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Estaji R, Hosseinzadeh M, Arabgol F, Nejati V. Transcranial direct current stimulation (tDCS) improves emotion regulation in children with attention-deficit hyperactivity disorder (ADHD). Sci Rep 2024; 14:13889. [PMID: 38880826 PMCID: PMC11180663 DOI: 10.1038/s41598-024-64886-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 06/13/2024] [Indexed: 06/18/2024] Open
Abstract
Children with attention deficit/hyperactivity disorder (ADHD) typically exhibit difficulties in emotion regulation. It has been shown that the dorsolateral prefrontal cortex (dlPFC) and ventromedial prefrontal cortex (vmPFC) are crucially involved in these deficient processes. In this study, we aimed to explore the impact of electrical stimulation over the left dlPFC and right vmPFC on emotion regulation in children with ADHD. Twenty-four children with ADHD completed the Emotional Go/No-Go and Emotional 1-Back tasks while undergoing transcranial direct current stimulation (tDCS) in three separate sessions, each with a different electrode placement: anodal dlPFC (F3)/cathodal vmPFC (Fp2), anodal vmPFC (Fp2)/cathodal dlPFC (F3), and sham stimulation. During both real tDCS conditions, the accuracy of pre-potent inhibitory control and working memory performance improved, but not speed. This study provides evidence that the left dlPFC and the right vmPFC are involved in emotion regulation in ADHD.
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Affiliation(s)
- Reza Estaji
- Department of Psychology, Shahid Beheshti University, Tehran, Iran
| | - Mariam Hosseinzadeh
- Department of Psychiatry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fariba Arabgol
- Department of Psychiatry, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Behavioral Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Vahid Nejati
- Department of Psychology, Shahid Beheshti University, Tehran, Iran.
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Li Y, Zhao W, Peng X. Investigating mechanism of the effect of emotional facial expressions on attentional processing by data clustering approach. Sci Rep 2023; 13:6343. [PMID: 37072466 PMCID: PMC10113223 DOI: 10.1038/s41598-023-33197-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 04/08/2023] [Indexed: 05/03/2023] Open
Abstract
To explore the mechanism of the effect of emotional facial expression on attentional process, time course and topographic map of Electroencephalographic activities affected by emotional stimuli were investigated. Emotional Stroop task was used to collect 64-channel event-related potentials (ERP) in nonclinical participants, and data clustering was applied to find significant effect of sad and happy facial expression on ERP. Several significant ERP clusters were found in the sad and happy conditions respectively. In the sad condition, the decreased N170 in the bilateral parietooccipital areas, the increased P3 in the right centroparietal region and the increased negative deflection between 600 and 650 ms in the prefrontal regions were observed, these alterations reflected inhibited perceptual processing of sad facial expression, and increased activations of the orienting network and the executive control network in attentional system, respectively. In the happy condition, increased negative slow wave was found in the left centroparietal region indicating strengthened awareness and readiness for successive trials. Importantly, nonpathological attentional bias to sad facial expression in nonclinical participants was associated with inhibited perceptual processing and increased activations of the orienting and executive control networks. It provides the basis for better understanding and application of attentional bias in psychiatric clinical utilization.
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Affiliation(s)
- Yuezhi Li
- College of Mechatronics and Control Engineering, Shenzhen University, Shenzhen, 518060, Guangdong, China
| | - Weifeng Zhao
- Department of Psychiatry, Shenzhen Nanshan People's Hospital and the 6th Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, 518052, Guangdong, China.
