American Neuropsychiatric Association (ANPA): Annual Meeting

DENVER – Depressive symptoms were not associated with decreased hippocampal volume or reduced white matter intensity in a large, population-based study conducted in the elderly.

The study involved 1,161 cognitively normal participants in the population-based Mayo Clinic Study of Aging conducted in Olmsted County, Minn. Subjects averaged 79 years of age, and 49% were women. All underwent rigorous neurologic and cognitive evaluations as part of the study, and all had at least one brain MRI within 120 days of assessment for depression using the Beck Depression Inventory, Dr. Yingying Kumar said the meeting.

Considerable research effort has been devoted to correlating major depression with structural change in the hippocampus. The hippocampus is an attractive investigative focus because it has extensive connections with brain structures related to emotional behavior.

Prior brain MRI studies, however, yielded conflicting results. Most of the studies that have found a reduced hippocampal volume in association with depressive symptoms were relatively small – fewer than 100 subjects – and took place in clinical settings where participation was likely to be skewed toward a population with relatively severe depression, noted Dr. Kumar of the Mayo Clinic, Rochester, Minn.

The median Beck Depression Inventory (BDI) score in the Mayo Clinic study was 4, although individuals scored as high as 33. After adjusting for age, gender, and education, no correlation was found between BDI and total hippocampal volume, right or left hippocampal volume, or white matter intensity. There was, however, a nonsignificant trend for reduced whole brain volume with higher BDI scores (P = 0.06).

Dr. Kumar declared having no financial conflicts.

DENVER – Depressive symptoms were not associated with decreased hippocampal volume or reduced white matter intensity in a large, population-based study conducted in the elderly.

The study involved 1,161 cognitively normal participants in the population-based Mayo Clinic Study of Aging conducted in Olmsted County, Minn. Subjects averaged 79 years of age, and 49% were women. All underwent rigorous neurologic and cognitive evaluations as part of the study, and all had at least one brain MRI within 120 days of assessment for depression using the Beck Depression Inventory, Dr. Yingying Kumar said the meeting.

Considerable research effort has been devoted to correlating major depression with structural change in the hippocampus. The hippocampus is an attractive investigative focus because it has extensive connections with brain structures related to emotional behavior.

Prior brain MRI studies, however, yielded conflicting results. Most of the studies that have found a reduced hippocampal volume in association with depressive symptoms were relatively small – fewer than 100 subjects – and took place in clinical settings where participation was likely to be skewed toward a population with relatively severe depression, noted Dr. Kumar of the Mayo Clinic, Rochester, Minn.

The median Beck Depression Inventory (BDI) score in the Mayo Clinic study was 4, although individuals scored as high as 33. After adjusting for age, gender, and education, no correlation was found between BDI and total hippocampal volume, right or left hippocampal volume, or white matter intensity. There was, however, a nonsignificant trend for reduced whole brain volume with higher BDI scores (P = 0.06).

Dr. Kumar declared having no financial conflicts.

DENVER – Depressive symptoms were not associated with decreased hippocampal volume or reduced white matter intensity in a large, population-based study conducted in the elderly.

The study involved 1,161 cognitively normal participants in the population-based Mayo Clinic Study of Aging conducted in Olmsted County, Minn. Subjects averaged 79 years of age, and 49% were women. All underwent rigorous neurologic and cognitive evaluations as part of the study, and all had at least one brain MRI within 120 days of assessment for depression using the Beck Depression Inventory, Dr. Yingying Kumar said the meeting.

Considerable research effort has been devoted to correlating major depression with structural change in the hippocampus. The hippocampus is an attractive investigative focus because it has extensive connections with brain structures related to emotional behavior.

Prior brain MRI studies, however, yielded conflicting results. Most of the studies that have found a reduced hippocampal volume in association with depressive symptoms were relatively small – fewer than 100 subjects – and took place in clinical settings where participation was likely to be skewed toward a population with relatively severe depression, noted Dr. Kumar of the Mayo Clinic, Rochester, Minn.

The median Beck Depression Inventory (BDI) score in the Mayo Clinic study was 4, although individuals scored as high as 33. After adjusting for age, gender, and education, no correlation was found between BDI and total hippocampal volume, right or left hippocampal volume, or white matter intensity. There was, however, a nonsignificant trend for reduced whole brain volume with higher BDI scores (P = 0.06).

Dr. Kumar declared having no financial conflicts.

DENVER – Depressive symptoms were not associated with decreased hippocampal volume or reduced white matter intensity in a large, population-based study conducted in the elderly.

The study involved 1,161 cognitively normal participants in the population-based Mayo Clinic Study of Aging conducted in Olmsted County, Minn. Subjects averaged 79 years of age, and 49% were women. All underwent rigorous neurologic and cognitive evaluations as part of the study, and all had at least one brain MRI within 120 days of assessment for depression using the Beck Depression Inventory, Dr. Yingying Kumar said the meeting.

Considerable research effort has been devoted to correlating major depression with structural change in the hippocampus. The hippocampus is an attractive investigative focus because it has extensive connections with brain structures related to emotional behavior.

Prior brain MRI studies, however, yielded conflicting results. Most of the studies that have found a reduced hippocampal volume in association with depressive symptoms were relatively small – fewer than 100 subjects – and took place in clinical settings where participation was likely to be skewed toward a population with relatively severe depression, noted Dr. Kumar of the Mayo Clinic, Rochester, Minn.

The median Beck Depression Inventory (BDI) score in the Mayo Clinic study was 4, although individuals scored as high as 33. After adjusting for age, gender, and education, no correlation was found between BDI and total hippocampal volume, right or left hippocampal volume, or white matter intensity. There was, however, a nonsignificant trend for reduced whole brain volume with higher BDI scores (P = 0.06).

Dr. Kumar declared having no financial conflicts.

DENVER – Depressive symptoms were not associated with decreased hippocampal volume or reduced white matter intensity in a large, population-based study conducted in the elderly.

The study involved 1,161 cognitively normal participants in the population-based Mayo Clinic Study of Aging conducted in Olmsted County, Minn. Subjects averaged 79 years of age, and 49% were women. All underwent rigorous neurologic and cognitive evaluations as part of the study, and all had at least one brain MRI within 120 days of assessment for depression using the Beck Depression Inventory, Dr. Yingying Kumar said the meeting.

Considerable research effort has been devoted to correlating major depression with structural change in the hippocampus. The hippocampus is an attractive investigative focus because it has extensive connections with brain structures related to emotional behavior.

Prior brain MRI studies, however, yielded conflicting results. Most of the studies that have found a reduced hippocampal volume in association with depressive symptoms were relatively small – fewer than 100 subjects – and took place in clinical settings where participation was likely to be skewed toward a population with relatively severe depression, noted Dr. Kumar of the Mayo Clinic, Rochester, Minn.

The median Beck Depression Inventory (BDI) score in the Mayo Clinic study was 4, although individuals scored as high as 33. After adjusting for age, gender, and education, no correlation was found between BDI and total hippocampal volume, right or left hippocampal volume, or white matter intensity. There was, however, a nonsignificant trend for reduced whole brain volume with higher BDI scores (P = 0.06).

Dr. Kumar declared having no financial conflicts.

DENVER – Depressive symptoms were not associated with decreased hippocampal volume or reduced white matter intensity in a large, population-based study conducted in the elderly.

The study involved 1,161 cognitively normal participants in the population-based Mayo Clinic Study of Aging conducted in Olmsted County, Minn. Subjects averaged 79 years of age, and 49% were women. All underwent rigorous neurologic and cognitive evaluations as part of the study, and all had at least one brain MRI within 120 days of assessment for depression using the Beck Depression Inventory, Dr. Yingying Kumar said the meeting.

Considerable research effort has been devoted to correlating major depression with structural change in the hippocampus. The hippocampus is an attractive investigative focus because it has extensive connections with brain structures related to emotional behavior.

Prior brain MRI studies, however, yielded conflicting results. Most of the studies that have found a reduced hippocampal volume in association with depressive symptoms were relatively small – fewer than 100 subjects – and took place in clinical settings where participation was likely to be skewed toward a population with relatively severe depression, noted Dr. Kumar of the Mayo Clinic, Rochester, Minn.

