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Multichannel EEG cartography (48 channels) of schizophrenia, manla and depression
214S
Childhood disorderslEEO-mapping
BIOL. PSYCHIATRY 1997;42:15-2975
Conclusions: Results of this double-blind. placebo-controlled multicenter study demonstrate that sertraline Is a safe and effective treatment for children and adolescents 6-17 years old with obsessive compulsive disorder.
177-41 Ultra-rapid cycling bipolar disorders In children and adolescents: An underdiagnosed disease? F. Kochman, F. Ducrocq, PJ. Parquet. General Regional Hospital snd University of LlLLE. France We report seven cases of children and adolescent fulfilling criteria either for hypomanic episodes or major depressive disorders (according to DSM IV-Klddie-SADS-R semi-structured interview and confirmed by clinical im• pressions), each episode occurring within a very short period (from several hours to one week). 6 of these 7 young patients have suffered from repeated stressful events: parental or familial mistreatment; sexual abuses, repeated traumatic aban• donments. One of them has a familial history of bipolar disorder and has suffered from the regular hospltalisations of his mother (suffering from a bipolar II disorder). We hypothesize that bipolar disorders are not rare diseases In children and adolescents: (a) these disorders could occur by ultra-rapid cycling, with a rapid decrease of the symptoms, which could explain that they are underdiagnosed. (b) Repeated traumatic and stressful events could trigger the illness, ac• cording to Posfs kindling theory. This new theory raises important questions: can we consider these ultra• -rapid cycling episodes as an early onset of bipolar disorder? As a result should we treat these young patients? If yes, can we stop the natural evolu• tion of these early onset disorders by a treatment, with the aim of avoiding any kindling effects and the perpetuation of the illness?
177-51 Treatment of endogenous depressions In children N.M. lovchuk. Independenf Association of Child Psychiatrists and Psychologists. Moscow; Russia The experience of treatment of 220 children aged 3to 12 years with depres• sions in cyclothymia and circular schizophrenia Is generalized. The choice of antidepressant in childhood was limited due to their side effects (in this con• nection a number of antidepressants were not used in children treatment). as well as the age features of depression and the tendencies of the disease course In childhood: a great proportion of mixed affect, rapidity of polar phases change, lability, changeability of affect; multitudes change of their nuances In the course of one attack. Due the easiness of a inversion to mani• acal state or exc~ement (raptoldal states, anxious agitation, hypochondriac crises, hysteroformous and disphoric paroxysmal states) not only the use of stimulators of the type of sydnocarbum and sydnophenum was unaccept· able, but the prescription of such antidepressants as melipramln, Incazanum and cephedrinum was IIm~ed. The range of preparations of choice for the treatment of child depression was extremely close and included, In fact, only amitriptyllnum, anafranil, ludlomil, pyrazldolum and Russian sedative antide• pressant azaphenum that hasn't side effects practically. Polymorphism of the clinical picture that Included, besides the depressive symptomatic, also rudimentary persecution ideas, fragmentary hallucinatory disorders, signs of processual disturbances of thinking, neurosis-like and behavioural disorders dictated the necessity of combined treatment with the antidepressant therapy to be supplemental by neuroleptles, tranquillsers and nootrops.
177-61 schizophrenia, Multichannel EEG cartography (48 channels) of mania and depression P. Flor-Henry, A. Soong, J. Undo Alberta Hospital Edmonton. Edmonton, A/berta, Canada Methods: Unmedicated psychotics satlsfytng DSM-IV diagnostic criteria and normal controls were studied under resting conditions and during cognitive activation, all were dextrals. Sampling rate was 256 times a sec and 20-30 1 second segments judged to be free of artifacts on visual inspection were then passed through a digital filter removing all activities correlated with EMG, eye movements and EKG. After Fourier transformation topographic maps were constructed (spherical splines). Two topographic displays were constructed, one being a display of the power distribution and a second representing loadings of principal components obtained from the coherence matrix. Groups of electrodes with similar1y correlated activity were therefore
identified. The analysis of the differences between the groups was done for the four classical frequency bands. Results: In the abstract only the 20-50 Hz band will be reported. In both sexes the depressives had least and the schizophrenics most power in the frontotemporal area. This was bilateral In most cases, more on the right In depressives, more on the left in schizophrenia and more frontal in manies. There were differences between the sexes, for example female schizophre• nics showing an abnormal focus of coherence in the right temporoparietal region and the males a shift of coherence to the left hemisphere. The Implications of these findings will be discussed.
