The dorsal anterior cingulate cortex (dACC) has a near-ubiquitous presence in the neuroscience of cognitive control. It has been implicated in a diversity of functions, from reward processing and ...performance monitoring to the execution of control and action selection. Here, we propose that this diversity can be understood in terms of a single underlying function: allocation of control based on an evaluation of the expected value of control (EVC). We present a normative model of EVC that integrates three critical factors: the expected payoff from a controlled process, the amount of control that must be invested to achieve that payoff, and the cost in terms of cognitive effort. We propose that dACC integrates this information, using it to determine whether, where and how much control to allocate. We then consider how the EVC model can explain the diverse array of findings concerning dACC function.
The dorsal anterior cingulate cortex (dACC) has been implicated in diverse functions related to cognitive control. Here, Shenhav et al. propose a unifying view of dACC function where dACC integrates information about the expected value of control to determine whether, where and how much control to allocate.
Treatment Selection in Depression Cohen, Zachary D; DeRubeis, Robert J
Annual review of clinical psychology,
05/2018, Letnik:
14, Številka:
1
Journal Article
Recenzirano
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Mental health researchers and clinicians have long sought answers to the question "What works for whom?" The goal of precision medicine is to provide evidence-based answers to this question. ...Treatment selection in depression aims to help each individual receive the treatment, among the available options, that is most likely to lead to a positive outcome for them. Although patient variables that are predictive of response to treatment have been identified, this knowledge has not yet translated into real-world treatment recommendations. The Personalized Advantage Index (PAI) and related approaches combine information obtained prior to the initiation of treatment into multivariable prediction models that can generate individualized predictions to help clinicians and patients select the right treatment. With increasing availability of advanced statistical modeling approaches, as well as novel predictive variables and big data, treatment selection models promise to contribute to improved outcomes in depression.
COVID-19 is a multi-organ disease due to an infection with the SARS-CoV2 virus. It has become a pandemic in early 2020. The disease appears less devastating in children and adolescents. However, ...stress, quarantine and eventually mourning have major impacts on development. It is difficult to describe what this pandemic implies for a child psychiatrist, other than by giving a first-hand account. I propose to go through the main ethical questions that have arisen; to describe how my hospital team has reorganized itself to meet the new demands and questions, in particular by opening a unit dedicated to people with autism and challenging behaviors affected by COVID-19; and to address, in a context of national discussion, how the discipline has sought to understand the conditions of a certain well-being during quarantine. Finally, I will try to conclude with more speculative reflections on re-opening.
Debates over the function(s) of dorsal anterior cingulate cortex (dACC) have persisted for decades. So too have demonstrations of the region's association with cognitive control. Researchers have ...struggled to account for this association and, simultaneously, dACC's involvement in phenomena related to evaluation and motivation. We describe a recent integrative theory that achieves this goal. It proposes that dACC serves to specify the currently optimal allocation of control by determining the overall expected value of control (EVC), thereby licensing the associated cognitive effort. The EVC theory accounts for dACC's sensitivity to a wide array of experimental variables, and their relationship to subsequent control adjustments. Finally, we contrast our theory with a recent theory proposing a primary role for dACC in foraging-like decisions. We describe why the EVC theory offers a more comprehensive and coherent account of dACC function, including dACC's particular involvement in decisions regarding foraging or otherwise altering one's behavior.
The purpose of this American Gastroenterological Association (AGA) Institute Clinical Practice Update was to rapidly review the emerging evidence and provide timely expert recommendations regarding ...the management of patients with inflammatory bowel disease during the coronavirus disease 2019 pandemic. This expert commentary was commissioned and approved by the AGA Institute Clinical Practice Updates Committee and the AGA Governing Board to provide timely perspective on a topic of high clinical importance to the AGA membership, and underwent internal peer review by the Clinical Practice Updates Committee and external peer review through standard procedures of Gastroenterology.
Si l’influence de l’environnement et en particulier des traumatismes précoces, sur le développement de l’enfant et la survenue de psychopathologies est connue depuis les premières études ...épidémiologiques de la discipline, les 20 dernières années ont été marquées par des avancées importantes dans le champ des neurosciences, permettant de comprendre comment les traumatismes font trace au cours du développement de l’enfant. À partir d’exemples paradigmatiques, comme ceux des séparations précoces par abandon ou deuil, je propose d’étudier ces traces laissées : (1) au plan épigénétique dans l’étude de certains modèles animaux ; (2) dans quelques psychopathologies comme les troubles externalisés ; (3) mais aussi dans les systèmes biologiques fonctionnels ou anatomiques au cours du développement. À partir de données expérimentales issues de notre équipe, j’essaierai également de montrer comment ces traces peuvent rester inscrites à des niveaux non conscients, mais accessibles soit au travers d’une écoute spécifique soit au travers de l’expérience des interactions précoces mère–bébé quel que soit le sens de la dynamique d’interaction considérée (mère vers bébé ou bébé vers mère).
