Resting-state EEG delta power is associated with psychological pain in adults with a history of depression

Resting-state EEG features modulated by depressive state in healthy individuals: insights from theta PSD, theta-beta ratio, frontal-parietal PLV, and sLORETA

Depressive states in both healthy individuals and those with major depressive disorder exhibit differences primarily in symptom severity rather than symptom type, suggesting that there is a spectrum of depressive symptoms. The increasing prevalence of mild depression carries lifelong implications, emphasizing its clinical and social significance, which parallels that of moderate depression. Early intervention and psychotherapy have shown effective outcomes in subthreshold depression. Electroencephalography serves as a non-invasive, powerful tool in depression research, with many studies employing it to discover biomarkers and explore underlying mechanisms for the identification and diagnosis of depression. However, the efficacy of these biomarkers in distinguishing various depressive states in healthy individuals and in understanding the associated mechanisms remains uncertain. In our study, we examined the power spectrum density and the region-based phase-locking value in healthy individuals with various depressive states during their resting state. We found significant differences in neural activity, even among healthy individuals. Participants were categorized into high, middle, and low depressive state groups based on their response to a questionnaire, and eyes-open resting-state electroencephalography was conducted. We observed significant differences among the different depressive state groups in theta- and beta-band power, as well as correlations in the theta-beta ratio in the frontal lobe and phase-locking connections in the frontal, parietal, and temporal lobes. Standardized low-resolution electromagnetic tomography analysis for source localization comparing the differences in resting-state networks among the three depressive state groups showed significant differences in the frontal and temporal lobes. We anticipate that our study will contribute to the development of effective biomarkers for the early detection and prevention of depression.

Analysis of taVNS effects on autonomic and central nervous systems in healthy young adults based on HRV, EEG parameters

Objective.Transcutaneous auricular vagus nerve stimulation (taVNS), a non-invasive method of stimulating the vagus nerve, simultaneously affects the autonomic nervous system (ANS) and central nervous system (CNS) through efferent and afferent pathways. The purpose of this study is to analyze the effect of taVNS on the ANS and CNS through heart rate variability (HRV) and electroencephalography (EEG) parameters of identified responders.Approach.Two sets of data were collected from each of 10 healthy adult male subjects in their 20 s, and five HRV parameters from the time domain (RMSSD, pNN50, pNN30, pNN20, ppNNx) and two EEG parameters (power of alpha band, power of delta band) were extracted.Main results.Based on pNN50, responders to taVNS were identified; among them, pNN50 (p= 0.0041) and ppNNx (p= 0.0037) showed significant differences before and after taVNS. At the same time, for alpha power and delta power of EEG, significant difference (p< 0.05) was observed in most channels after taVNS compared to before stimulation.Significance.This study demonstrated the validity of identifying responders using pNN50 and the influence of taVNS on both the ANS and CNS. We conclude that taVNS can be used to treat a variety of diseases and as a tool to help control the ANS and CNS.

Adolescent nicotine exposure induces long-term, sex-specific disturbances in mood and anxiety-related behavioral, neuronal and molecular phenotypes in the mesocorticolimbic system

The majority of lifetime smokers begin using nicotine during adolescence, a critical period of brain development wherein neural circuits critical for mood, affect and cognition are vulnerable to drug-related insults. Specifically, brain regions such as the medial prefrontal cortex (mPFC), the ventral tegmental area (VTA), nucleus accumbens (NAc) and hippocampus, are implicated in both nicotine dependence and pathological phenotypes linked to mood and anxiety disorders. Clinical studies report that females experience higher rates of mood/anxiety disorders and are more resistant to smoking cessation therapies, suggesting potential sex-specific responses to nicotine exposure and later-life neuropsychiatric risk. However, the potential neural and molecular mechanisms underlying such sex differences are not clear. In the present study, we compared the impacts of adolescent nicotine exposure in male vs. female rat cohorts. We performed a combination of behavioral, electrophysiological and targeted protein expression analyses along with matrix assisted laser deionization imaging (MALDI) immediately post-adolescent exposure and later in early adulthood. We report that adolescent nicotine exposure induced long-lasting anxiety/depressive-like behaviors, disrupted neuronal activity patterns in the mPFC-VTA network and molecular alterations in various neural regions linked to affect, anxiety and cognition. Remarkably, these phenotypes were only observed in males and/or were expressed in the opposite direction in females. These findings identify a series of novel, sex-selective biomarkers for adolescent nicotine-induced neuropsychiatric risk, persisting into adulthood.

Relation between heart rate variability and spectral analysis of electroencephalogram in chronic neuropathic pain patients

Chronic neuropathic pain (CNP) is a complex condition often arising from neural maladaptation after nerve injury. Understanding CNP complications involves the intricate interplay between brain-heart dynamics, assessed through quantitative electroencephalogram (qEEG) and heart rate variability (HRV). However, insights into their interaction in chronic pain are limited. Resting EEG and simultaneous electrocardiogram (lead II) of the participants were recorded for qEEG and HRV analysis. Correlations between HRV and qEEG parameters were calculated and compared with age, sex, and body mass index (BMI)-matched controls. CNP patients showed reduced HRV and significant increases in qEEG power spectral densities within delta, theta, and beta frequency ranges. A positive correlation was found between low frequency/ high frequency (LF/HF) ratio in HRV analysis and theta, alpha, and beta frequency bands in qEEG among CNP patients. However, no significant correlation was observed between parasympathetic indices and theta, beta bands in qEEG within CNP group, unlike age, sex, and BMI-matched healthy controls. CNP patients display significant HRV reductions and distinctive qEEG patterns. While healthy controls exhibit significant correlations between parasympathetic HRV parameters and qEEG spectral densities, these relationships are diminished or absent in CNP individuals. LF/HF ratio, reflecting sympathovagal balance, correlates significantly with qEEG frequency bands (theta, alpha, beta), illuminating autonomic dysregulation in CNP. These findings emphasize the intricate brain-heart interplay in chronic pain, warranting further exploration.

The effects of electroencephalography functional connectivity during emotional recognition among patients with major depressive disorder and healthy controls

BACKGROUND

The brain of major depressive disorder (MDD) is associated with altered functional connectivity (FC) compared to that of healthy individuals when processing positive and negative visual stimuli. Building upon alterations in brain connectivity, some researchers have employed electroencephalography (EEG) to study FC in MDD, aiming to enhance both diagnosis and treatment; however, the results have been inconsistent and the studies involving FC during emotional recognition are limited. This study aims to 1) investigate the effects of MDD on EEG patterns during visual emotional processing, 2) explore the therapeutic effects of antidepressant treatment on brain FC within the first week, and assess whether these effects can be predictive of treatment outcomes four weeks later, and 3) study baseline FC parameter biomarkers that can be used to predict treatment responsiveness in MDD patients.

METHODS

This clinical observational study recruited 38 healthy controls (HC) and 48 MDD patients. Patients underwent an EEG exam while looking at validated images of happy and sad faces at week 0 and 1. MDD patients were categorized into treatment responders and non-responders after 4 weeks of treatment. We conducted the FC analysis (node strength (NS), global efficiency (GE), and cluster coefficient (CC)) on HC and MDD patients using graph theoretical analysis. Multivariable linear regression was used to evaluate the influence of MDD on FC compared to HC, while controlling for confounding variables including age, gender, and academic degrees.

RESULTS

At week 0 and week 1, MDD patients revealed to have significant reductions in FC parameters (NS, GE and CC) compared to HC. When comparing MDD patients at week 1 post-antidepressant treatment and pre-treatment, no significant differences in FC changes were observed. Multivariable regression revealed a significant negative effect on FC of MDD. Compared to the treatment non-responsive group, the responsive group revealed a significantly higher FC in delta band frequency at baseline.

