Monthly Archives: August 2011

Brodmann Area 10

Derived from Gray’s Anatomy 20th Edition 1918 Lithograph Reproduction, Public Domain

This is a brief overview of the research literature on Brodmann Area 10. A search was conducted on Medline using the search term “Brodmann Area 10″ and the results analysed for relevance and then included in the review. Brodmann Area 10 (BA10) is also known as the Frontal pole cortex and is known to be involved in cognition and more specifically in goal formation. In one paper, the authors argue that the left BA10 is involved in integrating information in higher level cognitive processes (paper freely available here). There is a lot of research supporting a role for BA10 in memory. BA10 has been found to have a relationship with prospective memory in a number of studies.  In another fMRI study people with focal brain lesions were compared with controls and the researchers identified an association between lesions in BA10 and impaired performance on time-based prospective memory tasks (paper freely available here)(there is also related research showing prospective memory alterations in people with Schizophrenia linking two of the BA10 research areas). There are a number of other studies supporting a role for BA10 in prospective memory (see this freely available paper and also this paper). BA10 was active in the recognition stage of a spatial memory task in an event-related fMRI study (paper freely available here). In an event-related/PET study activity in BA10 was increased during episodic memory retrieval.

There is evidence for the involvement of BA10 in other high level cognitive processes including risk-taking and more complex motor tasks. In one fMRI study, increased activity was observed in BA10 when subjects were following contextualised instructions in contrast with self-directed activity. An EEG study identified consistent activity in an area thought to correspond to BA10 during participation of subjects in a game involving the Prisoner’s Dilemma. Activation in BA10 was associated with performance in a negotiating game between two people (paper freely available here). Activity in BA10 was increased during performance of a risk-taking task in this H(2)(15)0 PET study (paper freely available here). Using Stereo Electroencephalography researchers recorded cortical activity in BA10 in patients with epilepsy who were due to undergo surgery. The researchers found that during imitation of movements performed by another person there was increased activity in BA10 in the theta band compared with two other tasks. When subjects moved their hand in response to auditory stimuli there was increased activity in the Gamma band. BA10 was activated in subjects during ordering of sequences from daily activities of differing frequency (paper freely available here). The researchers found that different parts of BA10 were activated depending on the frequency of the daily activities. In an fMRI study, BA10 was found to be active 2 seconds after the end of examination and identification of the orientation of an object by touch alone (paper freely available here). Brodmann Area 10 is active during olfaction tasks as in this fMRI study.

A number of studies look more closely at the functional connections of BA10 with other brain regions as well as gene correlations with performance on a verbal fluency task. In a meta-analysis of activation peaks in fMRI studies, the rostral Prefrontal Cortex (BA10) was divided into medial and lateral portions. The medial rPFC was associated with coactivation in the Posterior Cingulate, Posterior Superior Temporal Sulcus and the Temporal Pole while the lateral rPFC was associated with coactivation in the Dorsal Anterior Cingulate, Dorsolateral Prefrontal Cortex, lateral Parietal Cortex and Anterior Insula. As might be expected, the coactivation patterns were strongly influenced by the tasks performed during scanning. BA10 was one of the areas in which correlated activity provided an explanation of activation of Occipital Cortex by an auditory stimulus and the researchers suggest this supports the existence of a synchronised network involving these regions (paper freely available here). In one fMRI study, activity in BA10 was correlated with the number of Val alleles in the COMT gene during a semantic verbal fluency task.

The role of the rostral PFC is discussed in relation to a number of illnesses in this paper (freely available here). In Schizophrenia, BA10 was one of the areas showing reduced fractional anisotropy in an MRI study comparing people with Schizophrenia with a control group. Cytoarchitectural alterations were identified in BA10 in another study comparing the brains of people with Schizophrenia with controls (see this study also). Dysregulation of activity in BA10 was identified in people with Schizophrenia in one study which used power spectrum scale invariance as a marker of activity regulation. In another study, researchers found a reduction in Glutamate 1 and 2 receptors in BA10 in people with Schizophrenia compared to a control group. A reduction in certain subtypes of the metabotropic Glutamate 3 receptor was found in people with Schizophrenia relative to control in this post-mortem study. GABAA receptor binding activity was increased in people with Schizophrenia compared to controls in this study. Fatty acid composition in BA10 was altered in people with Schizophrenia relative to a control group in this post-mortem study (paper freely available here). In a PET/MRI study metabolic rates in BA10 were increased in people with Schizotypal Disorder compared to controls and people with Schizophrenia. In an fMRI study during performance on a reality monitoring task (whether a word had been read by the subject or the researcher) there was found to be an association between Schizotypal traits in adolescent subjects and activity in BA10. Decreased activity in BA10 in people with Schizophrenia and relatives were observed in comparison with a control group in an fMRI study examining volitional saccades.

