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- Efeito da musicoterapia nas perturbações do espectro do autismo: uma revisão baseada na evidênciaPublication . Freitas, Carina; Figueira, KatherineIntrodução: As perturbações do espetro do autismo são um conjunto de patologias do neurodesenvolvimento que se manifestam por dificuldades na comunicação e interação social, associadas a comportamentos repetitivos. A musicoterapia tem sido descrita na literatura como uma terapêutica complementar benéfica nestes pacientes. O objetivo deste trabalho consiste em rever a evidência do efeito da musicoterapia como intervenção não farmacológica, em crianças e adolescentes que sofrem desta patologia. Métodos: Pesquisaram-se normas de orientação clínica, revisões sistemáticas, metanálises e ensaios clínicos controlados e aleatorizados, nas bases de dados da National Guideline Clearinghouse, Scottish Intercollegiate Guidelines Network, Canadian Medical Association Infobase, Cochrane Library, Bandolier, Pubmed e Índex das Revistas Médicas Portuguesas, publicados desde sempre e até dezembro de 2015, em inglês ou português, com os termos MeSH, “music-therapy” e “autism spectrum disorder” ou “autistic disorder”. Resultados: Foram incluídos nesta revisão seis artigos: uma norma de orientação clínica, uma metanálise, duas revisões sistemáticas e dois ensaios clínicos controlados e aleatorizados. Na maioria dos estudos verificou-se que a musicoterapia apresenta evidência limitada como intervenção não farmacológica em crianças e adolescentes com perturbações do espetro do autismo. Conclusões: É necessária a realização de mais estudos de investigação, de boa qualidade metodológica, para se estabelecer a eficácia da musicoterapia neste grupo terapêutico.
- Neural correlates of familiarity in music listening: a systematic review and a neuroimaging meta-analysisPublication . Freitas, Carina; Manzato, Enrica; Burini, Alessandra; Taylor, Margot J.; Lerch, Jason P.; Anagnostou, EvdokiaFamiliarity in music has been reported as an important factor modulating emotional and hedonic responses in the brain. Familiarity and repetition may increase the liking of a piece of music, thus inducing positive emotions. Neuroimaging studies have focused on identifying the brain regions involved in the processing of familiar and unfamiliar musical stimuli. However, the use of different modalities and experimental designs has led to discrepant results and it is not clear which areas of the brain are most reliably engaged when listening to familiar and unfamiliar musical excerpts. In the present study, we conducted a systematic review from three databases (Medline, PsychoINFO, and Embase) using the keywords (recognition OR familiar OR familiarity OR exposure effect OR repetition) AND (music OR song) AND (brain OR brains OR neuroimaging OR functional Magnetic Resonance Imaging OR Position Emission Tomography OR Electroencephalography OR Event Related Potential OR Magnetoencephalography). Of the 704 titles identified, 23 neuroimaging studies met our inclusion criteria for the systematic review. After removing studies providing insufficient information or contrasts, 11 studies (involving 212 participants) qualified for the meta-analysis using the activation likelihood estimation (ALE) approach. Our results did not find significant peak activations consistently across included studies. Using a less conservative approach (p < 0.001, uncorrected for multiple comparisons) we found that the left superior frontal gyrus, the ventral lateral (VL) nucleus of the left thalamus, and the left medial surface of the superior frontal gyrus had the highest likelihood of being activated by familiar music. On the other hand, the left insula, and the right anterior cingulate cortex had the highest likelihood of being activated by unfamiliar music. We had expected limbic structures as top clusters when listening to familiar music. But, instead, music familiarity had a motor pattern of activation. This could reflect an audio-motor synchronization to the rhythm which is more engaging for familiar tunes, and/or a sing-along response in one’s mind, anticipating melodic, harmonic progressions, rhythms, timbres, and lyric events in the familiar songs. These data provide evidence for the need for larger neuroimaging studies to understand the neural correlates of music familiarity.