CONCLUSIONS

MDD patient group showed impaired FC during visual emotion-processing and we observed baseline FC parameters to be associated with treatment response at week 4. While signs of FC changes were observed in the brain after a week of treatment, it is possible that one week may still be insufficient to demonstrate significant alterations in the brain. Our results suggest the potential utilization of EEG-based FC as an indicative measure for predicting treatment response and monitoring treatment progress in MDD patients.

Resting-state electroencephalography delta and theta bands as compensatory oscillations in chronic neuropathic pain: a secondary data analysis

Chronic neuropathic pain (CNP) remains a significant clinical challenge, with complex neurophysiological underpinnings that are not fully understood. Identifying specific neural oscillatory patterns related to pain perception and interference can enhance our understanding and management of CNP. To analyze resting electroencephalography data from individuals with chronic neuropathic pain to explore the possible neural signatures associated with pain intensity, pain interference, and specific neuropathic pain characteristics. We conducted a secondary analysis from a cross-sectional study using electroencephalography data from a previous study, and Brief Pain Inventory from 36 patients with chronic neuropathic pain. For statistical analysis, we modeled a linear or logistic regression by dependent variable for each model. As independent variables, we used electroencephalography data with such brain oscillations: as delta, theta, alpha, and beta, as well as the oscillations low alpha, high alpha, low beta, and high beta, for the central, frontal, and parietal regions. All models tested for confounding factors such as age and medication. There were no significant models for Pain interference in general activity, walking, work, relationships, sleep, and enjoyment of life. However, the model for pain intensity during the past four weeks showed decreased alpha oscillations, and increased delta and theta oscillations were associated with decreased levels of pain, especially in the central area. In terms of pain interference in mood, the model showed high oscillatory Alpha signals in the frontal and central regions correlated with mood impairment due to pain. Our models confirm recent findings proposing that lower oscillatory frequencies, likely related to subcortical pain sources, may be associated with brain compensatory mechanisms and thus may be associated with decreased pain levels. On the other hand, higher frequencies, including alpha oscillations, may disrupt top-down compensatory mechanisms.

Prediction of brain sex from EEG: using large-scale heterogeneous dataset for developing a highly accurate and interpretable ML model

This study presents a comprehensive examination of sex-related differences in resting-state electroencephalogram (EEG) data, leveraging two different types of machine learning models to predict an individual's sex. We utilized data from the Two Decades-Brainclinics Research Archive for Insights in Neurophysiology (TDBRAIN) EEG study, affirming that gender prediction can be attained with noteworthy accuracy. The best performing model achieved an accuracy of 85% and an ROC AUC of 89%, surpassing all prior benchmarks set using EEG data and rivaling the top-tier results derived from fMRI studies. A comparative analysis of LightGBM and Deep Convolutional Neural Network (DCNN) models revealed DCNN's superior performance, attributed to its ability to learn complex spatial-temporal patterns in the EEG data and handle large volumes of data effectively. Despite this, interpretability remained a challenge for the DCNN model. The LightGBM interpretability analysis revealed that the most important EEG features for accurate sex prediction were related to left fronto-central and parietal EEG connectivity. We also showed the role of both low (delta and theta) and high (beta and gamma) activity in the accurate sex prediction. These results, however, have to be approached with caution, because it was obtained from a dataset comprised largely of participants with various mental health conditions, which limits the generalizability of the results and necessitates further validation in future studies. . Overall, the study illuminates the potential of interpretable machine learning for sex prediction, alongside highlighting the importance of considering individual differences in prediction sex from brain activity.

Decreased beta 1 (12-15 Hertz) power modulates the transfer of suicidal ideation to suicide in major depressive disorder

BACKGROUND

Suicide prevention for major depressive disorder (MDD) is a worldwide challenge, especially for suicide attempt (SA). Viewing suicide as a state rather than a lifetime event provided new perspectives on suicide research.

OBJECTIVE

This study aimed to verify and complement SAs biomarkers of MDD with a recent SA sample.

METHODS

This study included 189 participants (60 healthy controls; 47 MDD patients with non-suicide (MDD-NSs), 40 MDD patients with suicide ideation (MDD-SIs) and 42 MDD patients with SA (MDD-SAs)). MDD patients with an acute SA time was determined to be within 1 week since the last SA. SUICIDALITY Part in MINI was applied to evaluate suicidality. Absolute powers in 14 frequency bands were extracted from subject's resting-state electroencephalography data and compared within four groups. The relationship among suicidality, the number of SA and powers in significant frequency bands were investigated.

RESULTS

MDD-SIs had increased powers in delta, theta, alpha and beta band on the right frontocentral channels compared to MDD-NSs, while MDD-SAs had decreased powers in delta, beta and gamma bands on widely the right frontocentral and parietooccipital channels compared to MDD-SIs. Beta 1 power was the lowest in MDD-SAs and was modulated by the number of SA. The correlation between suicidality and beta 1 power was negative in MDD-SAs and positive in MDD-SIs.

CONCLUSION

Reduced beta 1 (12-15 Hz) power could be essential in promoting suicidal behaviour in MDD. Research on recent SA samples contributes to a better understanding of suicide mechanisms and preventing suicidal behaviour in MDD.

Depressive states in healthy subjects lead to biased processing in frontal-parietal ERPs during emotional stimuli

Subthreshold depressive (sD) states and major depression are considered to occur on a continuum, and there are only quantitative and not qualitative differences between depressive states in healthy individuals and patients with depression. sD is showing a progressively increasing prevalence and has a lifelong impact, and the social and clinical impacts of sD are no less than those of major depressive disorder (MDD). Because depression leads to biased cognition, patients with depression and healthy individuals show different visual processing properties. However, it remains unclear whether there are significant differences in visual information recognition among healthy individuals with various depressive states. In this study, we investigated the event-related potentials (ERPs) and event-related spectrum perturbation (ERSP) of healthy individuals with various depressive states during the perception of emotional visual stimulation. We show that different neural activities can be detected even among healthy individuals. We divided healthy participants into high, middle, and low depressive state groups and found that participants in a high depressive state had a lower P300 amplitude and significant differences in fast and slow neural responses in the frontal and parietal lobes. We anticipate our study to provide useful parameters for assessing the evaluation of depressive states in healthy individuals.

The Link between Suicidality and Electroencephalography Asymmetry: A Systematic Review and Meta-analysis

As one of the leading causes of death globally, suicide has been researched extensively to better understand factors that confer risk or resilience for suicidality. Promising areas of the literature have focused on brain-based factors that might indicate susceptibility to suicide. Some studies have investigated the link between electroencephalography (EEG) asymmetry, referring to differences in electrical activity in the brain from the left to right hemisphere, and suicidality. The present study is a comprehensive review and meta-analysis of the literature to see if certain patterns in EEG asymmetry serve as a diathesis for suicidal thoughts and behaviors. The results of the current investigation found that EEG asymmetry was not systematically related to suicide based on the literature reviewed. While the present review does not rule out all brain-based factors, the findings suggest that EEG asymmetry may not be a biomarker for suicidality.

Psychological pain in depressive disorder: A concept analysis

AIM AND OBJECTIVES

The purpose of this paper is to identify a precise definition of the concept of psychological pain in the field of depressive disorder.

BACKGROUND

Psychological pain is widespread in patients with depressive disorder and plays a central role in the suicide process. However, psychological pain is currently complex and broadly defined and does not reflect the unique nature of psychological pain in depressed patients.

DESIGN

A concept analysis.