In a study looking at awareness of functional impairment in people with Alzheimer’s Disease, researchers found an association between reduced awareness of impairment and fMRI activity in BA10 during a Go-No-Go task. In a post-mortem study people who had been diagnosed with Alzheimer’s Disease were compared with those without Alzheimer’s Disease (paper freely available here). The researchers sampled the arterioles supplying the Frontal Cortex and they mention BA10 specifically. The researchers found a significant inverse correlation between arteriolar amyloid levels and smooth muscle actin. Smooth muscle Actin was reduced more than 10 fold in the Alzheimer’s Disease group compared to the control group. Alpha-1 receptors in the brain were investigated in Alzheimer’s Disease in this study. Researchers used [125I]2-(beta-4-hydroxyphenylethylamino-ethyltetralone ([ 125I]HEAT) to bind to Alpha-1 receptors. They identified a class of binding sites in BA10 and found that Alpha-1 binding was significantly reduced in the Prefrontal Cortex in people with Alzheimer’s Disease relative to controls. Histopathological analysis was used to characterise the pathology in BA10 in different forms of DSM-III dementia including Alzheimer’s Disease in this study. However not all studies show differences in BA10 in Alzheimer’s Disease. This study for instance shows that nicotine binding is similar in BA10 in people with Alzheimer’s Disease and controls. In a PET study involving people with Parkinsons Disease (administered Apomorphine – a dopamine agonist) there was found to be an absence of the increased activity in BA10 during a motor task observed in the healthy control group (paper freely available here). Cerebral perfusion was reduced in BA10 in people with Parkinson’s Disease from baseline to follow-up at one year when the researchers used 99mTcHMPAO cerebral perfusion SPECT but this was not seen in the control group (paper freely available here). In a H(2)(15)O-PET study people with Parkinsons Disease and also those with Huntington’s Disease exhibited decreased activation of BA10 in response to sensory stimulation in comparison with a control group (paper freely available here). A reduction in N-Acetylaspartate was seen in BA10 in people with Huntington’s Disease compared to a control group in this postmortem study.

In a small post-mortem study of people who had Major Depressive Disorder researchers identified a reduction in the expression of three antiapoptotic genes in BA10. In an MRI-PET study of unmedicated patients with Major Depression Disorder (MDD) researchers found an increase in regional Cerebral Blood Flow in BA10 in people with MDD in comparison with the control group. Event related potentials were reduced in BA10 relative to controls in people with unmedicated MDD during performance in incongruent trials of the Stroop task (paper freely available here). In another event-related potentials study people with MDD manifested altered activity in BA10 relative to a control group 80 millseconds after committing an error on a Stroop Task and differentially recruited the Dorsolateral Prefrontal Cortex (DPFC) (paper freely available here). In another study there was found to be reduced expression of Protein Kinase subunits in BA10 in people who had been diagnosed with MDD. The protein kinases are involved in cell signals related to G-coupled receptors. Reduced activity in BA10 was observed in people with MDD in remission in another fMRI study in comparison with a control group. In a comparison of post-mortem gene expression in BA10 between people who had MDD and controls there was found to be an abundance of 5HT(2A) and a reduction in Protein Kinase A. Omega-3 fatty acid docosahexaenoic acid levels were reduced in BA10 in people with Bipolar Disorder compared to controls in one post-mortem study (paper freely available here).

There are a number of studies looking at BA10 in developmental conditions. In a study comparing people with learning disability of unclassified aetiology with controls and people with Down Syndrome, the first group were found to have increased cortical thickness in BA10. In an fMRI study (freely available here) investigating language processing in people with autism and controls, the latter group were found to have reduced BA10 activity in speaker incongruent sentences compared to speaker congruent sentences (i.e when the expression of the sentence matched the content e.g intonation). In another fMRI study (paper freely available here) people with Autism exhibited increased signal change in BA10 relative to a control group during performance of one executive task although this was not seen with another executive task and the researchers highlight the need to draw specific inferences on the basis of the type of executive tasks performed. In a PET study, there was found to be a reduction in regional Cerebral Blood Flow in BA10 in people with Obsessive Compulsive Disorder who had responded to behavioural therapy versus non-responders. Childhood and Adolescent pseudohypoacusis was associated with increased grey matter volume in BA10 in a small MRI study. In Children and Adolescents with conduct disturbances and other traits were found to have reduced activity in BA10 during a reversal learning task in comparison with a control group and children and adolescents with Attention Deficit/Hyperactivity Disorder alone (paper freely available here). Antineuronal antibody profiles in BA10 did not differentiate children with Tourettes and PANDAS from controls in this study. Cerebral glucose utilisation was decreased in BA10 in people with Congenital Scoliosis in comparison with controls in this PET study (paper freely available here).

