The meta-categorical role of the cerebellar vermis in psychopathology: support for Crow's continuum hypothesis
Abnormally high resting blood flow in the cerebellar
vermis of supine ADHD children and survivors of child abuse imaged
at Mclean Hospital appears to be associated with a greater incidence
of psychiatric symptoms such as behavioral hyperactivity, inattention
and LSCL-33 scores in these subjects. Recent functional imaging
studies also report high resting blood flow or activity in the
cerebellar vermis in symptomatic adults with ADHD, depression,
PTSD and schizophrenia. In addition, morphological alterations
of the cerebellar vermis have been associated with chronic alcoholism,
long-term lithium treatment, autism, fragile X, ADHD, schizophrenia
and a wide range of other developmental and neuro-degenerative
disorders. Electrical stimulation of the vermis has demonstrated
some efficacy in the treatment of epilepsy and a variety of psychiatric
disorders.
The vermis has a protracted period of postnatal development, which
may engender susceptibility to environmental insults or effects
of early child abuse. Interestingly, the fastigial nucleus, the
output nucleus of the vermis, has projections to brainstem regions
such as the LC, PAG, VTA, SN and parabrachal nucleus, implicating
it in bihemispheric emotional and attentional modulation. Therefore,
the vermis of the cerebellum may form an important locus of the
developmental psychopathology and neuropharmacology of childhood
abuse and hyperactivity. Could the cerebellar vermis represent
a common site of pathology in psychiatric disorders? If cerebellar
pathology transcends traditional psychiatric diagnostic boundaries
does this argue for a continuum approach as proposed by Crow (see
http://www.ama-assn.org/sci-pubs/journals/
archive/psyc/ vol_55/no_6/ycm7174x.htm) to the conceptualization
and genetic analysis of psychiatric disorders?
August, 1999
"fMRI Measures of the Cerebelluar Vermis in Childhood ADHD" to be given at the APA Boston symposium on The Application of Neuroimaging Methods to Understanding Developmental Disorders, August 23, 1999.
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The Paleocerebellum and Emotional Dysfunction
· Historically, the cerebellar vermis has long been
implicated in varous kinds of psychopathology. A wide range of
basic, clinical and brain imaging studies support a role for the
midline cerebellar vermis in aggression (Berman 1997), (Heath
1977), depression (Beauregard, Leroux et al. 1998), hyperactivity
(Berquin, Giedd et al. 1998),(Mostofsky, Reiss et al. 1998), (Altman
1987) , psychosis (Heath 1977) (Lauterbach 1996) and the enduring
effects of early trauma (Kling, Steinberg et al. 1979).
· The anterior cerebellar vermis (ACV) bilaterally influences dopamine release in the basal ganglia, amygdala and accumbens (Snider and Maiti 1976; Snider, Maiti et al. 1976; Supple and Kapp 1994) via fastigial nucleus projections (Heath and Harper 1974) to pontine and mesencephalic nuclear groups.
· The role of the vermis in bimanual and bipedal coordination (Ouchi, Okada et al. 1999) may provide theoretical insights into the role of ACV dysfunction in psychopathology.
OUR WORKING HYPOTHESES:
1) The ACV may function in emotional motor -- visceral coordination through bihemispheric switching of the forebrain limbic regions.
2) Abnormally elevated resting blood flow in the ACV may be a marker of neural dysfunction in this cerebellar area.
3) Impaired hemispheric shifting (for example, as observed
for binocular rivalry in bipolar disorder [Pettigrew and Miller
1998]) may represent a
functional trait common to both survivors of early child abuse
and hyperactive ADHD children.
4) Psychopharmacological interventions may restore normal switching
function by reducing resting blood flow in the ACV as is observed
with methylphenidate administration in hyperactive ADHD children
(OTHER SIDE).
Note: The findings reported
in this poster represent "work in progress" and may
be modified with further analysis.
LIMBIC SYSTEM CHECKLIST-33 (LSCL-33)
The LSCL-33, was designed to measure somatic, sensory, behavioral, and memory symptoms suggestive of temporal lobe epilepsy. Child abuse can be likened to a kindling phenomena (Teicher, Ito et al. 1997).
In a study of over 250 outpatients (Teicher, Glod et al. 1993),
physical abuse was found to be associated
with a 38% increase in LSCL-33 scores (P < 0.01), sexual abuse
with a 49% increase (P < 0.02), and
combined abuse with a 113% increase (P < 0.0001). Physical
or sexual abuse alone was associated with
elevated LSCL-33 scores only if the abuse occurred before age
18.
A strikingly robust correlation (BELOW) was observed between
blood flow in the midline vermis
and LSCL-33 scores.
(but not the right or left cerebellar hemispheres below)
The Somatic and Automatisms subcategories of the LSCL-33 were more highly correlated with vermia blood flow than Sensory and Memory subcategories (BELOW).
· The LSCL-33 appears to provide an indirect assessment of vermial blood flow.
· The use of chronic electrical stimulation of the ACV
to treat human epilepsy
is consistent with our findings and with the kindling hypothesis
of child abuse.
more to come
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A good current review o f the role of the cerebellum in psychopathology