Browse Health
Psychiatrist
36 years of experience
Accepting new patients

Education ?

Medical School
University Of Cairo (1974)
Foreign school

Affiliations ?

Dr. Boutros is affiliated with 4 hospitals.

Hospital Affilations

Score

Rankings

  • Detroit Receiving Hospital & University Health Center
    4201 Saint Antoine St, Detroit, MI 48201
    • Currently 3 of 4 crosses
    Top 50%
  • Detroit Receiving Hospital
  • Sinai-Grace Hospital
    6071 W Outer Dr, Detroit, MI 48235
  • Detroit Receiving - UHC
  • Publications & Research

    Dr. Boutros has contributed to 48 publications.
    Title A Pilot Study Revealing Impaired P50 Gating in Antisocial Personality Disorder.
    Date December 2009
    Journal The Journal of Neuropsychiatry and Clinical Neurosciences
    Excerpt

    The authors investigated preattentive filtering assessed by P50 gating in nine participants with antisocial personality disorder (ASPD) and seven with adult-onset antisocial behavior (AAB). Relative to 15 comparison subjects, gating was impaired in ASPD, suggesting abnormal pre-attentive filtering in pathological impulsivity.

    Title P50, N100, and P200 Sensory Gating: Relationships with Behavioral Inhibition, Attention, and Working Memory.
    Date November 2009
    Journal Psychophysiology
    Excerpt

    P50, N100, and P200 auditory sensory gating could reflect mechanisms involved in protecting higher-order cognitive functions, suggesting relationships between sensory gating and cognition. This hypothesis was tested in 56 healthy adults who were administered the paired-click paradigm and two adaptations of the continuous performance test (Immediate/Delayed Memory Task, IMT/DMT). Stronger P50 gating correlated with fewer commission errors and prolonged reaction times on the DMT. Stronger N100 and P200 gating correlated with better discriminability on the DMT. Finally, prolonged P200 latency related to better discriminability on the IMT. These findings suggest that P50, N100, and P200 gating could be involved in protecting cognition by affecting response bias, behavioral inhibition, working memory, or attention.

    Title Diminished P50, N100 and P200 Auditory Sensory Gating in Bipolar I Disorder.
    Date June 2009
    Journal Psychiatry Research
    Excerpt

    Bipolar I disorder is associated with diminished gating of the auditory evoked P50 component. P50 gating may relate to early filtering of sensory information, protecting higher-order cognitive functions. Gating of the auditory evoked N100 and P200 components has not been investigated in bipolar I disorder, although N100 and P200 gating could reflect different mechanisms and functions in the process of filtering sensory information in addition to those reflected by P50 gating. We investigated P50, N100, and P200 gating assessed with the paired-click paradigm in 22 subjects with bipolar I disorder and 54 healthy controls. Peak amplitudes and latencies were assessed at Cz for the P50, N100, and P200 components. Gating was defined as the reduction in peak amplitude from the first (S1) to the second stimulus (S2) of a stimulus pair, and expressed as gating ratio ([S2(amplitude)/S1(amplitude)]()100) and difference score (S1(amplitude)-S2(amplitude)). Group differences were detected with multivariate analyses and controlled for differences in age and ethnicity. Subjects with bipolar I disorder had higher P50, N100 and P200 ratios and lower difference scores compared with findings for controls. These findings extend the existing evidence on impaired sensory gating in bipolar I disorder beyond the P50, suggesting impaired filtering at both pre-attentive and early attentive levels in bipolar I disorder.

    Title Reduced Auditory Evoked Potential Component N100 in Schizophrenia--a Critical Review.
    Date February 2009
    Journal Psychiatry Research
    Excerpt

    The role of a reduced N100 (or N1) component of the auditory event related potential as a potential trait marker of schizophrenia is critically discussed in this review. We suggest that the extent of the N100 amplitude reduction in schizophrenia depends on experimental and subject factors, as well as on clinical variables: N100 is more consistently reduced in studies using interstimulus intervals (ISIs) >1 s than in studies using shorter ISIs. An increase of the N100 amplitude by allocation of attention is often lacking in schizophrenia patients. A reduction of the N100 amplitude is nevertheless also observed when such an allocation is not required, proposing that both endogenous and exogenous constituents of the N100 are affected by schizophrenia. N100 is more consistently reduced in medicated than unmedicated patients, but a reduction of the N100 amplitude as a consequence of antipsychotic medication was shown in only two of seven studies. In line with that, the association between the N100 reduction and degree of psychopathology of patients appears to be weak overall. A reduced N100 amplitude is found in first degree relatives of schizophrenia patients, but the risk of developing schizophrenia is not reflected in the N100 amplitude reduction.

    Title Electroencephalographic Cerebral Dysrhythmic Abnormalities in the Trinity of Nonepileptic General Population, Neuropsychiatric, and Neurobehavioral Disorders.
    Date July 2008
    Journal The Journal of Neuropsychiatry and Clinical Neurosciences
    Excerpt

    Subclinical electroencephalographic epileptiform discharges in neurobehavioral disorders are not uncommon. The clinical significance and behavioral, diagnostic, and therapeutic implications of this EEG cerebral dysrhythmia have not been fully examined. Currently the only connotation for distinctive epileptiform electroencephalographic patterns is epileptic seizures. Given the prevailing dogma of not treating EEGs, these potential aberrations are either disregarded as irrelevant or are misattributed to indicate epilepsy. This article reappraises the literature on paroxysmal EEG dysrhythmia in normative studies of the "healthy" nonepileptic general populations, neuropsychiatry, and in neurobehavioral disorders. These EEG aberrations may be reflective of underlying morpho-functional brain abnormalities that underpin various neurobehavioral disturbances.

    Title Genetic and Environmental Influences on Sensory Gating of Mid-latency Auditory Evoked Responses: a Twin Study.
    Date April 2007
    Journal Schizophrenia Research
    Excerpt

    A deficit in sensory gating measured by the suppression of P50 auditory event-related potential (ERP) has been implicated in the biological bases of schizophrenia and some other psychiatric disorders and proposed as a candidate endophenotype for genetic studies. More recently, it has been shown that gating deficits in schizophrenics extend to ERP components reflecting early attentive processing (the N1/P2 complex). However, evidence for heritability of sensory gating in the general population is very limited. Heritability of P50, N1, and P2 amplitudes and gating was estimated in 54 monozygotic and 55 dizygotic twin pairs using a dual-click auditory paradigm. Genetic model-fitting analysis showed high heritability of peak amplitudes of P50, N1, and P2 waves. Genetic influences on P50 gating (S2/S1) were modest, while heritability of N1 and P2 gating was high and significant. The alternative gating measure (S1-S2 difference) showed significant heritability for all three ERP components. Weak genetic influences on P50 gating ratio can be related to its poor test-retest reliability demonstrated in previous studies. These results suggest that gating measures derived from the N1/P2 wave complex may be useful endophenotypes for population-based genetic studies of the sensory gating function and its impairments in psychopathology.

