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Abnormal behavior, often referred to as mental illness, results from changes in brain function that influence thought patterns, behaviors, and social interactions. Psychologists and psychiatrists typically assess abnormal behavior using three primary criteria: deviance, maladaptation, and personal distress, particularly when these traits persist over long periods.
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Sigmund Freud, an Austrian neurologist born in 1856, significantly influenced psychology through his exploration of the unconscious mind. His interest in patients suffering from hysteria and neurosis — conditions without apparent physical causes — led him to theorize the existence of an unconscious mind, a repository for feelings and urges beyond our awareness. Freud's innovative approach included techniques such as dream analysis, free association, and attention to slips of the...
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MAD or MADness?

Francesco Fulvio Faletra1, Giuseppe Sgarito2, Francesca Parisi2

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Mitral annular disjunction (MAD) is a structural abnormality sometimes seen in mitral valve prolapse (MVP). While often benign, MAD in MVP patients may increase the risk of arrhythmias and sudden cardiac death (SCD).

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Area of Science:

  • Cardiology
  • Cardiac Imaging
  • Electrophysiology

Background:

  • Mitral valve prolapse (MVP) affects ~3% of people, usually benignly.
  • A small percentage of MVP patients risk severe regurgitation, arrhythmias, or sudden cardiac death (SCD).
  • Mitral annular disjunction (MAD), a separation of the mitral annulus from myocardium, is investigated as a potential marker for malignant MVP.

Purpose of the Study:

  • To explore the association between mitral annular disjunction (MAD) and adverse outcomes in mitral valve prolapse (MVP).
  • To clarify the diagnostic challenges and clinical significance of MAD, particularly in relation to arrhythmias and SCD.

Main Methods:

  • Review of echocardiography, 3D echocardiography, cardiac MRI, and CT for MAD diagnosis.
  • Analysis of studies investigating MAD in both normal hearts and MVP patients.
  • Examination of hypotheses regarding MAD's role in arrhythmogenesis and SCD.

Main Results:

  • MAD is observed in normal hearts, often as a benign posterior annulus variant.
  • MAD in MVP patients, especially with leaflet redundancy, is linked to increased arrhythmia and SCD risk.
  • The precise causal role of MAD in SCD remains uncertain, potentially being an associated finding rather than a direct cause.

Conclusions:

  • Mitral annular disjunction (MAD) is not exclusive to pathological MVP and can be a benign finding.
  • However, MAD in the context of MVP warrants further investigation due to its association with arrhythmias and sudden cardiac death.
  • Advanced imaging aids in understanding MAD, but its definitive role in fatal arrhythmias requires more research.