BA10 has also been investigated in relation to aging, hypoxia and a number of neurological conditions. In an electromagnetic tomography study exposure to hypoxia was associated with increased activity in BA10.  Aging was associated with reduced Polyunsaturated Fatty Acid (PUFA) levels in BA10 in a Post-Mortem study using Gas Chromatography (paper freely available here). BA10 was one of the areas  in which grey matter reduction was identified in people with Fascioscapulohumeral Dystrophy relative to a control group in this MRI study. BA10 was one of the areas in which there was reduced regional Cerebral Blood Flow relative to controls in people with Amyotrophic Lateral Sclerosis who scored within the population reference range on a verbal fluency task in this PET study. In an electrotomographic study event-related activity in people with insomnia was reduced during task performance in BA10 amongst other areas and the people with insomnia needed more trials to learn a selective memory task (paper freely available here).

Thus there is a relatively large research evidence base identifying the structural and functional characteristics of BA10 in different populations and across research paradigms. Many of the studies are of small sample size but nevertheless inform hypotheses for further work in this area. A number of studies suggest a role for BA10 in higher cognitive processes particularly memory. This forms a theoretical basis for investigating BA10’s putative role in a number of illnesses/conditions as can be seen from the studies above.

Appendix – Articles Reviewed in relation to Brodmann Areas or other Structures

Brodmann Area 1 – Somatosensory Cortex

An Investigation of D3 Receptors and Brodmann Area 1 in Schizophrenia

YouTubing the Somatosensory Cortex

Brodmann Area 2 – The Primary Motor Cortex

Brodmann Areas – Part 2: Area 4. The Primary Motor Cortex – A Brief Literature Review

YouTubing the Motor Cortex

Brodmann Area 6 (Agranular Frontal Area 6)

FDG-PET, Frontal Dysfunction and Mild Cognitive Impairment

Brodmann Area 6 – Premotor Cortex and the Supplementary Motor Area

YouTubing Brodmann Area 6

Brodmann Areas 5 and 7 (Somatosensory Association Cortex)

Brodmann Areas 5 and 7 (Somatosensory Association Cortex)

Brodmann Area 8

Brodmann Area 8

Youtubing Brodmann Area 8

Brodmann Area 9

Brodmann Area 9

YouTubing Brodmann Area 9

Brodmann Areas 13 and 14 (Insular Cortex)

What does the Insular Cortex Do Again?

Insular Cortex Infarction in Acute Middle Cerebral Artery Territory Stroke

The Insular Cortex and Neuropsychiatric Disorders

Developing a Model of the Insular Cortex and Emotional Regulation Part 1

Developing a Model of the Insular Cortex: A Recap

The Relationship of Blood Pressure to Subcortical Lesions

Pathobiology of Visceral Pain

Interoception and the Insular Cortex

A Case of Neurogenic T-Wave Inversion

Video Presentations on a Model of the Insular Cortex

MR Visualisations of the Insula

The Subjective Experience of Pain*

How Do You Feel? Interoception: The Sense of the Physiological Condition of the Body

How Do You Feel – Now? The Anterior Insula and Human Awareness

Role of the Insular Cortex in the Modulation of Pain

The Insular Cortex and Frontotemporal Dementia

A Case of Infarct Connecting the Insular Cortex and the Heart

The Insular Cortex: Part of the Brain that Connects Smell and Taste?

Stuttered Swallowing and the Insular Cortex

Brodmann Area 15 (Anterior Temporal Lobe – Controversial Area in Humans)

Review: The Anterior Temporal Lobes and Semantic Memory

Brodmann Area 25 – Anterior Cingulate Cortex

Brodman Areas Part 3. Brodmann Area 25 – The Anterior Cingulate Cortex

Brodmann Area 27 (Piriform Cortex)

Anosmia in Lewy Body Dementia

Brodmann Area 28  (Entorhinal Cortex)

MRI Measures of Temporoparietal Atrophy During Prodromal Alzheimer Disease*

Brodmann Areas 45, 46, 47 (Inferior Frontal Gyrus)

Which Bit of the Brain Detects the Emotions in Speech?

