Journal of affective disorders最新文献

Background: Borderline Personality Disorder (BPD) is a severe and heterogeneous psychiatric condition. Current research has some limitations: (1) findings from group (i.e., interindividual) analyses are often incorrectly generalized to individuals (i.e., intraindividual); and (2) research tends to emphasize common causes of symptomatology rather than exploring the interrelationships between symptoms.

Method: The current study aimed to analyze the intraindividual dynamics of central BPD symptoms using a temporal network analysis. Longitudinal measurement data collected over two years at regular six-month intervals in 212 patients diagnosed with BPD were used.

Results: The network analysis extracted temporal and contemporaneous intraindividual relationships, the former were directional relationships between previous emptiness and subsequent identity instability, as well as identity instability and anger dysregulation. Also, previous anger dysregulation predicted identity instability and subsequent emptiness. In the same time window, the contemporaneous network and its topology underscored the relevance of anger dysregulation for its relation to most BPD symptoms, including identity instability and suicidal intent.

Limitation: Measurements with widely spaced intervals do not capture symptom dynamics in a recording window similar to real-time.

Conclusion: Exploring the dynamic between anger dysregulation and identity instability may be crucial for understanding the severity of BPD at the individual level and could potentially inform treatment.

Purpose: Anxiety disorders are a major global issue. Diagnosis via symptoms, not biological causes, delivers poor treatment outcomes. Our frontal EEG biomarker, Goal Conflict Specific Rhythmicity (GCSR; 4-12 Hz), developed from our long-standing detailed neuropsychological theory of anxiety processes, is reduced by all chemical types of selective anxiolytic and is high in cases across a range of currently diagnosed anxiety disorders.

Methods: We assessed frontal sources of GCSR, recording scalp EEG at either low resolution (Experiment 1, 32 channels, University of Otago, ♀:33, ♂:16) or high resolution (Experiment 2, 128 channels, University of Auckland, ♀:10, ♂:8) in healthy participants performing a Stop Signal Task to generate GCSR as previously.

Principal results: sLORETA demonstrated GCSR sources consistently in the right inferior frontal gyrus and, more strongly but less consistently, medial frontal gyrus. Variation was consistent with that of stopping in the same Stop Signal Task, depending on task demands.

Major conclusions: The sources of GCSR are consistent with our theory that hippocampal output receives goal information, detects conflict, and returns a negative biasing signal to the areas encoding goals in the current task. They match the variation in the control of stopping when response urgency changes. GCSR appears to index a biological type of anxiety unlike any current diagnosis and should help improve accuracy of diagnosis - anchored to actions of selective anxiolytic drugs. This task-related frontal "theta" rhythmicity provides proof-of-concept for further development of our theory of the neuropsychology of anxiety in direct human tests.

Background: This analysis sought to identify potential clinical targets for the suicide crisis. Characteristics of a useful clinical target include elevation at the time of suicide crisis and responsiveness to rapid-acting interventions. Suicidal ideation (SI), depression, and hopelessness were hypothesized to meet these criteria.

Methods: Participants were 118 adults across the continuum of suicide risk, including 14 high-risk (HR) individuals who had attempted or seriously considered suicide within the last two weeks. Clinical characteristics were evaluated by: 1) comparing individuals with a recent crisis state to those whose suicide crises had resolved; 2) quantifying responses to a semi-structured interview about the time just before a suicide crisis; and 3) comparing symptomatology before and after an open-label ketamine infusion (0.5 mg/kg) in a subset of the HR group (n = 10).

Results: As hypothesized, SI, depression, and hopelessness were elevated just after a suicide crisis and responded to ketamine, although findings were mixed depending on the assessment used. Psychological pain and traumatic stress symptoms were also associated with the suicide crisis and responded to ketamine. Participants reported high levels of SI, depression, and anxiety just before their suicide attempt.

Limitations: Limitations include the small sample size, inconsistent assessments across analyses, and that ketamine was the only intervention examined.

