Rêves et émotions chez des sujets souffrant du trouble comportemental en sommeil paradoxal

Le trouble comportemental en sommeil paradoxal (TCSP) est caractérisé par des rêves intenses et une perte de l’atonie musculaire normalement présente au cours du sommeil paradoxal qui permet l’apparition de comportements oniriques isomorphiques au contenu des rêves. Quelques chercheurs ont étudié le contenu des rêves des patients atteints du TCSP, plusieurs ont trouvé une plus grande présence de thèmes menaçants et agressifs, d’autres ont obtenu des résultats plus mitigés. Ces études comportent des failles méthodologiques importantes, comme l’absence d’un groupe contrôle ou l’inclusion de patients consommant une médication psychoactive. La présence de rêves à caractère dysphorique a été associée, dans d’autres populations, à une psychopathologie marquée et à des difficultés émotionnelles, et cette association, quoiqu’inexplorée pourrait aussi être présente chez patients ayant un TCSP. La raison pour laquelle ces patients font des rêves plus dysphoriques est encore largement inconnue, de même qu’une partie des mécanismes qui génèrent les comportements oniriques. Le but du premier article de cette thèse était de mesurer l’alexithymie et la détresse des cauchemars chez les patients atteints du TCSP par rapport à des contrôles. Les résultats indiquent que les patients souffrent davantage d’alexithymie, et particulièrement d’une difficulté à identifier leurs émotions et qu’elle corrélait avec la détresse due aux cauchemars. Le second article estimait, à l'aide d'un questionnaire validé, la présence de rêves, la diversité des thèmes des rêves chez les patients et examinait leurs thèmes au cours de leur vie. Les patients rapportaient beaucoup plus de cauchemars et plus de thèmes à caractère menaçant, comme des agressions, des catastrophes, et des rêves où le rêveur a peu de contrôle. Le troisième article avait pour objectif de clarifier les écarts dans les résultats des études sur les rêves des patients, c'est-à-dire déterminer si l'agressivité rapportée par ces patients est vraiment une différence au niveau du contenu des rêves, ou s'il s'agit plutôt d'un problème dû à la détresse liée aux rêves. Un second objectif était de mesurer le degré de corrélation entre les comportements à l’éveil, comme les comportements miroirs, et les comportements oniriques chez les patients. L’article démontre que les patients ressentaient une plus grande détresse à l'éveil en lien avec leurs expériences oniriques et que leurs rêves étaient plus dysphoriques et contenaient plus d'anxiété. De plus, leurs résultats au questionnaire de comportements miroirs corrélaient avec la sévérité de leurs comportements oniriques, ce qui suggère que le système de neurones miroirs pourrait avoir une influence sur les manifestations de ces comportements chez les patients. Globalement, ces résultats suggèrent que des difficultés au niveau de la régulation émotionnelle pourraient expliquer à la fois les symptômes émotionnels à l’éveil et les difficultés nocturnes des patients. Nous suggérons qu'un déficit au niveau des régions régulatrices frontales pourrait être à la base des différentes difficultés éprouvées par les patients. De plus, il est possible que des anomalies au niveau du système de neurones miroirs aient à la fois un impact sur la capacité des patients à réguler leurs émotions, mais aussi sur les manifestations de comportements oniriques.

Efectividad de la ketamina en depresión bipolar: revisión sistemática de la literatura

Introducción: Aunque el hallazgo clínico más distintivo del Trastorno Afectivo Bipolar es el ánimo patológicamente elevado, este no suele ser el estado de ánimo prevalente de la enfermedad. La fase depresiva del trastorno o depresión bipolar es más crónica, conlleva a un mayor deterioro de la funcionalidad y representa un reto terapéutico habitual. En la actualidad, el manejo farmacológico de la depresión bipolar suele consistir en combinaciones de al menos dos medicamentos distintos, incluyendo estabilizadores del afecto (litio y anticonvulsivantes), antipsicóticos atípicos y antidepresivos. El objetivo central de este trabajo es evaluar la efectividad de la Ketamina en la depresión bipolar. Métodos: Revisión sistemática de la literatura de artículos que proporcionen información sobre la eficacia de la Ketamina en la fase depresiva del Trastorno Bipolar. Resultados: De los 147 artículos arrojados por la búsqueda, dos cumplieron los criterios de selección (n=33). En comparación con placebo, ketamina tiene un efecto antidepresivo rápido y duradero, incluso en pacientes que han recibido más de 3 medicamentos previamente. No se reportaron efectos adversos severos durante los estudios. Discusión. La evidencia actual apunta a que la ketamina es útil para el manejo de la depresión bipolar, incluso cuando es resistente al tratamiento, es segura y puede tener cierto efecto antisuicida. Es necesario ampliar la evidencia existente.