Medial Temporal Lobe

The Medial Temporal Lobe and Recognition Memory

Hippocampus

Review: Differences in Hippocampal Metabolism Between Amnestic and Non-Amnestic MCI Subjects

Anatomy of the Hippocampus

Review: Involvement of BDNF in Age-Dependent Alterations in the Hippocampus

Miscellaneous Subcortical Structures

Book Review: Subcortical Vascular Dementia

Review: Subcortical Vascular Ischaemic Dementia

Review: Psychiatric Disturbances in CADASIL

Review: Cognitive Decline in CADASIL

Review: Relationship Between 24-hour Blood Pressure, Subcortical Ischemic Lesions and Cognitive Impairment

Hypocretin and Neurological Disorders

A Case of Pontine and Extrapontine Myelinolysis with Catatonia

Generic Articles Relating to Localisation

A History of Human Brain Mapping

Book Review: Brain Architecture

Brain Folding and the Size of the Human Cerebral Cortex

An index of the site can be found here. The page contains links to all of the articles in the blog in chronological order. Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link. Podcast: You can listen to this post on Odiogo by clicking on this link (there may be a small delay between publishing of the blog article and the availability of the podcast). It is available for a limited period. TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link. Responses: If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk. Disclaimer: The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

News Roundup. August 2011 4th Edition

In the British Journal of Psychiatry there is an interesting paper looking at the associations between anxiety in older adults and cognition (Butters et al, 2011). The researchers compared 160 people without dementia meeting the DSM-IV criteria for Generalised Anxiety Disorder (GAD) with a control group (n=37) without a history of psychiatric illness. The Hamilton Rating Scales for Depression and Anxiety were used as well as a neuropsychological battery. The researchers found that the GAD group performed significantly worse than the control group (after a step-wise Bonferroni correction) on the letter number sequencing, the D-KEFS sorting test and the RBANS immediate memory and delayed memory tasks. These findings remained after excluding subjects who met criteria for Major Depressive Disorder which was expected to be a significant confounder. Escitalopram was part of the treatment program and Escitalopram use was associated with an improvement in the D-KEFS scores – a measure of executive function. In subjects that experienced a significant improvement in self-reported anxiety (using the Clinical Global Impressions scale) there was a corresponding improvement in RBANS immediate and delayed memory scores. The study has generated some very specific hypotheses for further testing.

In the USA, the Advisory Council on Alzheimer’s Research, Care and Service is convening quarterly meetings to examine issues such as the infrastructure for research into Alzheimer’s Disease. If this model is successful it will be interesting to see if it can be applied elsewhere.

A small double-blind randomised cross-over study recruiting people with behavioural variant Frontotemporal Dementia (bvFTD) showed a significant improvement in carer rated Neuropsychiatry Inventory (NPI) scores on the day of administration of 24 IU Oxytocin. These early results will need to be replicated with larger numbers of subjects.

Poor self-perception of health was one of the factors that was significantly associated with fear of developing Alzheimer’s Disease in a telephone survey of 2013 adults.

In one MRI study, researchers compared sequential MRI data on people with Normal Pressure Hydrocephalus (NPH), Parkinson’s Disease (PD), Alzheimer’s Disease (AD. This data was acquired from the Alzheimer’s Disease Neuroimaging Initiative) with healthy controls. The researchers were interested in factors that helped to discriminate NPH from AD and PD and the results suggested that ventricular volume and cortical thickness combined were better than ventricular volumes alone (as the latter values overlapped with the AD group).

Hodges and colleagues looked at representation of musical knowledge in a study comparing people with Semantic Dementia and AD with healthy controls (n=47). Using volume based analysis of the structural Magnetic Resonance images they identified decreasing right Anterior Temporal Pole volume as being significantly correlated with impaired performance on knowledge of popular melodies. Although the people with Semantic Dementia performed worse than the AD and control groups on the melody recognition task the relationship with rATP volume also held in this group.

Evolutionary Psychiatry

There is coverage of a paper published in PNAS about the origins of cooking. Cooking allowed for selective changes in the jaw and size of teeth in primates. By looking at fossil specimens and using the features of the jaw and teeth as proxy markers of cooking activity, the researchers hypothesise that cooking began approximately 1.9 million years ago. Other research suggests that cooking may have influenced the increase in brain volume that occurred in primate evolution.

There is coverage here of a recent finding of a 160 million year old placental mammal specimen. Hawks also has coverage of the paper here. There are various implications including the possibility that gene mutation rates in hominoids are much lower as well as the interpretation of lineages of early primates.

There is coverage of a PLOS-one paper here (via sandygautam) correlating increasing brain volume with maximal oxygen uptake in different species. Again there are various implications and in this context it is particularly interesting to note that Brain Derived Neutrophic Factor is secreted during exercise.

References

Butters et al. Changes in neuropsychological functioning following treatment for late-life generalised anxiety disorder. The British Journal of Psychiatry. 2011. 199. 211-218.

Appendix 1 –  Annual News Roundups

News Roundup 2008

News Roundup 2009

News Roundup 2010

Appendix 2 – Resources

There is a paper on Alzheimer’s Disease and Mild Cognitive Impairment freely available here.