    Title The Value of Quantitative Electroencephalography in Clinical Psychiatry: a Report by the Committee on Research of the American Neuropsychiatric Association.
    Date January 2007
    Journal The Journal of Neuropsychiatry and Clinical Neurosciences
    Excerpt

    The authors evaluate quantitative electroencephalography (qEEG) as a laboratory test in clinical psychiatry and describe specific techniques, including visual analysis, spectral analysis, univariate comparisons to normative healthy databases, multivariate comparisons to normative healthy and clinical databases, and advanced techniques that hold clinical promise. Controversial aspects of each technique are discussed, as are broader areas of criticism, such as commercial interests and standards of evidence. The published literature is selectively reviewed, and qEEG's applicability is assessed for disorders of childhood (learning and attentional disorders), dementia, mood disorders, anxiety, panic, obsessive-compulsive disorder, and schizophrenia. Emphasis is placed primarily on studies that use qEEG to aid in clinical diagnosis, and secondarily on studies that use qEEG to predict medication response or clinical course. Methodological problems are highlighted, the availability of large databases is discussed, and specific recommendations are made for further research and development. As a clinical laboratory test, qEEG's cautious use is recommended in attentional and learning disabilities of childhood, and in mood and dementing disorders of adulthood.

    Title Gamma-aminobutyric Acid-serotonin Interactions in Healthy Men: Implications for Network Models of Psychosis and Dissociation.
    Date March 2006
    Journal Biological Psychiatry
    Excerpt

    BACKGROUND: This study tested the hypothesis that deficits in gamma-aminobutyric acid type A (GABA(A)) receptor function might create a vulnerability to the psychotogenic and perceptual altering effects of serotonergic (5-HT(2A/2C)) receptor stimulation. The interactive effects of iomazenil, an antagonist and partial inverse agonist of the benzodiazepine site of the GABA(A) receptor complex, and m-chlorophenylpiperazine (m-CPP), a partial agonist of 5-HT(2A/2C) receptors, were studied in 23 healthy male subjects. METHODS: Subjects underwent 4 days of testing, during which they received intravenous infusions of iomazenil/placebo followed by m-CPP/placebo in a double-blind, randomized crossover design. Behavioral, cognitive, and hormonal data were collected before drug infusions and periodically for 200 min after. RESULTS: Iomazenil and m-CPP interacted in a synergistic manner to produce mild psychotic symptoms and perceptual disturbances without impairing cognition. Iomazenil and m-CPP increased anxiety in an additive fashion. Iomazenil and m-CPP interacted in a synergistic manner to increase serum cortisol. CONCLUSIONS: Gamma-aminobutyric acid-ergic deficits might increase the vulnerability to the psychotomimetic and perceptual altering effects of serotonergic agents. These data suggest that interactions between GABA(A) and 5-HT systems might contribute to the pathophysiology of psychosis and dissociative-like perceptual states.

    Title Temporoparietal Transcranial Magnetic Stimulation for Auditory Hallucinations: Safety, Efficacy and Moderators in a Fifty Patient Sample.
    Date October 2005
    Journal Biological Psychiatry
    Excerpt

    BACKGROUND: Auditory hallucinations are often resistant to treatment and can produce significant distress and behavioral difficulties. A preliminary report based on 24 patients with schizophrenia or schizoaffective disorder indicated greater improvement in auditory hallucinations following 1-hertz left temporoparietal repetitive transcranial magnetic stimulation (rTMS) compared to sham stimulation. Data from the full 50-subject sample incorporating 26 new patients are now presented to more comprehensively assess safety/tolerability, efficacy and moderators of this intervention. METHODS: Right-handed patients experiencing auditory hallucinations at least 5 times per day were randomly allocated to receive either rTMS or sham stimulation. A total of 132 minutes of rTMS was administered over 9 days at 90% motor threshold using a double-masked, sham-controlled, parallel design. RESULTS: Hallucination Change Score was more improved for rTMS relative to sham stimulation (p = .008) as was the Clinical Global Impressions Scale (p = .0004). Hallucination frequency was significantly decreased during rTMS relative to sham stimulation (p = .0014) and was a moderator of rTMS effects (p = .008). There was no evidence of neurocognitive impairment associated with rTMS. CONCLUSIONS: Left temporoparietal 1-hertz rTMS warrants further study as an intervention for auditory hallucinations. Data suggest that this intervention selectively alters neurobiological factors determining frequency of these hallucinations.

    Title Cortical Excitability in Cocaine-dependent Patients: a Replication and Extension of Tms Findings.
    Date July 2005
    Journal Journal of Psychiatric Research
    Excerpt

    Cortical excitability can be assessed by transcranial magnetic stimulation (TMS). Previously we observed that TMS motor threshold (MT) was elevated in abstinent cocaine-dependent subjects. In the current study we aimed at replicating our initial finding, exploring other TMS-based measures of excitability, and examining association with personality characteristics. Nineteen cocaine-dependent and 12 healthy control subjects were examined. Resting and activated motor thresholds (RMT and AMT) and duration of the cortical silent period (CSP) were examined. The Cocaine Experience Questionnaire (CEQ) was administered to assess cocaine-induced psychotic symptoms. The relationship between Minnesota Multiphasic Personality Inventory (MMPI) scales and cortical excitability measures was also examined. AMT was significantly elevated in cocaine-dependent subjects on both hemispheres. RMT was also significantly elevated on the right hemisphere. No CSP changes were noted. Patients with cocaine-induced paranoia had longer CSPs on the right hemisphere compared to subjects reporting no paranoid experiences. The patients displayed significantly elevated scores on several MMPI scales, though the scale scores did not correlate with cortical excitability measures. These data support our initial finding of decreased cortical excitability in abstinent cocaine-dependent subjects. We interpret this finding as a compensatory mechanism against the stimulating and epileptogenic effects of cocaine.