METHODS

Rodgers' evolutionary approach was used to analyse the concept of psychological pain in depressive disorders. PubMed, CINAHL, Embase, PsycINFO, Sinomed, CNKI, and Wanfang were searched and 49 articles met the inclusion criteria.

RESULTS

The key attributes of psychological pain were identified as negative affective perception, passive cognition and ineffective response, extreme behavioural tendency, and both state and trait characteristics. Antecedents included stressful life events, frustrated psychological needs, disease factors, physical factors, and negative cognitive biases. Consequences were the promotion of personal growth, enhanced meaning in life, low quality of life, barriers to treatment, high rates of psychiatric morbidity, self-harm, and suicide.

CONCLUSION

Psychological pain is a subjectively widespread, intense, and complex affective experience centered on feelings of suffering resulting from negative self-perceptions and ineffective coping based on personality traits. In addition, psychological pain has two traits: an immediate affective reflection arising from experiencing stressful life events and a persistent and stable emotional trait, respectively.

RELEVANCE TO CLINICAL PRACTICE

This study provides a conceptual framework to help clinical staff expand their knowledge of psychological pain and distinguish it from related terms. Interventions should address both the antecedents and the consequences and so this study suggests that future interventions could be developed in terms of positive emotions.

NO PATIENT OR PUBLIC CONTRIBUTION

This study did not recruit participants, therefore details of participants will not be involved.

A resting state EEG study on depressed persons with suicidal ideation

Background

Major Depressive Disorder (MDD) is a psychiatric illness that is often associated with potentially life-threatening physiological changes and increased risk for suicidal behavior. Electroencephalography (EEG) research suggests an association between depression and specific frequency imbalances in the frontal brain region. Further, while recently developed technology has been proposed to simplify EEG data acquisition, more research is still needed to support its use in patients with MDD.

Methods

Using the 14-channel EMOTIV EPOC cap, we recorded resting state EEG from 15 MDD patients with and MDD persons with suicidal ideation (SI) vs. 12 healthy controls (HC) to investigate putative power spectral density (PSD) between-group differences at the F3 and F4 electrode sites. Specifically, we explored 1) between-group alpha power asymmetries (AA), 2) between-group differences in delta, theta, alpha and beta power, 3) between PSD data and the scores in the Beck's Depression Inventory-II (BDI-II), Beck's Anxiety Inventory (BAI), Reasons for Living Inventory (RFL), and Self-Disgust Questionnaire (SDS).

Results

When compared to HC, patients had higher scores on the BAI (p = 0.0018), BDI-II (p = 0.0001) or SDS (p = 0.0142) scale and lower scores in the RFL (p = 0.0006) scale. The PSD analysis revealed no between-group difference or correlation with questionnaire scores for any of the measures considered.

Conclusions

The present study could not confirm previous research suggesting frequency-specific anomalies in depressed persons with SI but might suggest that frontal EEG imbalances reflect greater anxiety and negative self-referencing. Future studies should confirm these findings in a larger population sample.

Resting State EEG Correlates of Suicide Ideation and Suicide Attempt

Suicide is a global phenomenon that impacts individuals, families, and communities from all income groups and all regions worldwide. While it can be prevented if personalized interventions are implemented, more objective and reliable diagnostic methods are needed to complement interview-based risk assessments. In this context, electroencephalography (EEG) might play a key role. We systematically reviewed EEG resting state studies of adults with suicide ideation (SI) or with a history of suicide attempts (SAs). After searching for relevant studies using the PubMed and Web of Science databases, we applied the PRISMA method to exclude duplicates and studies that did not match our inclusion criteria. The selection process yielded seven studies, which suggest that imbalances in frontal and left temporal brain regions might reflect abnormal activation and correlate with psychological distress. Furthermore, asymmetrical activation in frontal and posterior cortical regions was detected in high-risk depressed persons, although the pattern in the frontal region was inverted in non-depressed persons. The literature reviewed suggests that SI and SA may be driven by separate neural circuits and that high-risk persons can be found within non-depressed populations. More research is needed to develop intelligent algorithms for the automated detection of high-risk EEG anomalies in the general population.

Low global frontal brain activity is associated with non-planned or impulsive suicide attempts. A preliminary study

BACKGROUND

Suicide prevention is limited by the frequent non-planned or impulsive nature of suicidal behavior. For instance, 25-62 % of suicide attempts, occur within 30 min of the onset of suicidal ideation. We aimed to examine frontal brain activity in depressed patients following a suicide attempt and its relationship with the duration of the suicidal process.

METHODS

We recruited 35 adult patients within three days of a suicide attempt of at least moderate lethality. Duration of the suicidal process was recorded in a semi-structured interview, including suicide contemplation (time from onset of suicidal ideation to decision to kill oneself) and suicide action intervals (time from the decision to kill oneself to suicide attempt). Resting state EEG data from AF7, AF8, TP9 and TP10 leads was collected with a portable MUSE 2 headband system. The average frequency values throughout a 5-minute portable EEG recording were extracted for delta (1-4 Hz), theta (4-8 Hz), alpha (8-13 Hz), and beta (13-30 Hz) waves.

RESULTS

Delta (r = 0.450, p = 0.021) and theta power (r = 0.395, p = 0.044) were positively correlated with the duration of the suicide action interval. There were no significant correlations of the suicide contemplation interval with clinical or EEG measures. Patients with suicide action interval shorter than 30 min showed lower delta power (U = 113, p = 0.049) compared with those with longer duration.

CONCLUSIONS

Lower theta and delta activity may reflect hindered cognitive control and inhibition in impulsive suicide attempters. Portable EEG may provide a valuable tool for clinical research and in the management of acutely suicidal patients.

Electroencephalogram and Physiological Responses as Affected by Slaughter Empathy in Goats

Recent advances in emotions and cognitive science make it imperative to assess the emotional stress in goats at the time of slaughter. The present study was envisaged to study the electroencephalogram and physiological responses as affected by slaughter empathy in goats. A total of 12 goats were divided into two groups viz., E-group (goats exposed to slaughter environment, n = 6) and S-group (goat slaughtered in front of E-group, n = 6). The electroencephalogram and physiological responses in male Boer cross goats (E-group) were recorded in a slaughterhouse in two stages viz., control (C) without exposure to the slaughter of conspecifics and treatment (T) while visualizing the slaughter of conspecifics (S—slaughter group). The exposure of the goat to the slaughter of a conspecific resulted in a heightened emotional state. It caused significant alterations in neurobiological activity as recorded with the significant changes in the EEG spectrum (beta waves (p = 0.000491), theta waves (p = 0.017), and median frequency MF or F50 (p = 0.002)). Emotional stress was also observed to significantly increase blood glucose (p = 0.031) and a non-significant (p = 0.225) increase in heart rate in goats. Thus, slaughter empathy was observed to exert a significant effect on the electric activity of neurons in the cerebrocortical area of the brain and an increase in blood glucose content.

Complexity and Entropy in Physiological Signals (CEPS): Resonance Breathing Rate Assessed Using Measures of Fractal Dimension, Heart Rate Asymmetry and Permutation Entropy

BACKGROUND

As technology becomes more sophisticated, more accessible methods of interpretating Big Data become essential. We have continued to develop Complexity and Entropy in Physiological Signals (CEPS) as an open access MATLAB® GUI (graphical user interface) providing multiple methods for the modification and analysis of physiological data.

