Publications (11)30.11 Total impact
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Article: Determinants of medicine-taking in psychiatric patients.
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ABSTRACT: Lack of adherence is a universal risk in medicine. Its consequences in terms of outcome, suffering and economic costs are immense. This is a selective review of the putative factors involved in medicine taking behavior. Adherence is multidetermined by a number of variables ranging from patient sociodemographic characteristics to factors related to patient/ psychiatrist interaction, drug tolerability and organization of care. A relevant piece of responsibility comes from the drug itself and the patient's subjective tolerability which together with the characteristics of long term treatment and insufficient insight and support result in poor or lack of adherence. The context of the patient/professional therapeutic alliance, the patient's capacities and health system availability are ultimately decisive.Current clinical pharmacology. 05/2011; 6(2):100-7. -
Article: Training-induced neuroanatomical plasticity in ADHD: a tensor-based morphometric study.
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ABSTRACT: Experience-based neuroplasticity has typically been associated with functional changes, but growing evidence indicates that training can also render dynamic structural alterations in the brain. Although research on training-induced morphological plasticity has consistently demonstrated rapid increases of gray matter volume in task-related regions, no studies have examined if local volumetric reductions in gray matter associated with certain psychiatric disorders may be reversible by adequate training. We aimed to assess whether a training program applied to ADHD patients can contravene some of the associated neuroanatomical alterations. High-resolution anatomical scans were acquired before and after the training period, and a whole-brain tensor-based morphometric approach was applied to extract a voxel-wise estimation of longitudinal changes in regional gray matter volume. Our results show focal volumetric gray matter increases in bilateral middle frontal cortex and right inferior-posterior cerebellum after cognitive training compared with the ADHD control group. The extent of gray matter volume increase in the inferior-posterior cerebellum was associated with attentional performance. These findings illustrate the capacity of the nervous system for rapid morphological adjustments in response to environmental triggers. Moreover, the dorsolateral prefrontal cortex and cerebellum are commonly considered sites of volumetric reduction in ADHD, and the inferior-posterior lobule of the cerebellum is associated with progressive symptom-related volume loss. Hence, the clusters of volumetric change observed in our study were confined to structures typically characterized by volume reduction in ADHD patients, providing preliminary indications that cognitive training may contravene some of the neuroanatomical deficits associated with the disorder.Human Brain Mapping 03/2011; 32(10):1741-9. · 5.88 Impact Factor -
Article: Quantitative MR analysis of caudate abnormalities in pediatric ADHD: proposal for a diagnostic test.
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ABSTRACT: Most morphometric magnetic resonance imaging (MRI) studies of pediatric attention-deficit/hyperactivity disorder (ADHD) with appropriate sample sizes reveal a decreased right caudate nucleus volume. Recently, our group reported that this decrease is mainly due to a diminished right caudate body volume (rCBV). Here, we hypothesize that, employing either the total bilateral caudate volume (tbCV) or the bilateral caudate body volume (bCBV) as scaling variables, the rCBV/tbCV and rCBV/bCBV ratios could be found diminished and used as a basis of an imaging diagnostic test. Volumetric caudate nucleus data were obtained from a case-control morphometric MRI study with 39 ADHD subjects and 39 handedness- and IQ-matched controls, using a novel semi-automated caudate segmentation procedure. Student t-tests comparing each relevant ratio were conducted between the two samples. After splitting the samples into two groups, a receiving operator characteristic (ROC) analysis was conducted on the training group to determine the optimal cut-off. Its performance was then examined on the test group. The rCBV/bCBV ratio was found to be statistically different. For a value equal or inferior to 0.48, the specificity was 95.00%. We propose using the rCBV/bCBV ratio to assist in the diagnosis of ADHD in children.Psychiatry Research 06/2010; 182(3):238-43. · 2.52 Impact Factor -
Article: Cerebellar neurometabolite abnormalities in pediatric attention/deficit hyperactivity disorder: a proton MR spectroscopic study.
