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559. Current cogntive functioning versus premorbid status as predictors of levels of functioning
170S
BIOL PSYCHIATRY 2000;47:1S–173S
These findings suggest that careful studies of cortical excitability may be useful in the prediction of treatment for depression and that neurophysiological abnormality may be modified by effective treatment.
557. PHASE RESETTING OF BACKGROUND EEG IS A MAJOR EP GENERATION MECHANISM
Saturday Abstracts
Response rates were comparable in both groups (chi square 1.75 p ⬎1); however delusional patients responded significantly better to ECT (chi square 6.0 p .01). Non-delusional patients responded equally well to ECT and TMS (chi square .0, p ⬎ .1). Cortical output maps were performed on 15 patients treated with TMS. Preliminary analysis of the results suggests that those patients demonstrating an excitability response (increased voltage in MEP) responded best to TMS. TMS was found to be as effective as ECT in this sample of severely depressed patients. Our results add to the growing body of evidence supporting the efficacy of TMS in depression. Our results also suggest that cortical output maps in the form of integrated MEP responses are of value for identifying those patients that will respond to TMS.
B.H. Jansen Department of Electrical and Computer Engineering, University of Houston, Houston, TX 77204-4793 Evidence is presented that evoked potentials (EPs) are in large part generated by way of phase reorganization of brain activity present at the moment of stimulus presentation. Phase reorganization manifests itself as an inter-trial alignment of “spontaneous” EEG activity following stimulus delivery. Specifically, oscillatory brain activity in specific frequency bands will crest at a fixed latency, irrespective of its phase at the moment of stimulation. The evidence was obtained from analyzing auditory EPs, obtained with a paired click paradigm. Two analysis methods were used. The first one involves fuzzy clustering-based selective averaging. The second approach is a novel decomposition method referred to as the piecewise Prony method (PPM). The PPM models single trial EPs as a summation of exponentially-decaying and/or increasing oscillatory components. Phase reorganization as a mechanism for EP generation does not necessarily invalidate the conventional ensemble averaging approach to EP enhancement. However, the ensemble average will be morphologically different from single trials responses, and the positive and negative components of the ensemble average should be interpreted as an epiphenomenon of the phase reorganization.
559. CURRENT COGNTIVE FUNCTIONING VERSUS PREMORBID STATUS AS PREDICTORS OF LEVELS OF FUNCTIONING P.D. Harvey, D.E. Mancini, H. Jacobsen, J.I. Friedman, V. Haroutunian, L. White, M. Parrella, K.L. Davis Mt. Sinai School of Medicine, New York, NY 10029
558. IS TRANSCRANIAL MAGNETIC STIMULATION AS EFFECTIVE AS ELECTROCONVULSIVE THERAPY IN THE TREATMENT OF SEVERE MAJOR DEPRESSION? L. Grunhaus, P.N. Dannon, O.T. Dolberg Psychiatry Division Sheba Medical Center, Tel Hashomer Israel 52621 In a previous report (Grunhaus et al in press) we described our experience with TMS in severe depressives finding that in non-delusional major depression (MD) TMS is as effective as ECT. In this communication we will expand on our previous results and explore the value of cortical output maps as correlates of response to TMS. Seventy patients meeting DSM-IV criteria for MD were referred to ECT by the treating clinician. Patients were assigned (after signing a consent form) to either ECT or rTMS according to an apriori generated random list. All psychotropic medications (with the exception of up to 3 mgs of lorazepam) were discontinued. Raters were kept blind to study group. ECT was administered according to established protocols. TMS was administered at 10Hz (90% motor threshold-MT) over the left dorsolateral prefrontal cortex using a figure-of-eight coil and a Magstim Rapid equipment. Twenty trains of six seconds duration were administered for up to twenty days. A cortical output map at 120% MT was performed during the first, fifth, tenth, and twentieth treatment. An integrated motor evoked potential (MEP) curve was obtained at baseline and 15 and 30 minutes post TMS.
Premorbid functioning is a well-known predictor of overall functional status in patients with schizophrenia. Yet, recent research has highlighted the important role of current cognitive functioning in the prediction of functional outcome. Cognitive functioning in schizophrenia is likely, however, to be influenced by premorbid factors. The specific causal relationship between these domains and functional status is not yet understood. In order to examine the role of premorbid status and current cognitive function for the prediction of functional outcome in schizophrenia, a large sample of currently hospitalized geriatric patients (n ⫽ 389) who varied widely in their lifetime functional outcome, ranging from a cyclical course of illness with brief inpatient stays to continuous illness for decades, were studied. Premorbid functioning was estimated with multiple demographic variables (years of education completed, employment and marital history) and by measures of reading ability. Current cognitive functioning was measured with a neuropsychological battery and functional status was rated with the SAFE scale. Education, reading, employment and marital history, as well as current cognitive functioning, were all significantly correlated with functional status (all r ⬎ .28, all p ⬍ .05) and all measures of premorbid status were significantly correlated with current cognitive functioning, (all r ⬎ .22, all p ⬍ .05). When a path analysis was employed, it was found that none of the measures of premorbid functioning were directly related to current functional status, when current cognitive status was considered. In contrast, current cognitive functioning accounted for close to 50% of the variance in functional status (R2 ⫽ .48, p ⬍ .001). These findings suggest that premorbid functioning influences functional status through its impact on cognitive functioning and not directly. These results suggest that interventions that change current cognitive status may influence functional skills.