| | - Xiaobo Peng
- College of Mechatronics and Control Engineering, Shenzhen University, Shenzhen, 518060, Guangdong, China
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Khafif TC, Kleinman A, Rocca CCDA, Belizário GO, Nader E, Caetano SC, Lafer B. Self-regulation in youth with bipolar disorder. REVISTA BRASILEIRA DE PSIQUIATRIA (SAO PAULO, BRAZIL : 1999) 2023; 45:20-27. [PMID: 35995462 PMCID: PMC9976910 DOI: 10.47626/1516-4446-2022-2668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 08/11/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To examine the composition of self-regulation in pediatric bipolar disorder (PBD) through the relationship between executive functions, emotion processing, and family environmental factors. METHODS 58 participants (36 with PBD and 22 controls), ages 12-17, were assessed using the Barratt Impulsiveness Scale (BIS), Conners' Continuous Performance Test (CPT-II), Wisconsin Cards Sorting Test (WCST), Computerized Neurocognitive Battery Emotion Recognition Test-Facial Emotion Recognition Test (PENNCNB ER-40), and Expressed Emotion Adjective Checklist Questionnaire (EEAC). RESULTS Adolescents with PBD displayed significant deficits in all three spheres when compared to the control group. Emotion processing correlated negatively with inhibition and attention, and correlated positively with mental flexibility/working memory. Family environmental factors correlated negatively with mental flexibility/working memory and emotion processing, and positively with attention and inhibition. These correlations indicate that better inhibitory control, attention, and mental flexibility/working memory are associated with greater emotion processing and a fitter family environment. CONCLUSION This study is the first to investigate all of the components of self-regulation deficits simultaneously in patients with PBD. Results suggest that self-regulation is essential for a comprehensive perspective of PBD and should be assessed in an integrative and multifaceted way. Understanding that self-regulation is impacted by the abovementioned factors should influence treatment and improve the functional impairments of daily life observed in this population.
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Affiliation(s)
- Tatiana Cohab Khafif
- Programa de Transtorno Bipolar, Departamento de Psiquiatria, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Ana Kleinman
- Programa de Transtorno Bipolar, Departamento de Psiquiatria, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Cristiana Castanho de Almeida Rocca
- Programa de Transtorno Bipolar, Departamento de Psiquiatria, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil. Unidade de Psicologia e Neuropsicologia, Faculdade de Medicina, USP, São Paulo, SP, Brazil
| | - Gabriel Okawa Belizário
- Programa de Transtorno Bipolar, Departamento de Psiquiatria, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Edmir Nader
- Programa de Transtorno Bipolar, Departamento de Psiquiatria, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Sheila C Caetano
- Departamento de Psiquiatria, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Beny Lafer
- Programa de Transtorno Bipolar, Departamento de Psiquiatria, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
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Slate SR, Busler JN, Mahon PB, Burdick KE. Age moderates the relationship between affective response inhibition and bipolar disorder in adults. J Affect Disord 2021; 295:298-304. [PMID: 34482062 PMCID: PMC8577218 DOI: 10.1016/j.jad.2021.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/05/2021] [Accepted: 08/18/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Patients with bipolar disorder (BD) often have impairments in neurocognition, including affective processing and affective response inhibition. While studies suggest that cognitive control in general may decline with age in BD, less is known about age-related changes in response inhibition to emotionally salient information. METHODS 258 participants with BD and 54 healthy controls, ages 18-70, completed the Cambridge Neuropsychological Test Automated Battery (CANTAB) Affective Go/No-Go task to assess affective response inhibition to positive and negative valenced stimuli. We examined the relationship between BD and affective response inhibition (number of commission and omission errors and reaction time), as well as a potential moderating effect of age, using mixed effects linear regression models. RESULTS The BD group made more omission and commission errors overall than the control group (p < 0.018). We observed a significant 3-way group-by-age-by-valence interaction for reaction time (p = 0.006). Within BD, a slower reaction time to negative than positive stimuli was found in middle and older age groups (p < 0.012), but not in the younger age group. No significant moderating effect of age was observed within the control group. CONCLUSIONS These cross-sectional findings indicate that compared with healthy controls, individuals with BD display differential and age-related effects in inhibition to emotionally salient information that is valence-dependent. The observed pattern of a switch in bias from negative to positive stimuli with age in BD may aid in our understanding of the progression of neurocognitive changes with aging in BD, as well as inform targeted treatments for cognitive symptoms.
