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Virtual City for Exposure Therapy in Phobias: Case Studies of Agoraphobia
- M. Jablonská, A. Francová, K. Janků, P. Stopková, E. Nosková, I. Fajnerová
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S194-S195
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Introduction
A phobia is a type of anxiety disorder that causes an individual to experience extreme, irrational fear about a situation, living creature, place, or object. The most common in the treatment of phobic disorders are in vivo exposures (IVEs) consisting of confrontation with feared stimulus until distress has decreased. Virtual reality exposure therapy (VRET) is a modern alternative to IVEs where patients are exposed to virtual anxiety-provoking environments, and its effectiveness has already been demonstrated in the treatment of most phobias (Freitas et al. Psychiatr q. 2021; 92(4):1685–1710).
ObjectivesThis paper aims to present a complex virtual city developed for VRET in different types of phobia. The VRET system is composed of several interactive environments (a skyscraper, a subway, a cinema, and a hospital) that can be combined in form of different scenarios targeting various phobias, allowing controlled and gradual exposure. Selected virtual environments will be presented in case studies of agoraphobic patients (F40 by ICD-10).
MethodsThe number of VRET sessions is individual, based on the need of each patient, starting with an introductory session including stimulus mapping and VR control explanation. Each session lasts about 30 minutes. During exposure, Subjective Units of Discomfort (SUDS) are assessed at various points. The scenarios for agoraphobia are typically composed of an elevator or subway ride, open spaces (city streets, the roof), or crowded interiors (the cinema). Environments allow various effects, elevator trembling, getting stuck situations and adjusting the number of people. All the scenes contain authentic ambient sounds.
ResultsWe present a case of a 33-year-old male patient experiencing intense fear of getting stuck or locked, turning into panic attacks. During 10 VRET sessions, the patient was exposed to different environments (subway, underground parking, elevator, cinema) focusing primarily on elevator rides, sometimes in combination with IVE, consisting of locking the door in the experimental room. Another case is a 59-year-old female patient with a fear of open spaces and crowd situations. This patient had 5 VRET sessions combining exposure to open spaces with subway rides. In addition, the patient was instructed to watch short 360° videos of crowd situations. The last case is a 20-year-old female patient with an intense fear of subway tunnels and sounds, enclosed spaces, and heights. During 4 VRET sessions, we mainly focused on the subway with additional IVEs in a real elevator.
ConclusionsSubjective evaluations during exposures indicate a reduction of anxiety across sessions. Based on the patient’s feedback we can conclude on a good acceptance of the technology and an improvement in real-life situations. These case studies demonstrate the valuable use of variable combinations of virtual scenarios in the treatment of agoraphobia.
Disclosure of InterestNone Declared
1H-MRS of the anterior cingulate cortex in obsessive-compulsive disorder: metabolic abnormalities in pgACC - controlled study
- E. Nosková, I. Fajnerová, D. Pajuelo, P. Stopková, J. Horáček
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S105-S106
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Introduction
Obsessive-compulsive disorder (OCD) is connected with increased activity in cortico-striatal-thalamic-cortical (CSTC) loop. The anterior cingulate cortex (ACC) is a part of this loop and plays a role in error detection and monitoring and processing of conflicting information, core OCD clinical signs. This area also contains a high density of Von Economo neurons. Biochemistry in this area is closely connected with the pathophysiology of OCD.
ObjectivesDecreased concentrations of total N-acetylaspartate (tNAA) have been reported in ACC in patients with OCD compared to healthy controls (HC), with increase after successful treatment. Findings by other metabolites: choline-containing compounds (tCho), total creatine (tCr) and myo-inositol are not consistent. Differences in levels of tNAA, tCho, tCr would correlate with the severity of symptoms measured by Y-BOCS. In the comparison in the subgroup of patients with/ without medication, there will be differences in levels of metabolites.
Methods54 patients diagnosed with OCD according to ICD-10 and DSM-IV criteria, and 54 HC matched for age and sex were included in the study. They underwent MRI and MR Spectroscopy on a 3T Magnetom Prisma scanner (Siemens, Germany) equipped with a 64-channel volume head coil (Fig. 2). After spectral quality control, 28 OCD and 28 HC subjects were included in the statistical analysis. OCD subjects were interviewed using the Y-BOCS to evaluate the severity of the symptoms. Patients enrolled in the study were without medication at least 5 days before MRI or on a stable dosage of SSRI antidepressants. To assess the intergroup differences Wilcoxon Rank Sum test or Kruskal-Wallis test was used as appropriate. The correlation between metabolite levels and clinical characteristics was assessed by Spearman’s rank correlation coefficient. The statistics were calculated using R, version 4.1.1.
ResultsWe found no differences in levels of tNAA in ACC in OCD vs. HC (p=0,21; see Tab.1, Fig.1). We found significantly increased level of tCho, tCr and Ins in OCD vs. HC (p=0,03; p=0,004 resp.; p=0,017 resp.). tCr levels corelated negatively with YBOCS compulsions subscale (p=0,046; cor=-0,38). tCho levels showed a trend to negative correlation with Y-BOCS compulsions subscale (p=0,067; cor=-0,35). Analysis on the subgroup with (13 subjects, 46,43 %) and without (13 subjects, 46,43 %) stable SSRI medication did not reveal significant differences.
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ConclusionsOur study found difference in ACC by OCD patients compared to HC, mainly increased tCho, tCr and Ins. Also, the study shows a significant correlation between the severity of compulsions and tCr levels. We can see this trend also in the correlation of the tCho and Y-BOCS compulsions subscale. Similar tNAA level by OCD and HC groups could indicates correctly adjusted medication or stable state by enrolled patients.
Disclosure of InterestNone Declared
Memory and medial temporal lobe structures in patients with schizophrenia and their siblings
- V. Vorackova, , P. Mohr, P. Knytl, , I. Fajnerova, A. Dorazilova, Z. Kratochvilova, A. Skoch, M. Rodriguez
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- Journal:
- European Psychiatry / Volume 41 / Issue S1 / April 2017
- Published online by Cambridge University Press:
- 23 March 2020, p. S389
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Episodic retrieval is characterized by the subjective experience of remembering. Semantic memory, on the other hand, is a more structured record of facts, meanings, concepts and knowledge about the external world that we have acquired. The medial temporal lobe (MTL), especially the hippocampus and parahippocampal cortex, plays a central role in both types of memory process. Published studies suggested that individuals with schizophrenia have deficits in episodic and semantic memory, as well as structural abnormalities of the medial temporal lobe. However, it is not clear whether reported correlations reflect the impact of the disease state or that of underlying genetic influences contributing to the risk. To understand better etiology and effects of psychosis on the global brain structure and cognitive processing, relatives of individuals with schizophrenia can be studied. The aim of our study was to examine the association between abnormalities of the MTL, psychopathology, and memory impairment in schizophrenia. Study sample (n = 60) consisted of first episode schizophrenia patients, their non-psychotic siblings and matching control subjects. We used high-resolution magnetic resonance imaging and probabilistic algorithms for image analysis. Episodic and semantic memory was measured with neuropsychological tests. Our results showed differences in memory performance between the groups. Neuropsychological data were correlated with MRI findings. The results may provide insight into etiology of schizophrenia and its effects on cognition and help to identify neuroanatomical and cognitive endophenotypes of psychotic disorders.
Supported by the grant projects MH CR AZV 15-28998A, MEYS NPU4NUDZ: LO1611; Czech Science Foundation, grant No. 16-13093S; Institutional Support 00023001IKEM.
Disclosure of interestThe authors have not supplied their declaration of competing interest.