Cheryl Richards edited Pathophysiology.md  about 8 years ago

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A three-stage instrumental-learning paradigm was used to compare antipsychotic-medicated and unmedicated TS adults with a control group \citep{26490329}. First, subjects learned to associate six different stimuli with six specific outcome pictures and a specific response (i.e., left or right key press). During the second stage, subjects were presented with two outcomes with an indication that one outcome was devalued so that it was no longer associated with point rewards and subjects had to press the key associated with the outcome that would still generate points. During the third stage (i.e., "slip-of-action" stage) the six comes were presented simultaneously with indications that two were devalued so that responding to the associated stimuli would no longer be rewarded with points. Subjects were instructed to press the correct key associated with stimuli associated with the still valued outcomes and withhold the response for stimuli associated with devalued outcomes. Subjects also did a Go-No Go task in which two of six cueing stimuli were devalued with instructions to withhold the key press response when the devalued stimulus was presented. This task provided determined whether excessive "slips of action" were related to a working memory deficit or deficient response inhibition rather than outcome devaluation insensitivity. There were no group performance differences for the first two stages of the instrumental learning task or on the baseline Go-NoGo task. However, unmedicated patients showed a significantly higher response rate to devalued outcomes compared to controls in Bonferroni-corrected post hoc analyses while there was no difference between medicated subjects and controls. In addition, in unmedicated subjects tic severity was correlated with response rates to devalued outcomes and was also correlated with stronger structural connectivity between the right supplementary motor cortex and the posterior putamen. The influence of comorbidities was minimized by excluding subjects with ADHD from the study. In addition, the results obtained in this study contrasted with results on similar tasks obtained with subjects with pure obsessive-compulsive disorder without tics. Delorme et al. argued that over-reliance on habits in pure OCD is associated with impaired knowledge of response-outcome associations while this type of learning was intact in both TS groups in this study and concluded that unmedicated TS subjects tend to engage in enhanced habit formation.   Sustained attention, using a continuous performance test, was examined in 48 children who had OCD alone, tic disorders (TD) alone or both OCD and TD. The challenges of trying to separate out the effects due to comorbidities is evident in this study \cite{25296570}. A high rate of ADHD was seen in all groups (i.e., 62% of the OCD+TD group, 27% in the TD alone group, and 20% in the OCD alone group. Anxiety was also commonly seen (i.e., 77% in the OCD+TD group compared to 49% for the other two groups combined). The OCD+TD group had more errors of omission and did more poorly on other measures of sustained attention compared to the other two groups. Although an attempt was made to examine the specific effect of ADHD in the OCD+TD group,the subgroups were quite small (i.e., 8 in the OCD+TD+ADHD, 5 in the OCD+TD-ADHD) thereby limiting the power to detect additional differences. However, reaction time variability, which is commonly seen in ADHD was higher in the OCD+TD group than for the groups with OCD alone or TD alone.  *Title** | **Comment** |  |:----------|:------------|  | Anthropomorphic triangles \citep*{26177119} | This clever study results from Dr. Eddy's research on social cognition in TS. People with TS and controls demonstrated intact mentalizing when observing animated triangles demonstrating simple and complex interactions. However, people with TS tended to attribute human-like intentions when the two triangles were moving randomly. This tendency was not explained by other constructs such as executive function, alexithymia or clinical symptoms.|