Efectos del consumo de cigarrillo en la presentación y severidad de la dismenorrea

Introducción: La dismenorrea se presenta como una patología cada vez más frecuente en mujeres de 16-30 años. Dentro de los factores asociados a su presentación, el consumo de tabaco ha revelado resultados contradictorios. El objetivo del presente estudio es explorar la asociación entre el consumo de cigarrillo y la presentación de dismenorrea, y determinar si los trastornos del ánimo y la depresión, alteran dicha asociación. Materiales y métodos: Se realizó un estudio de prevalencia analítica en mujeres de la Universidad del Rosario matriculadas en pregrado durante el primer semestre de 2013, para determinar la asociación entre el consumo de tabaco y la presentación de dismenorrea. En el estudio se tuvieron en cuenta variables tradicionalmente relacionadas con dismenorrea, incluyendo las variables ansiedad y depresión como potenciales variables de confusión. Los registros fueron analizados en el programa Estadístico IBM SPSS Statistics Versión 20.0. Resultados: Se realizaron 538 cuestionarios en total. La edad promedio fue 19.92±2.0 años. La prevalencia de dismenorrea se estimó en 89.3%, la prevalencia de tabaquismo 11.7%. No se encontró una asociación entre dismenorrea y tabaquismo (OR 3.197; IC95% 0.694-14.724). Dentro de las variables analizadas, la depresión y la ansiedad constituyen factores de riesgo independientes para la presentación de dismenorrea con una asociación estadísticamente significativa p=0.026 y p=0.024 respectivamente. El análisis multivariado encuentra como factor determinante en la presentación de dismenorrea, la interacción de depresión y ansiedad controlando por las variables tradicionales p<0.0001. Sin embargo, esta asociación se pierde cuando se analiza en la categoría de dismenorrea severa y gana relevancia el uso de métodos de anticoncepción diferentes a los hormonales, mientras que el hecho de haber iniciado la vida sexual presenta una tendencia limítrofe de riesgo. Conclusiones: No se puede demostrar que el tabaco es un factor asociado a la presentación de dismenorrea. Los trastornos del ánimo y la ansiedad constituyen factores determinantes a la presentación de dismenorrea independientemente de la presencia de otros concomitantes. Las variables de asociación se modifican cuando la variable dependiente se categoriza en su estado más severo. Se necesitan estudios más amplios y detallados para establecer dicha asociación.

Papel de la diplomacia cultural de corea del sur para consolidar su marca país en Colombia en el periodo 2011- 2013

El presente trabajo de investigación busca analizar el papel de la Diplomacia Cultural de Corea del Sur en el posicionamiento de su marca país en Colombia en el periodo 2011-2013. Se pretende demostrar que desde el 2011 la diplomacia cultural de Corea del Sur ha sido usada como estrategia sistemática y armónica del Gobierno de Lee Myung Bak en alianza con los sectores público y privado, a fin de posicionar su marca país en Colombia y promover a través de la llamada “Ola Coreana” la demanda por parte de la sociedad colombiana de productos culturales y educativos coreanos. Al ser este un estudio de caso que aborda experiencias concretas durante un periodo de tiempo de 3 años, el diseño metodológico será longitudinal dentro de un marco cualitativo de investigación, usando como principal técnica el análisis documental.

Los otros programas educativos.