An index of the site can be found here. The page contains links to all of the articles in the blog in chronological order. Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link. Podcast: You can listen to this post on Odiogo by clicking on this link (there may be a small delay between publishing of the blog article and the availability of the podcast). It is available for a limited period. TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link. Responses: If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk. Disclaimer: The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

YouTubing Brodmann Area 9

Derived from Gray’s Anatomy 20th Edition 1918 Lithograph Reproduction, Public Domain

Detailed here are the results of a search on YouTube looking to identify videos relating to Brodmann Area 9. Initially the search terms ‘Brodmann Area 9′ and ‘Dorsolateral Prefrontal Cortex’ (DLPFC) were used. However this needed to be expanded with the search term ‘Prefrontal Cortex’. Unfortunately this is a very broad term as the Prefrontal Cortex encompasses Brodmann Areas 8-11 and 44-47 and so the results of this search are not always relevant to the search question. The search identified one video which was a lighthearted rap about the brain. There is a very short segment on the DLPFC but the video is probably aimed at those with little background knowledge of the brain although it might still be used to supplement teaching in this area. This brief video shows interconnected areas in the Prefrontal Cortex (PFC) and cerebellum although there is no labelling on the image and I wasn’t clear on how the image was constructed.  A study looking at the involvement of PFC in memory formation is discussed in this video. In this video author Matthew Segall discusses the Prefrontal Cortex in the context of the relationship between emotions and reasoning which fits into some of his other interesting philosophy that he disseminates through the medium of YouTube. Dr Earl Miller gives an interesting overview of the Prefrontal Cortex in this video. There were perhaps more interesting videos returned from a search for frontal lobe but as this term is extremely broad it moves further away from the original question.

An index of the site can be found here. The page contains links to all of the articles in the blog in chronological order. Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link. Podcast: You can listen to this post on Odiogo by clicking on this link (there may be a small delay between publishing of the blog article and the availability of the podcast). It is available for a limited period. TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link. Responses: If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk. Disclaimer: The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

Review of Thomas Kuhn’s ‘The Structure of Scientific Revolutions’. Chapter 12.

Chapter 12 in Thomas Kuhn’s ‘The Structure of Scientific Revolutions’ is titled ‘The Resolution of Revolutions’. Kuhn suggests that those involved in scientific revolutions have characteristics which are different from those of scientists involved in ‘normal science’. Thus he suggests that such scientists are usually new to the field and for various reasons are not under an obligation to operate within the boundaries of the paradigm but instead are able to challenge the paradigm itself. He then goes onto talk about the validations of theories and this gets quite interesting. Kuhn categorises the validation approaches as follows

1. Categorical

2. Probabilistic

So the first question to ask about the validation process is whether or not a theory completely accounts for the experimental data. In a categorical model of theories, the theory would be expected to account for all of the data. However this would be unrealistic and Kuhn suggests instead that most scientists consider a probabilistic model of theory validation in which the theory accounts for most of the experimental findings. Another approach to validation of theories is also considered by Kuhn contrasting

1. Identification of evidence for the theory

2. Falsification

A theory can thus be validated by the identification of supporting evidence or by surviving attempts to falsify the theory with experimental observations which do not fit with the theory’s predictions. The suggestion of a principle of falsification in science was developed by Karl Popper. Kuhn then refers back to anomalies in the experimental data which are sufficient to generate a challenge to the dominant paradigm. This allows the beginning of an appraisal of the paradigm itself but it is only when the conflicting paradigm is developed that the necessary debate can begin. Kuhn then gives some of the characteristics of the subsequent debate which results in the resolution of revolutions. This is an elegant chapter with Kuhn drawing together the threads from previous chapters into a narrative with powerful explanatory properties.

References

Thomas Kuhn. The Structure of Scientific Revolutions. Narrated by Dennis Holland. (Paperback originally published in 1962). Audible. 2009.

Appendix

For a review of the Introduction see here.

For a review of Chapter 1 see here.

For a review of Chapter 2 see here.

For a review of Chapter 3 see here.

For a review of Chapter 4 see here.

For a review of Chapter 5 see here.

For a review of Chapter 6 see here.

For a review of Chapter 7 see here.

For a review of Chapter 8 see here.

For a review of Chapter 9 see here.

For a review of Chapter 10 see here.

For a review of Chapter 11 see here.

In Support of Method – Critique of Feyerebend’s ‘Against Method’ see here.

An index of the site can be found here. The page contains links to all of the articles in the blog in chronological order. Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link. Podcast: You can listen to this post on Odiogo by clicking on this link (there may be a small delay between publishing of the blog article and the availability of the podcast). It is available for a limited period. TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link. Responses: If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk. Disclaimer: The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

The Big Society and Mental Health – Part 2

The Big Society is the Government’s strategy for reshaping society by introducing competition into the delivery of services. Third sector, public and private organisations are eligible to deliver these services. By positioning the Big Society as a solution to the Broken Society, David Cameron intends that this approach will solve society’s problems. Where do Mental Health and Well-being Services fit into this?