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ABSTRACT: We designed a case-control proton magnetic resonance spectroscopic study comparing the cerebellar and prefrontal regions of a group of 17 ADHD (attention deficit/hyperactivity disorder) medicated children and a group of 17 control children matched for laterality, gender and age. As we had found decreased gray matter volume in the right prefrontal region and the left cerebellar hemisphere in a previous voxel-based morphometry study conducted on an independent ADHD sample, we tested the hypothesis that these regions should show neurometabolite abnormalities. MRI (magnetic resonance imaging) was performed with a 1.5 T system; spectral acquisition was performed with a single-voxel technique and a PRESS sequence. Two volumes of interest were selected in the right prefrontal region and the left cerebellar hemisphere. NAA (N-acetylaspartate), Cre (creatine), Cho (choline), MI (myo-inositol) and Glx (glutamate-glutamine) resonance intensities were absolutely quantified. In the left cerebellar hemisphere, ADHD children showed significant decreased MI and NAA absolute concentrations with high effect sizes (p=0.004, ES=1.184; p=0.001, ES=1.083). The diminished absolute concentration of the NAA could be related to a gray matter volume decrease in the same cerebellar region found in the previous voxel-based morphometry MRI study, while the reduced MI absolute concentration could express a decreased glial density. This is the first proton MR spectroscopic study examining the cerebellum and it provides additional support for the role of cerebellum in the ADHD neurobiology.Neuroscience Letters 02/2010; 470(1):60-4. · 2.11 Impact Factor -
Article: Neural correlates of impaired emotional discrimination in borderline personality disorder: an fMRI study.
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ABSTRACT: A common approach to study neuronal aspects of emotional reactivity of borderline personality disorder (BPD) is to study the brain response to emotional faces with functional magnetic resonance imaging (fMRI). 10 BPD patients and 10 matched controls were submitted to an emotional discrimination task in which subjects had to identify an emotional face from a neutral face while fMRI data was acquired. BPD patients made more mistakes than controls in the discrimination task when negative faces were involved. The emotional discrimination task activated brain areas that are known to participate in processing of emotional faces (fusiform gyrus, insula and amygdala) regardless of the psychiatric condition. Additionally, BPD showed higher activation than controls in the middle and inferior temporal cortical areas, brain areas that participate in the processing of face features that carry emotional value. Furthermore, activity at this site correlated with impulsivity score in the Zuckerman-Kuhlman Personality Questionnaire. Our findings may be related to cognitive impairment that may be characteristic of the disorder.Progress in Neuro-Psychopharmacology and Biological Psychiatry 09/2009; 33(8):1537-45. · 3.25 Impact Factor -
Article: Neurobiological substrates of social cognition impairment in attention-deficit hyperactivity disorder: gathering insights from seven structural and functional magnetic resonance imaging studies.
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ABSTRACT: Social cognitive neuroscience is beginning to unravel a neuroanatomy of social cognition, networks of brain regions especially involved in social cognition and social functioning. It is widely acknowledged that social functioning and social cognition are impaired in attention-deficit hyperactivity disorder (ADHD). Although an impressive amount of neuroscientific research has been conducted in ADHD, little effort has been made to link those deficits in social cognition and functioning to the well-known brain abnormalities detected in structural and functional neuroimaging studies. We review seven functional and magnetic resonance studies conducted at our laboratory in ADHD samples during the last 5 years in order to scrutinize whether the putative neuroanatomic regions underpinning social cognition are affected in ADHD. The orbitofrontal cortex (OFC), the caudate nucleus, the ventral striatum, and the cerebellum are among those regions that displayed functional or morphometric abnormalities in our ADHD samples. The OFC is clearly involved in social cognition, and several features of OFC dysfunction may be related to the social cognition and function impairment in ADHD. In contrast to the OFC, the role of the caudate nucleus, the ventral striatum, and the cerebellum is elusive. However, on one hand, there is converging evidence from human and animal neuropsychology, neuroscience, and psychiatry that support the role of such areas in social cognition, mainly through its involvement in emotional processing. On the other hand, the morphometric and functional ADHD abnormalities in these regions could account for the impoverished social functioning and the deficient social cognition skills of ADHD children.Annals of the New York Academy of Sciences 07/2009; 1167:212-20. · 3.15 Impact Factor -