177.71 The spontaneous fluctuations of EEG and plasma ACTH are correlated In physiological conditions W.G. Sannita, S. Garbarino, F. Bollatl, V. Cavaciottl, P. Lazzerinl. Center for Neuroactive Drugs. DISMR. University, Genova. Italy, Dept. of Psychiatry, State University of New York, Stony Brook. NY, USA Endogenous ACTH is thought to modulate brain function and electrophysi• ology in physiological conditions Independent of CNS steroid effect. Method: Eight healthy male volunteers (24.5 :l: 1.8 yr.) were stud• Ied. Multi-lead EEG recordings (power spectral analysis; brain mapping) and plasma/serum levels of ACTH, cortisol and glucose (RIA or hexokl• nasalG6p-DH essay) (6 per SUbject) were obtained in controlled conditions in a 6-h period. Results: The power of EEG 'alpha' activity covaried with spontaneous changes of plasma ACTH In the physiological range (3.1-17.6 pmollL), in the absence of pUlsatile changes or Indication of hormonal response to stress. The correlation was described by a quadratic regression model (estimated maximum EEG power at 12-14 pmol/L ACTH). and proved independent from the extent of ACTH var1atlon. Two SUbgroups of subjects could be separated, with apparent cut-off at 8-10 pmollL No correlation was observed between EEG and cortisol (7.8-47.2 nmollL) or glucose (3.37~.6 mmol/L). A direct ACTH modulation on structures regulating brain electrophysiology or common factors (eg corticotropin-releasing hormone) pacing both ACTH and EEG are suggested. These observations provide possible Interpretations for Individual differences in the EEG pattem(s).
177-81 Theta EEG Interhemispheric coordination during hallucinations In psychotic patients and In normal subjects P. Cazard, Ph. Loron, F. Gekiere, M. Basquln, J.-F. Allilalre. CNRS. Pedopsychiatry, Adult Psychiatry. Neurology. HtJpital de la SaIp6triere. Paris, France. CHS Paul Guiraud. Vil/eluif, France Objective: Interhemispheric functional coordination impairments. as well as left temporal lobe abnormal activities, are often postulated In accounting for positive symptoms In schizophrenia. Our aim was to study during re• laxed mental states spontaneous Interhemispheric EEG evolution In normal subjects and In psychotic patients during production of acoustical-verbal hallucinations. Method: Six EEG leads (F3, F4, T3, T4, P3, P4, each referenced to Cz and sampled at 1000 hZ), were recorded continuously for 30 minutes, as well as, for psychotic patients, the times of reported hallucinations. For filtered theta rhythms, several parameters (frequency, phase relationship. coherence, FFT of cross-eorrelograms (FFT C-C) correlations of FFT C-C with frequency differences and with phase relationships) were computed each second and analyzed (LabVIEW and Data Desk). Results: 1) It was observed, both In patients and in normals, slow Oscil• lations of the temporal theta phase relationship apart from the line of zero phase difference (period 40-00 seconds). 2) In one psychotic patient (OSM IV F20.0) treated with Haloperidol (5 mg/24 h), It was observed during his brief hallucinations, a decrease ot FFT c-c between theta rhythms, a pos_ Itive correlation of the FFT c-c with phase precession of the right temporal theta and a negative correlation with the advance of the left theta. 3) On 12 hallucinations, 10 were signaled while theta rhythms zero phase difference. 4) The same patient one year later, hallucination free under adjunction of Mi. anserin (90 mg/24 h) to unchanged dosage of Haloperidol, was requested to signal "false voices· at Will, for testing the EEG Impact of such signalization in these conditions, we observed Instead an increase of FFTC-C. • Conclusions: 1) This EEG analysis demonstrated. especially In one patient during hallucinations, a functional Isolation of left temporal lobe. 2) Verbal expression of certain mental events could be time related to phase difference line zercH:rosslng.