The median Beck Depression Inventory (BDI) score in the Mayo Clinic study was 4, although individuals scored as high as 33. After adjusting for age, gender, and education, no correlation was found between BDI and total hippocampal volume, right or left hippocampal volume, or white matter intensity. There was, however, a nonsignificant trend for reduced whole brain volume with higher BDI scores (P = 0.06).

Dr. Kumar declared having no financial conflicts.

DENVER – Depressive symptoms were not associated with decreased hippocampal volume or reduced white matter intensity in a large, population-based study conducted in the elderly.

The study involved 1,161 cognitively normal participants in the population-based Mayo Clinic Study of Aging conducted in Olmsted County, Minn. Subjects averaged 79 years of age, and 49% were women. All underwent rigorous neurologic and cognitive evaluations as part of the study, and all had at least one brain MRI within 120 days of assessment for depression using the Beck Depression Inventory, Dr. Yingying Kumar said the meeting.

Considerable research effort has been devoted to correlating major depression with structural change in the hippocampus. The hippocampus is an attractive investigative focus because it has extensive connections with brain structures related to emotional behavior.

Prior brain MRI studies, however, yielded conflicting results. Most of the studies that have found a reduced hippocampal volume in association with depressive symptoms were relatively small – fewer than 100 subjects – and took place in clinical settings where participation was likely to be skewed toward a population with relatively severe depression, noted Dr. Kumar of the Mayo Clinic, Rochester, Minn.

The median Beck Depression Inventory (BDI) score in the Mayo Clinic study was 4, although individuals scored as high as 33. After adjusting for age, gender, and education, no correlation was found between BDI and total hippocampal volume, right or left hippocampal volume, or white matter intensity. There was, however, a nonsignificant trend for reduced whole brain volume with higher BDI scores (P = 0.06).

Dr. Kumar declared having no financial conflicts.

DENVER – Depressive symptoms were not associated with decreased hippocampal volume or reduced white matter intensity in a large, population-based study conducted in the elderly.

The study involved 1,161 cognitively normal participants in the population-based Mayo Clinic Study of Aging conducted in Olmsted County, Minn. Subjects averaged 79 years of age, and 49% were women. All underwent rigorous neurologic and cognitive evaluations as part of the study, and all had at least one brain MRI within 120 days of assessment for depression using the Beck Depression Inventory, Dr. Yingying Kumar said the meeting.

Considerable research effort has been devoted to correlating major depression with structural change in the hippocampus. The hippocampus is an attractive investigative focus because it has extensive connections with brain structures related to emotional behavior.

Prior brain MRI studies, however, yielded conflicting results. Most of the studies that have found a reduced hippocampal volume in association with depressive symptoms were relatively small – fewer than 100 subjects – and took place in clinical settings where participation was likely to be skewed toward a population with relatively severe depression, noted Dr. Kumar of the Mayo Clinic, Rochester, Minn.

The median Beck Depression Inventory (BDI) score in the Mayo Clinic study was 4, although individuals scored as high as 33. After adjusting for age, gender, and education, no correlation was found between BDI and total hippocampal volume, right or left hippocampal volume, or white matter intensity. There was, however, a nonsignificant trend for reduced whole brain volume with higher BDI scores (P = 0.06).

Dr. Kumar declared having no financial conflicts.

DENVER – Depressive symptoms were not associated with decreased hippocampal volume or reduced white matter intensity in a large, population-based study conducted in the elderly.

The study involved 1,161 cognitively normal participants in the population-based Mayo Clinic Study of Aging conducted in Olmsted County, Minn. Subjects averaged 79 years of age, and 49% were women. All underwent rigorous neurologic and cognitive evaluations as part of the study, and all had at least one brain MRI within 120 days of assessment for depression using the Beck Depression Inventory, Dr. Yingying Kumar said the meeting.

Considerable research effort has been devoted to correlating major depression with structural change in the hippocampus. The hippocampus is an attractive investigative focus because it has extensive connections with brain structures related to emotional behavior.

Prior brain MRI studies, however, yielded conflicting results. Most of the studies that have found a reduced hippocampal volume in association with depressive symptoms were relatively small – fewer than 100 subjects – and took place in clinical settings where participation was likely to be skewed toward a population with relatively severe depression, noted Dr. Kumar of the Mayo Clinic, Rochester, Minn.

The median Beck Depression Inventory (BDI) score in the Mayo Clinic study was 4, although individuals scored as high as 33. After adjusting for age, gender, and education, no correlation was found between BDI and total hippocampal volume, right or left hippocampal volume, or white matter intensity. There was, however, a nonsignificant trend for reduced whole brain volume with higher BDI scores (P = 0.06).

Dr. Kumar declared having no financial conflicts.

DENVER – The common denominator between joint hypermobility and panic disorder might lie in the significantly enlarged amygdalae shown to be present in individuals with lax joints in a recent study.

Joint hypermobility is far more prevalent among patients with panic disorder than in the general population. Joint hypermobility also has been linked to mitral valve prolapse, irritable bowel syndrome, and fibromyalgia. The new finding that enlargement of the amygdalae is seen bilaterally in individuals with lax joints is consistent with the notion that joint hypermobility merely represents one readily observable feature of a broader multisystem phenotype, Dr. Jessica Eccles asserted at the annual meeting of the American Neuropsychiatric Association.

She reported on the findings of brain imaging using MRI with voxel-based morphometry conducted in a selected sample of 72 subjects. Thirty-six of the 72 subjects met criteria for joint hypermobility syndrome based on their Beighton hypermobility score, which awards points for the ability to bend one’s thumb back so it’s touching the forearm, bend the fifth finger back more than 90 degrees, and so forth.

The joint hypermobility group had significantly larger amygdalae, with increased gray matter volumes bilaterally, compared with the nonhypermobility group. And within the hypermobility group, the degree of hypermobility correlated with the volume of the left lateral occipital cortex and correlated negatively with the right superior temporal and bilateral inferior parietal gray matter volumes, according to Dr. Eccles, academic clinical fellow in psychiatry at the Brighton and Sussex Medical School, U.K.

The amygdala is a brain center that figures prominently in emotional reactions. An alteration in this brain structure seen with joint hypermobility fits nicely with the concept that this connective tissue disorder is associated with panic disorder, she added.

Subjects with joint hypermobility also exhibited significantly greater interoceptive awareness – that is, sensitivity to stimuli originating inside the body, such as heart beat – as assessed on the Porges Body Perception Questionnaire. In addition, they scored higher than nonhypermobile subjects on the Beck Anxiety Inventory.

The initial link between joint hypermobility and panic disorder was discovered in a case-control study by Spanish investigators. They found that joint hypermobility syndrome as assessed by blinded raters was present in 68% of outpatients with an anxiety disorder, compared with 10% of psychiatric patient controls and 12.5% of medical patients. Women with an anxiety disorder were more than 20 times as likely to have joint hypermobility syndrome than were nonanxious controls, as were younger patients with an anxiety disorder (Am. J. Psychiatry 1998;155:1,578-83).

This work triggered further published studies, all of which were included in a recent analysis that concluded joint hypermobility is more prevalent in patients with panic disorder or agoraphobia, and that individuals who present with joint hypermobility have an increased prevalence of panic disorder and agoraphobia (Curr. Psychiatry Rep. 2011;13:18-25).

Dr. Eccles declared having no financial conflicts.

DENVER – The common denominator between joint hypermobility and panic disorder might lie in the significantly enlarged amygdalae shown to be present in individuals with lax joints in a recent study.

Joint hypermobility is far more prevalent among patients with panic disorder than in the general population. Joint hypermobility also has been linked to mitral valve prolapse, irritable bowel syndrome, and fibromyalgia. The new finding that enlargement of the amygdalae is seen bilaterally in individuals with lax joints is consistent with the notion that joint hypermobility merely represents one readily observable feature of a broader multisystem phenotype, Dr. Jessica Eccles asserted at the annual meeting of the American Neuropsychiatric Association.

She reported on the findings of brain imaging using MRI with voxel-based morphometry conducted in a selected sample of 72 subjects. Thirty-six of the 72 subjects met criteria for joint hypermobility syndrome based on their Beighton hypermobility score, which awards points for the ability to bend one’s thumb back so it’s touching the forearm, bend the fifth finger back more than 90 degrees, and so forth.