    Title Morphological and Latency Abnormalities of the Mid-latency Auditory Evoked Responses in Schizophrenia: a Preliminary Report.
    Date December 2004
    Journal Schizophrenia Research
    Excerpt

    INTRODUCTION: Evoked potential (EP) amplitude and latency abnormalities have been extensively examined in schizophrenia. Morphological abnormalities of the mid-latency auditory evoked responses (MLAERs; P50, N100, P200), on the other hand, received very little attention. METHODS: Based on a priori defined set of morphological criteria, the morphology and latency of the MLAERs were blindly compared between stable outpatients with schizophrenia (N=27) and age- and gender-matched healthy control subjects (N=22). The morphology of the MLAERs was considered abnormal if one or more of the components fell outside the expected latency range, if one or more of the components were missing, or if a later occurring component was smaller in amplitude than an earlier occurring one. RESULTS: Of the 27 schizophrenia subjects, 20 had waveforms that were deemed atypical, while only 8 from the control group were classified as atypical (chi(2)=5.52, p<0.02). The latencies of the P50 and N100 components, identified based on morphology, were significantly prolonged in schizophrenia patients. CONCLUSIONS: These preliminary data suggest that morphological abnormalities of the MLAERs in schizophrenia patients are significant and should be taken into consideration when examining the MLAERs of this patient population.

    Title Altered Nmda Glutamate Receptor Antagonist Response in Individuals with a Family Vulnerability to Alcoholism.
    Date November 2004
    Journal The American Journal of Psychiatry
    Excerpt

    A family history of alcoholism is a risk factor for the development of ethanol dependence. Ethanol is an antagonist of the N-methyl-d-aspartate (NMDA) glutamate receptor, and alterations in NMDA receptor function are thought to be involved in ethanol abuse and dependence. The purpose of this study was to determine in healthy individuals with no ethanol dependence whether response to the NMDA receptor antagonist ketamine would differentiate those with a family history of ethanol dependence from those without such a family history.

    Title Altered Nmda Glutamate Receptor Antagonist Response in Recovering Ethanol-dependent Patients.
    Date January 2004
    Journal Neuropsychopharmacology : Official Publication of the American College of Neuropsychopharmacology
    Excerpt

    Ethanol is an antagonist of the N-methyl-D-aspartate (NMDA) glutamate receptor. Ethanol dependence upregulates NMDA receptors and contributes to crosstolerance with selective NMDA receptor antagonists in animals. This study evaluated whether recovering ethanol-dependent patients show evidence of a reduced level of response to the effects of the NMDA receptor antagonist, ketamine. In this double-blind study, 34 recently detoxified alcohol-dependent patients and 26 healthy comparison subjects completed 3 test days involving a 40-min infusion of saline, ketamine 0.1 mg/kg, or ketamine 0.5 mg/kg in a randomized order. Recovering ethanol-dependent patients showed reduced perceptual alterations, dysphoric mood, and impairments in executive cognitive functions during ketamine infusion relative to the healthy comparison group. No attenuation of ketamine-induced amnestic effects, euphoria, or activation was observed. The alterations in NMDA receptor function observed in recovering ethanol-dependent patients may have important implications for ethanol tolerance, ethanol dependence, and the treatment of alcoholism.

    Title Electrophysiological Aberrations in Borderline Personality Disorder: State of the Evidence.
    Date June 2003
    Journal The Journal of Neuropsychiatry and Clinical Neurosciences
    Excerpt

    Electrophysiological technology is noninvasive and relatively inexpensive. In order to assess the usefulness of this technology in probing the pathophysiology of borderline personality disorder (BPD), we reviewed the literature in which an electrophysiological modality was used to examine BPD. Twenty-two articles were identified, from which diagnostic criteria and data on comorbidity and control groups were extracted. Although the majority of studies pointed to a high prevalence of electrophysiological aberrations in patients, very few studies had adequate control groups and adequate evaluation of comorbidity. We conclude that although the existing literature reflects a preliminary stage of the field, it suggests that electrophysiological investigations may be useful in investigating BPD.

    Title Lack of a Therapeutic Effect of a 2-week Sub-threshold Transcranial Magnetic Stimulation Course for Treatment-resistant Depression.
    Date May 2003
    Journal Psychiatry Research
    Excerpt

    Stimulation parameters seem to strongly influence the efficacy of repetitive transcranial magnetic stimulation (rTMS) in the management of treatment-resistant depressed patients. The most effective and safest parameters are yet to be defined. Moreover, systematic follow-up data available to document the duration of the therapeutic effects remain sparse. Twenty-one treatment-resistant depressed patients were randomized to either active rTMS (N=12) or to sham (N=9) treatment in a double-blind design. Patients were kept on their medications. Sub-motor-threshold (MT) stimulation (80% MT) was delivered for 10 consecutive work days (20 Hz, 2-s trains, 20 trains). Subjects meeting pre-set criteria for responding were entered into a follow-up phase for up to 5 months. Utilizing the above stimulation parameters, we found no significant difference between groups. Six patients in the active group and one subject in the sham group met criteria for the follow-up phase. The period of time before subjects met criteria for relapse was highly variable ranging from 2 to 20 weeks. Sub-threshold rTMS stimulation for 2 weeks is not significantly superior to sham treatment for treatment-resistant depressed patients. The duration of the therapeutic effects of rTMS delivered to the left prefrontal cortex using the above-described parameters is highly variable.

    Title Phase Synchronization of the Ongoing Eeg and Auditory Ep Generation.
    Date February 2003
    Journal Clinical Neurophysiology : Official Journal of the International Federation of Clinical Neurophysiology
    Excerpt

    We investigated the role of phase synchronization of the spontaneous electroencephalogram (EEG) in auditory evoked potential (EP) generation in a sample of healthy individuals.

