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Robles E, Angelone C, Ondé D, Vázquez C. Somatic symptoms in the general population of Spain: Validation and normative data of the Patient Health Questionnaire-15 (PHQ-15). J Affect Disord 2024; 362:762-771. [PMID: 39029703 DOI: 10.1016/j.jad.2024.07.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 07/01/2024] [Accepted: 07/14/2024] [Indexed: 07/21/2024]
Abstract
OBJECTIVE The Patient Health Questionnaire (PHQ-15) has been widely used to assess somatic symptoms. This study aimed to analyze the psychometric properties of the Spanish version of the PHQ-15, its structure and score distribution across demographic variables in a Spanish sample. In addition, we examined variations in somatic symptoms among different demographic subgroups. METHOD 1495 individuals from the Spanish population answered a series of self-reported measures, including PHQ-15. To examine the factorial structure of the PHQ-15, Confirmatory Factor Analysis (CFA) was performed. Additionally, a bifactor CFA model was examined using the Exploratory Structural Equation Modeling (ESEM) framework. RESULTS Women showed more somatic symptoms than men, and younger individuals showed more somatic symptoms than the older ones. It was also revealed positive associations between somatic symptoms and levels of depression, anxiety, and suspiciousness, while negative associations were found between somatic symptoms and perceived resilience and happiness. Regarding the factorial structure of the PHQ-15, although the one-factor and bifactor models were suitable, the bifactor model underscores the presence of a robust general factor. LIMITATIONS It is a cross-sectional study, not including non-institutionalized individuals. CONCLUSION Somatic symptoms are more frequent in women and younger individuals. Furthermore, the presence of physical symptoms is associated to other psychological aspects, such as depression or anxiety. Finally, bifactor model was the most appropriate to explain the factorial structure of the PHQ-15.
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Affiliation(s)
- Elena Robles
- School of Psychology, Complutense University, Madrid, Spain
| | - Chiara Angelone
- School of Psychology and Education, University of Bologna, Bologna, Italy
| | - Daniel Ondé
- School of Psychology, Complutense University, Madrid, Spain
| | - Carmelo Vázquez
- School of Psychology, Complutense University, Madrid, Spain.
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Mo D, Zheng H, Li WZ, Chen L, Tao R, Zhong H, Liu H. A study of somatization symptoms and low-frequency amplitude fluctuations of emotional memory in adolescent depression. Psychiatry Res Neuroimaging 2024; 344:111867. [PMID: 39153231 DOI: 10.1016/j.pscychresns.2024.111867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 07/30/2024] [Accepted: 08/06/2024] [Indexed: 08/19/2024]
Abstract
Studies have revealed that somatization symptoms are associated with emotional memory in adolescents with depressive disorders. This study investigated somatization symptoms and emotional memory among adolescents with depressive disorders using low-frequency amplitude fluctuations (ALFF). Participants were categorized into the somatization symptoms (FSS) group, non-FSS group and healthy control group (HC). The correctness of negative picture re-recognition was higher in the FFS and HC group than in the non-FSS group. The right superior occipital gyrus and right inferior temporal gyrus were significantly larger in the FSS group than those in the non-FSS and HC groups. Additionally, the ALFF in the superior occipital and inferior temporal gyrus were positively correlated with CSI score. Furthermore, the ALFF values in the temporal region positively correlated with correct negative image re-recognition. The negative image re-recognition rate was positively correlated with the ALFF in the left and right middle occipital gyri. These findings indicated that somatization symptoms in adolescent depression are associated with the superior occipital gyrus and inferior temporal gyrus. Notably, somatization symptoms play a role in memory bias within depressive disorders, with middle occipital and inferior temporal gyri potentially serving as significant brain regions.
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Affiliation(s)
- Daming Mo
- Department of Child and Adolescent Mental Disorder, Affiliated Psychological Hospital of Anhui Medical University, Hefei, China; Department of Psychiatry, Anhui Mental Health Center, Hefei, China
| | - Hongyu Zheng
- Department of Child and Adolescent Mental Disorder, Affiliated Psychological Hospital of Anhui Medical University, Hefei, China; Department of Psychiatry, Anhui Mental Health Center, Hefei, China
| | - Wen Zheng Li
- Department of Child and Adolescent Mental Disorder, Affiliated Psychological Hospital of Anhui Medical University, Hefei, China; Department of Psychiatry, Anhui Mental Health Center, Hefei, China
| | - Long Chen
- Department of Child and Adolescent Mental Disorder, Affiliated Psychological Hospital of Anhui Medical University, Hefei, China; Department of Psychiatry, Anhui Mental Health Center, Hefei, China
| | - Rui Tao
- Department of Psychiatry, Chao Hu Hospital of Anhui Medical University, Hefei, China
| | - Hui Zhong
- Department of Child and Adolescent Mental Disorder, Affiliated Psychological Hospital of Anhui Medical University, Hefei, China; Department of Psychiatry, Anhui Mental Health Center, Hefei, China
| | - Huanzhong Liu
- Department of Psychiatry, Chao Hu Hospital of Anhui Medical University, Hefei, China; Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.
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Wang S, Xu Y, Xiao X, Guo P, Lv L, Fang Y, Huang J, Zhang N, Feng M, Cheng S, Wang S, Chen H. Intravenous infusion with esketamine rapidly alleviates refractory somatic symptom disorder: A case report. Asian J Psychiatr 2024; 97:104076. [PMID: 38797621 DOI: 10.1016/j.ajp.2024.104076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 04/16/2024] [Accepted: 04/21/2024] [Indexed: 05/29/2024]
Affiliation(s)
- Shikai Wang
- Department of Psychiatry, Huzhou Third Municipal Hospital Affiliated to Huzhou University, Huzhou, Zhejiang, China.
| | - Yong Xu
- Department of Psychiatry, University of Health and Rehabilitation Sciences Qingdao Hospital, Qingdao, Shandong, China.
| | - Xiaoqing Xiao
- Department of Anesthesiology, Huzhou Third Municipal Hospital Affiliated to Huzhou University, Huzhou, Zhejiang, China.
| | - Ping Guo
- Department of Psychiatry, Huzhou Third Municipal Hospital Affiliated to Huzhou University, Huzhou, Zhejiang, China.