The joint hypermobility group had significantly larger amygdalae, with increased gray matter volumes bilaterally, compared with the nonhypermobility group. And within the hypermobility group, the degree of hypermobility correlated with the volume of the left lateral occipital cortex and correlated negatively with the right superior temporal and bilateral inferior parietal gray matter volumes, according to Dr. Eccles, academic clinical fellow in psychiatry at the Brighton and Sussex Medical School, U.K.

The amygdala is a brain center that figures prominently in emotional reactions. An alteration in this brain structure seen with joint hypermobility fits nicely with the concept that this connective tissue disorder is associated with panic disorder, she added.

Subjects with joint hypermobility also exhibited significantly greater interoceptive awareness – that is, sensitivity to stimuli originating inside the body, such as heart beat – as assessed on the Porges Body Perception Questionnaire. In addition, they scored higher than nonhypermobile subjects on the Beck Anxiety Inventory.

The initial link between joint hypermobility and panic disorder was discovered in a case-control study by Spanish investigators. They found that joint hypermobility syndrome as assessed by blinded raters was present in 68% of outpatients with an anxiety disorder, compared with 10% of psychiatric patient controls and 12.5% of medical patients. Women with an anxiety disorder were more than 20 times as likely to have joint hypermobility syndrome than were nonanxious controls, as were younger patients with an anxiety disorder (Am. J. Psychiatry 1998;155:1,578-83).

This work triggered further published studies, all of which were included in a recent analysis that concluded joint hypermobility is more prevalent in patients with panic disorder or agoraphobia, and that individuals who present with joint hypermobility have an increased prevalence of panic disorder and agoraphobia (Curr. Psychiatry Rep. 2011;13:18-25).

Dr. Eccles declared having no financial conflicts.

DENVER – The common denominator between joint hypermobility and panic disorder might lie in the significantly enlarged amygdalae shown to be present in individuals with lax joints in a recent study.

Joint hypermobility is far more prevalent among patients with panic disorder than in the general population. Joint hypermobility also has been linked to mitral valve prolapse, irritable bowel syndrome, and fibromyalgia. The new finding that enlargement of the amygdalae is seen bilaterally in individuals with lax joints is consistent with the notion that joint hypermobility merely represents one readily observable feature of a broader multisystem phenotype, Dr. Jessica Eccles asserted at the annual meeting of the American Neuropsychiatric Association.

She reported on the findings of brain imaging using MRI with voxel-based morphometry conducted in a selected sample of 72 subjects. Thirty-six of the 72 subjects met criteria for joint hypermobility syndrome based on their Beighton hypermobility score, which awards points for the ability to bend one’s thumb back so it’s touching the forearm, bend the fifth finger back more than 90 degrees, and so forth.

The joint hypermobility group had significantly larger amygdalae, with increased gray matter volumes bilaterally, compared with the nonhypermobility group. And within the hypermobility group, the degree of hypermobility correlated with the volume of the left lateral occipital cortex and correlated negatively with the right superior temporal and bilateral inferior parietal gray matter volumes, according to Dr. Eccles, academic clinical fellow in psychiatry at the Brighton and Sussex Medical School, U.K.

The amygdala is a brain center that figures prominently in emotional reactions. An alteration in this brain structure seen with joint hypermobility fits nicely with the concept that this connective tissue disorder is associated with panic disorder, she added.

Subjects with joint hypermobility also exhibited significantly greater interoceptive awareness – that is, sensitivity to stimuli originating inside the body, such as heart beat – as assessed on the Porges Body Perception Questionnaire. In addition, they scored higher than nonhypermobile subjects on the Beck Anxiety Inventory.

The initial link between joint hypermobility and panic disorder was discovered in a case-control study by Spanish investigators. They found that joint hypermobility syndrome as assessed by blinded raters was present in 68% of outpatients with an anxiety disorder, compared with 10% of psychiatric patient controls and 12.5% of medical patients. Women with an anxiety disorder were more than 20 times as likely to have joint hypermobility syndrome than were nonanxious controls, as were younger patients with an anxiety disorder (Am. J. Psychiatry 1998;155:1,578-83).

This work triggered further published studies, all of which were included in a recent analysis that concluded joint hypermobility is more prevalent in patients with panic disorder or agoraphobia, and that individuals who present with joint hypermobility have an increased prevalence of panic disorder and agoraphobia (Curr. Psychiatry Rep. 2011;13:18-25).

Dr. Eccles declared having no financial conflicts.

DENVER – The common denominator between joint hypermobility and panic disorder might lie in the significantly enlarged amygdalae shown to be present in individuals with lax joints in a recent study.

Joint hypermobility is far more prevalent among patients with panic disorder than in the general population. Joint hypermobility also has been linked to mitral valve prolapse, irritable bowel syndrome, and fibromyalgia. The new finding that enlargement of the amygdalae is seen bilaterally in individuals with lax joints is consistent with the notion that joint hypermobility merely represents one readily observable feature of a broader multisystem phenotype, Dr. Jessica Eccles asserted at the annual meeting of the American Neuropsychiatric Association.

She reported on the findings of brain imaging using MRI with voxel-based morphometry conducted in a selected sample of 72 subjects. Thirty-six of the 72 subjects met criteria for joint hypermobility syndrome based on their Beighton hypermobility score, which awards points for the ability to bend one’s thumb back so it’s touching the forearm, bend the fifth finger back more than 90 degrees, and so forth.

The joint hypermobility group had significantly larger amygdalae, with increased gray matter volumes bilaterally, compared with the nonhypermobility group. And within the hypermobility group, the degree of hypermobility correlated with the volume of the left lateral occipital cortex and correlated negatively with the right superior temporal and bilateral inferior parietal gray matter volumes, according to Dr. Eccles, academic clinical fellow in psychiatry at the Brighton and Sussex Medical School, U.K.

The amygdala is a brain center that figures prominently in emotional reactions. An alteration in this brain structure seen with joint hypermobility fits nicely with the concept that this connective tissue disorder is associated with panic disorder, she added.

Subjects with joint hypermobility also exhibited significantly greater interoceptive awareness – that is, sensitivity to stimuli originating inside the body, such as heart beat – as assessed on the Porges Body Perception Questionnaire. In addition, they scored higher than nonhypermobile subjects on the Beck Anxiety Inventory.

The initial link between joint hypermobility and panic disorder was discovered in a case-control study by Spanish investigators. They found that joint hypermobility syndrome as assessed by blinded raters was present in 68% of outpatients with an anxiety disorder, compared with 10% of psychiatric patient controls and 12.5% of medical patients. Women with an anxiety disorder were more than 20 times as likely to have joint hypermobility syndrome than were nonanxious controls, as were younger patients with an anxiety disorder (Am. J. Psychiatry 1998;155:1,578-83).

This work triggered further published studies, all of which were included in a recent analysis that concluded joint hypermobility is more prevalent in patients with panic disorder or agoraphobia, and that individuals who present with joint hypermobility have an increased prevalence of panic disorder and agoraphobia (Curr. Psychiatry Rep. 2011;13:18-25).

Dr. Eccles declared having no financial conflicts.

DENVER – The common denominator between joint hypermobility and panic disorder might lie in the significantly enlarged amygdalae shown to be present in individuals with lax joints in a recent study.

Joint hypermobility is far more prevalent among patients with panic disorder than in the general population. Joint hypermobility also has been linked to mitral valve prolapse, irritable bowel syndrome, and fibromyalgia. The new finding that enlargement of the amygdalae is seen bilaterally in individuals with lax joints is consistent with the notion that joint hypermobility merely represents one readily observable feature of a broader multisystem phenotype, Dr. Jessica Eccles asserted at the annual meeting of the American Neuropsychiatric Association.

She reported on the findings of brain imaging using MRI with voxel-based morphometry conducted in a selected sample of 72 subjects. Thirty-six of the 72 subjects met criteria for joint hypermobility syndrome based on their Beighton hypermobility score, which awards points for the ability to bend one’s thumb back so it’s touching the forearm, bend the fifth finger back more than 90 degrees, and so forth.

The joint hypermobility group had significantly larger amygdalae, with increased gray matter volumes bilaterally, compared with the nonhypermobility group. And within the hypermobility group, the degree of hypermobility correlated with the volume of the left lateral occipital cortex and correlated negatively with the right superior temporal and bilateral inferior parietal gray matter volumes, according to Dr. Eccles, academic clinical fellow in psychiatry at the Brighton and Sussex Medical School, U.K.