    Title The Effect of Tryptophan Depletion on Alcohol Self-administration in Non-treatment-seeking Alcoholic Individuals.
    Date February 2003
    Journal Alcoholism, Clinical and Experimental Research
    Excerpt

    BACKGROUND: Alcohol self-administration in the laboratory has been used to evaluate pharmacological treatments and neurobiological mechanisms that underlie alcohol use in alcohol-dependent individuals. This study evaluated whether attenuation of serotonin synthesis via depletion of its precursor tryptophan reduces the amount of alcohol consumed in a self-administration paradigm in non-treatment-seeking individuals with alcohol use disorders. METHODS: Individuals with alcohol dependence (n = 8) and alcohol abuse (n = 4) who were not seeking treatment were recruited by advertisement and participated in two test days, 1 week apart. Each test session was preceded by administration of a concentrated amino acid drink that resulted in a rapid and significant decline in plasma free tryptophan (active depletion) or a similar drink containing tryptophan (placebo depletion). Tests were conducted in a randomized, double-blind fashion. The test session began with a cue exposure session where subjects were exposed to their favorite alcoholic beverage and asked to rate their craving for alcohol. After this, subjects were administered a priming drink designed to raise blood alcohol levels to 0.02 g%. Subjects then had the opportunity to drink up to eight additional drinks, each designed to raise blood alcohol levels by 0.02 g%, or to receive $3 for each drink not consumed over a 2-hr period. RESULTS: There were no significant differences in alcohol consumed or subjective intoxication with active tryptophan depletion compared with placebo. Self-reported craving correlated with the amount of alcohol consumed in the session. CONCLUSIONS: These data question the dependence of alcohol self-administration on the ongoing synthesis of serotonin.

    Title The Health-related Effects of Alcohol Use in Older Persons: a Systematic Review.
    Date January 2003
    Journal Substance Abuse : Official Publication of the Association for Medical Education and Research in Substance Abuse
    Excerpt

    Increased alcohol consumption is associated with substantial morbidity and mortality in young and middle-aged adult populations, but its effects on the health of older adults have received less attention. The objective of the study was to review published studies that assessed the effects of alcohol on falls or fall injuries, functional impairment, cognitive impairment, and all-cause mortality among older adults. MEDLINE database and bibliographies of selected citations were searched for English language studies published between 1966 and 1998 that examined the relationship between alcohol and one or more of the above outcomes. Also a study was analyzed if it included participants 60 years of age or older, or a broader age range of participants and reported results for older subgroups, or predominantly older participants as evidenced by a mean age of 65 years of age or above. Information on studies' sample sizes, exposure and outcome measures, and risk estimates were extracted, and articles were evaluated for methodologic quality using predetermined criteria. Eighty-four studies were identified that examined 91 potential exposure-outcome associations including falls or fall injuries (n = 26); functional impairment (n = 13); cognitive impairment (n = 32); and all-cause mortality (n = 20). The percentage of studies demonstrating harm, no association, or benefit by outcome included falls (15% vs. 81% vs. 4%); functional disability (38% vs. 46% vs. 16%); cognitive impairment (31% vs. 66% vs. 3%); and all-cause mortality (15% vs. 65% vs. 20%). Studies (n = 84) inconsistently adhered to methodologic standards. Although 90% provided eligibility criteria; 61% cited participation rates; and 73% described the methods used to measure alcohol exposure; only 44% adjusted for potentially important confounding factors; and 26% distinguished former drinkers from nondrinkers. Of the cohort studies (n = 47), 30% assessed for change in participants' exposure status over time, and 17% determined whether losses to follow-up varied by exposure status. The magnitude of risk posed by alcohol use for falls or fall injuries, functional disability, cognitive impairment, and all-cause mortality among older adults remains uncertain. Prospective studies are needed to better define the health-related effects of alcohol use in older populations.

    Title Transcranial Magnetic Stimulation of Left Temporoparietal Cortex and Medication-resistant Auditory Hallucinations.
    Date January 2003
    Journal Archives of General Psychiatry
    Excerpt

    BACKGROUND: Neuroimaging studies suggest that auditory hallucinations (AHs) of speech arise, at least in part, from activation of brain areas underlying speech perception. One-hertz repetitive transcranial magnetic stimulation (rTMS) produces sustained reductions in cortical activation. Recent results of 4-day administration of 1-Hz rTMS to left temporoparietal cortex were superior to those of sham stimulation in reducing AHs. We sought to determine if a more extended trial of rTMS could significantly reduce AHs that were resistant to antipsychotic medication. METHODS: Twenty-four patients with schizophrenia or schizoaffective disorder and medication-resistant AHs were randomly allocated to receive rTMS or sham stimulation for 9 days at 90% of motor threshold. Patients receiving sham stimulation were subsequently offered an open-label trial of rTMS. Neuropsychological assessments were administered at baseline and during and following each arm of the trial. RESULTS: Auditory hallucinations were robustly improved with rTMS relative to sham stimulation. Frequency and attentional salience were the 2 aspects of hallucinatory experience that showed greatest improvement. Duration of putative treatment effects ranged widely, with 52% of patients maintaining improvement for at least 15 weeks. Repetitive transcranial magnetic stimulation was well tolerated, without evidence of neuropsychological impairment. CONCLUSIONS: These data suggest that the mechanism of AHs involves activation of the left temporoparietal cortex. One-hertz rTMS deserves additional study as a possible treatment for this syndrome.

    Title Sensory Gating and Psychosis Vulnerability in Cocaine-dependent Individuals: Preliminary Data.
    Date June 2002
    Journal Biological Psychiatry
    Excerpt

    Factors increasing vulnerability of a cocaine user to develop psychotic symptoms are unknown. Deficits in sensory gating and attention, such as those occurring in idiopathic psychosis, might represent experimentally tractable factors contributing to vulnerability to cocaine-induced paranoia.

    Title Effect of Tryptophan Depletion on Alcohol Cue-induced Craving in Abstinent Alcoholic Patients.
    Date September 2001
    Journal Alcoholism, Clinical and Experimental Research
    Excerpt

    The capacity of alcohol cues to precipitate the desire to drink may be an important determinant of relapse to alcohol use in recovering alcohol-dependent patients. This study evaluated whether attenuation of serotonin synthesis via depletion of its precursor tryptophan reduces the magnitude of cue-induced craving for alcohol in recently abstinent alcoholic individuals.

    Title Eeg Monitoring in Depressed Patients Undergoing Repetitive Transcranial Magnetic Stimulation.
    Date September 2001
    Journal The Journal of Neuropsychiatry and Clinical Neurosciences
    Excerpt

    To date, 33 subjects diagnosed with major depressive disorder have undergone transcranial magnetic stimulation (TMS) in the authors' clinic. Five of these patients showed minimal electroencephalogram (EEG) variants at baseline. The authors describe the course of treatment and serial EEGs in 3 of the 5 patients who did not show progressive EEG changes in association with active rTMS. These three cases suggest that minimal EEG anomalies at baseline need not serve as a contraindication to undergoing rTMS. Two patients with progressive EEG changes in association with sham rTMS in one and active rTMS in the other are also discussed.

