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S S Shergill

Publications and source records attributed to S S Shergill.

13 recordsLinked to original sources
PubMed2006

Timing of covert articulation: an fMRI study.

Timing is an important constituent of speech and language. Different brain regions have been associated with time management functions such as time estimation and motor timing. This study aims to identify the less well known neural networks associated with timing of internally paced covert articulation. Functional MRI was performed on subjects who either spontaneously, or in response to a visual cue, covertly generated words every 2 s. Results show the involvement of anterior cingulate gyrus, right dorsolateral and inferior frontal and right inferior parietal cortices in a putatively modality independent circuit associated with timing of covert speech. Modality specific activation in the right temporal cortex may have reflected the involvement of this region in auditory-verbal processing.

Adult↗
PubMed2006

Prosodic discrimination in patients with schizophrenia.

Fifteen patients with prominent positive symptoms of schizophrenia and 15 normal controls performed verbal prosodic and pure musical discrimination tasks, with changes in pitch and timing parameters. The patients' performance was comparable to that of controls on the discrimination of terminal pitch changes, but significantly poorer on the more difficult internal pitch discrimination. The latter deficit was positively correlated with the severity of their positive symptoms. The results suggest that patients have a deficit in processing fundamental aspects of prosody, which is associated with the presence of positive symptoms.

Adult↗
PubMed2001

A functional study of auditory verbal imagery.

BACKGROUND: We used functional MRI to examine the functional anatomy of inner speech and different forms of auditory verbal imagery (imagining speech) in normal volunteers. We hypothesized that generating inner speech and auditory verbal imagery would be associated with left inferior frontal activation, and that generating auditory verbal imagery would involve additional activation in the lateral temporal cortices. METHODS: Subjects were scanned, while performing inner speech and auditory verbal imagery tasks, using a 1.5 Tesla magnet. RESULTS: The generation of inner speech was associated with activation in the left inferior frontal/insula region, the left temporo-parietal cortex, right cerebellum and the supplementary motor area. Auditory verbal imagery in general, as indexed by the three imagery tasks combined, was associated with activation in the areas engaged during the inner speech task, plus the left precentral and superior temporal gyri (STG), and the right homologues of all these areas. CONCLUSIONS: These results are consistent with the use of the 'articulatory loop' during both inner speech and auditory verbal imagery, and the greater engagement of verbal self-monitoring during auditory verbal imagery.

Adult↗
PubMed2001

Modality specific neural correlates of auditory and somatic hallucinations.

Somatic hallucinations occur in schizophrenia and other psychotic disorders, although auditory hallucinations are more common. Although the neural correlates of auditory hallucinations have been described in several neuroimaging studies, little is known of the pathophysiology of somatic hallucinations. Functional magnetic resonance imaging (fMRI) was used to compare the distribution of brain activity during somatic and auditory verbal hallucinations, occurring at different times in a 36 year old man with schizophrenia. Somatic hallucinations were associated with activation in the primary somatosensory and posterior parietal cortex, areas that normally mediate tactile perception. Auditory hallucinations were associated with activation in the middle and superior temporal cortex, areas involved in processing external speech. Hallucinations in a given modality seem to involve areas that normally process sensory information in that modality.

Adult↗
PubMed2000

Mapping auditory hallucinations in schizophrenia using functional magnetic resonance imaging.

BACKGROUND: Perceptions of speech in the absence of an auditory stimulus (auditory verbal hallucinations) are a cardinal feature of schizophrenia. Functional neuroimaging provides a powerful means of measuring neural activity during auditory hallucinations, but the results from previous studies have been inconsistent. This may reflect the acquisition of small numbers of images in each subject and the confounding effects of patients actively signaling when hallucinations occur. METHODS: We examined 6 patients with schizophrenia who were experiencing frequent auditory hallucinations, using a novel functional magnetic resonance imaging method that permitted the measurement of spontaneous neural activity without requiring subjects to signal when hallucinations occurred. Approximately 50 individual scans were acquired at unpredictable intervals in each subject while they were intermittently hallucinating. Immediately after each scan, subjects reported whether they had been hallucinating at that instant. Neural activity when patients were and were not experiencing hallucinations was compared in each subject and the group as a whole. RESULTS: Auditory hallucinations were associated with activation in the inferior frontal/insular, anterior cingulate, and temporal cortex bilaterally (with greater responses on the right), the right thalamus and inferior colliculus, and the left hippocampus and parahippocampal cortex (P<.0001). CONCLUSIONS: Auditory hallucinations may be mediated by a distributed network of cortical and subcortical areas. Previous neuroimaging studies of auditory hallucinations may have identified different components of this network.