Childhood disorderslEEO-mapping
BIOL. PSYCHIATRY 1997;42:15-2975
Conclusions: Results of this double-blind. placebo-controlled multicenter study demonstrate that sertraline Is a safe and effective treatment for children and adolescents 6-17 years old with obsessive compulsive disorder.
177-41 Ultra-rapid cycling bipolar disorders In children and adolescents: An underdiagnosed disease? F. Kochman, F. Ducrocq, PJ. Parquet. General Regional Hospital snd University of LlLLE. France We report seven cases of children and adolescent fulfilling criteria either for hypomanic episodes or major depressive disorders (according to DSM IV-Klddie-SADS-R semi-structured interview and confirmed by clinical im• pressions), each episode occurring within a very short period (from several hours to one week). 6 of these 7 young patients have suffered from repeated stressful events: parental or familial mistreatment; sexual abuses, repeated traumatic aban• donments. One of them has a familial history of bipolar disorder and has suffered from the regular hospltalisations of his mother (suffering from a bipolar II disorder). We hypothesize that bipolar disorders are not rare diseases In children and adolescents: (a) these disorders could occur by ultra-rapid cycling, with a rapid decrease of the symptoms, which could explain that they are underdiagnosed. (b) Repeated traumatic and stressful events could trigger the illness, ac• cording to Posfs kindling theory. This new theory raises important questions: can we consider these ultra• -rapid cycling episodes as an early onset of bipolar disorder? As a result should we treat these young patients? If yes, can we stop the natural evolu• tion of these early onset disorders by a treatment, with the aim of avoiding any kindling effects and the perpetuation of the illness?
177-51 Treatment of endogenous depressions In children N.M. lovchuk. Independenf Association of Child Psychiatrists and Psychologists. Moscow; Russia The experience of treatment of 220 children aged 3to 12 years with depres• sions in cyclothymia and circular schizophrenia Is generalized. The choice of antidepressant in childhood was limited due to their side effects (in this con• nection a number of antidepressants were not used in children treatment). as well as the age features of depression and the tendencies of the disease course In childhood: a great proportion of mixed affect, rapidity of polar phases change, lability, changeability of affect; multitudes change of their nuances In the course of one attack. Due the easiness of a inversion to mani• acal state or exc~ement (raptoldal states, anxious agitation, hypochondriac crises, hysteroformous and disphoric paroxysmal states) not only the use of stimulators of the type of sydnocarbum and sydnophenum was unaccept· able, but the prescription of such antidepressants as melipramln, Incazanum and cephedrinum was IIm~ed. The range of preparations of choice for the treatment of child depression was extremely close and included, In fact, only amitriptyllnum, anafranil, ludlomil, pyrazldolum and Russian sedative antide• pressant azaphenum that hasn't side effects practically. Polymorphism of the clinical picture that Included, besides the depressive symptomatic, also rudimentary persecution ideas, fragmentary hallucinatory disorders, signs of processual disturbances of thinking, neurosis-like and behavioural disorders dictated the necessity of combined treatment with the antidepressant therapy to be supplemental by neuroleptles, tranquillsers and nootrops.
177-61 schizophrenia, Multichannel EEG cartography (48 channels) of mania and depression P. Flor-Henry, A. Soong, J. Undo Alberta Hospital Edmonton. Edmonton, A/berta, Canada Methods: Unmedicated psychotics satlsfytng DSM-IV diagnostic criteria and normal controls were studied under resting conditions and during cognitive activation, all were dextrals. Sampling rate was 256 times a sec and 20-30 1 second segments judged to be free of artifacts on visual inspection were then passed through a digital filter removing all activities correlated with EMG, eye movements and EKG. After Fourier transformation topographic maps were constructed (spherical splines). Two topographic displays were constructed, one being a display of the power distribution and a second representing loadings of principal components obtained from the coherence matrix. Groups of electrodes with similar1y correlated activity were therefore
identified. The analysis of the differences between the groups was done for the four classical frequency bands. Results: In the abstract only the 20-50 Hz band will be reported. In both sexes the depressives had least and the schizophrenics most power in the frontotemporal area. This was bilateral In most cases, more on the right In depressives, more on the left in schizophrenia and more frontal in manies. There were differences between the sexes, for example female schizophre• nics showing an abnormal focus of coherence in the right temporoparietal region and the males a shift of coherence to the left hemisphere. The Implications of these findings will be discussed.