There are numerous problems that face society. Economic problems for instance influence issues as diverse as employment, crime and education. Economic solutions to problems in society can be unique. Take the adjustment of interest rates for instance. Interest rates affect housing and manufacturing and these in turn have profound effects on society. There is no doubting the significance of such adjustments in interest rates. As well as economic solutions there are other approaches to solving problems in society. Although such approaches have close relationships with economics on a number of levels these approaches like the adjustment in interest rates have unique features. Such approaches includes those of Mental Health and Well-Being services.

Although Mental Health and Well-Being services ultimately solve specific problems in society and deliver services to a community, the building blocks of this problem solving approach are centred around the individual. For instance, the diagnostic label while investigated in populations is applied to the individual. The presentation of the person is assessed and if the features of this presentation fit a recognised pattern and meet the diagnostic criteria then a diagnosis can be established and specific services can be delivered. Although this is a crude characterisation of the diagnostic approach it highlights the structured process which leads to services being delivered to a population with certain needs. Services are not usually restricted to a single diagnosis but have a broader set of criteria for services.

Since Mental Health and Well-Being services deliver specialised services they also possess skills and expertise relevant to a specific set of problems. This is the essential feature of services which could mean that there is an important role in the Big Society. If certain problems in society are defined and organisations invited to tender solutions to those problems then Mental Health and Well-being services could be eligible to tender for those services if their expertise could be focused on those problems. The first stage in this process is to identify the ‘Big Society problems’ for which solutions are being sought and to identify biological, psychological and sociological contributions to that problem. If these are significant and there are services which can potentially deliver solutions then they can be proposed in the tendering process with a view to reconfiguration and expansion providing it does not detract from the core service. There will be numerous opportunities of this nature over coming years and it offers the potential not just to contribute to society in the short term but also to how Mental Health and Well-being services engage with society in the long term.

An index of the site can be found here. The page contains links to all of the articles in the blog in chronological order. Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link. Podcast: You can listen to this post on Odiogo by clicking on this link (there may be a small delay between publishing of the blog article and the availability of the podcast). It is available for a limited period. TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link. Responses: If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk. Disclaimer: The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

Brodmann Area 9

Derived from Gray’s Anatomy 20th Edition 1918 Lithograph Reproduction, Public Domain

This is a brief overview of the literature on Brodmann Area 9 (BA9) which overlaps with the Dorsolateral Prefrontal Cortex (which also includes BA10-12 and BA 45-47 although there is some variation according to definition). Medline was searched using the term ‘Brodmann Area 9′ and retrieved articles were scanned for relevance. From the retrieved papers there was a demarcation between physiological and pathological studies with the majority of studies falling into the latter category. In terms of physiological studies predicting how narratives progressed was assumed by the researchers in one study to result from ‘strategic inference’ and they correlated an increased haemodynamic response in the Left BA9 region. Von Economo Neurons were identified in BA9 in one small immunohistochemical study. Comprehension of idioms was associated with activity in BA9 in one study (freely available here). NK1 and NK3 receptors were identified in BA9 cell layers in one study. BA9 activation was increased in a semantic categorisation task in one fMRI study. A combined PET and Magnetoencephalography study identified BA9 as being associated with motor readiness in this study. A ‘Theory of Mind’ task was associated with left sided BA9 activation in one study. 488 unique proteins were identified in a shotgun mass spectrometry proteome study of BA9.

In terms of pathological studies there were a large number of conditions associated with BA9 including Bipolar Disorder, Schizophrenia, Vascular Dementia, Parkinson’s Disease and Congenital Scoliosis. In an analysis of fMRI studies there was found to be an association between BA9 and depressive disorder although the finer details differed between studies. Epidural Cortical Stimulation of left BA9 was associated with clinical improvement in treatment resistant depression in this study (n=12). Major Depressive Disorder was associated with significantly lower neuropeptide somatostatin in the Dorsolateral Prefrontal Cortex in comparison with a control group and a group with Bipolar Disorder. In a small post-mortem study (n=20) pro-apoptotic factors were found to be significantly increased in BA9 in the brains of people with Bipolar Disorder compared to a control group with the researchers speculating on a degenerative association (freely available here).In a study in which the researchers sampled grey matter lipid levels in the BA9 region and found significant difference in their sample of people with Bipolar Disorder and Schizophrenia in comparison with a control group. There was found to be a significant reduction in Oligodendrocytes layer VI of BA9 in people with Schizophrenia, Major Depressive Disorder and Bipolar Disorder in one study. Neuropeptide Y mRNA expression was decreased in people with Bipolar Disorder in one study compared to a control group.