    Title Auditory Verbal Hallucinations and Dysfunction of the Neural Substrates of Speech.
    Date August 2001
    Journal Schizophrenia Research
    Excerpt

    OBJECTIVE: to evaluate the neural substrate of auditory verbal hallucinations (AVH), the correlation between AVH and subvocal speech (hereafter SVS), and the relationship between speech and AVH. METHOD: we reviewed the papers found by an electronic literature search on hallucinations and speech. The review was extended to the papers cited in these publications and to classical works. RESULTS: there is no conclusive evidence of structural abnormality of the speech perception area in hallucinating schizophrenic patients. However there is evidence of electrophysiological abnormalities of the auditory and speech perception cortices. Functional imaging data are inconsistent, yet point to the left superior temporal gyrus as one of the neural substrates for AVH. There is also evidence that SVS could accompany the experience of AVH. CONCLUSION: there is evidence that dysfunction of brain areas responsible for speech generation is a fundamental mechanism for generating AVH in schizophrenia. It results in a secondary activation of Wernicke's area (speech perception) and Broca's area (speech expression). The first leading to the experience of hallucinations, and the second, eventually, gives rise to a variable degree of vocal muscle activity detectable by EMG, and/or faint vocalizations detectable by sensitive microphones placed at proximity of the larynx. Direct stimulation or disease of Wernicke's area produces AVH without SVS.

    Title Elevated Motor Threshold in Drug-free, Cocaine-dependent Patients Assessed with Transcranial Magnetic Stimulation.
    Date June 2001
    Journal Biological Psychiatry
    Excerpt

    BACKGROUND: Transcranial magnetic stimulation (TMS) provides a noninvasive method of examining cortical inhibitory and excitatory processes and cortical excitability in awake subjects. There is evidence from clinical and electroencephalographic (EEG) data that cortical excitability may be abnormal in some psychiatric populations. Chronic cocaine abuse influences a number of neurotransmitters that are involved in the excitatory/inhibitory balance of the cerebral cortex. This pilot study was conducted to ascertain the possible utility of TMS in examining cortical excitability in a population of chronic cocaine abusers. METHODS: The right and left motor thresholds of ten cocaine-dependent subjects, according to DSM-IV, and ten normal control subjects were examined using single pulse TMS. RESULTS: The resting motor thresholds resulting from stimulation of the right or the left motor cortical regions were significantly elevated in cocaine-dependent subjects compared with matched control subjects. CONCLUSIONS: These pilot data suggest that chronic cocaine use significantly alters cortical excitability in the direction of increased inhibition or decreased excitability. We hypothesize that this observation reflects adaptation to those effects of cocaine intoxication that promote cortical excitability and seizures.

    Title Similarities in the Disturbances in Cortical Information Processing in Alcoholism and Aging: a Pilot Evoked Potential Study.
    Date May 2001
    Journal International Psychogeriatrics / Ipa
    Excerpt

    OBJECTIVE: To examine the hypothesis that chronic alcohol use causes accelerated aging of the brain. METHODS: The auditory evoked potentials (EPs) were compared in three groups of 10 subjects each: (a) middle-aged individuals meeting DSM-IV criteria for alcohol dependence, (b) age- and gender-matched group of healthy individuals, and (c) an older (>65 years) group of gender-matched healthy individuals. Multiple levels of cortical information processing were examined using EPs. Early stages of information processing, related to sensory gating and stimulus classification (P50, N100/P200), were studied using a paired-click paradigm. Later stages of information processing associated with memory upgrading and identification of novel stimuli (P300) were studied using an oddball paradigm. RESULTS: The amplitude and latency of the P300 of the alcoholic patients and the older healthy subjects differed significantly from those of the younger healthy group. Both groups showed changes that have been reported in association with aging. A tendency towards decreased sensory gating in later stages of information processing was noted in the aged healthy individuals. CONCLUSIONS: These data suggest that alcohol dependence may accelerate the aging process. The tendency towards a sensory gating deficit during the attentive phase of information processing in older healthy subjects requires further investigation because it may be a marker for an increased proneness to developing psychotic symptoms in that group.

    Title Contingency Management Interventions: from Research to Practice.
    Date May 2001
    Journal The American Journal of Psychiatry
    Title Electroencephalogram and Repetitive Transcranial Magnetic Stimulation.
    Date March 2001
    Journal Depression and Anxiety
    Excerpt

    Scalp recordings of the electroencephalogram (EEG) have been used in association with repetitive transcranial magnetic stimulation (rTMS) investigations as a safety measure in monitoring ongoing EEG activity and as a neurophysiologic tool in examining the specific effects induced by the magnetic stimulus on the EEG or evoked potentials (EPs). Medline review on the use of EEG or EPs with rTMS reveals that this area has been largely unexplored. Limited available studies attest to the potential for studies combining EEG/EPs and rTMS to be useful in further elucidating the normal brain physiology. Herein, we report on our experience with continuous EEG sampling combined with rTMS in patients with major depression (n = 14), schizophrenia (n = 7), and obsessive-compulsive disorder (n = 5). Our data support the practice of using continuous EEG monitoring when the stimulation parameters fall outside established safety guidelines.

    Title Transcranial Magnetic Stimulation and Auditory Hallucinations in Schizophrenia.
    Date April 2000
    Journal Lancet
    Excerpt

    12 patients with schizophrenia and auditory hallucinations received 1 Hz transcranial magnetic stimulation of left temporoparietial cortex. In a double-blind crossover trial, active stimulation significantly reduced hallucinations relative to sham stimulation.