177.71 The spontaneous fluctuations of EEG and plasma ACTH are correlated In physiological conditions W.G. Sannita, S. Garbarino, F. Bollatl, V. Cavaciottl, P. Lazzerinl. Center for Neuroactive Drugs. DISMR. University, Genova. Italy, Dept. of Psychiatry, State University of New York, Stony Brook. NY, USA Endogenous ACTH is thought to modulate brain function and electrophysi• ology in physiological conditions Independent of CNS steroid effect. Method: Eight healthy male volunteers (24.5 :l: 1.8 yr.) were stud• Ied. Multi-lead EEG recordings (power spectral analysis; brain mapping) and plasma/serum levels of ACTH, cortisol and glucose (RIA or hexokl• nasalG6p-DH essay) (6 per SUbject) were obtained in controlled conditions in a 6-h period. Results: The power of EEG 'alpha' activity covaried with spontaneous changes of plasma ACTH In the physiological range (3.1-17.6 pmollL), in the absence of pUlsatile changes or Indication of hormonal response to stress. The correlation was described by a quadratic regression model (estimated maximum EEG power at 12-14 pmol/L ACTH). and proved independent from the extent of ACTH var1atlon. Two SUbgroups of subjects could be separated, with apparent cut-off at 8-10 pmollL No correlation was observed between EEG and cortisol (7.8-47.2 nmollL) or glucose (3.37~.6 mmol/L). A direct ACTH modulation on structures regulating brain electrophysiology or common factors (eg corticotropin-releasing hormone) pacing both ACTH and EEG are suggested. These observations provide possible Interpretations for Individual differences in the EEG pattem(s).
177-81 Theta EEG Interhemispheric coordination during hallucinations In psychotic patients and In normal subjects P. Cazard, Ph. Loron, F. Gekiere, M. Basquln, J.-F. Allilalre. CNRS. Pedopsychiatry, Adult Psychiatry. Neurology. HtJpital de la SaIp6triere. Paris, France. CHS Paul Guiraud. Vil/eluif, France Objective: Interhemispheric functional coordination impairments. as well as left temporal lobe abnormal activities, are often postulated In accounting for positive symptoms In schizophrenia. Our aim was to study during re• laxed mental states spontaneous Interhemispheric EEG evolution In normal subjects and In psychotic patients during production of acoustical-verbal hallucinations. Method: Six EEG leads (F3, F4, T3, T4, P3, P4, each referenced to Cz and sampled at 1000 hZ), were recorded continuously for 30 minutes, as well as, for psychotic patients, the times of reported hallucinations. For filtered theta rhythms, several parameters (frequency, phase relationship. coherence, FFT of cross-eorrelograms (FFT C-C) correlations of FFT C-C with frequency differences and with phase relationships) were computed each second and analyzed (LabVIEW and Data Desk). Results: 1) It was observed, both In patients and in normals, slow Oscil• lations of the temporal theta phase relationship apart from the line of zero phase difference (period 40-00 seconds). 2) In one psychotic patient (OSM IV F20.0) treated with Haloperidol (5 mg/24 h), It was observed during his brief hallucinations, a decrease ot FFT c-c between theta rhythms, a pos_ Itive correlation of the FFT c-c with phase precession of the right temporal theta and a negative correlation with the advance of the left theta. 3) On 12 hallucinations, 10 were signaled while theta rhythms zero phase difference. 4) The same patient one year later, hallucination free under adjunction of Mi. anserin (90 mg/24 h) to unchanged dosage of Haloperidol, was requested to signal "false voices· at Will, for testing the EEG Impact of such signalization in these conditions, we observed Instead an increase of FFTC-C. • Conclusions: 1) This EEG analysis demonstrated. especially In one patient during hallucinations, a functional Isolation of left temporal lobe. 2) Verbal expression of certain mental events could be time related to phase difference line zercH:rosslng.