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Affiliation(s)
- Sarah Rose Slate
- Brigham & Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Jessica N. Busler
- Brigham & Women’s Hospital, Harvard Medical School, Boston, MA, USA,Harvard T. H. Chan School of Public Health
| | - Pamela B. Mahon
- Brigham & Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Katherine E. Burdick
- Brigham & Women’s Hospital, Harvard Medical School, Boston, MA, USA,Corresponding author: Department of Psychiatry, Brigham & Women’s Hospital, Boston, MA 02115.
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Khafif TC, Rotenberg LDS, Nascimento C, Beraldi GH, Lafer B. Emotion regulation in pediatric bipolar disorder: A meta-analysis of published studies. J Affect Disord 2021; 285:86-96. [PMID: 33639359 DOI: 10.1016/j.jad.2021.02.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 01/14/2021] [Accepted: 02/01/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Emotion regulation is a relatively recent topic in psychiatry, and has only recently begun to be tested across Pediatric Bipolar Disorder (PBD). To date, no meta-analysis has investigated the presence of emotion regulation deficits in PBD patients. OBJECTIVES The aim of this study is to understand where the literature stands on this topic, as well as how different researchers are measuring and grasping the concept of emotion regulation in pediatric bipolar disorders. METHODS A systematic search of trials using the terms ("Pediatric Bipolar Disorder") AND ("Emotion Regulation" OR "Affect Regulation" OR "Mood Lability" OR "Mood Instability" OR "Irritability") was conducted using PubMed, Google Scholar, ResearchGate, Web of Science and Psych Info databases. Of the initial 366 articles identified, 8 met eligibility criteria for the meta-analysis and were included in this study. RESULTS There is a statistically significant difference in Accuracy in Emotion Regulation tasks, with a tendency for lower accuracy in PBD patients; however, both groups did not differ statistically regarding Response Time. CONCLUSION Our data suggests that PBD patients do present emotion regulation deficits, particularly regarding facial emotion recognition and affective language interference tasks mediated by cognitive assignments. These results have important implications in developing novel psychotherapeutic interventions for this population.
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Affiliation(s)
- Tatiana Cohab Khafif
- Bipolar Disorder Program (PROMAN), Department of Psychiatry, University of São Paulo Medical School, Rua Dr. Ovídio Pires de Campos, 785, São Paulo, Brazil.
| | - Luisa de Siqueira Rotenberg
- Bipolar Disorder Program (PROMAN), Department of Psychiatry, University of São Paulo Medical School, Rua Dr. Ovídio Pires de Campos, 785, São Paulo, Brazil
| | - Camila Nascimento
- Bipolar Disorder Program (PROMAN), Department of Psychiatry, University of São Paulo Medical School, Rua Dr. Ovídio Pires de Campos, 785, São Paulo, Brazil
| | - Gabriel Henrique Beraldi
- Bipolar Disorder Program (PROMAN), Department of Psychiatry, University of São Paulo Medical School, Rua Dr. Ovídio Pires de Campos, 785, São Paulo, Brazil
| | - Beny Lafer
- Bipolar Disorder Program (PROMAN), Department of Psychiatry, University of São Paulo Medical School, Rua Dr. Ovídio Pires de Campos, 785, São Paulo, Brazil
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Vaughn-Coaxum RA, Merranko J, Birmaher B, Dickstein DP, Hafeman D, Levenson JC, Liao F, Gill MK, Hower H, Goldstein BI, Strober M, Ryan ND, Diler R, Keller MB, Yen S, Weinstock L, Axelson D, Goldstein TR. Longitudinal course of depressive symptom severity among youths with bipolar disorders: Moderating influences of sustained attention and history of child maltreatment. J Affect Disord 2021; 282:261-271. [PMID: 33418377 PMCID: PMC8073228 DOI: 10.1016/j.jad.2020.12.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 12/10/2020] [Accepted: 12/21/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pediatric bipolar disorders are often characterized by disruptions in cognitive functioning, and exposure to child maltreatment (e.g., physical and sexual abuse) is associated with a significantly poorer course of illness. Although clinical and developmental research has shown maltreatment to be robustly associated with poorer cognitive functioning, it is unclear whether maltreatment and cognitive function jointly influence the clinical course of bipolar symptoms. METHODS This secondary analysis examined moderating effects of lifetime childhood physical and sexual abuse, and cognitive disruptions (sustained attention, affective information processing), on longitudinal ratings of depression symptom severity in youths from the Course and Outcome of Bipolar Youth (COBY) study, examined from intake (M = 12.24 years) through age 22 (N = 198; 43.9% female; Mean age of bipolar onset = 8.85 years). RESULTS A significant moderating effect was detected for sustained attention and maltreatment history. In the context of lower sustained attention, maltreatment exposure was associated with higher depression symptom severity during childhood, but not late adolescence. There was no association between maltreatment and symptom severity in the context of higher sustained attention, and no association between attention and depression symptom severity for non-maltreated youths. LIMITATIONS Depression symptom ratings at each assessment were subject to retrospective recall bias despite the longitudinal design. Cognitive assessments were administered at different ages across youths. CONCLUSIONS Depressive symptoms in pediatric bipolar may be jointly moderated by impairments in attention and exposure to maltreatment. Assessment of these risks, particularly in childhood, may be beneficial for considering risk of recurrence or chronicity of depressive symptoms.