Auditory Perception↗
PubMed2000

Functional anatomy of auditory verbal imagery in schizophrenic patients with auditory hallucinations.

OBJECTIVE: This study investigated the functional neuroanatomy of inner speech and auditory verbal imagery in schizophrenic patients predisposed to auditory hallucinations. METHOD: Eight patients with schizophrenia with a history of prominent auditory hallucinations and six comparison subjects underwent functional magnetic resonance imaging while generating inner speech or imagining external speech. RESULTS: Patients showed no differences while generating inner speech but experienced a relatively attenuated response in the posterior cerebellar cortex, hippocampi, and lenticular nuclei bilaterally and the right thalamus, middle and superior temporal cortex, and left nucleus accumbens during auditory verbal imagery. CONCLUSIONS: Patients with schizophrenia who were prone to auditory hallucinations show attenuated activation when processing inner speech in areas implicated in verbal self-monitoring.

Adult↗
PubMed1999

Outcome in refractory depression.

BACKGROUND: Failure to respond to first-line antidepressant treatment can occur in up to 40% of patients with depressive illness. A proven strategy for managing this refractory depression is lithium augmentation. The long-term outcome and optimal management of patients treated with lithium augmentation remains unclear. We describe a 4-8 year naturalistic follow-up of patients treated with lithium augmentation in two controlled studies of its efficacy in refractory depression. METHOD: Cases were followed up with personal interview where possible, and by telephone and general practitioner contact otherwise. Lifetime clinical status was ascertained using the Schedule for Affective Disorders and Schizophrenia-Lifetime (SADS-L). RESULTS: We obtained outcome data on 53 of the original eligible 76 patients. There was a good outcome in 38 (72%) patients. Good outcome was associated with a less endogenous nature of depression and an absence of previous hospitalisations. CONCLUSIONS: There do not seem to be any specific prognostic indicators of long-term outcome to lithium augmentation beyond those recognised to be relevant in the outcome of depression generally. LIMITATIONS: The conclusions are limited by incomplete follow-up of the total original sample and lack of objective illness and medication data for the intervening period.

Adult↗
PubMed1998

Auditory hallucinations: a review of psychological treatments.

Auditory hallucinations (AH) occur frequently amongst psychiatric patients, being most common in schizophrenia. In 25-30% of cases they are refractory to traditional antipsychotic drugs. A variety of psychosocial treatments have been used, but their efficacy remains unclear. This review aims to bring together the more recent studies of psychological treatments and discuss them in the context of recent cognitive models of hallucinations and functional imaging studies. The search strategy included the following sources: MEDLINE, Embase and Psychlit. Strategies reported by patients can be categorised as: (1) distracting activities, such as listening to music; (2) behavioural tasks, such as taking exercise; (3) cognitive tasks, such as ignoring AH. Almost all the strategies produced some benefit in some patients: treatment often improved AH-associated distress, rather than frequency of AH. There are many difficulties in conducting research on AH. Treatment should be individually tailored and used as an adjunct to pharmacotherapy. Future theory-driven studies need to be based on complex aetiological models and incorporate functional imaging to elucidate the physiological changes induced by therapeutic interventions.

Antipsychotic Agents↗
PubMed1998

Communication of psychiatric diagnosis.