| | - Liang Lv
- Department of Psychiatry, Huzhou Third Municipal Hospital Affiliated to Huzhou University, Huzhou, Zhejiang, China.
| | - Yu Fang
- Department of Psychiatry, Huzhou Third Municipal Hospital Affiliated to Huzhou University, Huzhou, Zhejiang, China.
| | - Juanjuan Huang
- Department of Anesthesiology, Huzhou Third Municipal Hospital Affiliated to Huzhou University, Huzhou, Zhejiang, China.
| | - Na Zhang
- Department of Psychiatry, Huzhou Third Municipal Hospital Affiliated to Huzhou University, Huzhou, Zhejiang, China.
| | - Min Feng
- Department of Psychiatry, Huzhou Third Municipal Hospital Affiliated to Huzhou University, Huzhou, Zhejiang, China.
| | - Shanfei Cheng
- Department of Anesthesiology, Huzhou Third Municipal Hospital Affiliated to Huzhou University, Huzhou, Zhejiang, China.
| | - Shiliang Wang
- Department of Psychiatry, Huzhou Third Municipal Hospital Affiliated to Huzhou University, Huzhou, Zhejiang, China.
| | - Huanxin Chen
- Key Laboratory, Huzhou Third Municipal Hospital Affiliated to Huzhou University, Huzhou, Zhejiang, China.
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Liu P, Jing L, Guo F, Xu Y, Cheng J, Liu S, Liu L, Liu Z, Zhang K, Sun N. Characteristics of gut microbiota and its correlation with hs-CRP and somatic symptoms in first-episode treatment-naive major depressive disorder. J Affect Disord 2024; 356:664-671. [PMID: 38615845 DOI: 10.1016/j.jad.2024.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 03/26/2024] [Accepted: 04/03/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVE Most patients with major depressive disorder (MDD) have somatic symptoms, but little studies pay attention in the microbial-inflammatory mechanisms of these somatic symptoms. Our study aimed to investigate alterations in gut microbiota and its correlation with inflammatory marker levels and somatic symptoms in first-episode treatment-naive MDD. METHODS Subjects contained 160 MDD patients and 101 healthy controls (HCs). MDD patients were divided into MDD with somatic symptoms group (MDDS) and MDD without somatic symptoms group (MDDN) based on Somatic Self-rating Scale (SSS). 16S ribosomal RNA sequencing were performed to analyze the composition of the fecal microbiota. The inflammatory factors were measured using enzyme linked immunosorbent assay (ELISA). Correlation among the altered gut microbiota, inflammatory factor and severity of clinical symptoms were analysized. RESULTS Relative to HCs, MDD patients had higher levels of high-sensitivity C-reactive protein (hs-CRP) as well as disordered α-diversity and β-diversity of gut microbiota. Linear discriminant effect size (LEfSe) analysis showed that MDD patients had higher proportions of Bifidobacterium, Blautia, Haemophilus and lower proportions of Bacteroides, Faecalibacterium, Roseburia, Dialister, Sutterella, Parabacteroides, Bordetella, and Phascolarctobacterium from the genus aspect. Furthermore, correlation analysis showed Bacteroides and Roseburia had negative correlations with the hs-CRP, HAMD-24, the total and factor scores of SSS in all participants. Further, compared with MDDN, the Pielous evenness was higher in MDDS. Random Forest (RF) analysis showed 20 most important genera discriminating MDD-S and MDDN, HCs. The ROC analysis showed that the AUC was 0.90 and 0.81 combining these genera respectively. CONCLUSION Our study manifested MDD patients showed disordered gut microbiota and elevated hs-CRP levels, and altered gut microbiota was closely associated with hs-CRP, depressive symptoms, and somatic symptoms.
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Affiliation(s)
- Penghong Liu
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan 030001, PR China; Shanxi Medical University, Taiyuan 030001, PR China
| | - Lin Jing
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan 030001, PR China; Shanxi Medical University, Taiyuan 030001, PR China
| | - Fengtao Guo
- Shanxi Medical University, Taiyuan 030001, PR China
| | - Yunfan Xu
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan 030001, PR China; Shanxi Medical University, Taiyuan 030001, PR China
| | - Junxiang Cheng
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan 030001, PR China; Shanxi Medical University, Taiyuan 030001, PR China
| | - Shasha Liu
- Shanxi Medical University, Taiyuan 030001, PR China
| | - Lixin Liu
- Shanxi Medical University, Taiyuan 030001, PR China; Experimental Center of Science and Research, The First Hospital of Shanxi Medical University, PR China
| | - Zhifen Liu
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan 030001, PR China
| | - Kerang Zhang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan 030001, PR China; Shanxi Medical University, Taiyuan 030001, PR China.
| | - Ning Sun
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan 030001, PR China; Shanxi Medical University, Taiyuan 030001, PR China.
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Ferstl M, Kühnel A, Klaus J, Lin WM, Kroemer NB. Non-invasive vagus nerve stimulation conditions increased invigoration and wanting in depression. Compr Psychiatry 2024; 132:152488. [PMID: 38657358 DOI: 10.1016/j.comppsych.2024.152488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 04/02/2024] [Accepted: 04/13/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Major depressive disorder (MDD) is often marked by impaired motivation and reward processing, known as anhedonia. Many patients do not respond to first-line treatments, and improvements in motivation can be slow, creating an urgent need for rapid interventions. Recently, we demonstrated that transcutaneous auricular vagus nerve stimulation (taVNS) acutely boosts effort invigoration in healthy participants, but its effects on depression remain unclear. OBJECTIVE To assess the impact of taVNS on effort invigoration and maintenance in a sample that includes patients with MDD, evaluating the generalizability of our findings. METHODS We used a single-blind, randomized crossover design in 30 patients with MDD and 29 matched (age, sex, and BMI) healthy control participants (HCP). RESULTS Consistent with prior findings, taVNS increased effort invigoration for rewards in both groups during Session 1 (p = .040), particularly for less wanted rewards in HCP (pboot < 0.001). However, invigoration remained elevated in all participants, and no acute changes were observed in Session 2 (Δinvigoration = 3.3, p = .12). Crucially, throughout Session 1, we found taVNS-induced increases in effort invigoration (pboot = 0.008) and wanting (pboot = 0.010) in patients with MDD, with gains in wanting maintained across sessions (Δwanting = 0.06, p = .97). CONCLUSIONS Our study replicates the invigorating effects of taVNS in Session 1 and reveals its generalizability to depression. Furthermore, we expand upon previous research by showing taVNS-induced conditioning effects on invigoration and wanting within Session 1 in patients that were largely sustained. While enduring motivational improvements present challenges for crossover designs, they are highly desirable in interventions and warrant further follow-up research.