METHODS

To demonstrate the functionality of the software, data were collected from 44 healthy adults for a study investigating the effects on vagal tone of breathing paced at five different rates, as well as self-paced and un-paced. Five-minute 15-s recordings were used. Results were also compared with those from shorter segments of the data. Electrocardiogram (ECG), electrodermal activity (EDA) and Respiration (RSP) data were recorded. Particular attention was paid to COVID risk mitigation, and to parameter tuning for the CEPS measures. For comparison, data were processed using Kubios HRV, RR-APET and DynamicalSystems.jl software. We also compared findings for ECG RR interval (RRi) data resampled at 4 Hz (4R) or 10 Hz (10R), and non-resampled (noR). In total, we used around 190-220 measures from CEPS at various scales, depending on the analysis undertaken, with our investigation focused on three families of measures: 22 fractal dimension (FD) measures, 40 heart rate asymmetries or measures derived from Poincaré plots (HRA), and 8 measures based on permutation entropy (PE).

RESULTS

FDs for the RRi data differentiated strongly between breathing rates, whether data were resampled or not, increasing between 5 and 7 breaths per minute (BrPM). Largest effect sizes for RRi (4R and noR) differentiation between breathing rates were found for the PE-based measures. Measures that both differentiated well between breathing rates and were consistent across different RRi data lengths (1-5 min) included five PE-based (noR) and three FDs (4R). Of the top 12 measures with short-data values consistently within ± 5% of their values for the 5-min data, five were FDs, one was PE-based, and none were HRAs. Effect sizes were usually greater for CEPS measures than for those implemented in DynamicalSystems.jl.

CONCLUSION

The updated CEPS software enables visualisation and analysis of multichannel physiological data using a variety of established and recently introduced complexity entropy measures. Although equal resampling is theoretically important for FD estimation, it appears that FD measures may also be usefully applied to non-resampled data.

How to measure mental pain: a systematic review assessing measures of mental pain

QUESTION

Although mental pain is present in many mental disorders and is a predictor of suicide, it is rarely investigated in research or treated in care. A valid tool to measure it is a necessary first step towards better understanding, predicting and ultimately relieving this pain.

STUDY SELECTION AND ANALYSIS

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we performed a systematic review to identify all published standardised measures of mental pain. We used qualitative content analysis to evaluate the similarity of each measure, quantified via Jaccard Index scores ranging from no similarity (0) to full similarity (1). Finally, using the Consensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology, we evaluated each measure's development (assessing 35 features), its content validity (31 features) and if the latter was rated at least adequate, its other psychometric properties.

FINDINGS

We identified 10 self-reported scales of mental pain in 2658 screened studies relying on diverse definitions of this construct. The highest average similarity coefficient for any given measure was 0.24, indicative of weak similarity (individual pairwise coefficients from 0 to 0.5). Little to no information was provided regarding the development and the content validity of all 10 scales. Therefore, their development and content validity were rated 'inadequate' or 'doubtful'.

CONCLUSIONS AND CLINICAL IMPLICATIONS

There is not enough evidence of validity to recommend using one measure over others in research or clinical practice. Heterogeneous use of disparate measures across studies limits comparison and combination of their results in meta-analyses. Development by all stakeholders (especially patients) of a consensual patient-reported measure for mental pain is needed.

PROSPERO REGISTRATION NUMBER

CRD42021242679.

Alterations in patients with first-episode depression in the eyes-open and eyes-closed conditions: A resting-state EEG study

Altered resting-state EEG activity has been repeatedly reported in major depressive disorder (MDD), but no robust biomarkers have been identified until now. The poor consistency of EEG alterations may be due to inconsistent resting conditions; that is, the eyes-open (EO) and eyes-closed (EC) conditions. Here, we explored the effect of the EO and EC conditions on EEG biomarkers for discriminating MDD subjects and healthy control (HC) subjects. EEG data were recorded from 30 first-episode MDD and 26 HC subjects during an 8-min resting-state session. The features were extracted using spectral power, Lempel-Ziv complexity, and detrended fluctuation analysis. Significant features were further selected via the sequential backward feature selection algorithm. Support vector machine (SVM), logistic regression, and linear discriminate analysis were used to determine a better resting condition to provide more reliable estimates for identifying MDD. Compared with the HC group, we found that the MDD group exhibited widespread increased β and γ powers (p < 0.01) in both conditions. In the EO condition, the MDD group showed increased complexity and scaling exponents in the α band relative to HC subjects (p < 0.05). The best classification performance of the combined feature sets was found in the EO condition, with the leave-one-out classification accuracy of 89.29%, sensitivity of 90.00%, and specificity of 88.46% using SVM with the linear kernel classifier when the threshold was set to 0.7, followed by the β and γ spectral features with an average accuracy of 83.93%. Overall, EO and EC conditions indeed affected the between-group variance, and the EO condition is suggested as the more separable resting condition to identify depression. Specially, the β and γ powers are suggested as potential biomarkers for first-episode MDD.

Changes in Brain Electrical Activity According to Post-traumatic Stress Symptoms in Survivors of the Sewol Ferry Disaster: A 1-year Longitudinal Study

Objective

The pathology of post-traumatic stress disorder (PTSD) is associated with changes in brain structure and function, especially in the amygdala, medial prefrontal cortex, hippocampus, and insula. Survivors of tragic accidents often experience psychological stress and develop post-traumatic stress symptoms (PTSS), regardless of the diagnosis of PTSD. This study aimed to evaluate electroencephalographic changes according to PTSS in victims of a single traumatic event.

Methods

This study enrolled 60 survivors of the Sewol ferry disaster that occurred in 2014 from Danwon High School and collected electroencephalographic data through 19 channels twice for each person in 2014 and 2015 (mean 451.88 [standard deviation 25.77] days of follow-up). PTSS was assessed using the PTSD Checklist-Civilian Version (PCL-C) and the participants were divided into two groups according to the differences in PCL-C scores between 2014 and 2015. Electroencephalographic data were converted to three-dimensional data to perform low-resolution electrical tomographic analysis.

Results

Significant electroencephalographic changes over time were observed. The group of participants with worsened PCL-C score showed an increased change of delta slow waves in Brodmann areas 13 and 44, with the largest difference in the insula region, compared to those with improved PCL-C scores.

Conclusion

Our findings suggests that the electrophysiological changes in the insula are associated with PTSS changes.

Trail Making Test Performance Using a Touch-Sensitive Tablet: Behavioral Kinematics and Electroencephalography

The Trail Making Test (TMT) is widely used to probe brain function and is performed with pen and paper, involving Parts A (linking numbers) and B (alternating between linking numbers and letters). The relationship between TMT performance and the underlying brain activity remains to be characterized in detail. Accordingly, sixteen healthy young adults performed the TMT using a touch-sensitive tablet to capture enhanced performance metrics, such as the speed of linking movements, during simultaneous electroencephalography (EEG). Linking and non-linking periods were derived as estimates of the time spent executing and preparing movements, respectively. The seconds per link (SPL) was also used to quantify TMT performance. A strong effect of TMT Part A and B was observed on the SPL value as expected (Part B showing increased SPL value); whereas the EEG results indicated robust effects of linking and non-linking periods in multiple frequency bands, and effects consistent with the underlying cognitive demands of the test.

The pain of grief: Exploring the concept of psychological pain and its relation to complicated grief, depression, and risk for suicide in bereaved adults

OBJECTIVE

Emotional or psychological pain is a core symptom of complicated grief (CG), yet its correlates are largely unexamined among bereaved individuals.

METHOD

Bereaved adults (N = 135) completed self-reports regarding psychological pain, CG, depression, and suicidality. We assessed correlations among these variables and tested whether psychological pain was elevated among individuals with CG and individuals with current or past suicidal thoughts and behaviors. Using logistic regression, we also assessed psychological pain, depression, and CG symptom severity as predictors of suicide risk.

