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Additional info for Psychiatry [Blueprints - Notes and Cases]

Example text

2004a, b). The electric field generated by DBS (Fig. 2a) can be represented on the axon by a series of extracellular voltages at the nodes of Ranvier. If the electrical stimulation is strong enough, the extracellular voltage will depolarize the axon until its membrane potential, the voltage difference between the inside and the outside of the axon, reaches its firing threshold and an action potential is generated (Fig. 2b). This basic response of an axon to a depolarizing extracellular electric field is related to the second spatial derivative of the voltage distribution along the axon (McNeal 1976).

This model should, however, be expanded to include the BNST as an important component of anxiety circuitry. In most mammals, the extended amygdala consists of a ring of neurons encircling the internal capsule and basal ganglia. Remnants from an embryonic continuous structure connecting the BNST and the central nucleus of the amygdala form interrupted cell columns within the stria terminalis as it takes a semicircular detour above and behind the internal capsule and thalamus (Martin et al. 1991).

Similarly, abnormal neural activity has been reported in the amygdala, thalamus, and orbitofrontal and anterior cingulate cortices of depressed patients (Schulman et al. 2011; Smith et al. 2011). Functional imaging studies have shown that successful treatment of MDD and OCD is associated with normalization of abnormal basal metabolism in both local and remote regions of the brain. In particular, activity in the SCC and prefrontal cortex areas of the brain has normalized following chronic therapeutic SCC DBS (Mayberg et al.

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