Whether traumatic events and history enhance the risk of later psychopathology is no longer controversial since early description of posttraumatic stress disorder by psychoanalysts after World War I. However, whether the best model is the so-called vulnerability one (meaning genetically predetermined development) or the probabilistic epigenetic one (meaning that trauma can impact biological levels in a permanent manner as well) is still debated.
To critically review the literature to explore supporting data on how “trauma gets under the skin” leaving measurable consequences at a biological and/or psychological level.
I critically reviewed the literature and selected studies investigating impact of early trauma (e.g. severe deprivation, maltreatment and/or abuse) at biological and/or psychological levels. I will also summarize experimental data from recent work of the Salpétrière group focusing on the impact of traumatic experience on early interaction or psychoanalytic listening.
There is now a consistent amount of data supporting the probabilistic epigenetic model of development. We found studies showing how traumatic experience can impact development from: (1) animal models of early separation; (2) human longitudinal studies controlling for confounding variables such as genetic ones; (3) human studies with different neurobiological correlates (e.g. neuro-imaging data; electro-encephalographic parameters; epigenetic markers). Furthermore, we were able to show in three different experiments that: (1) psychoanalysts are able to identify, without explicit knowledge and above the level of chance, healthy adults whose siblings had experienced cancer during childhood; (2) false positive ultrasound screening for soft markers may impact mother-infant interaction negatively; (3) caregivers of infants who will later develop autism adapt their interaction dynamic unconsciously before being aware of child psychopathology.
Trauma should not anymore be regarded only as an “outside” event as impact can be evidenced at biological levels that have long lasting effects during development and even in next generations.
Historically, the locus coeruleus-norepinephrine (LC-NE) system has been implicated in arousal, but recent findings suggest that this system plays a more complex and specific role in the control of ...behavior than investigators previously thought. We review neurophysiological and modeling studies in monkey that support a new theory of LC-NE function. LC neurons exhibit two modes of activity, phasic and tonic. Phasic LC activation is driven by the outcome of task-related decision processes and is proposed to facilitate ensuing behaviors and to help optimize task performance (exploitation). When utility in the task wanes, LC neurons exhibit a tonic activity mode, associated with disengagement from the current task and a search for alternative behaviors (exploration). Monkey LC receives prominent, direct inputs from the anterior cingulate (ACC) and orbitofrontal cortices (OFC), both of which are thought to monitor task-related utility. We propose that these frontal areas produce the above patterns of LC activity to optimize utility on both short and long timescales.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
This article describes the use of eculizumab in patients with atypical hemolytic–uremic syndrome. This C5 inhibitor was associated with improvement in complement-mediated thrombotic microangiopathy ...and with significant improvement in time-dependent renal function.
Atypical hemolytic–uremic syndrome is a genetic, chronic, and progressive inflammatory disease that affects patients of all ages.
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This syndrome is caused by defects in regulation of the complement system. These defects are inherited, acquired, or both, and they result in chronic, uncontrolled activation of the complement system
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which leads to platelet, leukocyte, and endothelial-cell activation and systemic thrombotic microangiopathy.
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Affected patients have a lifelong risk of systemic clinical complications of thrombotic microangiopathy, including damage to multiple organ systems (e.g., the central nervous system, kidneys, heart, and gastrointestinal tract).
Although plasma exchange or infusion has been used . . .
Attention is commonly thought to be manifest through local variations in neural gain. However, what would be the effects of brain-wide changes in gain? We hypothesized that global fluctuations in ...gain modulate the breadth of attention and the degree to which processing is focused on aspects of the environment to which one is predisposed to attend. We found that measures of pupil diameter, which are thought to track levels of locus coeruleus norepinephrine activity and neural gain, were correlated with the degree to which learning was focused on stimulus dimensions that individual human participants were more predisposed to process. In support of our interpretation of this effect in terms of global changes in gain, we found that the measured pupillary and behavioral variables were strongly correlated with global changes in the strength and clustering of functional connectivity, as brain-wide fluctuations of gain would predict.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
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