Integrative Objective Quantification of Individual Locomotor Behavior in Depressive Patients: Implications for Their Stratification and Personalized Treatment Monitoring
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Svetlozar Haralanov [1] ; Evelina Haralanova [1] ; Diana Bogdanova [1] ; Roumen Dimitrov [1] ; Emil Milushev [1] ; Diana Shkodrova [1]
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[1] University Hospital of Neurology and Psychiatry
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- Localización: Psychiatry and Neuroscience Update: From Epistemology to Clinical Psychiatry – Vol. IV / Pascual Ángel Gargiulo (ed. lit.), Humberto Luis Mesones Arroyo (ed. lit.), 2021, ISBN 978-3-030-61721-9, págs. 555-574
- Idioma: inglés
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Resumen
Psychomotor disturbances (PMDs) are cardinal symptoms of endogenous depressions, which are objectively measurable and might reflect their neurobiological mechanisms. However, in clinical practice, PMDs are evaluated and measured subjectively: through observation and rating scales. We have developed an original method for integrative objective quantification of the individual locomotor behavior (LMB) during execution of the stepping test of Unterberger. The method is based on computerized ultrasonic cranio-corpography (CCG) with subsequent spatial-temporal equilibriometric movement pattern analysis. It allows a very precise evaluation of bipolar deviations from the norm (toward inhibition or activation) in three distinct CCG parameters, relevant to PMDs: (1) conscious and volitional, self-initiated, goal-directed psychomotor activity; (2) unconscious and unintentional anteropulsion of the center of gravity; and (3) unconscious and automatic, lateral-medial protective psychomotor reactivity during the swing phase of locomotor cycle. Empirical data from cross-sectional and longitudinal examinations of 200 depressive patients compared to 200 matched healthy controls demonstrated that two contrasting poles of PMDs could be identified at the individual-patient level: with over-inhibited and over-activated LMB (hypolocomotion and hyperlocomotion). They could be better differentiated by a composite spatial-temporal equilibriometric psychomotor index, which integrates the degrees of deviation from the norm in the three CCG parameters. Moreover, we propose a new dopamine hypothesis that links hypolocomotion with underlying hypodopaminergia and hyperlocomotion with underlying hyperdopaminergia. Finally, our findings and conceptual analyzes are discussed in the light of their clinical implications for objective and quantitative stratification of depressive patients, which permits a more personalized treatment selection with subsequent instrumental treatment monitoring.