Se proponen dos programas considerados de interés por sus contenidos y valores que difunden: 'Taz-Mania' serie de dibujos animados para público mayor de cinco años, y 'Cuestión Capital' documental dedicado al urbanismo dirigido a niños, jóvenes y mayores.

Tamoxifen as a potential antileishmanial agent: efficacy in the treatment of Leishmania braziliensis and Leishmania chagasi infections

The aim of this study was to evaluate the efficacy of tamoxifen in vivo in experimental models of cutaneous (CL) and visceral leishmaniasis (VL) caused by Leishmania braziliensis and Leishmania chagasi, respectively. Drug activity was assessed against intracellular amastigotes by treating infected macrophage cultures and evaluating the number of infected cells. In vivo efficacy of tamoxifen was tested in L. braziliensis-infected BALB/c mice and in L. chagasi-infected hamsters. Treatment with 20 mg/kg/day tamoxifen was administered for 15 days by the intraperitoneal route. Efficacy was evaluated through measurements of lesion size, parasite burden at the lesion site or liver and spleen and survival rate. Tamoxifen killed L. braziliensis and L. chagasi intracellular amastigotes with 50% inhibitory concentrations (IC(50)) of 1.9 +/- 0.2 and 2.4 +/- 0.3 mu M, respectively. Treatment of L. braziliensis-infected mice with tamoxifen resulted in significant reductions in lesion size and 99% decrease in parasite burden, compared with mock-treated controls. L. chagasi-infected hamsters treated with tamoxifen showed significant reductions in liver parasite load expressed as Leishman-Donovan units and 95% to 98% reduction in spleen parasite burden. All animals treated with tamoxifen survived while 100% of the mock-treated animals had died by 11 weeks after the interruption of treatment. Tamoxifen is effective in the treatment of CL and VL in rodent models.

OSCILLATOR STRENGTHS AND LIFETIMES FOR THE P XII

Semi-empirical weighted oscillator strengths (gf) and lifetimes presented in this work for all experimentally known electric dipole P XII spectral lines and energy levels were computed within a multiconfiguration Hartree-Fock relativistic approach. In this calculation, the electrostatic parameters were optimized by a least-squares procedure in order to improve the adjustment to experimental energy levels. The method produces lifetime and gf values that are in agreement with intensity observations used for the interpretation of spectrograms of solar and laboratory plasmas.

Functional and Structural Connectivity Between the Perigenual Anterior Cingulate and Amygdala in Bipolar Disorder

Objective: Abnormalities in the morphology and function of two gray matter structures central to emotional processing, the perigenual anterior cingulate cortex (pACC) and amygdala, have consistently been reported in bipolar disorder (BD). Evidence implicates abnormalities in their connectivity in BD. This study investigates the potential disruptions in pACC-amygdala functional connectivity and associated abnormalities in white matter that provides structural connections between the two brain regions in BD. Methods: Thirty-three individuals with BD and 31 healthy comparison subjects (HC) participated in a scanning session during which functional magnetic resonance imaging (fMRI) during processing of face stimuli and diffusion tensor imaging (DTI) were performed. The strength of pACC-amygdala functional connections was compared between BD and HC groups, and associations between these functional connectivity measures from the fMRI scans and regional fractional anisotropy (FA) from the DTI scans were assessed. Results: Functional connectivity was decreased between the pACC and amygdala in the BD group compared with HC group, during the processing of fearful and happy faces (p < .005). Moreover, a significant positive association between pACC-amygdala functional coupling and FA in ventrofrontal white matter, including the region of the uncinate fasciculus, was identified (p < .005). Conclusion: This study provides evidence for abnormalities in pACC-amygdala functional connectivity during emotional processing in BD. The significant association between pACC-amygdala functional connectivity and the structural integrity of white matter that contains pACC-amygdala connections suggest that disruptions in white matter connectivity may contribute to disturbances in the coordinated responses of the pACC and amygdala during emotional processing in BD.

