this study. RESULTS: In pedophilia there was a significant depletion of the C22:6n-3 (docosahexaenoic acid, DHA), total n-3 fractions and an increase in the total n-6/n-3 and C20:4n-6/C20:5n-3 (arachidonic acid/eicosapentaenoic acid) ratios. Using the NEO Personality Inventory, lower DHA in pedophiles is related to more impulsiveness and lower agreeableness (trust, altruism, straightforwardness, compliance) and conscientiousness (self-discipline). CONCLUSIONS: The results of this study suggest that a depletion of the serum phospholipid n-3 higher unsaturated fatty acids (HUFAs) and, in particular, of DHA may take part in the pathophysiology of pedophilia. One hypothesis is that a depletion of n-3 HUFAs and DHA may cause alterations in the serotonergic turnover, which are related to impulse discontrol and aggression-hostility, behaviors which are associated with pedophilia.

Case-Control Studies↗
PubMed2005

The use of atypical antipsychotics in the treatment of catatonia.

PURPOSE: Evidence indicates that classical antipsychotics may aggravate non-malignant and malignant catatonia (MC). Atypical antipsychotics are less likely to cause movement disorders than classical antipsychotics and they are being frequently prescribed in disorders that can be associated with catatonia. Therefore, the important question that arises is whether atypical antipsychotics have a role to play in the treatment of catatonia. MATERIALS AND METHODS: A Medline search was performed to locate papers on the use of atypical antipsychotics in catatonia published between 1970 and 31st December 2004. RESULTS: The literature on the use of atypical antipsychotics in catatonia consists of case reports and retrospective studies. In most cases of non-MC a reduction of the catatonic symptoms is reported upon treatment with atypical antipsychotics. Cases of MC relate mainly to the neuroleptic malignant syndrome (NMS), which is considered as an iatrogenic stuporous variant of MC caused by antipsychotics. CONCLUSION: There are indications that atypical antipsychotics may be useful in non-MC. As a consequence, one should not only focus on the possible extrapyramidal and autonomic side effects of these drugs, but also on the possible beneficial effects on certain brain functions and on the catatonic symptomatology. However, randomized controlled trials are needed to evaluate the effect of these drugs, and caution is advisable, since cases of NMS have been linked to treatment with atypical antipsychotics. There is no evidence to prescribe atypical antipsychotics in MC.

Antipsychotic Agents↗
PubMed2004

The ADP-IV questionnaire: differential validity and concordance with the semi-structured interview.

The Assessment of DSM-IV Personality Disorders questionnaire (ADP-IV) is a self-report measure of the DSM-IV Axis II personality disorders (PDs). The ADP-IV assesses for each DSM-IV criterion its typicality as well as the accompanying distress and impairment. This study investigates two important aspects of the construct validity of the ADP-IV: (a) the differential validity (i.e., the ability to differentiate between a sample of the general Flemish population ( n = 659) and a sample of psychiatric inpatients ( n = 487) with a high prevalence of clinical PD diagnoses, and patients with and without a PD in the psychiatric sample; (b) the convergent validity with the SCID-II semi-structured interview in a population of psychiatric inpatients ( n = 59). The results indicate a good differential validity: the dimensional scales and the categorical measures discriminated well between both groups and between patients with and without a PD diagnosis in the psychiatric sample. Concerning the concordance with the SCID-II, a decent level of agreement is exemplified by a correlation of.67 between the dimensional total scores of both instruments and by kappa coefficients for an "any" Axis II diagnosis at the.50 level. In conclusion, the results indicate that the ADP-IV is an efficient method for assessing PD in dimensional and categorical ways.

Adolescent↗
PubMed2003

Electrical stimulation of the anterior limbs of the internal capsules in patients with severe obsessive-compulsive disorder: anecdotal reports.

Anterior capsular stimulation induces some improvement in severe treatment-resistant OCD patients. At this stage, not all stimulation-induced effects can be explained. The effects are a valuable source for further neurophysiologic and neuroanatomic research. It was reassuring that when the group of Drs Rasmussen, Greenberg, and Friehs in Providence and the group of Drs Rezai, Montgomery, and Malone in Cleveland started to operate on OCD patients using exactly the same technique, similar effects were seen in the patients. The authors still want to stress that anterior capsular stimulation remains investigational and needs optimization, especially to try to solve the problem of the short battery life of the stimulators.

Adult↗