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Affiliation(s)
- Magdalena Ferstl
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health, University of Tübingen, Tübingen, Germany
| | - Anne Kühnel
- Section of Medical Psychology, Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Bonn, Bonn, Germany
| | - Johannes Klaus
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health, University of Tübingen, Tübingen, Germany
| | - Wy Ming Lin
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health, University of Tübingen, Tübingen, Germany; Hector Research Institute for Education Science and Psychology, University of Tübingen, Tübingen, Germany
| | - Nils B Kroemer
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health, University of Tübingen, Tübingen, Germany; Section of Medical Psychology, Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Bonn, Bonn, Germany; German Center for Mental Health (DZPG), Germany.
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Fermin ASR, Sasaoka T, Maekawa T, Ono K, Chan HL, Yamawaki S. Insula-cortico-subcortical networks predict interoceptive awareness and stress resilience. Asian J Psychiatr 2024; 95:103991. [PMID: 38484483 DOI: 10.1016/j.ajp.2024.103991] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/25/2024] [Accepted: 02/28/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND Interoception, the neural sensing of visceral signals, and interoceptive awareness (IA), the conscious perception of interoception, are crucial for life survival functions and mental health. Resilience, the capacity to overcome adversity, has been associated with reduced interoceptive disturbances. Here, we sought evidence for our Insula Modular Active Control (IMAC) model that suggest that the insula, a brain region specialized in the processing of interoceptive information, realizes IA and contributes to resilience and mental health via cortico-subcortical connections. METHODS 64 healthy participants (32 females; ages 18-34 years) answered questionnaires that assess IA and resilience. Mental health was evaluated with the Beck Depression Inventory II that assesses depressive mood. Participants also underwent a 15 minute resting-state functional resonance imaging session. Pearson correlations and mediation analyses were used to investigate the relationship between IA and resilience and their contributions to depressive mood. We then performed insula seed-based functional connectivity analyzes to identify insula networks involved in IA, resilience and depressive mood. RESULTS We first demonstrated that resilience mediates the relationship between IA and depressive mood. Second, shared and distinct intra-insula, insula-cortical and insula-subcortical networks were associated with IA, resilience and also predicted the degree of experienced depressive mood. Third, while resilience was associated with stronger insula-precuneus, insula-cerebellum and insula-prefrontal networks, IA was linked with stronger intra-insula, insula-striatum and insula-motor networks. CONCLUSIONS Our findings help understand the roles of insula-cortico-subcortical networks in IA and resilience. These results also highlight the potential use of insula networks as biomarkers for depression prediction.
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Affiliation(s)
- Alan S R Fermin
- Center for Brain, Mind and Kansei Sciences Research, Hiroshima University, Hiroshima, Japan.
| | - Takafumi Sasaoka
- Center for Brain, Mind and Kansei Sciences Research, Hiroshima University, Hiroshima, Japan
| | - Toru Maekawa
- Center for Brain, Mind and Kansei Sciences Research, Hiroshima University, Hiroshima, Japan
| | - Kentaro Ono
- Center for Brain, Mind and Kansei Sciences Research, Hiroshima University, Hiroshima, Japan
| | - Hui-Ling Chan
- Center for Brain, Mind and Kansei Sciences Research, Hiroshima University, Hiroshima, Japan
| | - Shigeto Yamawaki
- Center for Brain, Mind and Kansei Sciences Research, Hiroshima University, Hiroshima, Japan
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Jiang Y, Zhu D, Huang X, Li Y, Chen Y, Jiang Y, Wang W, Guo L, Chen Y, Liao Y, Liu Y, Zhang H, Le GH, McIntyre RS, Fan B, Lu C. Associations between somatic symptoms and remission of major depressive disorder: A longitudinal study in China. J Psychiatr Res 2024; 172:382-390. [PMID: 38452636 DOI: 10.1016/j.jpsychires.2024.02.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 02/17/2024] [Accepted: 02/24/2024] [Indexed: 03/09/2024]
Abstract
Previous studies have documented negative associations between somatic symptoms and remission of major depressive disorder (MDD). However, the correlations of specific somatic symptoms with remission remain uncertain. We aimed to explore the associations between specific somatic symptoms and remission focusing on sex differences among patients with MDD. We used data from patients with MDD in the Depression Cohort in China. At baseline, total somatic symptoms were evaluated using the 28-item Somatic Symptoms Inventory and were categorized into pain, autonomic, energy, and central nervous system (CNS) symptoms. To measure remission of MDD, depressive symptoms were evaluated using the Patient Health Questionnaire-9 after 3 months of treatment. We ultimately included 634 patients. Compared with quartile 1 of total somatic symptom scores, the full-adjusted ORs (95% CIs) for remission from quartile 2 to quartile 4 were 0.52 (0.30, 0.90), 0.44 (0.23, 0.83), and 0.36 (0.17, 0.75), respectively (P-value for trend = 0.005). The restricted cubic spline showed no non-linear associations between total somatic symptoms with remission (P-value for non-linear = 0.238). Pain, autonomic, and CNS symptoms showed similar results. Sex-stratified analysis showed that total somatic symptoms, pain symptoms, and autonomic symptoms were negatively correlated with remission in females, whereas CNS symptoms were negatively associated with remission in males. Our findings indicate that specific somatic symptoms exert differential effects on remission of MDD. Therapeutic interventions that target pain, autonomic, and CNS symptoms may increase the probability of remission. Furthermore, interventions for somatic symptoms should be tailored by sex, and females deserve more attention.