Article: Neurobiological Substrates of Social Cognition Impairment in Attention‐Deficit Hyperactivity Disorder
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ABSTRACT: Social cognitive neuroscience is beginning to unravel a neuroanatomy of social cognition, networks of brain regions especially involved in social cognition and social functioning. It is widely acknowledged that social functioning and social cognition are impaired in attention-deficit hyperactivity disorder (ADHD). Although an impressive amount of neuroscientific research has been conducted in ADHD, little effort has been made to link those deficits in social cognition and functioning to the well-known brain abnormalities detected in structural and functional neuroimaging studies. We review seven functional and magnetic resonance studies conducted at our laboratory in ADHD samples during the last 5 years in order to scrutinize whether the putative neuroanatomic regions underpinning social cognition are affected in ADHD. The orbitofrontal cortex (OFC), the caudate nucleus, the ventral striatum, and the cerebellum are among those regions that displayed functional or morphometric abnormalities in our ADHD samples. The OFC is clearly involved in social cognition, and several features of OFC dysfunction may be related to the social cognition and function impairment in ADHD. In contrast to the OFC, the role of the caudate nucleus, the ventral striatum, and the cerebellum is elusive. However, on one hand, there is converging evidence from human and animal neuropsychology, neuroscience, and psychiatry that support the role of such areas in social cognition, mainly through its involvement in emotional processing. On the other hand, the morphometric and functional ADHD abnormalities in these regions could account for the impoverished social functioning and the deficient social cognition skills of ADHD children.Annals of the New York Academy of Sciences 06/2009; 1167(1):212 - 220. · 3.15 Impact Factor -
Article: Differential abnormalities of the head and body of the caudate nucleus in attention deficit-hyperactivity disorder.
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ABSTRACT: The aim of the study is to present a new method for the segmentation of the caudate nucleus and use it to compare the caudate heads and bodies of an attention deficit-hyperactivity disorder (ADHD) group with those of a control group. We used a 1.5-T system to acquire magnetic resonance brain scans from 39 children with ADHD, as defined by DSM-IV TR, and 39 age, handedness and IQ matched controls. The new method for caudate head and body segmentation was applied to obtain semi-automatic volumes and asymmetric patterns. Bilateral volumetric measures of the head, body, and head-body of the caudate nuclei were compared within groups and between ADHD and control groups. Although the group factor was not significant, there were first and second order interactions. The analysis of simple effects showed that the right body and right head+body of the ADHD group was significantly smaller than in the control group, although the ADHD right caudate head was bigger. No ADHD within-group caudate differences were found. Controls showed a significantly larger left caudate head and a significantly bigger caudate right body and right head+body. Our new method for segmenting the caudate nucleus detected differential abnormalities of the right caudate head and body in the ADHD group, explaining previous heterogeneous findings in the literature.Psychiatry Research 08/2008; 163(3):270-8. · 2.52 Impact Factor -
Article: Pediatric OCD structural brain deficits in conflict monitoring circuits: a voxel-based morphometry study.
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ABSTRACT: The aim of this study is to use a voxel-based morphometry protocol to compare the brains of 18 children with obsessive-compulsive disorder (OCD) with those of a healthy group matched for gender and handedness. Images were acquired with a 1.5-T MRI scanner, spatially normalized, and segmented with an optimized voxel-based morphometry protocol. OCD children presented a 5.93% reduction of gray matter (GM) total volume in comparison with control brains. We identified OCD brain volume reductions in regions that have been extensively related to action monitoring and error signaling processes. Specifically, we found decreased bilateral GM in frontal (significant after Family Wise Error (FEW), multiple comparisons correction) and cingulate regions as well as decreased white matter (WM) in bilateral frontal and right parietal (p<0.001 uncorrected). Additionally, we found a negative correlation between symptom severity and bilateral hippocampal GM-volume (p<0.001uncorrected) as well as a positive correlation between age and GM left caudate volume (p=0.037 FWE small volume corrected) in the OCD group. As a conclusion, our results point to conflict monitoring structural brain regions as primary deficits in pediatric OCD, and to striatal abnormalities as age-related deficits.Neuroscience Letters 07/2007; 421(3):218-23. · 2.11 Impact Factor -
Article: Utilization of psychiatric emergency services by homeless persons in Spain.