The amygdala is a brain center that figures prominently in emotional reactions. An alteration in this brain structure seen with joint hypermobility fits nicely with the concept that this connective tissue disorder is associated with panic disorder, she added.

Subjects with joint hypermobility also exhibited significantly greater interoceptive awareness – that is, sensitivity to stimuli originating inside the body, such as heart beat – as assessed on the Porges Body Perception Questionnaire. In addition, they scored higher than nonhypermobile subjects on the Beck Anxiety Inventory.

The initial link between joint hypermobility and panic disorder was discovered in a case-control study by Spanish investigators. They found that joint hypermobility syndrome as assessed by blinded raters was present in 68% of outpatients with an anxiety disorder, compared with 10% of psychiatric patient controls and 12.5% of medical patients. Women with an anxiety disorder were more than 20 times as likely to have joint hypermobility syndrome than were nonanxious controls, as were younger patients with an anxiety disorder (Am. J. Psychiatry 1998;155:1,578-83).

This work triggered further published studies, all of which were included in a recent analysis that concluded joint hypermobility is more prevalent in patients with panic disorder or agoraphobia, and that individuals who present with joint hypermobility have an increased prevalence of panic disorder and agoraphobia (Curr. Psychiatry Rep. 2011;13:18-25).

Dr. Eccles declared having no financial conflicts.

DENVER – The common denominator between joint hypermobility and panic disorder might lie in the significantly enlarged amygdalae shown to be present in individuals with lax joints in a recent study.

Joint hypermobility is far more prevalent among patients with panic disorder than in the general population. Joint hypermobility also has been linked to mitral valve prolapse, irritable bowel syndrome, and fibromyalgia. The new finding that enlargement of the amygdalae is seen bilaterally in individuals with lax joints is consistent with the notion that joint hypermobility merely represents one readily observable feature of a broader multisystem phenotype, Dr. Jessica Eccles asserted at the annual meeting of the American Neuropsychiatric Association.

She reported on the findings of brain imaging using MRI with voxel-based morphometry conducted in a selected sample of 72 subjects. Thirty-six of the 72 subjects met criteria for joint hypermobility syndrome based on their Beighton hypermobility score, which awards points for the ability to bend one’s thumb back so it’s touching the forearm, bend the fifth finger back more than 90 degrees, and so forth.

The joint hypermobility group had significantly larger amygdalae, with increased gray matter volumes bilaterally, compared with the nonhypermobility group. And within the hypermobility group, the degree of hypermobility correlated with the volume of the left lateral occipital cortex and correlated negatively with the right superior temporal and bilateral inferior parietal gray matter volumes, according to Dr. Eccles, academic clinical fellow in psychiatry at the Brighton and Sussex Medical School, U.K.

The amygdala is a brain center that figures prominently in emotional reactions. An alteration in this brain structure seen with joint hypermobility fits nicely with the concept that this connective tissue disorder is associated with panic disorder, she added.

Subjects with joint hypermobility also exhibited significantly greater interoceptive awareness – that is, sensitivity to stimuli originating inside the body, such as heart beat – as assessed on the Porges Body Perception Questionnaire. In addition, they scored higher than nonhypermobile subjects on the Beck Anxiety Inventory.

The initial link between joint hypermobility and panic disorder was discovered in a case-control study by Spanish investigators. They found that joint hypermobility syndrome as assessed by blinded raters was present in 68% of outpatients with an anxiety disorder, compared with 10% of psychiatric patient controls and 12.5% of medical patients. Women with an anxiety disorder were more than 20 times as likely to have joint hypermobility syndrome than were nonanxious controls, as were younger patients with an anxiety disorder (Am. J. Psychiatry 1998;155:1,578-83).

This work triggered further published studies, all of which were included in a recent analysis that concluded joint hypermobility is more prevalent in patients with panic disorder or agoraphobia, and that individuals who present with joint hypermobility have an increased prevalence of panic disorder and agoraphobia (Curr. Psychiatry Rep. 2011;13:18-25).

Dr. Eccles declared having no financial conflicts.

DENVER – Acupressure shows promise as an adjuvant therapy for cognitive impairment due to traumatic brain injury, a study has shown.

Patients with traumatic brain injury (TBI) showed significant improvements on the Stroop task and Digit Span Test following Jin Shin acupressure sessions in a randomized, single-blind, sham-acupressure-controlled clinical trial, Kristina L. McFadden reported at the annual meeting of the American Neuropsychiatric Association.

These improvements are suggestive of enhanced working memory function, added Ms. McFadden, a doctoral student in the behavioral neuroscience program at the University of Colorado, Boulder. She and her coauthors also reported their results in the Journal of Neurotrauma (2011;28:21-34).

Acupressure has previously been reported to be effective for depression, back pain, and nausea. The Jin Shin style of acupressure is based on traditional Chinese acupuncture theory. It’s safe and can easily be taught to novices, making it well suited for patient self-care, according to Ms. McFadden.

She reported on 38 TBI patients in their early 20s who were randomized to eight 40-minute sessions of acupressure or sham therapy using placebo acupoints, with all sessions being provided by the same highly experienced acupressurist. The sessions were carried out over a 2-week period. The two patient groups were similar in terms of key baseline characteristics, including their number of head injuries, number of TBI-sensitive symptoms, and time since TBI, which was about 2 years in both groups.

The study hypothesis was that acupressure would result in improved scores on cognitive tests as a result of an enhanced relaxation response with resultant stress reduction. The impairments in memory and attention that are common sequelae of TBI are often exacerbated by stress, she noted.

The active treatment group demonstrated significantly decreased P300 amplitude and latency on the Stroop task and significant improvement on the Digit Span Test; the control group did not. The acupressure group also showed a greater reduction in scores on the Perceived Stress Scale than did controls.

The mechanism of benefit for acupressure is unclear. One theory is that the treatment effect results from an increase in parasympathetic nervous system activity accompanied by dampening of sympathetic nervous system activity. Consistent with this notion, Ms. McFadden and her coworkers have previously shown in a randomized trial that Jin Shin acupressure modulates autonomic nervous system activity in stroke survivors (Complement. Ther. Med. 2010;18:42-8).

The current study was supported by the Colorado Traumatic Brain Injury Trust Fund. Ms. McFadden said she had no relevant financial disclosures.

DENVER – Acupressure shows promise as an adjuvant therapy for cognitive impairment due to traumatic brain injury, a study has shown.

Patients with traumatic brain injury (TBI) showed significant improvements on the Stroop task and Digit Span Test following Jin Shin acupressure sessions in a randomized, single-blind, sham-acupressure-controlled clinical trial, Kristina L. McFadden reported at the annual meeting of the American Neuropsychiatric Association.

These improvements are suggestive of enhanced working memory function, added Ms. McFadden, a doctoral student in the behavioral neuroscience program at the University of Colorado, Boulder. She and her coauthors also reported their results in the Journal of Neurotrauma (2011;28:21-34).

Acupressure has previously been reported to be effective for depression, back pain, and nausea. The Jin Shin style of acupressure is based on traditional Chinese acupuncture theory. It’s safe and can easily be taught to novices, making it well suited for patient self-care, according to Ms. McFadden.

She reported on 38 TBI patients in their early 20s who were randomized to eight 40-minute sessions of acupressure or sham therapy using placebo acupoints, with all sessions being provided by the same highly experienced acupressurist. The sessions were carried out over a 2-week period. The two patient groups were similar in terms of key baseline characteristics, including their number of head injuries, number of TBI-sensitive symptoms, and time since TBI, which was about 2 years in both groups.

The study hypothesis was that acupressure would result in improved scores on cognitive tests as a result of an enhanced relaxation response with resultant stress reduction. The impairments in memory and attention that are common sequelae of TBI are often exacerbated by stress, she noted.

The active treatment group demonstrated significantly decreased P300 amplitude and latency on the Stroop task and significant improvement on the Digit Span Test; the control group did not. The acupressure group also showed a greater reduction in scores on the Perceived Stress Scale than did controls.

The mechanism of benefit for acupressure is unclear. One theory is that the treatment effect results from an increase in parasympathetic nervous system activity accompanied by dampening of sympathetic nervous system activity. Consistent with this notion, Ms. McFadden and her coworkers have previously shown in a randomized trial that Jin Shin acupressure modulates autonomic nervous system activity in stroke survivors (Complement. Ther. Med. 2010;18:42-8).