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Affiliation(s)
- Yingchen Jiang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China; Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Dongjian Zhu
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Xinyu Huang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China; Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Yanzhi Li
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China; Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Ya Chen
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China; Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Yunbin Jiang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China; Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Wanxin Wang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China; Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Lan Guo
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China; Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Yan Chen
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Yuhua Liao
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Yifeng Liu
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Huimin Zhang
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Gia Han Le
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Brain and Cognition Discovery Foundation, Toronto, Ontario, Canada; Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada
| | - Roger S McIntyre
- Brain and Cognition Discovery Foundation, Toronto, Ontario, Canada; Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Beifang Fan
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China.
| | - Ciyong Lu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China; Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou, 510080, China.
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Lee DY, Kim N, Park C, Gan S, Son SJ, Park RW, Park B. Explainable multimodal prediction of treatment-resistance in patients with depression leveraging brain morphometry and natural language processing. Psychiatry Res 2024; 334:115817. [PMID: 38430816 DOI: 10.1016/j.psychres.2024.115817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 02/19/2024] [Accepted: 02/23/2024] [Indexed: 03/05/2024]
Abstract
Although 20 % of patients with depression receiving treatment do not achieve remission, predicting treatment-resistant depression (TRD) remains challenging. In this study, we aimed to develop an explainable multimodal prediction model for TRD using structured electronic medical record data, brain morphometry, and natural language processing. In total, 247 patients with a new depressive episode were included. TRD-predictive models were developed based on the combination of following parameters: selected tabular dataset features, independent components-map weightings from brain T1-weighted magnetic resonance imaging (MRI), and topic probabilities from clinical notes. All models applied the extreme gradient boosting (XGBoost) algorithm via five-fold cross-validation. The model using all data sources showed the highest area under the receiver operating characteristic of 0.794, followed by models that used combined brain MRI and structured data, brain MRI and clinical notes, clinical notes and structured data, brain MRI only, structured data only, and clinical notes only (0.770, 0.762, 0.728, 0.703, 0.684, and 0.569, respectively). Classifications of TRD were driven by several predictors, such as previous exposure to antidepressants and antihypertensive medications, sensorimotor network, default mode network, and somatic symptoms. Our findings suggest that a combination of clinical data with neuroimaging and natural language processing variables improves the prediction of TRD.
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Affiliation(s)
- Dong Yun Lee
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, South Korea; Department of Medical Sciences, Graduate School of Ajou University, Suwon, South Korea
| | - Narae Kim
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, South Korea; Department of Biomedical Sciences, Graduate School of Ajou University, Suwon, South Korea
| | - ChulHyoung Park
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, South Korea; Department of Medical Sciences, Graduate School of Ajou University, Suwon, South Korea
| | - Sujin Gan
- Department of Biomedical Sciences, Graduate School of Ajou University, Suwon, South Korea
| | - Sang Joon Son
- Department of Psychiatry, Ajou University School of Medicine, Suwon, South Korea
| | - Rae Woong Park
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, South Korea; Department of Biomedical Sciences, Graduate School of Ajou University, Suwon, South Korea.
| | - Bumhee Park
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, South Korea; Office of Biostatistics, Medical Research Collaborating Center, Ajou Research Institute for Innovative Medicine, Ajou University Medical Center, Suwon, South Korea.
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Müller-Tasch T, Löwe B, Frankenstein L, Frey N, Haass M, Friederich HC. Somatic symptom profile in patients with chronic heart failure with and without depressive comorbidity. Front Psychiatry 2024; 15:1356497. [PMID: 38566960 PMCID: PMC10985237 DOI: 10.3389/fpsyt.2024.1356497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 03/08/2024] [Indexed: 04/04/2024] Open
Abstract
Background Patients with chronic heart failure (CHF) frequently suffer from depressive comorbidity. CHF and depressive comorbidity can cause somatic symptoms. The correct attribution of somatic symptoms is important. Thus, we aimed to assess potential differences in somatic symptom severity between CHF patients with and without depressive comorbidity. Methods We evaluated depressive comorbidity using the Patient Health Questionnaire-9 (PHQ-9), somatic symptom severity with the Patient Health Questionnaire-15 (PHQ-15), and sociodemographic and medical variables in 308 CHF outpatients. To compare somatic symptom severity between CHF patients with and without depressive comorbidity, we conducted item-level analyses of covariance. Results Of the 308 participating patients, 93 (30.3%) met the PHQ-9 criteria for depressive comorbidity. These patients did not differ from those without depressive comorbidity with regard to age, sex, left ventricular function, and multimorbidity. Patients with depressive comorbidity scored significantly higher on ten out of thirteen PHQ-15 items than patients without depressive comorbidity. The largest effect sizes (0.71-0.80) were shown for symptoms of headache, chest pain, shortness of breath, and palpitations, and the latter three were potentially attributable to heart failure. Conclusions Among patients with CHF, somatic symptoms are more pronounced in those with depressive comorbidity than those without depressive comorbidity. This finding is especially true for cardiac symptoms independent of CHF severity. The potential interpretation of somatic symptoms as correlates of depressive comorbidity must be recognized in clinical practice.
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Affiliation(s)
- Thomas Müller-Tasch
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum am Weissenhof, Weinsberg, Germany
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Heidelberg, Germany
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Lutz Frankenstein
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany
| | - Norbert Frey
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany
| | - Markus Haass
- Department of Cardiology, Theresien Hospital Mannheim, Mannheim, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Heidelberg, Germany
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Teckentrup V, Kroemer NB. Mechanisms for survival: vagal control of goal-directed behavior. Trends Cogn Sci 2024; 28:237-251. [PMID: 38036309 DOI: 10.1016/j.tics.2023.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/01/2023] [Accepted: 11/02/2023] [Indexed: 12/02/2023]
Abstract
Survival is a fundamental physiological drive, and neural circuits have evolved to prioritize actions that meet the energy demands of the body. This fine-tuning of goal-directed actions based on metabolic states ('allostasis') is deeply rooted in our brain, and hindbrain nuclei orchestrate the vital communication between the brain and body through the vagus nerve. Despite mounting evidence for vagal control of allostatic behavior in animals, its broader function in humans is still contested. Based on stimulation studies, we propose that the vagal afferent pathway supports transitions between survival modes by gating the integration of ascending bodily signals, thereby regulating reward-seeking. By reconceptualizing vagal signals as catalysts for goal-directed behavior, our perspective opens new avenues for theory-driven translational work in mental disorders.