We examined whether psychiatric patients knew their diagnosis, the significance they attached to it, and the impact of being informed in a systematic fashion according to their wishes. We also assessed whether the nature of the psychiatric diagnosis influenced what patients were told by their psychiatrists. The three parts of the study included questionnaire responses from 28 consultant psychiatrists: case-note reviews and questionnaire responses of 200 adult psychiatric in-patients: and a pilot study informing 28 adult psychiatric day hospital patients of their diagnosis according to their wishes. The results showed that of 126 in-patients, 53% had not been told their diagnosis, although most wanted to know. Of those informed, 75% agreed with their diagnosis. The majority of patients considered a psychiatric diagnosis to be as real as a physical diagnosis and helpful in their treatment. Patients with schizophrenia were less likely to have been informed of their diagnosis, and psychiatrists were also more reticent regarding the diagnosis of personality disorder. All patients who were systematically informed, in the pilot study agreed with their diagnosis. We conclude that most patients agree with their diagnosis and its usefulness. All patients should be asked whether they want to know their diagnosis and be informed appropriately.

Adolescent↗
PubMed1997

Pharmacological choices after one antidepressant fails: a survey of UK psychiatrists.

BACKGROUND: At least 30% of depressed patients fail to respond to adequate first-line anti-depressant medication. Several pharmacological strategies have been suggested to treat such refractory depression. There has been no survey of United Kingdom psychiatrists' treatment preferences for refractory depression. This study was carried out to determine both experience and preference of various strategies for management of refractory depression. METHOD: A total of 300 fellows, members and inceptors of the Royal College of Psychiatrists were randomly selected and approached by postal questionnaire. They were asked to comment on management of a detailed clinical vignette of a case of depression with initial treatment failure. RESULTS: The response rate was 63% (n = 175). The most popular treatment choices were increasing dosage of tricyclic medication and change of medication of SSRI. The most rarely selected were augmentation with triiodothyronine (T3) and augmentation with tryptophan or MAOIs. Treatment choice was significantly influenced by previous experience. A large number (39%) of psychiatrists were not confident in treating refractory depression. CONCLUSION: Surprisingly few psychiatrists chose to use the best proven pharmacological treatments such as augmentation with lithium or T3. In view of this and the considerable proportion of psychiatrists lacking confidence in the management of refractory depression, this topic deserves priority as a topic for continuing professional development (CPD) courses.

Antidepressive Agents↗
PubMed1996

Patients' views towards care received from psychiatrists.

BACKGROUND: Measurement of the quality of psychiatric care including assessment of patients' views have become increasingly important as expectations of the standard of care rises. METHODS: Attitudes and satisfaction of acute psychiatric in-patients were investigated using a questionnaire looking at satisfaction, patients' views on personal and professional qualities of psychiatrists, empowerment and insight. RESULTS: The response rate was 79.2% (137 out of 173). Patients with a diagnosis of a non-affective psychotic illness, particularly those lacking insight were significantly less satisfied with their care. Respondents were more satisfied with the personal rather than the professional qualities of the doctors, and less satisfied with their empowerment and doctors' availability. CONCLUSIONS: In-patients' attitudes towards their psychiatric care involves a complex relationship between clinical and sociocultural characteristics. Satisfaction studies can serve as an important monitor and reminder of patient dissent.

Adult↗
PubMedDate not supplied

A comparative study of ophthalmodynamometry in hypertensive and non-hypertensive cases.

Ophthalmodynamometry was done on 100 hypertensive cases and 100 non-hypertensive cases who had clear media and no glaucoma. The ratio of the pressure mean ophthalmic: pressure mean brachial in the non-hypertensive group was 0.71:1.0, which rose to 0.78:1.0 in the hypertensive group. The ophthalmic humeral diastolic ratio increased with the severity of fundus changes. The pressure mean ophthalmic showed higher values with increasing grades of fundus changes. Those cases having a pressure mean opthalmic higher than the expected value in the hypertensive group as compared to the cases having a pressure mean ophthalmic lower than the expected value, were at a greater risk or had a graver prognosis. The importance of ophthalmodynamometry is stressed for the prognosis of hypertension along with the fundus examination.

Blood Pressure↗