Abnormal Corpus Callosum Integrity in Bipolar Disorder: A Diffusion Tensor Imaging Study

Objective: Abnormalities in the anterior interhemispheric connections provided by the corpus callosum (CC) have long been implicated in bipolar disorder (BID). In this study, we used complementary diffusion tensor imaging methods to study the structural integrity of the CC and localization of potential abnormalities in BD. Methods: Subjects included 33 participants with BID and 40 healthy comparison participants. Fractional anisotropy (FA) measures were compared between groups with region of interest (ROD methods to investigate the anterior, middle, and posterior CC and voxel-based methods to further localize abnormalities. Results: In ROI-based analyses, FA was significantly decreased in the anterior and middle CC in the BID group (p <.05). Voxel-based analyses similarly localized group differences to the genu, rostral body, and anterior midbody of CC (p <.05, corrected). Conclusion: The findings demonstrate abnormalities in the structural integrity of the anterior CC in BID that might contribute to altered interhemispheric connectivity in this disorder.

Herb-drug interactions: a literature review

Herbs are often administered in combination with therapeutic drugs, raising the potential of herb-drug interactions. An extensive review of the literature identified reported herb-drug interactions with clinical significance, many of which are from case reports and limited clinical observations.
Cases have been published reporting enhanced anticoagulation and bleeding when patients on long-term warfarin therapy also took Salvia miltiorrhiza (danshen). Allium sativum (garlic) decreased the area under the plasma concentration-time curve (AUC) and maximum plasma concentration of saquinavir, but not ritonavir and paracetamol (acetaminophen), in volunteers. A. sativum increased the clotting time and international normalised ratio of warfarin and caused hypoglycaemia when taken with chlorpropamide. Ginkgo biloba (ginkgo) caused bleeding when combined with warfarin or aspirin (acetylsalicylic acid), raised blood pressure when combined with a thiazide diuretic and even caused coma when combined with trazodone in patients. Panax ginseng (ginseng) reduced the blood concentrations of alcohol (ethanol) and warfarin, and induced mania when used concomitantly with phenelzine, but ginseng increased the efficacy of influenza vaccination. Scutellaria baicalensis (huangqin) ameliorated irinotecan-induced gastrointestinal toxicity in cancer patients.
Piper methysticum (kava) increased the 'off' periods in patients with parkinsonism taking levodopa and induced a semicomatose state when given concomitantly with alprazolam. Kava enhanced the hypnotic effect of alcohol in mice, but this was not observed in humans. Silybum marianum (milk thistle) decreased the trough concentrations of indinavir in humans. Piperine from black (Piper nigrum Linn) and long (P. longum Linn) peppers increased the AUC of phenytoin, propranolol and theophylline in healthy volunteers and plasma concentrations of rifamipicin (rifampin) in patients with pulmonary tuberculosis. Eleutheroccus senticosus (Siberian ginseng) increased the serum concentration of digoxin, but did not alter the pharmacokinetics of dextromethorphan and alprazolam in humans. Hypericum perforatum (hypericum; St John's wort) decreased the blood concentrations of ciclosporin (cyclosporin), midazolam, tacrolimus, amitriptyline, digoxin, indinavir, warfarin, phenprocoumon and theophylline, but did not alter the pharmacokinetics of carbamazepine, pravastatin, mycophenolate mofetil and dextromethorphan. Cases have been reported where decreased ciclosporin concentrations led to organ rejection. Hypericum also caused breakthrough bleeding and unplanned pregnancies when used concomitantly with oral contraceptives. It also caused serotonin syndrome when used in combination with selective serotonin reuptake inhibitors (e.g. sertraline and paroxetine).
In conclusion, interactions between herbal medicines and prescribed drugs can occur and may lead to serious clinical consequences. There are other theoretical interactions indicated by preclinical data. Both pharmacokinetic and/or pharmacodynamic mechanisms have been considered to play a role in these interactions, although the underlying mechanisms for the altered drug effects and/or concentrations by concomitant herbal medicines are yet to be determined. The clinical importance of herb-drug interactions depends on many factors associated with the particular herb, drug and patient. Herbs should be appropriately labeled to alert consumers to potential interactions when concomitantly used with drugs, and to recommend a consultation with their general practitioners and other medical carers.