RESULTS

Psychological pain was strongly associated with both CG and depression severity and was elevated among subjects reporting current or past suicidality. CG and depression were not statistically significant predictors of suicidal ideation after accounting for the effects of psychological pain.

CONCLUSIONS

Psychological pain is strongly associated with bereavement-related psychopathology and warrants further investigation in studies examining the nature and treatment of CG.

Research on Psychache in Suicidal Population: A Bibliometric and Visual Analysis of Papers Published During 1994-2020

Background: Psychache is a negative introspective experience, which is positively associated with the risk of suicide, independently of depression. It is undeniable that psychache is an important influencing factor to trigger suicide, which can also mediate the effect between depression and suicide variables. Nevertheless, the research tendency and current hotspots on psychache of suicide population have not been systematically investigated based on bibliometric analysis. Aim: The aim of the study was to analyze the research status, hotspots, and frontiers of psychological pain in the field of suicidology, so as to provide reference for domestic clinical research. Methods: The literature related to psychache in suicide individuals published from 1994 to 2020 was included and selected from the Web of Science Core Collection database on May 28, 2021. CiteSpace (version 5.7.R2) software was used to visualize and analyze highly cited journals, authors, and articles as well as co-occurrence analysis for countries, institution, authors, and keywords. Results: A total of 230 articles from the WoS database were included. The number of papers over the years showed an overall upward trend. The United States has made the largest contribution, with the majority of publications (89, 38.70%), followed by Canada (48, 20.87%), Israel (31, 13.48%), China (20, 8.80%), and Portugal (17, 7.39%). The most productive institution was Queen's University. Edwin S. Shneidman has the largest achievement and profound influence, and the most prolific author is Ronald R. Holden. However, the cooperation between institutions and authors was comparatively weak. The current hotspots in this field focus on the studies on the relationships between depression, despair, psychache, and suicide, the risk assessments of psychological pain, and the development of psychological pain scales. Suicide and Life-Threatening Behavior was the most frequently cited journal in this field. Conclusions: This analysis not only reveals the current research trend and hotspots but also provides some instructive suggestions on the development of psychache in the suicidology. Future work should pay more attention to develop effective psychological pain intervention programs for diverse suicide population. Additionally, longitudinal study can also be conducted to grasp the trajectory changes of psychological pain among suicide individuals.

Preclinical Considerations about Affective Disorders and Pain: A Broadly Intertwined, yet Often Under-Explored, Relationship Having Major Clinical Implications

Background: Pain, a distinctive undesirable experience, encompasses several different and fluctuating presentations across varying mood disorders. Therefore, the present narrative review aimed to shed further light on the matter, accounting for both experimental animal models and clinical observations about major depressive disorder (MDD) pathology. Method: Major databases were inquired from inception until April 2016 for records about MDD and pain. Results: Pain and MDD are tightly associated with each other in a bi-directional fashion. Several cross-sectional and retrospective studies indicated a high presence of pain in the context of mood disorders, including MDD (up to 65%), but also increased prevalence rates in the case of mood disorders documented among people with a primary diagnosis of either psychological or somatic pain (prevalence rates exceeding 45%). The clinical implications of these observations suggest the need to account for mood and pain manifestations as a whole rather than distinct entities in order to deliver more effective interventions. Limitations: Narrative review, lack of systematic control groups (e.g., people with the primary diagnosis at review, but not the associated comorbidity as a study) to allow reliable comparisons. Prevalence rates and clinical features associated with pain varied across different studies as corresponding operational definitions did. Conclusions: Pain may have a detrimental effect on the course of mood disorders-the opposite holds. Promoting a timely recognition and management of such an often neglected comorbidity would therefore represent a primary goal toward the delivery of effective, multi-disciplinary care.

"Nothing Hurts Less Than Being Dead": Psychological Pain in Case Descriptions of Psychiatric Euthanasia and Assisted Suicide from the Netherlands: « Rien ne fait moins mal qu'être mort »: La douleur psychologique dans les descriptions de cas d'euthanasie et de suicide assisté psychiatrique aux Pays-Bas

OBJECTIVES

Euthanasia and assisted suicide (EAS) of individuals with mental disorders is a growing practice in several countries, including the Netherlands. Here, we aimed to identify the most frequent dimensions of and associated factors to psychological pain, which has been associated with suicidality, in individuals undergoing psychiatric EAS.

METHODS

An exploratory retrospective content analysis of the English translation of 66 digital case records of individuals who died by EAS in the Netherlands between 2011 and 2014 was performed. Nine standard psychological pain dimensions (irreversibility, loss of control, emptiness, emotional flooding, freezing, social distancing, narcissistic wounds, confusion, and self-estrangement), illness, and sociodemographic variables were evaluated by 2 independent raters using a premade data abstraction form (Kohen κ > 0.8 in all cases).

RESULTS

The mean number of dimensions was 4.64 ± 1.20 (median = 5), out of 9. The most frequent dimensions were irreversibility, loss of control, emptiness, and emotional flooding, in decreasing order. Past treatment refusal and the mention of social connections in case descriptions were related to the higher number of psychological pain dimensions (4.89 ± 1.24 vs. 4.31 ± 1.07, P = 0.03 and 5.05 ± 1.17 vs. 4.43 ± 1.17, P = 0.03, respectively). Emotional flooding was the only dimension specifically associated with specific psychiatric conditions, namely posttraumatic phenomena and personality disorders.

CONCLUSIONS

Numerous psychological pain dimensions were detected in case descriptions of individuals who underwent EAS before the procedure. Subjective nature of the study precludes definite conclusions but suggest that future studies should explore psychological pain and the role of interventions targeting it in patients requesting EAS.

Disorders of human consciousness in the Tri-partite synapses

Conscious Action Theory extends quantum theory to macroscopic phenomena and suggests physical correlates of consciousness occur at the intersection of external measurement signals and internally generated signals from memories that model the outside world. This physical theory predicts conscious phenomena happen at all scales and differ only by the size and complexity of material organizations involved. At the scale of the human "Brain" consciousness is predicted to happen where the processing loop of activity in the Glial network interfaces with the real world input-output processing loop of the Nuronal network. This happens at the Tripartite synapses creating an intersection plenum in biological systems that produces the experience of empty space and the objects it contains. Analysis of the transmitter-receptor strengths implementing the control and feedback between the Glial and Neuronal networks indicate imbalances can be directly related to schizophrenia, mania, epilepsy, and depression. This paper addresses three topics supporting the above mechanisms for normal consciousness functioning and its medical deviations. First we preset the architecture of a pan-psychic physical theory, which supports the hypothesis that tri-partite synapses are the location of human conscious experience. Second we discuss the inner workings of the Glial network to support long term memory and control functions corresponding to the inner feeling of the "I" self. Third, we consider the relation between psychiatric conditions and the balance states between the number of neuronal transmitters and astrocytic receptors.

The acceptability of smokeless tobacco products depends on nicotine levels

Understanding the role nicotine plays in initiating and sustaining addiction has been of interest for the scientific community and general population, with the idea that low levels of nicotine will reduce abuse liability associated with smokeless tobacco products. Previously, research has relied on subjective assessments to determine consumer acceptability, but these measures cannot provide a characterization of the physiological responses associated with nicotine use. Consumer acceptability arises from psychological and neurophysiological factors, thus establishing the need to use subjective and objective measurements in conjunction. This study provides a comprehensive characterization of the subjective and objective effects of smokeless tobacco product use with varying levels of nicotine. EEG data were recorded before and after the use of four different smokeless tobacco products and one control product over five separate visits, with participants arriving to each visit after 12 h of tobacco abstinence. These products have distinct consumer acceptability levels and patterns of use characteristics ranging from starter products to those used primarily by established users. Subjective results showed that smokeless tobacco products with higher levels of nicotine were more successful in reducing craving and more reinforcing than those with lower levels. These results were concordant with the activity present in the EEG recordings where products with high nicotine levels produced larger changes in the amplitude of the event-related signal than those with low levels. This study is fundamental in understanding the relationship between subjective and objective smokeless tobacco acceptability measurements, as mediated by the different levels of nicotine in each product.