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Affiliation(s)
| | | | | | - Daniel P. Dickstein
- McLean Hospital, Harvard Medical School,Brown University, Warren Alpert Medical School
| | | | | | - Fangzi Liao
- University of Pittsburgh, School of Medicine
| | | | - Heather Hower
- Brown University, Warren Alpert Medical School,University of California at San Diego, School of Medicine
| | | | - Michael Strober
- University of California at Los Angeles, David Geffen School of Medicine
| | | | - Rasim Diler
- University of Pittsburgh, School of Medicine
| | | | - Shirley Yen
- Brown University, Warren Alpert Medical School,Harvard Medical School, Beth Israel Deaconess Medical Center and Massachusetts Mental Health Center
| | | | - David Axelson
- Ohio State University, Nationwide Children’s Hospital
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7
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Personalized and precision medicine as informants for treatment management of bipolar disorder. Int Clin Psychopharmacol 2019; 34:189-205. [PMID: 30932919 DOI: 10.1097/yic.0000000000000260] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
DSM-5 diagnostic categories, defined by a set of psychopathological symptoms are heterogeneous conditions that may include different biological entities, with distinct etiopathogenesis, different courses and requiring different treatment management. For bipolar disorder the major evidences for this lack of validity are the long paths before a proper diagnosis, the inconsistence of treatment guidelines, the long phases of pharmacological adjustment and the low average of long-term treatment response rates. Personalized medicine for mental disorders aims to couple established clinical-pathological indexes with new molecular profiling to create diagnostic, prognostic and therapeutic strategies precisely tailored to each patient. Regarding bipolar disorder, the clinical history and presentation are still the most reliable markers in stratifying patients and guiding therapeutic management, despite the research goes to great lengths to develop new neuropsychological or biological markers that can reliably predict individual therapy effectiveness. We provide an overview of the advancements in personalized medicine in bipolar disorder, with particular attention to how psychopathology, age at onset, comorbidity, course and staging, genetic and epigenetic, imaging and biomarkers can influence treatment management and provide an integration to the conventional treatment guidelines. This approach may offer a new and rational path for the development of treatments for targeted subgroups of patients with bipolar disorder.
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8
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Emotional Understanding, Reactivity, and Regulation in Young Children with ADHD Symptoms. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2018; 45:1297-1310. [PMID: 27957717 DOI: 10.1007/s10802-016-0244-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The goal of the present study was to examine whether young children with attention-deficit/hyperactivity disorder (ADHD) symptoms experience difficulties with emotional understanding, reactivity, and regulation. Participants were 64 children, 4 to 7 years of age (43 boys, 20 girls), 29 with ADHD symptoms and 34 typically developing children. Children completed an emotion matching task and parents reported on child lability and emotional regulation. Children also completed a frustrating computer task. Facial expressions of emotions were coded and children self reported affect during the task. Parent reports indicated heightened lability and impaired emotional regulation abilities in children with ADHD symptoms. Compared to typically developing children, children with ADHD symptoms demonstrated emotional understanding impairments in matching similar expressions and matching expressions to situations, but not in producing expression labels or matching expression labels to images. Self-reports of negative affect during the frustration task indicated that children with ADHD symptoms experienced more difficulty with emotional regulation than typically developing children. Behavioral observations during the frustration task indicated that the two groups demonstrated a similar increase in expressed negative affect during frustration; however, children with ADHD symptoms showed higher levels of negative affect across all four conditions of the task. This study suggests that the deficits documented in older children with ADHD are already evident during the preschool years, and distinct from the developmentally appropriate emotional dysregulation seen in typically developing preschoolers.