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Affiliation(s)
- Vanessa Teckentrup
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health, University of Tübingen, 72076 Tübingen, Germany; School of Psychology and Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin 2, Ireland
| | - Nils B Kroemer
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health, University of Tübingen, 72076 Tübingen, Germany; Section of Medical Psychology, Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Bonn, 53127 Bonn, Germany; German Center for Mental Health (DZPG), 72076 Tübingen, Germany.
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11
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Prout TA. Commentary on Loades et al. (2022): The landscape of adolescent depression. Psychother Res 2024; 34:276-278. [PMID: 37014779 DOI: 10.1080/10503307.2023.2194559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 03/20/2023] [Indexed: 04/05/2023] Open
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Zhou J, Zhou J, Feng Y, Feng L, Xiao L, Chen X, Feng Z, Yang J, Wang G. The novel subtype of major depressive disorder characterized by somatic symptoms is associated with poor treatment efficacy and prognosis: A data-driven cluster analysis of a prospective cohort in China. J Affect Disord 2024; 347:576-583. [PMID: 38065479 DOI: 10.1016/j.jad.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 11/15/2023] [Accepted: 12/02/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND There is not yet a valid and evidence-based system to classify patients with MDD into more homogeneous subtypes based on their clinical features. This study aims to identify symptom-based subtypes of MDD and investigate whether the treatment outcomes of those subtypes would be different. METHOD The cohort was established at 12 densely populated cities of China. A total of 1487 patients were enrolled. All participants were 18-65 years old and diagnosed with MDD. Participants were followed up at baseline, weeks 4, 8, and 12, and months 4 and 6. K-means algorithm was used to cluster patients with MDD according to clinical symptoms. The network analysis was adopted to characterize and compare the symptom patterns in the clusters. We also examined the associations between the clusters and the clinical outcomes. RESULTS The optimal number of the clusters was determined to be 2. Each cluster's maximum Jaccard Co-efficient was calculated to be >0.5 (cluster1 = 0.53, cluster 2 = 0.67). The symptom "depressed mood" and some other affective symptoms were the most prominent in cluster 1. Somatic symptoms, such as weight loss and general somatic symptoms, had the greatest expected influence in cluster 2. Compared with the response rates of the patients in the "somatic cluster", those of the patients in the "affective cluster" were significantly higher (P < 0.05). CONCLUSIONS Patients with MDD might be classified into two symptom-based subtypes featured with affective symptoms or somatic symptoms. The treatment efficacy and prognosis of the subtype featured with somatic symptoms may be worse.
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Affiliation(s)
- Jingjing Zhou
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Jia Zhou
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Yuan Feng
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Lei Feng
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Le Xiao
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Xu Chen
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Zizhao Feng
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Jian Yang
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.
| | - Gang Wang
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.
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13
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Vilalta-Lacarra A, Vilalta-Franch J, Serrano-Sarbosa D, Martí-Lluch R, Marrugat J, Garre-Olmo J. Association of depression phenotypes and antidepressant treatment with mortality due to cancer and other causes: a community-based cohort study. Front Psychol 2023; 14:1192462. [PMID: 37711322 PMCID: PMC10497951 DOI: 10.3389/fpsyg.2023.1192462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 07/31/2023] [Indexed: 09/16/2023] Open
Abstract
Objective This study aimed to assess the association of somatic depressive symptoms (SDS), cognitive/emotional depressive symptoms (C-EDS), and antidepressant treatment on mortality due to cancer and other causes in a community cohort. Methods A community-based sample recruited in 1995, 2000, and 2005 aged between 35 and 75 years was examined in two waves and followed for a median of 6.7 years. SDS and C-EDS phenotypes were assessed using the Patient Health Questionnaire-9. Medication used by participants was collected. Deaths and their causes were registered during follow-up. Cox proportional hazard models stratified by sex were performed to determine the association between depressive phenotypes and mortality. Results The cohort consisted of 5,646 individuals (53.9% women) with a mean age of 64 years (SD = 11.89). During the follow-up, 392 deaths were recorded, of which 27.8% were due to cancer. C-EDS phenotype was associated with an increased risk of cancer mortality in both men (HR = 2.23; 95% CI = 1.11-4.44) and women (HR = 3.69; 95% CI = 1.69-8.09), and SDS was significantly associated with non-cancer mortality in men (HR = 2.16; 95 CI % = 1.46-3.18). Selective serotonin reuptake inhibitors (SSRIs) were significantly associated with both cancer (HR = 2.78; 95% CI = 1.10-6.98) and non-cancer mortality (HR = 2.94; 95% CI = 1.76-4.90) only in the male population. Conclusion C-EDS phenotype was related to an increased risk of cancer mortality at 6 years. In addition, the use of SSRIs in the male population was associated with cancer and all-cause mortality.