The bipolar depression rating scale (BDRS) : its development, validation and utility

Objectives: Unipolar and bipolar depression differ neurobiologically and in clinical presentation. Existing depression rating instruments, used in bipolar depression, fail to capture the necessary phenomenological nuances, as they are based on and skewed towards the characteristics of unipolar depression. Both clinically and in research there is a growing need for a new observer-rated scale that is specifically designed to assess bipolar depression.

Methods: An instrument reflecting the characteristics of bipolar depression was drafted by the authors, and administered to 122 participants aged 18–65 (44 males and 78 females) with a diagnosis of DSM-IV bipolar disorder, who were currently experiencing symptoms of depression. The Bipolar Depression Rating Scale (BDRS) was administered together with the Hamilton Depression Rating Scale (HAM-D), Montgomery Asberg Depression Rating Scale (MADRS) and Young Mania Rating Scale (YMRS).

Results: The BDRS has strong internal consistency (Cronbach's alpha = 0.917), and robust correlation coefficients with the MADRS (r = 0.906) and HAM-D (r = 0.744), and the mixed subscale correlated with the YMRS (r = 0.757). Exploratory factor analysis showed a three-factor solution gave the best account of the data. These factors corresponded to depression (somatic), depression (psychological) and mixed symptom clusters.

Conclusions: This study provides evidence for the validity of the BDRS for the measurement of depression in bipolar disorder. These results suggest good internal validity, provisional evidence of inter-rater reliability and strong correlations with other depression rating scales.

Family interactions and the development of borderline personality symptoms

This thesis investigated the emergence of borderline personality disorder in adolescence. It found that adolescent sensitivity to, and maternal socialization of, aggressive behaviour is associated with borderline pathology. Change in pathology over time was related to adolescent dysphoric behaviour and sensitivity to inconsistent displays of maternal negative emotion.

A role for glutathione in the pathophysiology of bipolar disorder and schizophrenia? Animal models and relevance to clinical practice.

The tripeptide, glutathione (glutamylcysteinylglycine) is the primary endogenous free radical scavenger in the human body. When glutathione (GSH) levels are reduced there is an increased potential for cellular oxidative stress, characterised by an increase and accruement of reactive oxygen species (ROS). Oxidative stress has been implicated in the pathology of schizophrenia and bipolar disorder. This could partly be caused by alterations in dopaminergic and glutamatergic activity that are implicated in these illnesses. Glutamate and dopamine are highly redox reactive molecules and produce ROS during normal neurotransmission. Alterations to these neurotransmitter pathways may therefore increase the oxidative burden in the brain. Furthermore, mitochondrial dysfunction, as a source of oxidative stress, has been documented in both schizophrenia and bipolar disorder. The combination of altered neurotransmission and this mitochondrial dysfunction leading to oxidative damage may ultimately contribute to illness symptoms. Animal models have been established to investigate the involvement of glutathione depletion in aspects of schizophrenia and bipolar disorder to further characterise the role of oxidative stress in psychopathology. Stemming from preclinical evidence, clinical studies have recently shown antioxidant precursor treatment to be effective in schizophrenia and bipolar disorder, providing a novel clinical angle to augment often suboptimal conventional treatments.

Diagnosing bipolar disorder : how can we do it better?

• Accurate diagnosis of bipolar disorder is essential for effective treatment.

• The diagnosis of bipolar disorder is particularly complex, resulting in lengthy delays between first presentation and initiation of appropriate therapy. Inappropriate therapy destabilises the course and outcome of the disease.

• Although the defining features of bipolar disorder are manic or hypomanic episodes, patients typically present for treatment of depression and commonly deny symptoms of mood elevation.

• A correct diagnosis can easily be masked by comorbidities, personality issues and complex phenomenology.

• A diagnosis of bipolar disorder can be assisted by:

   → asking about symptoms of mania or hypomania in every patient presenting with symptoms of depression.

   → recognising mixed states in which manic and depressive symptoms occur simultaneously.

   → identifying the features of bipolar depression that distinguish it from unipolar depression.

• There is a risk of over-diagnosis of bipolar disorder among patients who are histrionic, show abnormal illness behaviour MJA 2006; 184: 459–462 and/or have issues of secondary gain.