Conclusions: These results underscore the importance of SI, depression, hopelessness, psychological pain, and traumatic stress in this population, all of which were elevated during the suicide crisis and responded to ketamine. A multifactorial and longitudinal approach is indicated to assess and treat suicide risk.

Background: Affective bias toward negativity is associated with depression and may represent a promising treatment target. Stimulating the dorsolateral prefrontal cortex (dlPFC) with deep Transcranial Magnetic Stimulation (dTMS) could lead to shifts in affective bias. The current study examined behavioral and neural correlates of affective bias in the context of dTMS in adolescents with treatment-resistant depression (TRD).

Methods: Adolescents completed a Word-Face Stroop (WFS) task during an fMRI scan before and after 30 sessions of dTMS targeting the left dlPFC. In the task, participants were shown words superimposed on faces in either a "congruent" (both word and face were positive or both negative) or an "incongruent" fashion; in both cases, participants identified whether the words were positive or negative. We examined pre-post intervention neural and behavioral WFS changes and their correlations with clinical improvement.

Results: Usable pre- and post-intervention WFS data were available for 10 adolescents with TRD (Age, years: M = 16.3, SD = 1.09) for behavioral data; 9 for neuroimaging data. After treatment, although changes in behavioral performance did not suggest improved affective bias, amygdala activation decreased during the negative word/happy face condition, which correlated with clinical improvement. Overall, clinical improvement correlated with decreased neural activation during congruent conditions.

Limitations: Major limitations include the small sample size, lack of a sham control group, and unknown psychometric properties.

Conclusions: Preliminary findings suggesting improving neural efficiency and normalizing affective bias in those with the most clinical improvement highlight the potential importance of targeting affective bias in treating adolescents with TRD.

Background: Self-criticism is a risk factor for depression and depressive symptom persistence, however higher degrees of self-criticism have been associated with greater antidepressant benefits from repetitive transcranial magnetic stimulation (rTMS), suggesting that self-criticism may act as a proxy for function of the targeted circuit. We test this hypothesis using secondary data from an rTMS treatment trial where an NMDA receptor agonist (D-Cycloserine) was used to enhance TMS synaptic plasticity to improve efficacy. We hypothesized that self-criticism would be more strongly associated with treatment outcome when stimulation was paired with D-Cycloserine than with a placebo.

Methods: In a 4-week single-site double-blind randomized placebo-controlled trial, fifty adults with Major Depressive Disorder (MDD) (NCT03937596) were randomized to receive placebo or D-Cycloserine (100 mg) with daily intermittent theta-burst stimulation (iTBS) to the left dorsolateral prefrontal cortex (DLPFC). At baseline and after treatment, self-criticism was assessed using the Depressive Experiences Questionnaire as a secondary trial outcome and depressive symptoms were assessed using the clinician rated Montgomery Asberg Depression Rating scale (MADRS). Clinical response was defined as a ≥50 % decrease on the MADRS.

Results: Self-criticism differentially predicted antidepressant effects when operationalized as both percent decrease on the MADRS and clinical response (≥50 % decrease), with a statistically significantly stronger association in the iTBS+D-Cycloserine group than the iTBS+Placebo condition. Self-criticism did not significantly change in either condition over the course of treatment.

Conclusions: Our data suggests that iTBS to the left DLPFC engages a circuit related to self-criticism. Higher levels of self-criticism predicted better response to iTBS with an adjuvant that enhances synaptic plasticity. This suggests that personality traits may be used to tailor non-invasive neurostimulation treatments.

Background: Deficits in working memory (WM) are common in patients with Major Depression Disorder (MDD). Previous research mainly in healthy adults indicated that physical exercise training may improve cognitive functions by stimulating neuronal plasticity particularly in hippocampal structures. Thus, the goal of this functional Magnetic Resonance Imaging (fMRI) study was to examine alterations in neuronal activity during a WM task and to investigate changes in brain volume and functioning following a physical exercise training in patients with MDD with a specific focus on hippocampal structures.