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Affiliation(s)
| | | | - Domènec Serrano-Sarbosa
- Girona Biomedical Research Institute (IDIBGI), Girona, Spain
- Institut d'Assistencia Sanitaria, Girona, Spain
- Department of Medical Sciences, University of Girona, Girona, Spain
| | - Ruth Martí-Lluch
- Girona Biomedical Research Institute (IDIBGI), Girona, Spain
- Vascular Health Research Group (ISV-Girona), Foundation University Institute for Primary Health Care Research Jordi Gol i Gurina, Girona, Spain
| | - Jaume Marrugat
- IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
- CIBERCV de Investigación en Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain
| | - Josep Garre-Olmo
- Girona Biomedical Research Institute (IDIBGI), Girona, Spain
- Department of Nursing, University of Girona, Girona, Spain
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14
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Mo D, Guo P, Hu S, Tao R, Zhong H, Liu H. Characteristics and correlation of gray matter volume and somatic symptoms in adolescent patients with depressive disorder. Front Psychiatry 2023; 14:1197854. [PMID: 37559918 PMCID: PMC10407247 DOI: 10.3389/fpsyt.2023.1197854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 07/10/2023] [Indexed: 08/11/2023] Open
Abstract
Background Adolescent patients with depressive disorders commonly exhibit somatic symptoms, which have a significant negative impact on their treatment and prognosis. Despite this, specific brain imaging characteristics of these symptoms have been poorly studied. Methods The Hamilton Depression Rating scale (HAMD-17), Children's Functional Somatization scale (CSI), and Toronto Alexithymia scale (TAS) were used to evaluate the clinical symptoms of adolescent depression. We analyzed the correlation between brain gray matter volume (GMV) and clinical symptoms in adolescent patients with depression and somatic symptoms. Results The depression subgroups with and without functional somatic symptoms (FSS) had higher scores on the HAMD-17, CSI, and TAS than the normal control group. The group with FSS had higher HAMD-17, CSI, and TAS scores than the depression group without FSS (p < 0.05). CSI and TAS scores were positively correlated (r = 0.378, p < 0.05). The GMV of the right supplementary motor area was higher in the depression groups with and without FSSs than in the normal control group, and the GMV was higher in the group without FSS than in the group with FSS (F = 29.394, p < 0.05). The GMV of the right supplementary motor area was negatively correlated with CSI in the depressed group with FSS (r = -0.376, p < 0.05). In the group with depression exhibiting FSS, CSI scores were positively correlated with GMV of the middle occipital gyrus (pr = 0.665, p = 0.0001), and TAS scores were positively correlated with GMV of the caudate nucleus (pr = 0.551, p = 0.001). Conclusion Somatic symptoms of adolescent depressive disorder are associated with alexithymia; moreover, somatic symptoms and alexithymia in adolescent patients with depressive disorders are correlated with GMV changes in different brain regions.
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Affiliation(s)
- Daming Mo
- Department of Psychiatry, Chao hu Hospital of Anhui Medical University, Hefei, China
- Department of Child and Adolescent Mental Disorder, Affiliated Psychological Hospital of Anhui Medical University, Hefei, China
- Department of Psychiatry, Anhui Mental Health Center, Hefei, China
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
| | - Pengfei Guo
- Department of Psychiatry, Hangzhou Seventh People’s Hospital, Hangzhou, China
| | - Shuwen Hu
- Clinical Psychological Science, Anhui Provincial Children’s Hospital, Hefei, China
| | - Rui Tao
- Department of Psychiatry, Anhui Mental Health Center, Hefei, China
| | - Hui Zhong
- Department of Child and Adolescent Mental Disorder, Affiliated Psychological Hospital of Anhui Medical University, Hefei, China
- Department of Psychiatry, Anhui Mental Health Center, Hefei, China
| | - Huanzhong Liu
- Department of Psychiatry, Chao hu Hospital of Anhui Medical University, Hefei, China
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
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15
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van Oort J, Llera A, Kohn N, Mei T, Collard RM, Duyser FA, Vrijsen JN, Beckmann CF, Schene AH, Fernández G, Tendolkar I, van Eijndhoven PFP. Brain structure and function link to variation in biobehavioral dimensions across the psychopathological continuum. eLife 2023; 12:e85006. [PMID: 37334965 PMCID: PMC10519708 DOI: 10.7554/elife.85006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 06/16/2023] [Indexed: 06/21/2023] Open
Abstract
In line with the Research Domain Criteria (RDoC) , we set out to investigate the brain basis of psychopathology within a transdiagnostic, dimensional framework. We performed an integrative structural-functional linked independent component analysis to study the relationship between brain measures and a broad set of biobehavioral measures in a sample (n = 295) with both mentally healthy participants and patients with diverse non-psychotic psychiatric disorders (i.e. mood, anxiety, addiction, and neurodevelopmental disorders). To get a more complete understanding of the underlying brain mechanisms, we used gray and white matter measures for brain structure and both resting-state and stress scans for brain function. The results emphasize the importance of the executive control network (ECN) during the functional scans for the understanding of transdiagnostic symptom dimensions. The connectivity between the ECN and the frontoparietal network in the aftermath of stress was correlated with symptom dimensions across both the cognitive and negative valence domains, and also with various other health-related biological and behavioral measures. Finally, we identified a multimodal component that was specifically associated with the diagnosis of autism spectrum disorder (ASD). The involvement of the default mode network, precentral gyrus, and thalamus across the different modalities of this component may reflect the broad functional domains that may be affected in ASD, like theory of mind, motor problems, and sensitivity to sensory stimuli, respectively. Taken together, the findings from our extensive, exploratory analyses emphasize the importance of a dimensional and more integrative approach for getting a better understanding of the brain basis of psychopathology.