Exploration of time-frequency reassignment and homologous inter-hemispheric asymmetry analysis of MCI-AD brain activity

BACKGROUND

In this study, nonlinear based time-frequency (TF) and time domain investigations are employed for the analysis of electroencephalogram (EEG) signals of mild cognitive impairment-Alzheimer's disease (MCI-AD) patients and healthy controls. This study attempts to comprehend the cognitive decline of MCI-AD under both resting and cognitive task conditions.

RESULTS

Wavelet-based synchrosqueezing transform (SST) alleviates the smearing of energy observed in the spectrogram around the central frequencies in short-time Fourier transform (STFT), and continuous wavelet transform (CWT). A precise TF representation is assured due to the reassignment of scale variable to the frequency variable. It is discerned from the studies of time domain measures encompassing fractal dimension (FD) and approximate entropy (ApEn), that the parietal lobe is the most affected in MCI-AD under both resting and cognitive states. Alterations in asymmetry in the brain hemispheres are analysed using the homologous areas inter-hemispheric symmetry (HArS).

CONCLUSION

Time and time-frequency domain analysis of EEG signals have been used for distinguishing various brain states. Therefore, EEG analysis is highly useful for the screening of AD in its prodromal phase.

Impact of emotional and motivational regulation on putting performance: a frontal alpha asymmetry study

Background

The efficacy of emotional and motivational regulation can determine athletic performance. Giving the short duration and fast changing nature of emotions experienced by athletes in competition, it is important to examine the temporal dynamics of emotional and motivational regulation. The aim of this study was to investigate emotional and motivational regulation as measured by frontal alpha asymmetry in skilled golfers during putting performance after a performance failure.

Methods

Twenty skilled university golfers were recruited and requested to perform 40 putts at an individualized difficulty level of 40-60% successful putting rate. Trials immediately after a failed putt were selected for analysis. Successful performances were those trials where a hole was and unsuccessful performances were those that failed. The frontal alpha asymmetry index of LnF4-LnF3 was derived for statistical analysis.

Results

(1) Successful performance was preceded by a larger frontal alpha asymmetry index at T2 than that of T1, and (2) a larger frontal alpha asymmetry index was observed for unsuccessful performance than for successful performance at T1.

Discussion

The results suggest that successful emotional and motivational regulation was characterized by a progressive increase of frontal alpha asymmetry, which led to subsequent putting success when facing an emotionally provocative putting failure. These findings shed light on the application of frontal alpha asymmetry for the understanding and enhancement of emotional and motivational regulation during sport performance.

Evaluating the Contribution of EEG Power Profiles to Characterize and Discriminate Posttraumatic Stress Symptom Factors in a Combat-Exposed Population

This study investigated the use of resting-state electroencephalography (EEG) data to help differentiate posttraumatic stress disorder (PTSD) symptom factors. The sample, 147 combat-exposed OIF/OEF (Operation Iraqi Freedom/Operation Enduring Freedom) Veterans and service members, was a polytrauma population with variable PTSD and mild traumatic brain injury (mTBI) diagnoses. Participants completed the PTSD Checklist (PCL) and resting-state EEG was assessed for 10 minutes, with eyes closed. Regional averages of absolute power in alpha, beta, delta, and theta frequency bands were computed to estimate a single EEG common factor per band. An oblique 4 common-factor model was then fit to the 17 PCL items that included a residual EEG factor as an exogenous predictor with the group mean effect of mTBI on the EEG factor removed. Separate comparative model testing sequences for the alpha, beta, delta, and theta EEG factor frequency bands were conducted. An inverse relationship of delta and theta frequency bands on avoidance and numbing symptom factors (but not re-experiencing and hyperarousal) was found. Results provide evidence for possible neurobiological basis for the 4 PTSD symptom factors.

Electroencephalogram alpha asymmetry in patients with depressive disorders: current perspectives

PURPOSE

Electroencephalogram (EEG) alpha asymmetry (AA) in depressive disorders has been of interest over the last few decades, but it continues to remain unclear whether EEG AA can discriminate between healthy and depressive individuals.

MATERIALS AND METHODS

A systematic literature search for papers addressing EEG AA using the keywords alpha asymmetry, depression, and EEG was performed in PubMed. All studies were checked for sample size, gender, handedness, reference, recording protocol, EEG band range, impedance, type of analysis, drugs, and comorbidity.

RESULTS

A total of 61 articles were found, of which 44 met our inclusion criteria. They have been consecutively analyzed in respect of methodology and results. Approximately 25% (11/44) of the studies did not mention or ignored handedness, 41% (18/44) of the studies used data with only self-reported handedness, and only 34.1% (15/44) of all studies tested handedness. Only 35% (15/44) of the studies reported pharmacological treatment, and only 35% (15/44) of the studies controlled for medication. A total of 52% (23/44) of the studies reported comorbidity, and only 30% (13/44) of the studies controlled for comorbidity. Only 29.6% (13/44) of the studies reported education. In all, 30.5% (13/44) of the studies analyzed group differences and correlations, while 15.9 (7/44) of the studies used only correlational analyses. A total of 52.3% (23/44) of the studies analyzed only group differences. Alpha range was fixed (8-13 Hz) in 59.1% (26/44) of all studies. Reference to common average was used in seven of 44 studies (15.9%). In all, nine of 44 (20.5%) studies used the midline central position as reference, 22 of 44 (50%) studies used the ear or the mastoid as reference, and four of 44 (9.1%) studies used the nose as reference.

CONCLUSION

Discriminative power of EEG AA for depressed and healthy controls remains unclear. A systematic analysis of 44 studies revealed that differences in methodology and disregarding proper sampling are problematic. Ignoring handedness, gender, age, medication, and comorbidity could explain inconsistent findings. Hence, we formulated a guideline for requirements for future studies on EEG AA in order to allow for better comparisons.

Psychological Pain, Depression, and Suicide: Recent Evidences and Future Directions

PURPOSE OF REVIEW

The definition of psychological pain is complex. It is a lasting unpleasant and unsustainable feeling characterized by a perception of inability or deficiency of the self, as well as frustrated psychological needs and social disconnection. The aim of our review was to summarize the most recent and updated findings supporting the role of psychological pain in the pathophysiology of depression and suicidal behavior. We also explored the relationship between psychological and physical pain in depression and suicide.

RECENT FINDINGS

Psychological pain is a prominent dimension of depressive disorder and has been associated with higher risk of suicidal ideation and suicidal behavior. Sensitivity to psychological and physical pain is increased in depression. Conversely, higher tolerance to physical pain is associated with suicidal behavior. A better understanding of the pathophysiology of pain processing in depression and suicide offers new therapeutic options for the treatment of depression through the use of analgesic drugs.