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ABSTRACT: Studies examining the relationship between homeless persons and the use of psychiatric emergency services (PES) in a country with universal access to health care are lacking. This study aimed to determine the prevalence of homelessness in adults visiting a PES in Spain, identify the differences between homeless and non-homeless patients in the use of PES and analyze the factors associated with homelessness and the decision to hospitalize. The study included a total of 11 578 consecutive admissions to a PES in a tertiary hospital in Barcelona, Spain, over a 4-year period. Data collected included socio-demographic and clinical information, and score on the Severity of Psychiatric Illness (SPI) scale. Multivariate logistic regression analyses were used to calculate odds ratios for the factors associated with homelessness and the decision to hospitalize. Five hundred sixty (4.8%) admissions were considered homeless. Homeless patients had more psychotic and drug abuse disorders, greater severity of symptoms, more risk of being a danger to others and more frequent hospitalization needs than non-homeless patients. Factors related to homelessness were male gender, substance abuse and immigrant status from North Africa, Sub-Sahara Africa and Western countries. The decision to hospitalize homeless patients was associated with psychosis diagnosis, suicide risk, danger to others, symptom severity, medical problems and noncompliance with treatment. In an attempt to decrease the use of emergency resources and prevent the risk of homelessness, mental health planners in a universal healthcare system should improve outpatient access for populations with risk factors such as substance abuse and immigration.General Hospital Psychiatry 30(1):14-9. · 2.74 Impact Factor -
Article: Joint hypermobility syndrome is a risk factor trait for anxiety disorders: a 15-year follow-up cohort study.
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ABSTRACT: The objective of the study was to assess whether joint hypermobility syndrome (JHS) is a risk factor for developing anxiety disorders using a 15-year prospective cohort study. The initial cohort recruited 158 subjects aged 16 to 20 years from the general population in a Spanish rural town. The cohort was studied at baseline and at a 15-year follow-up. Joint hypermobility syndrome was assessed using Beighton's criteria, and the psychiatric disorders were assessed using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Disorders. Subjects with anxiety disorders at baseline were excluded from the follow-up. Joint hypermobility syndrome at baseline was found in 29 of 158 subjects (21.1%). Cumulative incidence of panic/agoraphobia disorder at follow-up, as main diagnosis, was significantly higher for the JHS group (41.4%) than for the control group (1.9%), with a relative risk of 22.3 [95% confidence interval (CI) 4.6-108.7, P<.0001] (Number Needed to Treat [NNT] 3, 95% CI 2.9-2.3). Incidence of social phobia and simple phobia was also significantly higher for the JHS group [relative risk (RR)=6.52, 95% CI 1.7-24.2, P<.001 and RR=3.31, 95% CI 1.1-9.6, P=.02, respectively]. Moreover, anxiolytic drug use was nearly fourfold higher among JHS compared to non-JHS subjects. Joint hypermobility syndrome was associated with higher risk of developing anxiety disorders. If replicated, these findings may give enhanced value to JHS assessment in clinical and general population studies.General hospital psychiatry 33(4):363-70. · 2.67 Impact Factor
Top co-authors
Top Journals
Institutions
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2011
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Consorci MAR Parc de Salut de Barcelona
- Neuropsychiatry and Drug Addiction Institute (INAD)
Barcelona, Catalonia, Spain
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2007–2011
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Autonomous University of Barcelona
- Departamento de Psiquiatría y Medicina Legal
Cerdanyola del Vallès, Catalonia, Spain
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2009
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Parc de Salut Mar
Barcelona, Catalonia, Spain
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