The current study was supported by the Colorado Traumatic Brain Injury Trust Fund. Ms. McFadden said she had no relevant financial disclosures.

DENVER – Acupressure shows promise as an adjuvant therapy for cognitive impairment due to traumatic brain injury, a study has shown.

Patients with traumatic brain injury (TBI) showed significant improvements on the Stroop task and Digit Span Test following Jin Shin acupressure sessions in a randomized, single-blind, sham-acupressure-controlled clinical trial, Kristina L. McFadden reported at the annual meeting of the American Neuropsychiatric Association.

These improvements are suggestive of enhanced working memory function, added Ms. McFadden, a doctoral student in the behavioral neuroscience program at the University of Colorado, Boulder. She and her coauthors also reported their results in the Journal of Neurotrauma (2011;28:21-34).

Acupressure has previously been reported to be effective for depression, back pain, and nausea. The Jin Shin style of acupressure is based on traditional Chinese acupuncture theory. It’s safe and can easily be taught to novices, making it well suited for patient self-care, according to Ms. McFadden.

She reported on 38 TBI patients in their early 20s who were randomized to eight 40-minute sessions of acupressure or sham therapy using placebo acupoints, with all sessions being provided by the same highly experienced acupressurist. The sessions were carried out over a 2-week period. The two patient groups were similar in terms of key baseline characteristics, including their number of head injuries, number of TBI-sensitive symptoms, and time since TBI, which was about 2 years in both groups.

The study hypothesis was that acupressure would result in improved scores on cognitive tests as a result of an enhanced relaxation response with resultant stress reduction. The impairments in memory and attention that are common sequelae of TBI are often exacerbated by stress, she noted.

The active treatment group demonstrated significantly decreased P300 amplitude and latency on the Stroop task and significant improvement on the Digit Span Test; the control group did not. The acupressure group also showed a greater reduction in scores on the Perceived Stress Scale than did controls.

The mechanism of benefit for acupressure is unclear. One theory is that the treatment effect results from an increase in parasympathetic nervous system activity accompanied by dampening of sympathetic nervous system activity. Consistent with this notion, Ms. McFadden and her coworkers have previously shown in a randomized trial that Jin Shin acupressure modulates autonomic nervous system activity in stroke survivors (Complement. Ther. Med. 2010;18:42-8).

The current study was supported by the Colorado Traumatic Brain Injury Trust Fund. Ms. McFadden said she had no relevant financial disclosures.

DENVER – Acupressure shows promise as an adjuvant therapy for cognitive impairment due to traumatic brain injury, a study has shown.

Patients with traumatic brain injury (TBI) showed significant improvements on the Stroop task and Digit Span Test following Jin Shin acupressure sessions in a randomized, single-blind, sham-acupressure-controlled clinical trial, Kristina L. McFadden reported at the annual meeting of the American Neuropsychiatric Association.

These improvements are suggestive of enhanced working memory function, added Ms. McFadden, a doctoral student in the behavioral neuroscience program at the University of Colorado, Boulder. She and her coauthors also reported their results in the Journal of Neurotrauma (2011;28:21-34).

Acupressure has previously been reported to be effective for depression, back pain, and nausea. The Jin Shin style of acupressure is based on traditional Chinese acupuncture theory. It’s safe and can easily be taught to novices, making it well suited for patient self-care, according to Ms. McFadden.

She reported on 38 TBI patients in their early 20s who were randomized to eight 40-minute sessions of acupressure or sham therapy using placebo acupoints, with all sessions being provided by the same highly experienced acupressurist. The sessions were carried out over a 2-week period. The two patient groups were similar in terms of key baseline characteristics, including their number of head injuries, number of TBI-sensitive symptoms, and time since TBI, which was about 2 years in both groups.

The study hypothesis was that acupressure would result in improved scores on cognitive tests as a result of an enhanced relaxation response with resultant stress reduction. The impairments in memory and attention that are common sequelae of TBI are often exacerbated by stress, she noted.

The active treatment group demonstrated significantly decreased P300 amplitude and latency on the Stroop task and significant improvement on the Digit Span Test; the control group did not. The acupressure group also showed a greater reduction in scores on the Perceived Stress Scale than did controls.

The mechanism of benefit for acupressure is unclear. One theory is that the treatment effect results from an increase in parasympathetic nervous system activity accompanied by dampening of sympathetic nervous system activity. Consistent with this notion, Ms. McFadden and her coworkers have previously shown in a randomized trial that Jin Shin acupressure modulates autonomic nervous system activity in stroke survivors (Complement. Ther. Med. 2010;18:42-8).

The current study was supported by the Colorado Traumatic Brain Injury Trust Fund. Ms. McFadden said she had no relevant financial disclosures.

DENVER – Acupressure shows promise as an adjuvant therapy for cognitive impairment due to traumatic brain injury, a study has shown.

Patients with traumatic brain injury (TBI) showed significant improvements on the Stroop task and Digit Span Test following Jin Shin acupressure sessions in a randomized, single-blind, sham-acupressure-controlled clinical trial, Kristina L. McFadden reported at the annual meeting of the American Neuropsychiatric Association.

These improvements are suggestive of enhanced working memory function, added Ms. McFadden, a doctoral student in the behavioral neuroscience program at the University of Colorado, Boulder. She and her coauthors also reported their results in the Journal of Neurotrauma (2011;28:21-34).

Acupressure has previously been reported to be effective for depression, back pain, and nausea. The Jin Shin style of acupressure is based on traditional Chinese acupuncture theory. It’s safe and can easily be taught to novices, making it well suited for patient self-care, according to Ms. McFadden.

She reported on 38 TBI patients in their early 20s who were randomized to eight 40-minute sessions of acupressure or sham therapy using placebo acupoints, with all sessions being provided by the same highly experienced acupressurist. The sessions were carried out over a 2-week period. The two patient groups were similar in terms of key baseline characteristics, including their number of head injuries, number of TBI-sensitive symptoms, and time since TBI, which was about 2 years in both groups.

The study hypothesis was that acupressure would result in improved scores on cognitive tests as a result of an enhanced relaxation response with resultant stress reduction. The impairments in memory and attention that are common sequelae of TBI are often exacerbated by stress, she noted.

The active treatment group demonstrated significantly decreased P300 amplitude and latency on the Stroop task and significant improvement on the Digit Span Test; the control group did not. The acupressure group also showed a greater reduction in scores on the Perceived Stress Scale than did controls.

The mechanism of benefit for acupressure is unclear. One theory is that the treatment effect results from an increase in parasympathetic nervous system activity accompanied by dampening of sympathetic nervous system activity. Consistent with this notion, Ms. McFadden and her coworkers have previously shown in a randomized trial that Jin Shin acupressure modulates autonomic nervous system activity in stroke survivors (Complement. Ther. Med. 2010;18:42-8).

The current study was supported by the Colorado Traumatic Brain Injury Trust Fund. Ms. McFadden said she had no relevant financial disclosures.

DENVER – Acupressure shows promise as an adjuvant therapy for cognitive impairment due to traumatic brain injury, a study has shown.

Patients with traumatic brain injury (TBI) showed significant improvements on the Stroop task and Digit Span Test following Jin Shin acupressure sessions in a randomized, single-blind, sham-acupressure-controlled clinical trial, Kristina L. McFadden reported at the annual meeting of the American Neuropsychiatric Association.

These improvements are suggestive of enhanced working memory function, added Ms. McFadden, a doctoral student in the behavioral neuroscience program at the University of Colorado, Boulder. She and her coauthors also reported their results in the Journal of Neurotrauma (2011;28:21-34).

Acupressure has previously been reported to be effective for depression, back pain, and nausea. The Jin Shin style of acupressure is based on traditional Chinese acupuncture theory. It’s safe and can easily be taught to novices, making it well suited for patient self-care, according to Ms. McFadden.

She reported on 38 TBI patients in their early 20s who were randomized to eight 40-minute sessions of acupressure or sham therapy using placebo acupoints, with all sessions being provided by the same highly experienced acupressurist. The sessions were carried out over a 2-week period. The two patient groups were similar in terms of key baseline characteristics, including their number of head injuries, number of TBI-sensitive symptoms, and time since TBI, which was about 2 years in both groups.

The study hypothesis was that acupressure would result in improved scores on cognitive tests as a result of an enhanced relaxation response with resultant stress reduction. The impairments in memory and attention that are common sequelae of TBI are often exacerbated by stress, she noted.