In a study of people with Schizophrenia, performance on the Wisconsin Card Sorting Test was lower in a low performing on an eye tracking task compared to a high performing group. Interestingly there was no associated change in regional Cerebral Blood Flow (rCBF) in the DLPFC using SPECT.  Postsynaptic density protein 95 (PSD95) mRNA was reduced in BA9 in people with Schizophrenia compared to a control group in one study. Pyramidal cell density in BA9 were asymmetrical and reversed in a comparison of controls with people with schizophrenia (freely available here).  Patients with schizophrenia showed significantly different signal dynamics between the Right Amygdala and BA9 compared to a control group in this study. Minor changes in BA9 were found in a small study comparing people with Schizophrenia with a control group. One study found decreased Glutamic Acid Decarboxylase mRNA expression in BA9 in Parkinson’s Disease in a small post-mortem study comparing people with Parkinson’s Disease with a control group. Levels of monocyte chemo-attractant protein were found to be significantly reduced in people with  Vascular Dementia and Mixed Dementia compared to a control group  in this small study. Loss of vesicular glutamate transporters VGLUT1 and VGLUT2 in BA9 was associated with cognitive decline in Alzheimer’s Disease in one study. Cognitively normal people over the age of 65 displayed no evidence of loss of synaptic volume density in BA9 lamina III and V in one study. Somatostatin deficit were only identified in BA9 and not other areas in Alzheimer’s Disease in this study. Loss of somatostatin immunoreactivity was found in BA9 in people with Alzheimer’s Disease carrying the APOE4 allele compared to a group that did not carry the allele and the researchers suggest that this may be a marker of somatostatinergic dysfunction. There were significant differences between people with Alzheimer’s Disease and controls in fatty acid levels in BA9 in this study.

In a comparison of proteomes in BA9 in controls and people with alcohol misuse there were a number of differently expressed proteins in the latter group including Thiamine-dependent enzymes transketolase and pyruvate dehydrogenase (E1β ubunit). In an EEG study there was a significant difference in Medial Prefrontal Cortex P300 responses to food between groups categorised according to BMI. 5-HT2A binding potential in the BA9 was associated with aggressive behaviour in a small PET case-control study (freely available here).  In an fMRI study insomnia (freely available here) was associated with hypoactivation of BA9 with activity increasing after sleep therapy. In a small case-control study glucose hypometabolism was found in people with congenital scoliosis compared to a control group (freely available here).

 Appendix – Articles Reviewed in relation to Brodmann Areas or other Structures

Brodmann Area 1 – Somatosensory Cortex

An Investigation of D3 Receptors and Brodmann Area 1 in Schizophrenia

YouTubing the Somatosensory Cortex

Brodmann Area 2 – The Primary Motor Cortex

Brodmann Areas – Part 2: Area 4. The Primary Motor Cortex – A Brief Literature Review

YouTubing the Motor Cortex

Brodmann Area 6 (Agranular Frontal Area 6)

FDG-PET, Frontal Dysfunction and Mild Cognitive Impairment

Brodmann Area 6 – Premotor Cortex and the Supplementary Motor Area

YouTubing Brodmann Area 6

Brodmann Areas 5 and 7 (Somatosensory Association Cortex)

Brodmann Areas 5 and 7 (Somatosensory Association Cortex)

Brodmann Area 8

Brodmann Area 8

Youtubing Brodmann Area 8

Brodmann Areas 13 and 14 (Insular Cortex)

What does the Insular Cortex Do Again?

Insular Cortex Infarction in Acute Middle Cerebral Artery Territory Stroke

The Insular Cortex and Neuropsychiatric Disorders

Developing a Model of the Insular Cortex and Emotional Regulation Part 1

Developing a Model of the Insular Cortex: A Recap

The Relationship of Blood Pressure to Subcortical Lesions

Pathobiology of Visceral Pain

Interoception and the Insular Cortex

A Case of Neurogenic T-Wave Inversion

Video Presentations on a Model of the Insular Cortex

MR Visualisations of the Insula

The Subjective Experience of Pain*

How Do You Feel? Interoception: The Sense of the Physiological Condition of the Body

How Do You Feel – Now? The Anterior Insula and Human Awareness

Role of the Insular Cortex in the Modulation of Pain

The Insular Cortex and Frontotemporal Dementia

A Case of Infarct Connecting the Insular Cortex and the Heart

The Insular Cortex: Part of the Brain that Connects Smell and Taste?