Methods: 86 (39 female) MDD outpatients (average age 37.3), diagnosed by clinical psychologists, were randomly assigned to one of three groups for a 12-week intervention: High intensity exercise training (HEX), low intensity exercise training (LEX) or waiting list control group (WL). An n-back task (with WM loads of 0, 1, 2, and 3) during fMRI was conducted before and after interventions/waiting period.

Results: Both exercise groups showed better performance and shorter reaction times at higher WM loads after 12-weeks of physical exercise training. Specifically in the HEX, we found an improvement in physical fitness and an increase in neural activation in the left hippocampus as compared to the WL following the exercise training. Training-related structural volume changes in gray matter or hippocampus were not detected.

Conclusions: Our results partly support the hypothesis that physical exercise training positively affects WM functions by improving neuronal plasticity in hippocampal regions. Exercise training seems to be a promising intervention to improve deficient WM performance in patients with MDD.

Clinical trials registration name: Neurobiological correlates and mechanisms of the augmentation of psychotherapy with endurance exercise in mild to moderate depression - SPeED, http://apps.who.int/trialsearch/Trial2.aspx?TrialID=DRKS00008869, DRKS00008869.

Background: Patients with major depressive disorder (MDD) hospitalized for psychiatric emergencies (PE) represent a high-risk population, requiring immediate intervention. Overall survival and healthcare resource utilization were evaluated among MDD patients with PE (MDD-PE) vs without PE (MDD-nonPE) using data from the Hungarian National Health Insurance Fund database (2009 to 2020).

Methods: Patients with MDD were selected if they had at least (i) 2 records of MDD diagnosis, or (ii) 1 record of MDD diagnosis and 1 prescription of antidepressant within 90 days of each other between 01 January 2010 and 31 December 2020. MDD-PE patients should have an inpatient hospitalization in a psychiatric ward dedicated for acute treatment, and/or a visit to an emergency department with ≥1 psychiatric and/or suicidal condition among the discharge diagnoses. Patients in the MDD-PE and MDD-nonPE cohorts were matched using a 1:1 propensity score matching algorithm based on age, gender, location of residence, and selected pre-index comorbidities.

Results: 28,988 MDD-PE and 28,988 MDD-nonPE patients were included after propensity score matching. Overall survival was significantly shorter among MDD-PE vs matched MDD-nonPE patients (HR: 1.40, 95%CI: 1.33-1.48; p < 0.001). MDD-PE (vs matched MDD-nonPE) patients had significantly higher mean all-cause inpatient admissions (3.9 vs 1.4, p < 0.001) per patient per year (PPPY), and MDD-related inpatient admissions (2.3 vs 0.7, p < 0.001) PPPY with more days in hospital PPPY (all-cause: 65.4 vs 17.4 days; MDD-related: 25.9 vs 8.7 days).

Conclusions: Findings emphasize the need for comprehensive care prioritizing increased vigilance for suicide risk and appropriate follow-up post-discharge among MDD-PE patients.

Background: This study investigated the associations between adverse childhood experiences (ACEs), adverse adulthood experiences (AAEs), allostatic load (AL) changes, and later depression symptoms trajectories in middle-aged and older Chinese longitudinally.

Methods: 1921 individuals aged ≥45 years at baseline were included from the China Health and Retirement Longitudinal Study (CHARLS). Measures included ACEs, AAEs, depression symptoms scores, health-related factors, and demographic characteristics. AL changes were assessed by the difference in AL scores between wave 3 (2015) and wave 1(2011).

Results: Compared to consistently low trajectory, 2 or more ACEs (OR 1.78, 95 % CI 1.28-2.46), 2 or more AAEs (OR 1.82, 95 % CI 1.26-2.64), decreasing metabolic AL over time (OR 0.63, 95 % CI 0.46-0.86), increasing inflammatory AL over time (OR 1.60, 95 % CI 1.07-2.37), and decreasing renal AL over time (OR 1.38, 95 % CI 1.01-1.87) were associated with the low-moderate depression symptoms trajectory. Furthermore, 2 or more ACEs (OR 1.48, 95 % CI 1.10-2.00), 2 or more AAEs (OR 1.85, 95 % CI 1.32-2.60), decreasing metabolic AL over time (OR 0.75, 95 % CI 0.57-1.00), increasing inflammatory AL over time (OR 1.69, 95 % CI 1.19-2.42) were associated with the high-moderate depression symptoms trajectory.