The active treatment group demonstrated significantly decreased P300 amplitude and latency on the Stroop task and significant improvement on the Digit Span Test; the control group did not. The acupressure group also showed a greater reduction in scores on the Perceived Stress Scale than did controls.

The mechanism of benefit for acupressure is unclear. One theory is that the treatment effect results from an increase in parasympathetic nervous system activity accompanied by dampening of sympathetic nervous system activity. Consistent with this notion, Ms. McFadden and her coworkers have previously shown in a randomized trial that Jin Shin acupressure modulates autonomic nervous system activity in stroke survivors (Complement. Ther. Med. 2010;18:42-8).

The current study was supported by the Colorado Traumatic Brain Injury Trust Fund. Ms. McFadden said she had no relevant financial disclosures.

DENVER – Acupressure shows promise as an adjuvant therapy for cognitive impairment due to traumatic brain injury, a study has shown.

Patients with traumatic brain injury (TBI) showed significant improvements on the Stroop task and Digit Span Test following Jin Shin acupressure sessions in a randomized, single-blind, sham-acupressure-controlled clinical trial, Kristina L. McFadden reported at the annual meeting of the American Neuropsychiatric Association.

These improvements are suggestive of enhanced working memory function, added Ms. McFadden, a doctoral student in the behavioral neuroscience program at the University of Colorado, Boulder. She and her coauthors also reported their results in the Journal of Neurotrauma (2011;28:21-34).

Acupressure has previously been reported to be effective for depression, back pain, and nausea. The Jin Shin style of acupressure is based on traditional Chinese acupuncture theory. It’s safe and can easily be taught to novices, making it well suited for patient self-care, according to Ms. McFadden.

She reported on 38 TBI patients in their early 20s who were randomized to eight 40-minute sessions of acupressure or sham therapy using placebo acupoints, with all sessions being provided by the same highly experienced acupressurist. The sessions were carried out over a 2-week period. The two patient groups were similar in terms of key baseline characteristics, including their number of head injuries, number of TBI-sensitive symptoms, and time since TBI, which was about 2 years in both groups.

The study hypothesis was that acupressure would result in improved scores on cognitive tests as a result of an enhanced relaxation response with resultant stress reduction. The impairments in memory and attention that are common sequelae of TBI are often exacerbated by stress, she noted.

The active treatment group demonstrated significantly decreased P300 amplitude and latency on the Stroop task and significant improvement on the Digit Span Test; the control group did not. The acupressure group also showed a greater reduction in scores on the Perceived Stress Scale than did controls.

The mechanism of benefit for acupressure is unclear. One theory is that the treatment effect results from an increase in parasympathetic nervous system activity accompanied by dampening of sympathetic nervous system activity. Consistent with this notion, Ms. McFadden and her coworkers have previously shown in a randomized trial that Jin Shin acupressure modulates autonomic nervous system activity in stroke survivors (Complement. Ther. Med. 2010;18:42-8).

The current study was supported by the Colorado Traumatic Brain Injury Trust Fund. Ms. McFadden said she had no relevant financial disclosures.

DENVER – Acupressure shows promise as an adjuvant therapy for cognitive impairment due to traumatic brain injury, a study has shown.

Patients with traumatic brain injury (TBI) showed significant improvements on the Stroop task and Digit Span Test following Jin Shin acupressure sessions in a randomized, single-blind, sham-acupressure-controlled clinical trial, Kristina L. McFadden reported at the annual meeting of the American Neuropsychiatric Association.

These improvements are suggestive of enhanced working memory function, added Ms. McFadden, a doctoral student in the behavioral neuroscience program at the University of Colorado, Boulder. She and her coauthors also reported their results in the Journal of Neurotrauma (2011;28:21-34).

Acupressure has previously been reported to be effective for depression, back pain, and nausea. The Jin Shin style of acupressure is based on traditional Chinese acupuncture theory. It’s safe and can easily be taught to novices, making it well suited for patient self-care, according to Ms. McFadden.

She reported on 38 TBI patients in their early 20s who were randomized to eight 40-minute sessions of acupressure or sham therapy using placebo acupoints, with all sessions being provided by the same highly experienced acupressurist. The sessions were carried out over a 2-week period. The two patient groups were similar in terms of key baseline characteristics, including their number of head injuries, number of TBI-sensitive symptoms, and time since TBI, which was about 2 years in both groups.

The study hypothesis was that acupressure would result in improved scores on cognitive tests as a result of an enhanced relaxation response with resultant stress reduction. The impairments in memory and attention that are common sequelae of TBI are often exacerbated by stress, she noted.

The active treatment group demonstrated significantly decreased P300 amplitude and latency on the Stroop task and significant improvement on the Digit Span Test; the control group did not. The acupressure group also showed a greater reduction in scores on the Perceived Stress Scale than did controls.

The mechanism of benefit for acupressure is unclear. One theory is that the treatment effect results from an increase in parasympathetic nervous system activity accompanied by dampening of sympathetic nervous system activity. Consistent with this notion, Ms. McFadden and her coworkers have previously shown in a randomized trial that Jin Shin acupressure modulates autonomic nervous system activity in stroke survivors (Complement. Ther. Med. 2010;18:42-8).

The current study was supported by the Colorado Traumatic Brain Injury Trust Fund. Ms. McFadden said she had no relevant financial disclosures.

DENVER – Acupressure shows promise as an adjuvant therapy for cognitive impairment due to traumatic brain injury, a study has shown.

Patients with traumatic brain injury (TBI) showed significant improvements on the Stroop task and Digit Span Test following Jin Shin acupressure sessions in a randomized, single-blind, sham-acupressure-controlled clinical trial, Kristina L. McFadden reported at the annual meeting of the American Neuropsychiatric Association.

These improvements are suggestive of enhanced working memory function, added Ms. McFadden, a doctoral student in the behavioral neuroscience program at the University of Colorado, Boulder. She and her coauthors also reported their results in the Journal of Neurotrauma (2011;28:21-34).

Acupressure has previously been reported to be effective for depression, back pain, and nausea. The Jin Shin style of acupressure is based on traditional Chinese acupuncture theory. It’s safe and can easily be taught to novices, making it well suited for patient self-care, according to Ms. McFadden.

She reported on 38 TBI patients in their early 20s who were randomized to eight 40-minute sessions of acupressure or sham therapy using placebo acupoints, with all sessions being provided by the same highly experienced acupressurist. The sessions were carried out over a 2-week period. The two patient groups were similar in terms of key baseline characteristics, including their number of head injuries, number of TBI-sensitive symptoms, and time since TBI, which was about 2 years in both groups.

The study hypothesis was that acupressure would result in improved scores on cognitive tests as a result of an enhanced relaxation response with resultant stress reduction. The impairments in memory and attention that are common sequelae of TBI are often exacerbated by stress, she noted.

The active treatment group demonstrated significantly decreased P300 amplitude and latency on the Stroop task and significant improvement on the Digit Span Test; the control group did not. The acupressure group also showed a greater reduction in scores on the Perceived Stress Scale than did controls.

The mechanism of benefit for acupressure is unclear. One theory is that the treatment effect results from an increase in parasympathetic nervous system activity accompanied by dampening of sympathetic nervous system activity. Consistent with this notion, Ms. McFadden and her coworkers have previously shown in a randomized trial that Jin Shin acupressure modulates autonomic nervous system activity in stroke survivors (Complement. Ther. Med. 2010;18:42-8).

The current study was supported by the Colorado Traumatic Brain Injury Trust Fund. Ms. McFadden said she had no relevant financial disclosures.

DENVER – A simple illusion created using a mirror provides a low-cost, low-risk therapy for phantom limb pain in the intensive care unit, a study has shown.

Investigators at Walter Reed Army Medical Center have reported that mirror therapy for phantom limb pain was strikingly effective in a randomized, sham-controlled trial when used on an outpatient basis in rehabilitation therapy for individuals capable of sitting upright in a chair (N. Engl. J. Med. 2007;357:2206-7). But it can work in a bed-bound ICU patient as well, Dr. Nicholas H. Carter reported at the annual meeting of the American Neuropsychiatric Association.