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Cabeen RP, Laidlaw DH, Ruggieri A, Dickstein DP. Preliminary mapping of the structural effects of age in pediatric bipolar disorder with multimodal MR imaging. Psychiatry Res 2018; 273:54-62. [PMID: 29361347 PMCID: PMC5815932 DOI: 10.1016/j.pscychresns.2017.12.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 12/31/2017] [Accepted: 12/31/2017] [Indexed: 10/18/2022]
Abstract
This study investigates multimodal structural MR imaging biomarkers of development trajectories in pediatric bipolar disorder. T1-weighted and diffusion-weighted MR imaging was conducted to investigate cross-sectional group differences with age between typically developing controls (N = 26) and youths diagnosed with bipolar disorder (N = 26). Region-based analysis was used to examine cortical thickness of gray matter and diffusion tensor parameters in superficial white matter, and tractography-based analysis was used to examine deep white matter fiber bundles. Patients and controls showed significantly different maturation trajectories across brain areas; however, the magnitude of differences varied by region. The rate of cortical thinning with age was greater in patients than controls in the left frontal pole. While controls showed increasing fractional anisotropy (FA) and axial diffusivity (AD) with age, patients showed an opposite trend of decreasing FA and AD with age in fronto-temporal-striatal regions located in both superficial and deep white matter. The findings support fronto-temporal-striatal alterations in the developmental trajectories of youths diagnosed with bipolar disorder, and further, show the value of multimodal computational techniques in the assessment of neuropsychiatric disorders. These preliminary results warrant further investigation into longitudinal changes and the effects of treatment in the brain areas identified in this study.
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Affiliation(s)
- Ryan P Cabeen
- Laboratory of Neuro Imaging, USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA.
| | - David H Laidlaw
- Department of Computer Science, Brown University, Providence, RI, USA
| | - Amanda Ruggieri
- Pediatric Mood, Imaging & NeuroDevelopment Program, Bradley Hospital, Alpert Medical School of Brown University, Providence, RI, USA
| | - Daniel P Dickstein
- Pediatric Mood, Imaging & NeuroDevelopment Program, Bradley Hospital, Alpert Medical School of Brown University, Providence, RI, USA
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10
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Associations Among Posttraumatic Stress Disorder Symptoms, Substance Use, and Affective Attentional Processing in OEF/OIF/OND Veterans. J Nerv Ment Dis 2017; 205:725-731. [PMID: 28661934 PMCID: PMC9040388 DOI: 10.1097/nmd.0000000000000702] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The majority of research examining affective attentional bias in posttraumatic stress disorder (PTSD) has not examined the influence of co-occurring psychiatric disorders. This study examined the individual and interactive effects of PTSD symptoms and substance use disorders (SUDs) on affective attentional processing among 323 veterans deployed to Iraq or Afghanistan. Participants were divided into those with SUD (SUD+, n = 46) and those without (SUD-, n = 277). Substance use disorder was determined using the Structured Clinical Interview for DSM-IV. Posttraumatic stress disorder was measured using the Clinician Administered PTSD Scale. A computerized go/no-go task (Robbins et al., 1994, Robbins et al.,1998) assessed affective attentional processing. Relative to those without SUD, those with SUD showed a significant association between PTSD symptoms and increased omission and commission accuracy rates and decreased d prime. No effects of valence were found. Findings suggest the need to consider co-occurring SUD when investigating the effects of PTSD on attentional control.
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