Conclusion: Experiencing more ACEs and AAEs was associated with higher depression symptoms trajectories. Moreover, participants with decreasing metabolic AL over time showed a low depression symptoms trajectory, while those with increasing inflammatory AL over time and decreasing renal AL over time showed a worse depression symptoms trajectory. These findings highlighted the physiological damage caused by stress on mental health outcomes.

Background: Limited research has been conducted on self-harm among preadolescents in China. This study investigated the influence of multidimensional stress on high levels of self-harm behavior in preadolescents.

Method: This large-scale cross-sectional study of 7-14-year-old primary school students in grades 3-6 was conducted in Southwest China between September and December 2020. Data on sociodemographic characteristics and multidimensional stressors were collected and analyzed.

Results: The self-harm prevalence among the 48,117 preadolescents was 13.6 % (n = 6561), with respective prevalence rates of 13.2 % in males and 14.1 % in females. Chi-square and binary logistic regression analyses were employed. The most important factors for self-harm were ranked as follows: high academic pressure (OR = 2.00, 95 % CI 1.90-2.09), poor relationship with parents (OR = 1.89, 95 % CI 1.78-2.00), frequently being bullied (OR = 1.53, 95 % CI 1.47-1.60), early-onset menstruation (OR = 1.33, 95 % CI 1.22-1.46), frequent smartphone use (OR = 1.31, 95 % CI 1.26-1.37), poor classmate relationships (OR = 1.31, 95 % CI 1.24-1.38), poor relationship between parents (OR = 1.11, 95 % CI 1.08-1.14), poor family financial situation (OR = 1.11, 95 % CI 1.05-1.17), and being bullied within the past 1 month (OR = 1.05, 95 % CI 1.02-1.07).

Limitations: The limitations of this study include its cross-sectional design, the use of a non-structured questionnaire, the subjectivity of some items, the reliance on a single question about self-harm, and the possibility that participants may have concealed the true nature of their behaviors.

Conclusion: Preadolescents in China exhibited high rates of self-harm behaviors. It is recommended that schools and families pay more attention to the mental health of preadolescent students, especially with regard to self-harm, and develop targeted interventions to address this issue.

Background: Invasive vagus nerve stimulation (iVNS) is approved for the treatment of major depressive disorder (MDD). The limited understanding of its underlying mechanisms, however, hinders stratification and the prediction of treatment response. Given the strong projections of the afferent vagal nucleus to brain regions involved in emotional processing, we tested whether acute transauricular VNS (taVNS) can improve emotional processing that is a core deficit in MDD.

Methods: We performed a randomized controlled trial. The facial emotion recognition task was performed by 52 participants with MDD and 44 controls during taVNS and sham stimulation. Linear mixed-effect models were used to evaluate the effect of taVNS.

Results: At baseline, we found a negative bias across all participants with lower accuracy in detecting positive facial expressions (F(1, 173) = 17.39, p < 0.001) and more misclassification towards negative facial expressions (F(1, 173) = 13.73, p < 0.001). Acute taVNS improved the accuracy of detecting positive facial expressions across all participants (F(1, 90.26) = 6.49, p = 0.013), both at low and high intensity. Moreover, fewer negative emotional states as quantified by visual analogue scales were reported during taVNS (F(1, 85) = 5.34, p = 0.023). The effect of taVNS on ratings of positive emotional states was group-dependent (F(1, 86) = 4.20, p = 0.044), as only controls reported less positive emotions (t = 2.06, p = 0.042).

Conclusion: Independent of diagnosis acute taVNS has an impact on emotional processing. Future studies need to explore whether these acute effects can serve as a predictive marker for the long-term impact of taVNS.