He presented a case report involving a 24-year-old woman with systemic lupus erythematosus who developed severe, drug-refractory phantom limb and stump pain following a series of surgeries that culminated in an above-the-knee amputation of her left leg. Her hospitalization was prolonged because of numerous complications, including pneumonia, bilateral pneumothoraxes, sepsis, and pericardial effusion with tamponade. She had stump pain that improved only modestly, from 10 on a 10-point scale to 8, in response to hydromorphone. The patient also had two to three episodes of excruciating phantom limb pain per day, each lasting 10-15 minutes; numerous medications failed to provide any relief.

With the patient in a semi–Fowler’s position in her ICU bed and her stump and pelvis draped with sheets, a 2-by-3-foot mirror was positioned between her legs in the parasagittal plane so she could see the reflection of her exposed bare right leg.

Immediately prior to the initial session of mirror therapy the patient rated her stump pain as a 9, and 10 minutes earlier she had experienced what she described as a shock of phantom limb pain. After viewing the mirror for just 3 minutes, the patient reported that her stump pain had decreased to 4, with no further phantom limb sensations, according to Dr. Carter of Brown University, Providence, R.I.

The mirror was brought out again every time the patient felt the onset of phantom limb pain. She reported that 3-5 minutes of viewing the mirror typically decreased the phantom limb pain intensity from 7 to 3. Instead of lasting 10-15 minutes, as previously, the episodes now lasted about 5 minutes and decreased in number from two to three per day to one truncated episode per day or none. This was accompanied by complete resolution of the intense phantom itch.

Interestingly, the patient’s stump pain responded only to her first viewing of the mirror, Dr. Carter said. Subsequent sessions or mirror therapy had no substantial benefit for the stump pain.

This case sheds little new light on the mechanism of benefit for mirror therapy, a topic of considerable debate in the medical literature, he noted.

Some researchers have theorized that limb amputation may cause central neurologic remapping and deranged cortical output, which gets interpreted as pain. The theory that proprioceptive memory of the amputated limb accounts for phantom limb pain enjoys wide popularity.

Regardless, it’s axiomatic that when multiple senses provide conflicting input to the brain, vision trumps. Mirror therapy might activate mirror neurons in the brain hemisphere contralateral to the amputated limb and provide visual feedback against painful proprioceptive stimuli, Dr. Carter suggested.

He said he had no relevant financial disclosures.

DENVER – A simple illusion created using a mirror provides a low-cost, low-risk therapy for phantom limb pain in the intensive care unit, a study has shown.

Investigators at Walter Reed Army Medical Center have reported that mirror therapy for phantom limb pain was strikingly effective in a randomized, sham-controlled trial when used on an outpatient basis in rehabilitation therapy for individuals capable of sitting upright in a chair (N. Engl. J. Med. 2007;357:2206-7). But it can work in a bed-bound ICU patient as well, Dr. Nicholas H. Carter reported at the annual meeting of the American Neuropsychiatric Association.

He presented a case report involving a 24-year-old woman with systemic lupus erythematosus who developed severe, drug-refractory phantom limb and stump pain following a series of surgeries that culminated in an above-the-knee amputation of her left leg. Her hospitalization was prolonged because of numerous complications, including pneumonia, bilateral pneumothoraxes, sepsis, and pericardial effusion with tamponade. She had stump pain that improved only modestly, from 10 on a 10-point scale to 8, in response to hydromorphone. The patient also had two to three episodes of excruciating phantom limb pain per day, each lasting 10-15 minutes; numerous medications failed to provide any relief.

With the patient in a semi–Fowler’s position in her ICU bed and her stump and pelvis draped with sheets, a 2-by-3-foot mirror was positioned between her legs in the parasagittal plane so she could see the reflection of her exposed bare right leg.

Immediately prior to the initial session of mirror therapy the patient rated her stump pain as a 9, and 10 minutes earlier she had experienced what she described as a shock of phantom limb pain. After viewing the mirror for just 3 minutes, the patient reported that her stump pain had decreased to 4, with no further phantom limb sensations, according to Dr. Carter of Brown University, Providence, R.I.

The mirror was brought out again every time the patient felt the onset of phantom limb pain. She reported that 3-5 minutes of viewing the mirror typically decreased the phantom limb pain intensity from 7 to 3. Instead of lasting 10-15 minutes, as previously, the episodes now lasted about 5 minutes and decreased in number from two to three per day to one truncated episode per day or none. This was accompanied by complete resolution of the intense phantom itch.

Interestingly, the patient’s stump pain responded only to her first viewing of the mirror, Dr. Carter said. Subsequent sessions or mirror therapy had no substantial benefit for the stump pain.

This case sheds little new light on the mechanism of benefit for mirror therapy, a topic of considerable debate in the medical literature, he noted.

Some researchers have theorized that limb amputation may cause central neurologic remapping and deranged cortical output, which gets interpreted as pain. The theory that proprioceptive memory of the amputated limb accounts for phantom limb pain enjoys wide popularity.

Regardless, it’s axiomatic that when multiple senses provide conflicting input to the brain, vision trumps. Mirror therapy might activate mirror neurons in the brain hemisphere contralateral to the amputated limb and provide visual feedback against painful proprioceptive stimuli, Dr. Carter suggested.

He said he had no relevant financial disclosures.

DENVER – A simple illusion created using a mirror provides a low-cost, low-risk therapy for phantom limb pain in the intensive care unit, a study has shown.

Investigators at Walter Reed Army Medical Center have reported that mirror therapy for phantom limb pain was strikingly effective in a randomized, sham-controlled trial when used on an outpatient basis in rehabilitation therapy for individuals capable of sitting upright in a chair (N. Engl. J. Med. 2007;357:2206-7). But it can work in a bed-bound ICU patient as well, Dr. Nicholas H. Carter reported at the annual meeting of the American Neuropsychiatric Association.

He presented a case report involving a 24-year-old woman with systemic lupus erythematosus who developed severe, drug-refractory phantom limb and stump pain following a series of surgeries that culminated in an above-the-knee amputation of her left leg. Her hospitalization was prolonged because of numerous complications, including pneumonia, bilateral pneumothoraxes, sepsis, and pericardial effusion with tamponade. She had stump pain that improved only modestly, from 10 on a 10-point scale to 8, in response to hydromorphone. The patient also had two to three episodes of excruciating phantom limb pain per day, each lasting 10-15 minutes; numerous medications failed to provide any relief.

With the patient in a semi–Fowler’s position in her ICU bed and her stump and pelvis draped with sheets, a 2-by-3-foot mirror was positioned between her legs in the parasagittal plane so she could see the reflection of her exposed bare right leg.

Immediately prior to the initial session of mirror therapy the patient rated her stump pain as a 9, and 10 minutes earlier she had experienced what she described as a shock of phantom limb pain. After viewing the mirror for just 3 minutes, the patient reported that her stump pain had decreased to 4, with no further phantom limb sensations, according to Dr. Carter of Brown University, Providence, R.I.

The mirror was brought out again every time the patient felt the onset of phantom limb pain. She reported that 3-5 minutes of viewing the mirror typically decreased the phantom limb pain intensity from 7 to 3. Instead of lasting 10-15 minutes, as previously, the episodes now lasted about 5 minutes and decreased in number from two to three per day to one truncated episode per day or none. This was accompanied by complete resolution of the intense phantom itch.

Interestingly, the patient’s stump pain responded only to her first viewing of the mirror, Dr. Carter said. Subsequent sessions or mirror therapy had no substantial benefit for the stump pain.

This case sheds little new light on the mechanism of benefit for mirror therapy, a topic of considerable debate in the medical literature, he noted.

Some researchers have theorized that limb amputation may cause central neurologic remapping and deranged cortical output, which gets interpreted as pain. The theory that proprioceptive memory of the amputated limb accounts for phantom limb pain enjoys wide popularity.

Regardless, it’s axiomatic that when multiple senses provide conflicting input to the brain, vision trumps. Mirror therapy might activate mirror neurons in the brain hemisphere contralateral to the amputated limb and provide visual feedback against painful proprioceptive stimuli, Dr. Carter suggested.

He said he had no relevant financial disclosures.

DENVER – A simple illusion created using a mirror provides a low-cost, low-risk therapy for phantom limb pain in the intensive care unit, a study has shown.

Investigators at Walter Reed Army Medical Center have reported that mirror therapy for phantom limb pain was strikingly effective in a randomized, sham-controlled trial when used on an outpatient basis in rehabilitation therapy for individuals capable of sitting upright in a chair (N. Engl. J. Med. 2007;357:2206-7). But it can work in a bed-bound ICU patient as well, Dr. Nicholas H. Carter reported at the annual meeting of the American Neuropsychiatric Association.