    Title A Randomized Clinical Trial of Repetitive Transcranial Magnetic Stimulation in the Treatment of Major Depression.
    Date March 2000
    Journal Biological Psychiatry
    Excerpt

    BACKGROUND: Multiple groups have reported on the use of repetitive transcranial magnetic stimulation (rTMS) in treatment-resistant major depression. The purpose of this study is to assess the efficacy of rTMS in unmedicated, treatment-resistant patients who meet criteria for major depression. METHODS: Depressed subjects, who had failed to respond to a median of four treatment trials, were assigned in a randomized double-blind manner to receive either active (n = 10; 20 2-sec trains of 20 Hz stimulation with 58-sec intervals; delivered at 80% motor threshold with the figure-of-eight coil positioned over the left dorsolateral prefrontal cortex) or sham (n = 10; similar conditions with the coil elevated and angled 45 degrees tangentially to the scalp) rTMS. These sequences were applied during 10 consecutive weekdays. Continuous electroencephalogram sampling and daily motor threshold determinations were also obtained. RESULTS: The group mean 25-item Hamilton Depression Rating Scale (HDRS) score was 37.2 (+/- 2.0 SEM) points. Adjusted mean decreases in HDRS scores were 14.0 (+/- 3.7) and 0.2 (+/- 4.1) points for the active and control groups, respectively (p <.05). One of 10 subjects receiving active treatment demonstrated a robust response (i.e., HDRS decreased from 47 to 7 points); three other patients demonstrated 40-45% decreases in HDRS scores. No patients receiving sham treatment demonstrated partial or full responses. CONCLUSIONS: A 2-week course of active rTMS resulted in statistically significant but clinically modest reductions of depressive symptoms, as compared to sham rTMS in a population characterized by treatment resistance.

    Title Transcranial Magnetic Stimulation of Left Temporoparietal Cortex in Three Patients Reporting Hallucinated "voices".
    Date December 1999
    Journal Biological Psychiatry
    Excerpt

    BACKGROUND: Prior studies suggest that auditory hallucinations of "voices" arise from activation of speech perception areas of the cerebral cortex. Low frequency transcranial magnetic stimulation (TMS) can reduce cortical activation. METHODS: We have studied three schizophrenic patients reporting persistent auditory hallucinations to determine if low frequency TMS could curtail these experiences. One hertz stimulation of left temporoparietal cortex was compared with sham stimulation using a double-blind, cross-over design. RESULTS: All three patients demonstrated greater improvement in hallucination severity following active stimulation compared to sham stimulation. Two of the three patients reported near total cessation of hallucinations for > or = 2 weeks. CONCLUSIONS: TMS may advance our understanding of the mechanism and treatment of auditory hallucinations.

    Title Test-retest Reliability of the Rat N40 Auditory Evoked Response: Preliminary Data.
    Date March 1999
    Journal Psychiatry Research
    Excerpt

    The N40 auditory evoked potential (EP) in rats has been used to develop an animal model for the study of sensory gating mechanisms. In an examination of the test-retest reliability of sensory gating indices, derived from the rat N40 EP, six rats were tested four times daily for 5 consecutive days. A paired-click paradigm (S1-S2) was used, and both the S2/S1 amplitude ratio and the S1-S2 amplitude difference measures of sensory gating capacity were calculated. Based on the means of four daily trials, reliability coefficients were as follows; r = 0.69 for S1, and r = 0.66 for S2 amplitudes. A reliability coefficient of 0.59 was found for the S1-S2 difference measure, and one of 0.47 for the S2/S1 ratio measure. These results suggest that the N40 can be used to study sensory gating, but caution has to be exercised in interpreting the data particularly in a repeated measures design.

    Title Chronological Association Between Increases in Drug Abuse and Psychosis in Connecticut State Hospitals.
    Date June 1998
    Journal The Journal of Neuropsychiatry and Clinical Neurosciences
    Excerpt

    Disagreement remains as to whether drug use can result in an autonomous psychotic disorder. If drug use can create new psychosis cases, an increase in the number of psychosis patients ought to be observable following periods of increased drug use by the general population. First admissions data for the categories of drug abuse and schizophrenia/paranoid disorders from all Connecticut state hospitals from 1965 to 1983 were examined to determine the prevalence of psychotic disorders before, during, and after a period of increased drug use by the general population. Affective disorders first admissions were examined for comparison. A rapid increase in new schizophrenia admissions coincided with a peak period for drug-related admissions. The data suggest that increased drug use of the late 1960s may have contributed to the increase noted 3 to 5 years later in first admissions of patients diagnosed with psychotic disorders.

    Title Cannabis-induced Chronic Psychosis: an Underacknowledged Disorder?
    Date July 1997
    Journal The Australian and New Zealand Journal of Psychiatry
    Title Chronic Substance-induced Psychotic Disorders: State of the Literature.
    Date January 1997
    Journal The Journal of Neuropsychiatry and Clinical Neurosciences
    Excerpt

    Whether or not drug use can cause a chronic psychotic disorder that is clinically similar to schizophrenia and related disorders is an important question. In this review, the authors attempt to determine whether there is enough evidence in the literature to support the notion that illicit drug use can cause chronic psychotic disorders. They conclude the literature strongly suggests that a number of drugs of abuse in different classes (psychostimulants, hallucinogens, marijuana, and possibly industrial inhalants) can cause or increase the susceptibility for a state of chronic psychosis. It is also likely that the abuse of combinations of these drugs is capable of inducing similar syndromes.

    Title The P50 Evoked Potential Component and Mismatch Detection in Normal Volunteers: Implications for the Study of Sensory Gating.
    Date November 1995
    Journal Psychiatry Research
    Excerpt

    Sensory gating is a complex, multistage, multifaceted physiological function believed to be protecting higher cortical centers from being flooded with incoming irrelevant sensory stimuli. Failure of such mechanisms is hypothesized as one of the mechanisms underlying the development of psychotic states. Attenuation of the amplitude of the P50 evoked potential component with stimulus repetition is widely used to study sensory gating. In the current study, we investigated the responsiveness of the P50 component to changes in the physical characteristics of ongoing trains of auditory stimuli. Forty normal volunteers were studied in a modified oddball paradigm. At all cerebral locations studied, P50 amplitudes were higher in response to infrequent stimuli. We postulate that the increase in P50 amplitude reflects the system's recognition of novel stimuli or "gating in" of sensory input. The ratio of the amplitude of the responses to the infrequent stimuli to those of the frequent stimuli was significantly higher for the posterior temporal regions. This finding provides further evidence that the temporal lobes may be significantly involved in sensory gating processes. Although this study only included normal subjects, the data generated contribute to the understanding of sensory gating mechanisms that may be relevant to psychotic states.