- Analysis of the unpleasantness of sounds by schizophrenic patientsPublication . Freitas, Carina Patrícia de Barros; Griffiths, Timothy; Ribeiro, Joaquim AlexandreNo presente trabalho estudámos o processamento emocional de sons desagradáveis em doentes esquizofrénicos, em fases iniciais da doença. O estudo decorreu em doentes pertencentes à consulta externa dos Serviços de Psiquiatria do Hospital de Santa Maria e Hospital Júlio de Matos e a amostra consistiu em 29 doentes e 29 controlos emparelhados para o sexo e idade. As avaliações realizadas incluíram uma escala de Avaliação Breve do Estado Mental (MMSE), uma escala de gravidade dos sintomas positivos e negativos da esquizofrenia (PANSS) e uma bateria de sons desagradáveis desenvolvida para este estudo, intitulada de Newcastle Battery of Unpleasant Sounds (NBUS). Os resultados mostraram que os doentes esquizofrénicos têm uma percepção emocional preservada dos sons desagradáveis, na fase inicial da doença. Não se observaram correlações significativas entre medidas de gravidade clínica (duração da doença e sub escalas da PANSS) e os valores da avaliação dos referidos sons. Observou-se ainda que a bateria de sons apresentada revelou grande variabilidade nos valores obtidos na avaliação. Associações semânticas, assim como certas características acústicas dos sons poderão ter influenciado a percepção e avaliação emocional dos mesmos.
- Music therapy for adolescents with psychiatric disorders: an overviewPublication . Freitas, Carina; Fernández-Company, José Fernando; Pita, Marisela Figueira; García-Rodríguez, MaríaBackground: Although it is true that adolescence is a stage of evolutionary development in which there are innumerable windows of opportunity, it is also the peak age at which some psychiatric disorders may appear. On the other hand, music is an auditory stimulus that interests and motivates youngsters, as it is used for identity, social connection, and emotional regulation. Methods: We conducted a strategic search by consulting scientific databases. The following search terms were employed: Music Therapy AND Psychology AND Psychiatry AND Ado lescents. The following international electronic databases were searched: Medline, Ovid, and Cochrane Library. Results: A total of 142 sources were identified from which 9 papers on music therapy published exclusively in scientific journals specialized in psychology or child psychiatry were selected. The total number of participants was 651. The studies reported that music therapy interventions have the potential to improve self-esteem, social engagement, decrease social isolation, and depressive and anxiety symptoms in psychiatric adolescents (both in inpatient and outpatient settings). Conclusion: Given the heterogeneity and methodological quality of the few studies included, it is complex to extrapolate and generalize results. More quality research is needed to expand music therapy interventions on youth mental health.
- Psicomotricidade e saúde mental infantil e juvenil: caraterização de uma consulta de psicomotricidade integrada num serviço de pedopsiquiatriaPublication . Figueira, Katherine; Freitas, CarinaIntrodução: A intervenção psicomotora no âmbito da saúde mental infantil e juvenil foi introduzida em Portugal por João Dos Santos. Em contexto clínico, a Psicomotricidade visa compreender e resolver os conflitos internos da criança, recorrendo a técnicas de mediação corporal para a construção e restruturação do psiquismo. Objetivo: Caraterizar as primeiras consultas de Psicomotricidade do Serviço de Pedopsiquiatria do Hospital Dr. Nélio Mendonça efetuadas de 4 de outubro de 2013 a 30 de julho de 2015, e sensibilizar para o papel do psicomotricista no contexto de saúde mental infantil e juvenil. Material e Métodos: Consultou-se todos os processos clínicos selecionando as seguintes variáveis: sexo, idade, motivo da consulta, diagnóstico, perfil psicomotor e nível socioeconómico. Resultados: Neste período foram avaliadas em primeira consulta 42 crianças e jovens, com uma média etária de 9,69±2,74 anos, sendo a maioria do sexo masculino (n=31; 73,8%). O encaminhamento para a consulta de Psicomotricidade foi realizado maioritariamente pela equipa médica (n=28; 66,7%), sendo o principal motivo de encaminhamento os problemas relacionais. Os resultados da avaliação psicomotora revelaram que a maioria das crianças avaliadas (n=22; 52,4%) apresentava dispraxia. Quanto às caraterísticas psicopatológicas verificou se que uma percentagem significativa dos casos não apresentava qualquer diagnóstico (n=9; 21,4%). Conclusão: A terapia psicomotora no contexto de saúde mental infantil e juvenil assenta numa perspetiva sistémica. Vem trazer contributos importantes no cuidado prestado aos utentes por representar uma área de observação e compreensão das dificuldades da criança e do seu funcionamento psíquico, e ainda por representar um espaço terapêutico e pedagógico de reestruturação psíquica, que permite outra forma de expressão dos conflitos internos que não a linguagem.