He presented a case report involving a 24-year-old woman with systemic lupus erythematosus who developed severe, drug-refractory phantom limb and stump pain following a series of surgeries that culminated in an above-the-knee amputation of her left leg. Her hospitalization was prolonged because of numerous complications, including pneumonia, bilateral pneumothoraxes, sepsis, and pericardial effusion with tamponade. She had stump pain that improved only modestly, from 10 on a 10-point scale to 8, in response to hydromorphone. The patient also had two to three episodes of excruciating phantom limb pain per day, each lasting 10-15 minutes; numerous medications failed to provide any relief.

With the patient in a semi–Fowler’s position in her ICU bed and her stump and pelvis draped with sheets, a 2-by-3-foot mirror was positioned between her legs in the parasagittal plane so she could see the reflection of her exposed bare right leg.

Immediately prior to the initial session of mirror therapy the patient rated her stump pain as a 9, and 10 minutes earlier she had experienced what she described as a shock of phantom limb pain. After viewing the mirror for just 3 minutes, the patient reported that her stump pain had decreased to 4, with no further phantom limb sensations, according to Dr. Carter of Brown University, Providence, R.I.

The mirror was brought out again every time the patient felt the onset of phantom limb pain. She reported that 3-5 minutes of viewing the mirror typically decreased the phantom limb pain intensity from 7 to 3. Instead of lasting 10-15 minutes, as previously, the episodes now lasted about 5 minutes and decreased in number from two to three per day to one truncated episode per day or none. This was accompanied by complete resolution of the intense phantom itch.

Interestingly, the patient’s stump pain responded only to her first viewing of the mirror, Dr. Carter said. Subsequent sessions or mirror therapy had no substantial benefit for the stump pain.

This case sheds little new light on the mechanism of benefit for mirror therapy, a topic of considerable debate in the medical literature, he noted.

Some researchers have theorized that limb amputation may cause central neurologic remapping and deranged cortical output, which gets interpreted as pain. The theory that proprioceptive memory of the amputated limb accounts for phantom limb pain enjoys wide popularity.

Regardless, it’s axiomatic that when multiple senses provide conflicting input to the brain, vision trumps. Mirror therapy might activate mirror neurons in the brain hemisphere contralateral to the amputated limb and provide visual feedback against painful proprioceptive stimuli, Dr. Carter suggested.

He said he had no relevant financial disclosures.

DENVER – A simple illusion created using a mirror provides a low-cost, low-risk therapy for phantom limb pain in the intensive care unit, a study has shown.

Investigators at Walter Reed Army Medical Center have reported that mirror therapy for phantom limb pain was strikingly effective in a randomized, sham-controlled trial when used on an outpatient basis in rehabilitation therapy for individuals capable of sitting upright in a chair (N. Engl. J. Med. 2007;357:2206-7). But it can work in a bed-bound ICU patient as well, Dr. Nicholas H. Carter reported at the annual meeting of the American Neuropsychiatric Association.

He presented a case report involving a 24-year-old woman with systemic lupus erythematosus who developed severe, drug-refractory phantom limb and stump pain following a series of surgeries that culminated in an above-the-knee amputation of her left leg. Her hospitalization was prolonged because of numerous complications, including pneumonia, bilateral pneumothoraxes, sepsis, and pericardial effusion with tamponade. She had stump pain that improved only modestly, from 10 on a 10-point scale to 8, in response to hydromorphone. The patient also had two to three episodes of excruciating phantom limb pain per day, each lasting 10-15 minutes; numerous medications failed to provide any relief.

With the patient in a semi–Fowler’s position in her ICU bed and her stump and pelvis draped with sheets, a 2-by-3-foot mirror was positioned between her legs in the parasagittal plane so she could see the reflection of her exposed bare right leg.

Immediately prior to the initial session of mirror therapy the patient rated her stump pain as a 9, and 10 minutes earlier she had experienced what she described as a shock of phantom limb pain. After viewing the mirror for just 3 minutes, the patient reported that her stump pain had decreased to 4, with no further phantom limb sensations, according to Dr. Carter of Brown University, Providence, R.I.

The mirror was brought out again every time the patient felt the onset of phantom limb pain. She reported that 3-5 minutes of viewing the mirror typically decreased the phantom limb pain intensity from 7 to 3. Instead of lasting 10-15 minutes, as previously, the episodes now lasted about 5 minutes and decreased in number from two to three per day to one truncated episode per day or none. This was accompanied by complete resolution of the intense phantom itch.

Interestingly, the patient’s stump pain responded only to her first viewing of the mirror, Dr. Carter said. Subsequent sessions or mirror therapy had no substantial benefit for the stump pain.

This case sheds little new light on the mechanism of benefit for mirror therapy, a topic of considerable debate in the medical literature, he noted.

Some researchers have theorized that limb amputation may cause central neurologic remapping and deranged cortical output, which gets interpreted as pain. The theory that proprioceptive memory of the amputated limb accounts for phantom limb pain enjoys wide popularity.

Regardless, it’s axiomatic that when multiple senses provide conflicting input to the brain, vision trumps. Mirror therapy might activate mirror neurons in the brain hemisphere contralateral to the amputated limb and provide visual feedback against painful proprioceptive stimuli, Dr. Carter suggested.

He said he had no relevant financial disclosures.

DENVER – A simple illusion created using a mirror provides a low-cost, low-risk therapy for phantom limb pain in the intensive care unit, a study has shown.

Investigators at Walter Reed Army Medical Center have reported that mirror therapy for phantom limb pain was strikingly effective in a randomized, sham-controlled trial when used on an outpatient basis in rehabilitation therapy for individuals capable of sitting upright in a chair (N. Engl. J. Med. 2007;357:2206-7). But it can work in a bed-bound ICU patient as well, Dr. Nicholas H. Carter reported at the annual meeting of the American Neuropsychiatric Association.

He presented a case report involving a 24-year-old woman with systemic lupus erythematosus who developed severe, drug-refractory phantom limb and stump pain following a series of surgeries that culminated in an above-the-knee amputation of her left leg. Her hospitalization was prolonged because of numerous complications, including pneumonia, bilateral pneumothoraxes, sepsis, and pericardial effusion with tamponade. She had stump pain that improved only modestly, from 10 on a 10-point scale to 8, in response to hydromorphone. The patient also had two to three episodes of excruciating phantom limb pain per day, each lasting 10-15 minutes; numerous medications failed to provide any relief.

With the patient in a semi–Fowler’s position in her ICU bed and her stump and pelvis draped with sheets, a 2-by-3-foot mirror was positioned between her legs in the parasagittal plane so she could see the reflection of her exposed bare right leg.

Immediately prior to the initial session of mirror therapy the patient rated her stump pain as a 9, and 10 minutes earlier she had experienced what she described as a shock of phantom limb pain. After viewing the mirror for just 3 minutes, the patient reported that her stump pain had decreased to 4, with no further phantom limb sensations, according to Dr. Carter of Brown University, Providence, R.I.

The mirror was brought out again every time the patient felt the onset of phantom limb pain. She reported that 3-5 minutes of viewing the mirror typically decreased the phantom limb pain intensity from 7 to 3. Instead of lasting 10-15 minutes, as previously, the episodes now lasted about 5 minutes and decreased in number from two to three per day to one truncated episode per day or none. This was accompanied by complete resolution of the intense phantom itch.

Interestingly, the patient’s stump pain responded only to her first viewing of the mirror, Dr. Carter said. Subsequent sessions or mirror therapy had no substantial benefit for the stump pain.

This case sheds little new light on the mechanism of benefit for mirror therapy, a topic of considerable debate in the medical literature, he noted.

Some researchers have theorized that limb amputation may cause central neurologic remapping and deranged cortical output, which gets interpreted as pain. The theory that proprioceptive memory of the amputated limb accounts for phantom limb pain enjoys wide popularity.

Regardless, it’s axiomatic that when multiple senses provide conflicting input to the brain, vision trumps. Mirror therapy might activate mirror neurons in the brain hemisphere contralateral to the amputated limb and provide visual feedback against painful proprioceptive stimuli, Dr. Carter suggested.

He said he had no relevant financial disclosures.