A suicidal mind tends to maintain less negative information in visual working memory

The motivation to avoid psychological pain may characterize a suicidal mindset. This study examines how this motivational manifestation of suicidal ideation modulates the maintenance of affective information in visual working memory (WM). Forty-five outpatients with major depressive disorder (MDD) and twenty-five healthy participants performed visual WM change localization tasks with emotional (e.g., positive or negative schematic facial expressions) and non-emotional (e.g., colors) stimuli. The number of items that participants retained in WM (i.e., capacity) for each of those stimuli was measured. Based on the Beck Scale for Suicide Ideation, MDD patients were categorized into high and low suicidal ideation groups. These two groups had comparable depression levels. In addition to showing a smaller overall WM capacity for emotionally neutral information (colors), MDD patients with high suicidal ideation retained fewer negative schematic facial stimuli in WM. This disproportional reduction in the amount of negative information held in visual WM was correlated with levels of suicidal ideation and psychological pain across participants. Together, these results reveal the impact of pain avoidance motivation on information processing in WM and provide a novel perspective to understand aberrant cognitive patterns that are potentially driven by maladaptive affective processing in individuals with higher suicide risk.

Pleasure: The missing link in the regulation of sleep

Although largely unrecognized by sleep scholars, sleeping is a pleasure. This report aims first, to fill the gap: sleep, like food, water and sex, is a primary reinforcer. The levels of extracellular mesolimbic dopamine show circadian oscillations and mark the "wanting" for pro-homeostatic stimuli. Further, the dopamine levels decrease during waking and are replenished during sleep, in opposition to sleep propensity. The wanting of sleep, therefore, may explain the homeostatic and circadian regulation of sleep. Accordingly, sleep onset occurs when the displeasure of excessive waking is maximal, coinciding with the minimal levels of mesolimbic dopamine. Reciprocally, sleep ends after having replenished the limbic dopamine levels. Given the direct relation between waking and mesolimbic dopamine, sleep must serve primarily to gain an efficient waking. Pleasant sleep (i.e. emotional sleep), can only exist in animals capable of feeling emotions. Therefore, although sleep-like states have been described in invertebrates and primitive vertebrates, the association sleep-pleasure clearly marks a difference between the sleep of homeothermic vertebrates and cool blooded animals.

EEG correlates of induced anxiety in obsessive-compulsive patients: comparison of autobiographical and general anxiety scenarios

BACKGROUND

The underlying symptomatology of obsessive-compulsive disorder (OCD) can be viewed as an impairment in both cognitive and behavioral inhibition, regarding difficult inhibition of obsessions and behavioral compulsions. Converging results from neuroimaging and electroencephalographic (EEG) studies have identified changes in activities throughout the medial frontal and orbital cortex and subcortical structures supporting the cortico-striato-thalamo-cortical circuit model of OCD. This study aimed to elucidate the electrophysiological changes induced by autobiographical and general anxiety scenarios in patients with OCD.

METHODS

Resting-state eyes-closed EEG data were recorded in 19 OCD patients and 15 healthy controls. Cortical EEG sources were estimated by standardized low-resolution electromagnetic tomography (sLORETA). The changes in the emotional state were induced by two different scenarios: the autobiographical script related to patient's OCD symptoms and the script triggering general anxiety.

RESULTS

During the resting state, we proved increased delta activity in the frontal, limbic and temporal lobe and the sub-lobar area in OCD patients. In a comparison of neural activities during general anxiety in OCD patients and the control group, we proved an increase in delta (parietal, temporal, occipital, frontal and limbic lobes, and sub-lobal area), theta (temporal, parietal and occipital lobes) and alpha-1 activities (parietal lobe). Finally, we explored the neural activity of OCD patients during exposure to the autobiographic scenario. We proved an increase in beta-3 activity (left frontal lobe).

CONCLUSION

Our study proved differences in neural activation in OCD patients and healthy controls during imagination of general anxiety. Exposure to the autobiographic OCD scenario leads to activation of left frontal brain areas. The results show the possibility of using specific scenarios in OCD therapy.

Linking numbers to perceptions and experiences: Why we need transdisciplinary mixed-methods combining neurophysiological and qualitative data

Today, more and more problems that scientists need to tackle are complex problems. Many examples of these can be found in the health sciences, medicine and ecology. Typical features of complex problems are that they cannot be studied by one discipline and that they need to take into account subjective data as well as objective data. Two promising responses to deal with complex problems are Transdisciplinary and Mixed Method approaches. However, there is still a lacuna to fill, with transdisciplinary studies bridging the social sciences and biomedical sciences. More specifically, we need more and better studies that combine qualitative data about subjective experiences, perception and so on with objective, quantitative, neurophysiological data. We believe that the combination of qualitative and neurophysiological data is a good example of what we would like to call transdisciplinary mixed methods. In this article, we aim to explore the opportunities of transdisciplinary mixed-methods studies in which qualitative and neurophysiological data are used. We give a brief overview of what is characteristic for this kind of studies and illustrate this with examples; we point out strengths and limitations and propose an agenda for the future. We conclude that transdisciplinary mixed-methods studies in which qualitative and neurophysiological data are used have the potential to improve our knowledge about complex problems. A main obstacle seems to be that most scientists from the biomedical sciences are not familiar with the (qualitative) methods from the social sciences and vice versa. To end this ‘clash of paradigms’™, we urgently need to cultivate transdisciplinary thinking.

Altered insula-default mode network connectivity in fibromyalgia: a resting-state magnetoencephalographic study

Background

Fibromyalgia (FM) is a disabling chronic pain syndrome with unknown pathophysiology. Functional magnetic resonance imaging studies on FM have suggested altered brain connectivity between the insula and the default mode network (DMN). However, this connectivity change has not been characterized through direct neural signals for exploring the embedded spectrotemporal features and the pertinent clinical relevance.

Methods

We recorded the resting-state magnetoencephalographic activities of 28 patients with FM and 28 age- and sex-matched controls, and analyzed the source-based functional connectivity between the insula and the DMN at 1–40 Hz by using the minimum norm estimates and imaginary coherence methods. We also measured the connectivity between the DMN and the primary visual (V1) and somatosensory (S1) cortices as intrapatient negative controls. Connectivity measurement was further correlated with the clinical parameters of FM.

Results

Compared with the controls, patients with FM reported more tender points (15.2±2.0 vs. 5.9±3.7) and higher total tenderness score (TTS; 29.1±7.0 vs. 7.7±5.5; both p < 0.001); they also had decreased insula–DMN connectivity at the theta band (4–8 Hz; left, p = 0.007; right, p = 0.035), but displayed unchanged V1–DMN and S1–DMN connectivity (p > 0.05). When patients with FM and the controls were combined together, the insula-DMN theta connectivity was negatively correlated with the number of tender points (left insula, r = −0.428, p = 0.001; right insula, r = −0.4, p = 0.002) and TTS score (left insula, r = −0.429, p = 0.001; right insula, r = −0.389, p = 0.003). Furthermore, in patients with FM, the right insula–DMN connectivity at the beta band (13–25 Hz) was negatively correlated with the number of tender points (r = −0.532, p = 0.004) and TTS (r = −0.428, p = 0.023), and the bilateral insula–DMN connectivity at the delta band (1–4 Hz) was negatively correlated with FM Symptom Severity (left: r = −0.423, p = 0.025; right: r = −0.437, p = 0.020) and functional disability (Fibromyalgia Impact Questionnaire; left: r = −0.415, p = 0.028; right: r = −0.374, p = 0.050).

Conclusions

We confirmed the frequency-specific reorganization of the insula–DMN connectivity in FM. The clinical relevance of this connectivity change may warrant future studies to elucidate its causal relationship and potential as a neurological signature for FM.

Electronic supplementary material

The online version of this article (doi:10.1186/s10194-017-0799-x) contains supplementary material, which is available to authorized users.