- Comportamentos suicidários na criançaPublication . Basílio, Andreia; Freitas, CarinaOs comportamentos suicidários na criança são considerados situações raras. Contudo, o facto de estes parâmetros serem sub-notificados e pouco estudados dificulta a obtenção de estatísticas e informações fidedignas. O objetivo deste artigo é rever os conceitos atuais, epidemiologia, evolução do conceito de morte na criança, fatores de risco e de proteção e fornecer orientações para a avaliação clínica e abordagem terapêutica da crise suicidária.
- Neuroimaging studies on familiarity of music in children with autism spectrum disorderPublication . Freitas, Carina Patrícia de BarrosThe field of music neuroscience allows us to use music to investigate human cognition in vivo. Examining how brain processes familiar and unfamiliar music can elucidate underlying neural mechanisms of several cognitive processes. To date, familiarity in music listening and its neural correlates in typical adults have been investigated using a variety of neuroimaging techniques, yet the results are inconsistent. In addition, these correlates and respective functional connectivity related to music familiarity in typically developing (TD) children and children with autism spectrum disorder (ASD) are unknown. The present work consists of two studies. The first one reviews and qualitatively synthesizes relevant literature on the neural correlates of music familiarity, in healthy adult populations, using different neuroimaging methods. Then it estimates the brain areas most active when listening to familiar and unfamiliar musical excerpts using a coordinate-based meta-analyses technique of neuroimaging data. We established that motor brain structures were consistently active during familiar music listening. The activation of these motor-related areas could reflect audio-motor synchronization to elements of the music, such as rhythm and melody, so that one can tap, dance and “covert” sing along with a known song. Results from this research guided our second study. This work investigated the familiarity effect in music listening in both TD and ASD children, using magnetoencephalography (MEG). This technique enabled us to study brain connectivity and characterize the networks and frequency bands involved while listening to familiar and unfamiliar songs. TD children recruited a similar brain network as those in typical adults during familiar music listening, in the gamma frequency band. Compared to TD, children with ASD showed relatively intact processing of familiar songs but atypical processing of unfamiliar songs in theta and beta-bands. Atypical functional connectivity of other unfamiliar stimuli has been reported in ASD. Our findings reinforced that processing novelty is a challenge. Overall, this work contributes to the advancement of both fields of music neuroscience and brain connectivity in ASD.
