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Dong L, Liang HB, Du J, Wang Y, Zhou Q, Xin Z, Hu Y, Liu YS, Zhao R, Qiao Y, Zhou C, Liu JR, Du X. Microstructural Differences of the Cerebellum-Thalamus-Basal Ganglia-Limbic Cortex in Patients with Somatic Symptom Disorders: a Diffusion Kurtosis Imaging Study. CEREBELLUM (LONDON, ENGLAND) 2023; 22:840-851. [PMID: 35986875 DOI: 10.1007/s12311-022-01461-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/14/2022] [Indexed: 06/15/2023]
Abstract
Somatic symp tom disorders (SSDs) are a group of psychiatric disorders characterized by persistent disproportionate concern and obsessive behaviors regarding physical conditions. Currently, SSDs lack effective treatments and their pathophysiology is unclear. In this paper, we aimed to examine microstructural abnormalities in the brains of patients with SSD using diffusion kurtosis imaging (DKI) and to investigate the correlation between these abnormalities and clinical indicators. Diffusion kurtosis images were acquired from 30 patients with SSD and 30 healthy controls (HCs). Whole-brain maps of multiple diffusion measures, including fractional anisotropy (FA), axial diffusivity (AD), radial diffusivity (RD), mean diffusivity (MD), mean kurtosis (MK), radial kurtosis (RK), and axial kurtosis (AK), were calculated. To analyze differences between the two groups, nonparametric permutation testing with 10,000 randomized permutations and threshold-free cluster enhancement was used with family-wise error-corrected p values < 0.05 as the threshold for statistical significance. Then, the correlations between significant changes in these diffusion measures and clinical factors were examined. Compared to HCs, patients with SSD had significantly higher FA, MK, and RK and significantly lower MD and RD in the cerebellum, thalamus, basal ganglia, and limbic cortex. The FA in the left caudate and the pontine crossing tract were negatively correlated with disease duration; the MD and the RD in the genu of the corpus callosum were positively correlated with disease duration. Our findings highlight the role of the cerebellum-thalamus-basal ganglia-limbic cortex pathway, especially the cerebellum, in SSDs and enhance our understanding of the pathogenesis of SSDs.
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Affiliation(s)
- Liao Dong
- Department of Psychology, Shanghai University of Sport, Shanghai, 200438, China
- Shanghai Key Laboratory of Magnetic Resonance and Department of Physics, School of Physics and Electronic Science, East China Normal University, Shanghai, 200062, China
| | - Huai-Bin Liang
- Department of Neurology &Jiuyuan Municipal Stroke Center, Shanghai 9Th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
- Clinical Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Jiaxin Du
- Centre for Advanced Imaging, The University of Queensland, St Lucia, QLD, 4072, Australia
| | - Yingying Wang
- Department of Psychology, Shanghai University of Sport, Shanghai, 200438, China
| | - Qichen Zhou
- Department of Psychology, Shanghai University of Sport, Shanghai, 200438, China
| | - Ziyue Xin
- Department of Psychology, Shanghai University of Sport, Shanghai, 200438, China
| | - Yue Hu
- Department of Neurology &Jiuyuan Municipal Stroke Center, Shanghai 9Th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
- Clinical Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Yi-Sheng Liu
- Department of Neurology &Jiuyuan Municipal Stroke Center, Shanghai 9Th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Rong Zhao
- Department of Neurology &Jiuyuan Municipal Stroke Center, Shanghai 9Th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
- Clinical Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Yuan Qiao
- Department of Neurology &Jiuyuan Municipal Stroke Center, Shanghai 9Th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
- Clinical Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Chenglin Zhou
- Department of Psychology, Shanghai University of Sport, Shanghai, 200438, China
| | - Jian-Ren Liu
- Department of Neurology &Jiuyuan Municipal Stroke Center, Shanghai 9Th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China.
- Clinical Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China.
| | - Xiaoxia Du
- Department of Psychology, Shanghai University of Sport, Shanghai, 200438, China.