    Title Clinical Electroencephalograms in Patients with Catatonic Disorders.
    Date April 1995
    Journal Clinical Eeg (electroencephalography)
    Excerpt

    Catatonia is a neuropsychiatric syndrome of motor signs most frequently found in affective disorders and schizophrenia. Catatonic disorder due to a general medical condition has been added to the DSM-IV nosology. Laboratory studies, such as electroencephalography (EEG) may assist in the differential diagnosis of catatonic disorders. Twenty-six patients hospitalized on a general psychiatric unit or medical psychiatric unit received electroencephalograms (EEGs) as part of their routine care. Clinical EEG abnormalities were reported in 17 of these patients. The presence of abnormalities was associated with age greater than 40, diagnosis of neuroleptic malignant syndrome and the presence of general medical conditions associated with the development of catatonia. Although no specific EEG patterns were associated with catatonic disorder due to general medical conditions, these findings suggest that the EEG is an important tool in the evaluation of patients presenting with catatonia.

    Title Effects of Cocaine on Sensory Inhibition in Rats: Preliminary Data.
    Date January 1995
    Journal Biological Psychiatry
    Excerpt

    The purpose of this study was to determine the effect of cocaine on inhibitory sensory processing mechanisms in the brain. To accomplish this aim, recording electrodes were surgically placed into the vertex region of 12 rats. After recovery from surgery, rats were injected once daily for 5 days with either cocaine (20 mg/kg, IP) or saline. Immediately and 23 hr after each injection, the rats were tested for sensory gating mechanisms. They were presented with a series of two clicking sounds, a conditioning and testing click, delivered 0.5 sec apart, and the amplitude of the N40 responses to each of these clicks was recorded. The ratios of the amplitude of the N40 response to the testing click over that of the conditioning click (T/C ratio) were calculated for each animal for each testing period. The T/C ratios of the control (Saline-injected) animals were less than one, indicating that the conditioning stimulus was able to activate inhibitory neural pathways, producing a decrease in the response to the testing stimulus. The T/C ratios of the cocaine-treated animals were significantly greater than those of controls when the tests were conducted either immediately after injection or 23 hr later. These observations suggest that cocaine can impair mechanisms involved in the gating of responses to auditory stimuli. The higher T/C ratio found at 23 hr after cocaine injection suggests that an impairment in the gating mechanism may be produced by an arousal response that is associated with the environment in which the animals had been injected with cocaine.

    Title Reliability of P50 Auditory Event-related Potential Indices of Sensory Gating.
    Date November 1994
    Journal Psychophysiology
    Excerpt

    We examined the reliability of three traditional P50 auditory event-related potential indices under paired-click conditions: (a) the conditioning response (C), (b) the testing response (T), and (c) the testing to conditioning suppression ratio (T/C). Three alternative indices, (a) the (C - T) difference, (b) the (C - T)/(C + T) adjusted difference, and (c) the (T - T') residualized difference, where T' is the regression of T on C, were also studied. The N100 wave was used as a generalizability check. Although C and T amplitudes were reliably measured by traditional means, the T/C suppression ratio was not. For psychometric reasons that are described, the reliability of the suppression ratio is undermined principally by the correlation between C and T. The C - T difference score is a promising alternative to the unreliable T/C suppression ratio. Theoretical consequences of changed metrics are discussed.

    Title Test-retest Reliability of Prepulse Inhibition of the Acoustic Startle Response.
    Date March 1994
    Journal Biological Psychiatry
    Title The Effects of Severe Bruxism on Sleep Architecture: a Preliminary Report.
    Date June 1993
    Journal Clinical Eeg (electroencephalography)
    Excerpt

    Analysis of sleep in 5 severe bruxists revealed consistent sleep abnormalities. These abnormalities consisted of decreased REM latency (90%), decreased percentage of REM sleep (85%), and increased number of sleep stage transitions (75%). This sleep pattern suggests that bruxing can have a deleterious effect on sleep in otherwise healthy individuals. This effect on sleep can in the long run lead to difficulty in daytime functioning similar to the effects of sleep apnea or nocturnal myoclonus. These data also reveal a significant first night effect, hence future attempts at replicating and expanding these findings should take that into consideration. The small number of subjects studied, the lack of a standardized assessment of their daytime functioning, the lack of information regarding the degree of teethware and daytime bruxing activity limit the generalizability of our findings. A controlled study with a larger sample size can help further delineate the nature of such sleep changes as well as their impact on the patient's overall functioning.

    Title The Use of Electromyography and Muscle Palpation in the Diagnosis of Tension-type Headache with and Without Pericranial Muscle Involvement.
    Date July 1992
    Journal Pain
    Excerpt

    The Headache Classification Committee of the International Headache Society recently issued revised diagnostic criteria for headache disorders. According to these criteria, tension-type headache may be subclassified depending upon whether pericranial muscle disorder is found. The presence or absence of pericranial muscle disorder was to be determined by palpating the muscles for tenderness or by measuring electromyographic (EMG) activity. In this study, pericranial muscles were palpated, and EMG activity was measured in 27 episodic tension-type headache patients and 32 headache-free controls. All testing was done while the subjects were in a headache-free state. Muscle tenderness was positively associated with the diagnosis of tension-type headache. Headache subjects exhibited significantly higher levels of temporal EMG activity compared to controls, but EMG data were of little use in assigning individual subjects to diagnostic groups. Measures of muscle tenderness and hyperactivity were only weakly associated. Pericranial muscle tenderness and elevated EMG activity may index different aspects of abnormal muscle function.

    Title Electromyographic and Affective Responses of Episodic Tension-type Headache Patients and Headache-free Controls During Stressful Task Performance.
    Date June 1992
    Journal Journal of Behavioral Medicine
    Excerpt

    Thirty-four subjects meeting diagnostic criteria for episodic tension-type headache and 42 who rarely experienced headaches participated in two laboratory sessions in which cephalic electromyographic (EMG) activity, electrodermal activity, heart rate, and finger temperature were recorded. Subjects performed relaxation, choice reaction time, psychomotor tracking, voluntary muscle contraction, and cold pressor tasks. Headache subjects showed significantly greater EMG activity than controls during baseline and stressful task performance. During relaxation, both groups reduced EMG activity from baseline levels, and there was no significant difference in EMG level between the groups during relaxation. Headache subjects reported higher levels of subjective anxiety, depression, anger, and stress than controls. Headache subjects also reported higher levels of pain than controls, and headache subjects reported greater pain during stressful task performance relative to baseline and recovery periods.