- Cortical gyrification morphology in individuals with ASD and ADHD across the lifespan: a systematic review and meta-analysisPublication . Gharehgazlou, Avideh; Freitas, Carina; Ameis, Stephanie H; Taylor, Margot J.; Lerch, Jason P.; Radua, Joaquim; Anagnostou, EvdokiaAutism spectrum disorder (ASD) and attention-deficit hyperactivity disorder (ADHD) are common neurodevelopmental disorders (NDDs) that may impact brain maturation. A number of studies have examined cortical gyrification morphology in both NDDs. Here we review and when possible pool their results to better understand the shared and potentially disorder-specific gyrification features. We searched MEDLINE, PsycINFO, and EMBASE databases, and 24 and 10 studies met the criteria to be included in the systematic review and meta-analysis portions, respectively. Meta-analysis of local Gyrification Index (lGI) findings across ASD studies was conducted with SDM software adapted for surface-based morphometry studies. Meta-regressions were used to explore effects of age, sex, and sample size on gyrification differences. There were no significant differences in gyrification across groups. Qualitative synthesis of remaining ASD studies highlighted heterogeneity in findings. Large-scale ADHD studies reported no differences in gyrification between cases and controls suggesting that, similar to ASD, there is currently no evidence of differences in gyrification morphology compared with controls. Larger, longitudinal studies are needed to further clarify the effects of age, sex, and IQ on cortical gyrification in these NDDs.
- Atypical functional connectivity during unfamiliar music listening in children with autismPublication . Freitas, Carina; Hunt, Benjamin A. E.; Wong, Simeon M.; Ristic, Leanne; Fragiadakis, Susan; Chow, Stephanie; Iaboni, Alana; Brian, Jessica; Soorya, Latha; Chen, Joyce L.; Schachar, Russell; Dunkley, Benjamin T.; Taylor, Margot J.; Lerch, Jason P.; Anagnostou, EvdokiaBackground: Atypical processing of unfamiliar, but less so familiar, stimuli has been described in Autism Spectrum Disorder (ASD), in particular in relation to face processing. We examined the construct of familiarity in ASD using familiar and unfamiliar songs, to investigate the link between familiarity and autism symptoms, such as repetitive behavior. Methods: Forty-eight children, 24 with ASD (21 males, mean age = 9.96 years ± 1.54) and 24 typically developing (TD) controls (21 males, mean age = 10.17 ± 1.90) completed a music familiarity task using individually identified familiar compared to unfamiliar songs, while magnetoencephalography (MEG) was recorded. Each song was presented for 30 s. We used both amplitude envelope correlation (AEC) and the weighted phase lag index (wPLI) to assess functional connectivity between specific regions of interest (ROI) and non-ROI parcels, as well as at the whole brain level, to understand what is preserved and what is impaired in familiar music listening in this population. Results: Increased wPLI synchronization for familiar vs. unfamiliar music was found for typically developing children in the gamma frequency. There were no significant differences within the ASD group for this comparison. During the processing of unfamiliar music, we demonstrated left lateralized increased theta and beta band connectivity in children with ASD compared to controls. An interaction effect found greater alpha band connectivity in the TD group compared to ASD to unfamiliar music only, anchored in the left insula.Conclusion: Our results revealed atypical processing of unfamiliar songs in children with ASD, consistent with previous studies in other modalities reporting that processing novelty is a challenge for ASD. Relatively typical processing of familiar stimuli may represent a strength and may be of interest to strength-based intervention planning.
- Complex auditory musical hallucinations with ambivalent feelingsPublication . Canas-Simião, Hugo; Nascimento, Sandra Teles; Reis, João; Freitas, CarinaA 78-year-old woman with hypertension, diabetes mellitus type 2 and bilateral sensorineural hearing loss was referenced to geriatric psychiatry consultation. She presented cognitive dysfunction, erotomanic delusion and complex musical hallucinations (MH), described as hearing her neighbour singing a familiar church song along with bells in the background, making comments and talking to her. A computed tomography (CT) of the brain detected small right nucleocapsular and bilateral external capsules hypodensities of presumed vascular aetiology during hospitalisation. MH are a rare phenomenon with heterogeneous aetiology. Most frequently, the cause is hearing impairment; other causes include social isolation, cognitive dysfunction, vascular risk factors and medication. Studies suggest that some brain areas related to musical memory circuitry might be related and not fully mapped. Auditory verbal hallucinations with a voice that either comments, talks or sings to the patient have never been described in the literature, making this clinical case attractive.