Stuttered Swallowing and the Insular Cortex

Brodmann Area 15 (Anterior Temporal Lobe – Controversial Area in Humans)

Review: The Anterior Temporal Lobes and Semantic Memory

Brodmann Area 25 – Anterior Cingulate Cortex

Brodman Areas Part 3. Brodmann Area 25 – The Anterior Cingulate Cortex

Brodmann Area 27 (Piriform Cortex)

Anosmia in Lewy Body Dementia

Brodmann Area 28  (Entorhinal Cortex)

MRI Measures of Temporoparietal Atrophy During Prodromal Alzheimer Disease*

Brodmann Areas 45, 46, 47 (Inferior Frontal Gyrus)

Which Bit of the Brain Detects the Emotions in Speech?

Medial Temporal Lobe

The Medial Temporal Lobe and Recognition Memory

Hippocampus

Review: Differences in Hippocampal Metabolism Between Amnestic and Non-Amnestic MCI Subjects

Anatomy of the Hippocampus

Review: Involvement of BDNF in Age-Dependent Alterations in the Hippocampus

Miscellaneous Subcortical Structures

Book Review: Subcortical Vascular Dementia

Review: Subcortical Vascular Ischaemic Dementia

Review: Psychiatric Disturbances in CADASIL

Review: Cognitive Decline in CADASIL

Review: Relationship Between 24-hour Blood Pressure, Subcortical Ischemic Lesions and Cognitive Impairment

Hypocretin and Neurological Disorders

A Case of Pontine and Extrapontine Myelinolysis with Catatonia

Generic Articles Relating to Localisation

A History of Human Brain Mapping

Book Review: Brain Architecture

Brain Folding and the Size of the Human Cerebral Cortex

An index of the site can be found here. The page contains links to all of the articles in the blog in chronological order. Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link. Podcast: You can listen to this post on Odiogo by clicking on this link (there may be a small delay between publishing of the blog article and the availability of the podcast). It is available for a limited period. TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link. Responses: If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk. Disclaimer: The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

News Round-Up: August 2011 3rd Edition

There has been a new characterisation of the 3-dimensional structure of the alpha-synuclein protein associated with Lewy Body Dementia which should contribute towards molecular research in this area (also covered here). A role for Early Onset Alzheimer’s Disease related protein Presenilin-1 in a homeostatic scaling a form of synaptic plasticity has been identified in one study. There is a paper (freely available here) on MRI findings in neuroferritinopathy which include Basal Ganglia cysts, cerebellar and cerebral atrophy as well as gliosis. In a recent research study (paper freely available here) the researchers combine resting state and event related fMRI with event related potentials to better characterise the progression from Mild Cognitive Impairment to Alzheimer’s Disease. The researchers in a moderately sized SPECT study investigated aberrant motor behaviour in Alzheimer’s Disease. The researchers draw parallels between aberrant motor behaviour and Obsessive Compulsive Disorder which are supported by the increased uptake of the tracer 99Tc(m) hexamethylpropyleneamine oxime in the OrbitoFrontal Cortex compared to people with Alzheimer’s Disease without aberrant motor behaviour.

Miscellaneous

In a freely available paper researchers used fMRI to investigate imaging of future events (via MariaPage). They found evidence that when subjects had successfully recalled their imagined future events there was evidence that the right Hippocampus was activated. The researchers suggest that the Hippocampus is used to store the details of these imagined events. This continues the debate on the role of hippocampus in imagining future events. In another study the researchers examined the visual perception of objects. Visual information in the form of parts of a car were presented to the subjects with a number of transformations making it more difficult to identify the moving objects. In order to process the visual information the researchers suggested on the basis of their evidence that the visual information was being grouped and that the subjects were processing the data at a rate of about 10 groups per second. Furthermore the groups were being processed one at a time. If this is replicated then it means that when we perceive visual motion – for instance a group of cars driving down the road we would be processing them not as a group of cars moving but a sequential processing of individual cars. However the brain may have additional techniques for processing ‘natural’ visual information in contrast with the abstract information presented in this experiment.

Evolutionary Psychiatry

In one study there was a finding of the earliest appearance of nails in primates in T.Brandfi (55.8 million years ago). It had been previously hypothesised that nails appeared with an increase in body size in primates but this finding contradicted the hypothesis. There are various connections between nails, the central nervous system and behaviour. The connexin26 gene for instance relates sensorineural deafness to nail dystrophy. It has also been suggested that nails were selected in place of claws for foraging food on small branches. The nails can also be used for specialised actions including plucking*.

* Thus it might be expected that the utilisation of nails in extending the movement/behaviour repertoire should be accompanied by changes in the Motor Cortex.

An index of the site can be found here. The page contains links to all of the articles in the blog in chronological order. Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link. Podcast: You can listen to this post on Odiogo by clicking on this link (there may be a small delay between publishing of the blog article and the availability of the podcast). It is available for a limited period. TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link. Responses: If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk. Disclaimer: The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.