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Affiliation(s)
- Jasper van Oort
- Department of Psychiatry, Radboud University Nijmegen Medical CentreNijmegenNetherlands
- Department of Cognitive Neuroscience, Radboud University Nijmegen Medical CentreNijmegenNetherlands
| | - Alberto Llera
- Department of Cognitive Neuroscience, Radboud University Nijmegen Medical CentreNijmegenNetherlands
- Donders Institute for Brain, Cognition and Behavior, Radboud University NijmegenNijmegenNetherlands
| | - Nils Kohn
- Department of Cognitive Neuroscience, Radboud University Nijmegen Medical CentreNijmegenNetherlands
- Donders Institute for Brain, Cognition and Behavior, Radboud University NijmegenNijmegenNetherlands
| | - Ting Mei
- Department of Cognitive Neuroscience, Radboud University Nijmegen Medical CentreNijmegenNetherlands
- Donders Institute for Brain, Cognition and Behavior, Radboud University NijmegenNijmegenNetherlands
| | - Rose M Collard
- Department of Psychiatry, Radboud University Nijmegen Medical CentreNijmegenNetherlands
| | - Fleur A Duyser
- Department of Psychiatry, Radboud University Nijmegen Medical CentreNijmegenNetherlands
| | - Janna N Vrijsen
- Department of Cognitive Neuroscience, Radboud University Nijmegen Medical CentreNijmegenNetherlands
- Pro Persona Mental Health Care, Depression Expertise CenterNijmegenNetherlands
| | - Christian F Beckmann
- Department of Cognitive Neuroscience, Radboud University Nijmegen Medical CentreNijmegenNetherlands
- Donders Institute for Brain, Cognition and Behavior, Radboud University NijmegenNijmegenNetherlands
- Oxford Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB), University of OxfordOxfordUnited Kingdom
| | - Aart H Schene
- Department of Psychiatry, Radboud University Nijmegen Medical CentreNijmegenNetherlands
- Department of Cognitive Neuroscience, Radboud University Nijmegen Medical CentreNijmegenNetherlands
| | - Guillén Fernández
- Department of Cognitive Neuroscience, Radboud University Nijmegen Medical CentreNijmegenNetherlands
- Donders Institute for Brain, Cognition and Behavior, Radboud University NijmegenNijmegenNetherlands
| | - Indira Tendolkar
- Department of Psychiatry, Radboud University Nijmegen Medical CentreNijmegenNetherlands
- Department of Cognitive Neuroscience, Radboud University Nijmegen Medical CentreNijmegenNetherlands
| | - Philip FP van Eijndhoven
- Department of Psychiatry, Radboud University Nijmegen Medical CentreNijmegenNetherlands
- Department of Cognitive Neuroscience, Radboud University Nijmegen Medical CentreNijmegenNetherlands
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Li Y, Jia S, Cao B, Chen L, Shi Z, Zhang H. Network analysis of somatic symptoms in Chinese patients with depressive disorder. Front Public Health 2023; 11:1079873. [PMID: 36992877 PMCID: PMC10040552 DOI: 10.3389/fpubh.2023.1079873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 02/23/2023] [Indexed: 03/14/2023] Open
Abstract
IntroductionNetwork theory conceptualizes somatic symptoms as a network of individual symptoms that are interconnected and influenced by each other. In this conceptualization, the network's central symptoms have the strongest effect on other symptoms. Clinical symptoms of patients with depressive disorders are largely determined by their sociocultural context. To our knowledge, no previous study has investigated the network structure of somatic symptoms among Chinese patients with depressive disorders. The aim of this study was to characterize the somatic symptoms network structure in patients with depressive disorders in Shanghai, China.MethodA total of 177 participants were recruited between October 2018 and June 2019. The Chinese version of the Patient Health Questionnaire-15 was used to assess somatic symptoms. In order to quantify the somatic symptom network structure, indicators of “closeness,” “strength,” and “betweenness” were employed as identifiers for network-central symptoms.ResultThe symptoms of “feeling your heart pound or race,” “shortness of breath,” and “back pain” had the highest centrality values, indicating that these symptoms were central to the somatic symptom networks. Feeling tired or mentally ill had the strongest positive correlation with insomnia or other sleep problems (r = 0.419), followed by chest pain and breathlessness (r = 0.334), back pain, and limb or joint pain (r = 0.318).DiscussionPsychological and neurobiological research that offers insights into somatic symptoms may focus on these central symptoms as targets for treatment and future research.
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Affiliation(s)
- Yang Li
- Department of Nursing, Air Force Military Medical University, Xi'an, Shanxi, China
| | - Shoumei Jia
- School of Nursing, Fudan University, Shanghai, China
- *Correspondence: Shoumei Jia
| | - Baohua Cao
- Department of Nursing, Air Force Military Medical University, Xi'an, Shanxi, China
- Baohua Cao
| | - Li Chen
- Department of Nursing, Shanghai Mental Health Center, Shanghai, China
| | - Zhongying Shi
- Department of Nursing, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Hao Zhang
- Medical Department, The Chinese People's Liberation Army 985th Hospital, Taiyuan, Shanxi, China
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Sun N, Liu M, Liu P, Zhang A, Yang C, Liu Z, Li J, Li G, Wang Y, Zhang K. Abnormal cortical-striatal-thalamic-cortical circuit centered on the thalamus in MDD patients with somatic symptoms: Evidence from the REST-meta-MDD project. J Affect Disord 2023; 323:71-84. [PMID: 36395992 DOI: 10.1016/j.jad.2022.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 08/21/2022] [Accepted: 11/07/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Somatic symptoms are common comorbidities of major depressive disorder (MDD), and negatively impact the course and severity of the disease. In order to enrich the understanding of the pathological mechanism and clarify the neurobiological basis of somatic symptoms in depression, we attempted to explore the changes of brain structure and function in a large sample between depression with and without somatic symptoms. METHODS Structure magnetic resonance imaging (MRI) data were collected from 342 patients with somatic symptoms (SD), 208 patients without somatic symptoms (NSD), and 510 healthy controls (HCs) based on the REST-meta-MDD project. We analyzed the whole brain VBM maps of the three groups, and combined with weight degree centrality (DC) index, we investigated whether the brain regions with gray matter volume (GMV) and gray matter density (GMD) abnormalities in MDD patients with somatic symptoms had corresponding brain functional abnormalities. RESULTS Between depression with and without somatic symptoms, we found that there are extensive GMV and GMD differences involving cortical regions such as the temporal lobe, occipital lobe, and insula, as well as subcortical brain regions such as thalamus and striatum. The comparison results of weight DC signals of GMV and GMD abnormal clusters between the SD and NSD groups were basically consistent with the GMV and GMD abnormal clusters. CONCLUSION The results indicate that the structure and function of cortical-striatal-thalamic-cortical (CSTC) circuit centered on the thalamus were abnormal in MDD patients with somatic symptoms. This may be the neurobiological basis of somatic symptoms in MDD.
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Affiliation(s)
- Ning Sun
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, Shanxi 030001, China; Department of Mental Health, Shanxi Medical University, Taiyuan, Shanxi 030001, China
| | - Min Liu
- Department of Psychosomatic, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi 710032, China
| | - Penghong Liu
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, Shanxi 030001, China
| | - Aixia Zhang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, Shanxi 030001, China
| | - Chunxia Yang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, Shanxi 030001, China
| | - Zhifen Liu
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, Shanxi 030001, China; Department of Mental Health, Shanxi Medical University, Taiyuan, Shanxi 030001, China
| | - Jianying Li
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, Shanxi 030001, China
| | - Gaizhi Li
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, Shanxi 030001, China
| | - Yanfang Wang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, Shanxi 030001, China
| | - Kerang Zhang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, Shanxi 030001, China.