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Su Q, Yu M, Liu F, Zhang Z, Lei M, Jiang Y, Luo T, Guo W. Frequency-specific alterations of the frontal-cerebellar circuit in first-episode, drug-naive somatization disorder. J Affect Disord 2021; 280:319-325. [PMID: 33221718 DOI: 10.1016/j.jad.2020.11.090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 09/28/2020] [Accepted: 11/08/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND With the development of imaging techniques, evidence of abnormal neural activity has been implicated in patients with somatization disorder (SD). It remains unclear whether abnormal spontaneous neural activities are related to specific frequency bands. In this study, resting-state functional magnetic resonance imaging (fMRI) using the frequency-specific amplitude of low frequency fluctuation (ALFF) approach was applied to investigate changes in spontaneous neural activity in different frequency bands in patients with SD. METHODS Twenty-five first-episode, medication-naive patients with SD and 28 age-, sex-, education-matched healthy controls (HCs) underwent resting-state fMRI. The ALFF method with the classical low-frequency (0.01 - 0.08 Hz), slow-5 (0.01 - 0.027 Hz) and slow-4 (0.027 - 0.08 Hz) bands was employed to analyze the data. RESULTS With the classical low-frequency and slow-5 bands, patients with SD showed significantly increased ALFF in the left orbitofrontal cortex (OFC) and reduced ALFF in the right cerebellum compared with HCs. With the slow-4 band, patients with SD exhibited significantly reduced ALFF in the right cerebellum compared with HCs. However, no significant correlation was observed between the ALFF value in the left OFC or right cerebellum and clinical/cognitive variables. CONCLUSIONS Our findings indicate that there are abnormal regional activities of the left OFC and right cerebellum in first-episode, treatment-naive patients with SD, suggesting that these alterations occur early in the course of the disease and are independent of medication status. Our study provides novel evidence that different regional activities of the frontal-cerebellar circuit may be involved in the pathophysiology of SD.
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Affiliation(s)
- Qinji Su
- Mental Health Center, The Second Affiliated Hospital, Guangxi Medical University; Nanning, Guangxi 530021, China
| | - Miaoyu Yu
- Mental Health Center, The Second Affiliated Hospital, Guangxi Medical University; Nanning, Guangxi 530021, China
| | - Feng Liu
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Zhikun Zhang
- Mental Health Center, The Second Affiliated Hospital, Guangxi Medical University; Nanning, Guangxi 530021, China
| | - Meiying Lei
- Mental Health Center, The Second Affiliated Hospital, Guangxi Medical University; Nanning, Guangxi 530021, China
| | - Yongmei Jiang
- Mental Health Center, The Second Affiliated Hospital, Guangxi Medical University; Nanning, Guangxi 530021, China
| | - Tiantian Luo
- Mental Health Center, The Second Affiliated Hospital, Guangxi Medical University; Nanning, Guangxi 530021, China
| | - Wenbin Guo
- Mental Health Center, The Second Affiliated Hospital, Guangxi Medical University; Nanning, Guangxi 530021, China; Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China; National Clinical Research Center on Mental Disorders, Changsha, Hunan 410011, China.
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Rossetti MG, Delvecchio G, Calati R, Perlini C, Bellani M, Brambilla P. Structural neuroimaging of somatoform disorders: A systematic review. Neurosci Biobehav Rev 2020; 122:66-78. [PMID: 33359097 DOI: 10.1016/j.neubiorev.2020.12.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 11/25/2020] [Accepted: 12/16/2020] [Indexed: 10/22/2022]
Abstract
Although there has been an increment in neuroimaging research in somatoform disorders (SD), to date little is known about the neural correlates of these diseases. Therefore, in this systematic, review we aimed at summarizing the existing evidence of structural brain alterations in SD as per DSM-IV and DSM-5 criteria. Three electronic databases (Scopus, PubMed and Web of Science) were searched. Only case-control studies using structural neuroimaging were included. Forty-five out of 369 articles fulfilled inclusion criteria and were reviewed. Compared to controls, subjects with SD showed morphological alterations encompassing motor, limbic and somatosensory circuits. Although far from being conclusive, the results suggested that SD are characterized by selective alterations of large-scale brain networks implicated in cognitive control, emotion regulation and processing, stress and somatic-visceral perception. This review highlights the need for further multimodal neuroimaging studies with longitudinal designs, in larger and better-characterized samples, to elucidate the temporal and causal relationship between neuroanatomical changes and SD, which is paramount for informing tailored treatments.
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Affiliation(s)
- Maria Gloria Rossetti
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Italy; Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giuseppe Delvecchio
- University of Milan, Department of Pathophysiology and Transplantation, Milan, Italy
| | - Raffaella Calati
- Department of Psychology, University of Milano-Bicocca, Milan, Italy; Department of Adult Psychiatry, Nîmes University Hospital, Nîmes, France
| | - Cinzia Perlini
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Clinical Psychology, University of Verona, Verona, Italy; USD Clinical Psychology, Azienda Ospedaliera Universitaria Integrata (AOUI) of Verona, Verona, Italy
| | - Marcella Bellani
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Italy; UOC Psychiatry, Azienda Ospedaliera Universitaria Integrata (AOUI) of Verona, Verona, Italy
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; University of Milan, Department of Pathophysiology and Transplantation, Milan, Italy.