BIOL PSYCHIATRY 2000;47:1S–173S
These findings suggest that careful studies of cortical excitability may be useful in the prediction of treatment for depression and that neurophysiological abnormality may be modified by effective treatment.
557. PHASE RESETTING OF BACKGROUND EEG IS A MAJOR EP GENERATION MECHANISM
Saturday Abstracts
Response rates were comparable in both groups (chi square 1.75 p ⬎1); however delusional patients responded significantly better to ECT (chi square 6.0 p .01). Non-delusional patients responded equally well to ECT and TMS (chi square .0, p ⬎ .1). Cortical output maps were performed on 15 patients treated with TMS. Preliminary analysis of the results suggests that those patients demonstrating an excitability response (increased voltage in MEP) responded best to TMS. TMS was found to be as effective as ECT in this sample of severely depressed patients. Our results add to the growing body of evidence supporting the efficacy of TMS in depression. Our results also suggest that cortical output maps in the form of integrated MEP responses are of value for identifying those patients that will respond to TMS.
B.H. Jansen Department of Electrical and Computer Engineering, University of Houston, Houston, TX 77204-4793 Evidence is presented that evoked potentials (EPs) are in large part generated by way of phase reorganization of brain activity present at the moment of stimulus presentation. Phase reorganization manifests itself as an inter-trial alignment of “spontaneous” EEG activity following stimulus delivery. Specifically, oscillatory brain activity in specific frequency bands will crest at a fixed latency, irrespective of its phase at the moment of stimulation. The evidence was obtained from analyzing auditory EPs, obtained with a paired click paradigm. Two analysis methods were used. The first one involves fuzzy clustering-based selective averaging. The second approach is a novel decomposition method referred to as the piecewise Prony method (PPM). The PPM models single trial EPs as a summation of exponentially-decaying and/or increasing oscillatory components. Phase reorganization as a mechanism for EP generation does not necessarily invalidate the conventional ensemble averaging approach to EP enhancement. However, the ensemble average will be morphologically different from single trials responses, and the positive and negative components of the ensemble average should be interpreted as an epiphenomenon of the phase reorganization.
559. CURRENT COGNTIVE FUNCTIONING VERSUS PREMORBID STATUS AS PREDICTORS OF LEVELS OF FUNCTIONING P.D. Harvey, D.E. Mancini, H. Jacobsen, J.I. Friedman, V. Haroutunian, L. White, M. Parrella, K.L. Davis Mt. Sinai School of Medicine, New York, NY 10029
558. IS TRANSCRANIAL MAGNETIC STIMULATION AS EFFECTIVE AS ELECTROCONVULSIVE THERAPY IN THE TREATMENT OF SEVERE MAJOR DEPRESSION? L. Grunhaus, P.N. Dannon, O.T. Dolberg Psychiatry Division Sheba Medical Center, Tel Hashomer Israel 52621 In a previous report (Grunhaus et al in press) we described our experience with TMS in severe depressives finding that in non-delusional major depression (MD) TMS is as effective as ECT. In this communication we will expand on our previous results and explore the value of cortical output maps as correlates of response to TMS. Seventy patients meeting DSM-IV criteria for MD were referred to ECT by the treating clinician. Patients were assigned (after signing a consent form) to either ECT or rTMS according to an apriori generated random list. All psychotropic medications (with the exception of up to 3 mgs of lorazepam) were discontinued. Raters were kept blind to study group. ECT was administered according to established protocols. TMS was administered at 10Hz (90% motor threshold-MT) over the left dorsolateral prefrontal cortex using a figure-of-eight coil and a Magstim Rapid equipment. Twenty trains of six seconds duration were administered for up to twenty days. A cortical output map at 120% MT was performed during the first, fifth, tenth, and twentieth treatment. An integrated motor evoked potential (MEP) curve was obtained at baseline and 15 and 30 minutes post TMS.
Premorbid functioning is a well-known predictor of overall functional status in patients with schizophrenia. Yet, recent research has highlighted the important role of current cognitive functioning in the prediction of functional outcome. Cognitive functioning in schizophrenia is likely, however, to be influenced by premorbid factors. The specific causal relationship between these domains and functional status is not yet understood. In order to examine the role of premorbid status and current cognitive function for the prediction of functional outcome in schizophrenia, a large sample of currently hospitalized geriatric patients (n ⫽ 389) who varied widely in their lifetime functional outcome, ranging from a cyclical course of illness with brief inpatient stays to continuous illness for decades, were studied. Premorbid functioning was estimated with multiple demographic variables (years of education completed, employment and marital history) and by measures of reading ability. Current cognitive functioning was measured with a neuropsychological battery and functional status was rated with the SAFE scale. Education, reading, employment and marital history, as well as current cognitive functioning, were all significantly correlated with functional status (all r ⬎ .28, all p ⬍ .05) and all measures of premorbid status were significantly correlated with current cognitive functioning, (all r ⬎ .22, all p ⬍ .05). When a path analysis was employed, it was found that none of the measures of premorbid functioning were directly related to current functional status, when current cognitive status was considered. In contrast, current cognitive functioning accounted for close to 50% of the variance in functional status (R2 ⫽ .48, p ⬍ .001). These findings suggest that premorbid functioning influences functional status through its impact on cognitive functioning and not directly. These results suggest that interventions that change current cognitive status may influence functional skills.