    Title A Naturalistic Study of the Relationships Among Electromyographic Activity, Psychological Stress, and Pain in Ambulatory Tension-type Headache Patients and Headache-free Controls.
    Date February 1992
    Journal Psychosomatic Medicine
    Excerpt

    Twelve subjects who met diagnostic criteria for episodic tension-type headache and nine subjects who rarely or never suffered from headaches wore a computer-controlled electromyographic (EMG) activity recorder in their natural environment for 48 to 96 consecutive hours. EMG activity of the posterior neck or frontal muscles was recorded 24 hr per day. During waking hours, subjects rated their perceived levels of stress, pain, and negative affect at 30-min intervals. The EMG activity of headache and control subjects did not differ significantly, and EMG activity did not covary with stress, pain, or negative affect. Cross-correlations among EMG activity, pain, and stress revealed little evidence of leading, contemporaneous, or lagging relationships. Interrupted time series analysis showed no consistent muscle hyperactivity during a headache attack compared to a headache-free baseline period.

    Title Anger and Hostility in Tension-type Headache.
    Date September 1991
    Journal Headache
    Excerpt

    A battery of standardized psychometric tests was administered to a group of 47 episodic tension-type headache sufferers and 47 headache-free controls. Compared to controls, headache subjects showed higher levels of anxiety, depression, and anger/hostility. The groups did not differ significantly on a measure of anger expressed toward persons or objects, but headache subjects showed significantly greater levels of suppressed anger. The results provide objective data that are in general agreement with predictions derived from psychosomatic theories about the interrelationships among anxiety,

    Title The Effects of Psychological Stress on Electromyographic Activity and Negative Affect in Ambulatory Tension-type Headache Patients.
    Date June 1990
    Journal Headache
    Excerpt

    Fourteen female dental hygiene students (seven with episodic tension-type headache and seven who rarely or never experienced headache) wore an ambulatory electromyographic recorder and completed hourly subjective ratings of pain and negative affective states for six days while they carried out their normal daily activities. Three of the days were designated as high stress days by virtue of the fact that the students were required to take a major course examination or undergo a clinical evaluation on that day. The remaining three days were designated as low stress days by virtue of the fact that no unusual demands were made on the students, and they simply attended lectures as usual. All students showed significantly greater levels of electromyographic activity on the high stress days compared to the low stress days, but there was not a statistically significant difference between the headache and control groups. Headache group subjects reported significantly higher levels of pain compared to the control group, but their pain ratings did not differ between high and low stress days. Subjective ratings of negative affective states (anxiety, anger, sadness, and frustration) were significantly greater on high stress days compared to low stress days. Headache group subjects also exhibited a tendency to report higher levels of negative affective states than did control group subjects, but only in the case of frustration was the .05 level of statistical significance achieved.

    Title Role of the Unquantified Electroencephalography in Psychiatric Research.
    Date
    Journal Cns Spectrums
    Excerpt

    This paper outlines potential research applications of the unquantified (paper or digital) electroencephalography (EEG) in psychiatry. Three main areas are highlighted: first, the need for thorough familiarity with the unquantified EEG is emphasized, including the ability to confidently recognize all normal and abnormal activities that could influence further analysis of the record as well as artifacts that can contaminate the tracings; second, the fact that definitive studies relating EEG abnormalities to psychiatric symptomatology and clinical response are lacking; and third, the potential for EEG to be utilized as a tool to decrease the risk of invasive research studies is discussed.

    Title Schizophrenia, "just the Facts": What We Know in 2008 Part 3: Neurobiology.
    Date
    Journal Schizophrenia Research
    Excerpt

    Investigating the neurobiological basis of schizophrenia is a critical step toward establishing its diagnostic validity, predicting outcome, delineating causative mechanisms and identifying objective targets for treatment research. Over the past two decades, there have been several advances in this field, principally related to developments in neuroimaging, electrophysiological and neuropathological approaches. Several neurobiological alterations in domains of brain structure, physiology and neurochemistry have been documented that may reflect diverse pathophysiological pathways from the "genome to the phenome". While none of the observed abnormalities are likely to qualify as diagnostic markers at this time, many can serve as potential intermediate phenotypes for elucidating etiological factors including susceptibility genes, and as therapeutic targets for novel drug discovery. Despite several challenges including the substantial phenotypic, pathophysiologic and etiological heterogeneity of schizophrenia, technological limitations, and the less than ideal animal models, considerable progress has been made in characterizing the neurobiological substrate of schizophrenia. The accumulating fact-base on the neurobiology of schizophrenia calls for novel integrative model(s) that may generate new, testable predictions.

    Title The Role of Age, Gender, Education, and Intelligence in P50, N100, and P200 Auditory Sensory Gating.
    Date
    Journal Journal of Psychophysiology
    Excerpt

    P50, N100, and P200 auditory sensory gating reflect distinct mechanisms involved in protecting the integrity of higher-order functions. They have been implicated in multiple psychiatric disorders. Recent studies showed the (limited) effects of age and gender on sensory gating in control subjects, suggesting there may be other sources of variance. Two potential sources may be education and intelligence (intellectual capability), variables that frequently differ across studies and across experimental groups. We explored potential effects of age, gender, education, and intelligence (Shipley intelligence scale) on P50, N100, and P200 sensory gating measured with the paired-click paradigm in 60 healthy subjects recruited from the general population. Increased intellectual capability related to stronger N100 and P200 gating and more pronounced N100 and P200 amplitudes. In addition, increased age related to weaker P200 gating and smaller P200 amplitudes. Gender had negligible effects. Intellectual capability or age could contribute to variation in N100 or P200 auditory sensory gating and should be controlled for when studying sensory gating in clinical and control groups.

    Similar doctors nearby

    Dr. Eva Waineo

    Psychiatry
    5 years experience
    Detroit, MI

    Dr. Babu Vadlamudi

    Psychiatry
    37 years experience
    Detroit, MI

    Dr. David Rosenberg

    Psychiatry
    22 years experience
    Detroit, MI

    Dr. Tracy Snell

    Psychiatry
    2 years experience
    Detroit, MI

    Dr. Hyder Makki

    Psychiatry
    21 years experience
    Detroit, MI

    Dr. Susan Stine

    Addiction Psychiatry
    27 years experience
    Detroit, MI
    Search All Similar Doctors