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Zhao J, Su Q, Liu F, Zhang Z, Yang R, Guo W, Zhao J. Enhanced Connectivity of Thalamo-Cortical Networks in First-Episode, Treatment-Naive Somatization Disorder. Front Psychiatry 2020; 11:555836. [PMID: 33061917 PMCID: PMC7518236 DOI: 10.3389/fpsyt.2020.555836] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 08/18/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Dysfunctions of the thalamus and its projections to cortical cortices have been implicated in patient with somatization disorder (SD). However, changes in the anatomical specificity of thalamo-cortical functional connectivity (FC) in SD remain unclear. METHODS Resting-state fMRI scans were collected in 25 first-episode, drug-naive patients with SD, as well as 28 sex-, age-, and education-matched healthy controls. We parcellated the thalamus with seven predefined regions of interest (ROIs) and used them as seeds to map whole-brain FC. Correlation analysis was conducted in the patients. RESULTS We found an increased pattern of thalamic ROI-cortex connectivity in patients with SD. Patients with SD demonstrated enhanced thalamic connectivity to the bilateral anterior/middle cingulum, motor/sensory cortex, visual cortex, and auditory cortex. A significantly negative correlation was found between the right occipital thalamic ROI to the anterior cingulum and EPQ extraversion scores (r=0.404, p=0.045) after the Benjamini-Hochberg correction. CONCLUSIONS This study demonstrates that anatomical specificity of enhanced thalamo-cortical FCs exists in first-episode, drug-naive patients with SD. These findings further highlight the importance of the thalamic subregions in the pathophysiology of SD.
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Affiliation(s)
- Jin Zhao
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China.,Department of Psychiatry, Henan Mental Hospital, Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Qinji Su
- Mental Health Center, the Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Feng Liu
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Zhikun Zhang
- Mental Health Center, the Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Ru Yang
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Wenbin Guo
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China.,Department of Psychiatry, The Third People's Hospital of Foshan, Foshan, China
| | - Jingping Zhao
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China
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Bègue I, Adams C, Stone J, Perez DL. Structural alterations in functional neurological disorder and related conditions: a software and hardware problem? Neuroimage Clin 2019; 22:101798. [PMID: 31146322 PMCID: PMC6484222 DOI: 10.1016/j.nicl.2019.101798] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 03/20/2019] [Accepted: 03/26/2019] [Indexed: 01/01/2023]
Abstract
Functional neurological (conversion) disorder (FND) is a condition at the interface of neurology and psychiatry. A "software" vs. "hardware" analogy describes abnormal neurobiological mechanisms occurring in the context of intact macroscopic brain structure. While useful for explanatory and treatment models, this framework may require more nuanced considerations in the context of quantitative structural neuroimaging findings in FND. Moreover, high co-occurrence of FND and somatic symptom disorders (SSD) as defined in DSM-IV (somatization disorder, somatoform pain disorder, and undifferentiated somatoform disorder; referred to as SSD for brevity in this article) raises the possibility of a partially overlapping pathophysiology. In this systematic review, we use a transdiagnostic approach to review and appraise the structural neuroimaging literature in FND and SSD. While larger sample size studies are needed for definitive characterization, this article highlights that individuals with FND and SSD may exhibit sensorimotor, prefrontal, striatal-thalamic, paralimbic, and limbic structural alterations. The structural neuroimaging literature is contextualized within the neurobiology of stress-related neuroplasticity, gender differences, psychiatric comorbidities, and the greater spectrum of functional somatic disorders. Future directions that could accelerate the characterization of the pathophysiology of FND and DSM-5 SSD are outlined, including "disease staging" discussions to contextualize subgroups with or without structural changes. Emerging neuroimaging evidence suggests that some individuals with FND and SSD may have a "software" and "hardware" problem, although if structural alterations are present the neural mechanisms of functional disorders remain distinct from lesional neurological conditions. Furthermore, it remains unclear whether structural alterations relate to predisposing vulnerabilities or consequences of the disorder.
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Affiliation(s)
- Indrit Bègue
- Department of Psychiatry, University of Geneva, Switzerland; Service of Adult Psychiatry, Department of Mental Health and Psychiatry, University Hospitals of Geneva, Switzerland; Laboratory for Behavioral Neurology and Imaging of Cognition, Geneva Neuroscience Center, University of Geneva, Switzerland
| | - Caitlin Adams
- Functional Neurology Research Group, Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Inpatient Psychiatry Division, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jon Stone
- Centre for Clinical Brain Sciences, Western General Hospital, NHS Lothian and University of Edinburgh, Edinburgh, UK
| | - David L Perez
- Functional Neurology Research Group, Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA.
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