Utility of a time frame in assessing psychological pain and suicide ideation

Background

Assessing psychological pain has been recommended as an integral part of a comprehensive suicide risk assessment. The Psychache Scale, an established measure of psychological pain, does not specify a time frame for when pain is experienced, which may inadvertently increase the likelihood of identifying individuals as being at elevated suicide risk when they complete the Psychache Scale based on psychological pain experienced at some undefined time in the past.

Methods

We conducted a national general population survey among United States adults to determine whether addition of a time frame to the instructions of the Psychache Scale would more accurately reflect current psychological pain and more effectively identify people with current suicide ideation. A between-subjects design was used where respondents were randomized to complete the original Psychache scale or a modified scale with time frame. Data were collected online from September 2015 to June 2016. A total of 242 respondents had complete psychological pain data: 133 completed the original Psychache Scale and 109 completed the Psychache Scale with time frame.

Results

Addition of a time frame did not result in differences in psychological pain scores. However, when screening for participants with current suicide ideation, 13% fewer false positives were observed with the modified scale at higher cut-off values than previously reported (38 vs. 24). The substantial increase in positive predictive value suggests that a time frame is a worthwhile addition to the Psychache Scale.

Discussion

We recommend using the Psychache Scale with a time frame and testing the cut-off score for suicide ideation in population samples that reflect the general population more accurately. Psychological pain cut-off scores in clinical samples have yet to be established.

Assessment of psychological pain in suicidal veterans

Psychological pain is a relatively understudied and potentially important construct in the evaluation of suicidal risk. Psychological pain also referred to as 'mental pain' or 'psychache' can be defined as an adverse emotional reaction to a severe trauma (e.g., the loss of a child) or may be associated with an illness such as depression. When psychological pain levels reach intolerable levels, some individuals may view suicide as the only and final means of escape. To better understand psychological pain, we previously developed and validated a brief self-rating 10-item scale, Mee-Bunney Psychological Pain Assessment Scale [MBP] in depressed patients and non-psychiatric controls. Our results showed a significant increase in psychological pain in the depressed patients compared to controls. We also observed a significant linear correlation between psychological pain and suicidality in the depressed patient cohort. The current investigation extends our study of psychological pain to a diagnostically heterogeneous population of 57 US Veterans enrolled in a suicide prevention program. In addition to the MBP, we administered the Columbia Suicide Severity Rating Scale (C-SSRS), Beck Depression Inventory (BDI-II), Beck Hopelessness Scale (BHS), and the Barratt Impulsiveness Scale (BIS-11). Suicidal patients scoring above a predetermined threshold for high psychological pain also had significantly elevated scores on all the other assessments. Among all of the evaluations, psychological pain accounted for the most shared variance for suicidality (C-SSRS). Stepwise regression analyses showed that impulsiveness (BIS) and psychological pain (MBP) contributed more to suicidality than any of the other combined assessments. We followed patients for 15 months and identified a subgroup (24/57) with serious suicide events. Within this subgroup, 29% (7/24) had a serious suicidal event (determined by the lethality subscale of the C-SSRS), including one completed suicide. Our results build upon our earlier findings and recent literature supporting psychological pain as a potentially important construct. Systematically evaluating psychological pain along with additional measures of suicidality could improve risk assessment and more effectively guide clinical resource allocation toward prevention.

Electroencephalographic Fractal Dimension in Healthy Ageing and Alzheimer's Disease

Brain activity is complex; a reflection of its structural and functional organization. Among other measures of complexity, the fractal dimension is emerging as being sensitive to neuronal damage secondary to neurological and psychiatric diseases. Here, we calculated Higuchi’s fractal dimension (HFD) in resting-state eyes-closed electroencephalography (EEG) recordings from 41 healthy controls (age: 20–89 years) and 67 Alzheimer’s Disease (AD) patients (age: 50–88 years), to investigate whether HFD is sensitive to brain activity changes typical in healthy aging and in AD. Additionally, we considered whether AD-accelerating effects of the copper fraction not bound to ceruloplasmin (also called “free” copper) are reflected in HFD fluctuations. The HFD measure showed an inverted U-shaped relationship with age in healthy people (R² = .575, p < .001). Onset of HFD decline appeared around the age of 60, and was most evident in central-parietal regions. In this region, HFD decreased with aging stronger in the right than in the left hemisphere (p = .006). AD patients demonstrated reduced HFD compared to age- and education-matched healthy controls, especially in temporal-occipital regions. This was associated with decreasing cognitive status as assessed by mini-mental state examination, and with higher levels of non-ceruloplasmin copper. Taken together, our findings show that resting-state EEG complexity increases from youth to maturity and declines in healthy, aging individuals. In AD, brain activity complexity is further reduced in correlation with cognitive impairment. In addition, elevated levels of non-ceruloplasmin copper appear to accelerate the reduction of neural activity complexity. Overall, HDF appears to be a proper indicator for monitoring EEG-derived brain activity complexity in healthy and pathological aging.

Does suicidal desire moderate the association between frontal delta power and psychological pain?

Psychological pain frequently underlies thoughts of suicide. We investigated if recent suicidal desire moderated the association between potential neurophysiological markers and psychological pain assessed on the Psychache Scale (PS) and the Orbach & Mikulincer Mental Pain Questionnaire (OMMP). The OMMP specifically assesses current psychological pain that may more readily capture emotions present during recent suicidal desire. In contrast, the PS leaves the timeframe undefined. A secondary analysis was conducted of resting-state EEG data and heart rate obtained in adults with a history of depression. In simultaneous multiple regression models, while controlling for depressive symptoms, recent suicidal desire moderated associations with right-frontal EEG delta power (ΔR² = .07, p < .01) and low-frequency heart rate variability (nonsignificantly) for pain assessed on the PS. No indication for moderation was found for pain on the OMMP. The relationship between the two measures of psychological pain was stronger for individuals with recent suicidal desire (r = .75, p < .01 vs. r = .50, p < .05). The findings suggest that, unless a respondent’s psychological pain is recent and substantial, the PS may not capture the intensity of current psychological pain as effectively as the OMMP.

Cognitive deficits in patients with obsessive-compulsive disorder - electroencephalography correlates

BACKGROUND

Obsessive-compulsive disorder (OCD) is associated with cognitive dysfunction. Although there are several studies focused on the neurobiology of OCD, little is known about the biological correlates of the cognitive deficit linked to this disorder. The aim of our study was to examine the association between cognitive impairment and current source density markers in patients with OCD.

METHODS

Resting-state eyes-closed electroencephalography (EEG) data were recorded in 20 patients with OCD and 15 healthy controls who were involved in the study. Cortical EEG sources were estimated by standardized low-resolution electromagnetic tomography in seven frequency bands: delta (1.5-6 Hz), theta (6.5-8 Hz), alpha-1 (8.5-10 Hz), alpha-2 (10.5-12 Hz), beta-1 (12.5-18 Hz), beta-2 (18.5-21 Hz), and beta-3 (21.5-30 Hz). Cognitive performance was measured by the Trail-Making Test (versions A and B), Stroop CW Test, and D2 Test.

RESULTS

Frontal delta and theta EEG sources showed significantly higher activity in the whole group of patients with OCD (N=20) than in control subjects (N=15). Subsequent analysis revealed that this excess of low-frequency activity was present only in the subgroup of eleven patients with cognitive impairment (based on the performance in the Trail-Making Test - A). The subgroup of patients with normal cognitive functions (N=9) did not differ in cortical EEG sources from healthy controls.

CONCLUSION

The present results suggest that frontal low-frequency cortical sources of resting-state EEG rhythms can distinguish groups of cognitively impaired and cognitively intact patients with OCD. Based on our results, future studies should consider whether the present methodological approach provides clinically useful information for the revelation of cognitive impairment in patients with OCD.