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Effectiveness and Clinical Usefulness of Electronic Agenda-setting in Psychiatric Practices: A South Texas Psychiatric PBRN Study. J Psychiatr Pract 2023; 29:31-37. [PMID: 36649549 DOI: 10.1097/pra.0000000000000686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
There is a general consensus that the doctor-patient interview should be as productive and efficient as possible. This is becoming increasingly difficult in a health care insurance system that demands shorter appointment times. Clinicians must therefore find ways to condense the clinical encounter without sacrificing quality. The purposes of this study were: (1) to facilitate shared decision-making between psychiatrist and patient via pre-visit patient agenda-setting, (2) to evaluate the effectiveness and ease of use of the agenda-setting tool, and (3) to determine patient and clinician satisfaction with the clinical encounter. Patients completed questionnaires to assist in agenda-setting via an electronic tablet while in the waiting area before seeing the psychiatrist. Both patients and psychiatrists then completed post-visit questionnaires to assess their satisfaction with the encounter. We measured patient satisfaction and the extent to which the psychiatrist addressed concerns before and after the visit, as well as ease of use for the patient, psychiatrist satisfaction, and clinical helpfulness to the treating psychiatrist. Additional analyses also indicated that there was a significant increase in patient satisfaction scores, compared with an average of all previous visits, and a significant increase in the number of concerns addressed during the current visit when compared with the average number of previous concerns addressed. Patients reported little difficulty using the tablet. Similarly, psychiatrists reported that the device was helpful in the clinical setting and they expressed high levels of satisfaction with the visit. We hope our work will encourage others to use this agenda-setting tool in their practices to facilitate better patient care.
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Willems AE, Sura-de Jong M, van Beek AP, van Dijk G. Self-initiated dietary changes reduce general somatic and mental symptoms in a relatively healthy Dutch population. Prev Med Rep 2022; 30:102004. [PMID: 36245808 PMCID: PMC9562416 DOI: 10.1016/j.pmedr.2022.102004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 08/16/2022] [Accepted: 09/24/2022] [Indexed: 11/30/2022] Open
Abstract
The risk for development of non-communicable diseases (NCDs) can be predicted by somatic or mental symptoms and dietary alterations aimed at improvement of those symptoms could potentially delay development of NCDs. The goal of this study was to identify whether self-initiated dietary changes could reduce mental and somatic symptoms in relatively healthy individuals. Participants (n = 494) recruited from the Dutch population filled out weekly questionnaires on dietary intake, somatic and mental symptoms and physical activity at baseline and during dieting for four weeks. There was a significant reduction in mental and somatic symptoms, body weight, and waist circumference at four weeks, whereas physical activity remained unchanged. Five dietary patterns were identified by principal component analysis labelled “Processed foods”, “Animal source foods”, “Wheel of Five”, “Traditional Dutch”, and “Party”. Reduction in mental symptoms was correlated to increased physical activity and increased intake of Wheel of Five foods. Reduction in somatic symptoms was correlated to body weight loss and less Processed foods, more Wheel of Five foods, and lower intake of fat and protein. Higher intake of protein and fat and lower intake of carbohydrates, however, were correlated to body weight loss. In conclusion this research showed that a self-initiated dietary change can lead to a significant reduction of mental and somatic symptoms.
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Affiliation(s)
- Anouk E.M. Willems
- Van Hall Larenstein University of Applied Sciences, Applied Research Centre Food & Dairy, Leeuwarden, The Netherlands
- Groningen Institute for Evolutionary Life Sciences (GELIFES) – Neurobiology, University of Groningen, Groningen, The Netherlands
| | - Martina Sura-de Jong
- Van Hall Larenstein University of Applied Sciences, Applied Research Centre Food & Dairy, Leeuwarden, The Netherlands
| | - André P. van Beek
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gertjan van Dijk
- Groningen Institute for Evolutionary Life Sciences (GELIFES) – Neurobiology, University of Groningen, Groningen, The Netherlands
- Corresponding author at: G. van Dijk, Nijenborg 7, 9747AG Groningen, The Netherlands.
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Ssegonja R, Alaie I, Holmgren A, Bohman H, Päären A, von Knorring L, von Knorring AL, Jonsson U. Association of adolescent depression with subsequent prescriptions of anti-infectives and anti-inflammatories in adulthood: A longitudinal cohort study. Psychiatry Res 2022; 317:114813. [PMID: 36058038 DOI: 10.1016/j.psychres.2022.114813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/23/2022] [Accepted: 08/26/2022] [Indexed: 10/31/2022]
Abstract
New insights into how depression is linked to physical health throughout the lifespan could potentially inform clinical decision making. The aim of this study was to explore the association of adolescent depression with subsequent prescriptions of anti-infectives and anti-inflammatories in adulthood. The study was based on the Uppsala Longitudinal Adolescent Depression Study (ULADS), a Swedish prospective cohort study initiated in 1991. Depressed (n = 321) and non-depressed (n = 218) adolescents were followed prospectively using patient registries. The associations of adolescent depression (age 16-17 years) with subsequent prescription of anti-infectives and anti-inflammatories (age 30-40 years), were analysed using generalized linear models. Sub-analyses explored the impact of diagnostic characteristics in adolescence and reception of anti-depressants prescriptions in adulthood. The results suggest that females with persistent depressive disorder in adolescence have a higher rate of future prescriptions than non-depressed peers, with adjusted incidence rate ratio of 1.42 (1.06 to 1.92) for anti-infectives and 1.72 (1.10 to 2.70) for anti-inflammatories. These associations were mainly driven by those who were also prescribed antidepressants during the same period. Associations were less robust for females with episodic or subsyndromal depression in adolescence and for males. These findings emphasize the importance of integrated mental health services at the primary healthcare level.
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Affiliation(s)
- Richard Ssegonja
- Department of Public Health and Caring Science, Uppsala University, Uppsala, Sweden; Department of Medical Sciences, Respiratory, Allergy- and Sleep Medicine Research Unit, Uppsala University, Uppsala, Sweden.
| | - Iman Alaie
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Medical Sciences, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden
| | - Amanda Holmgren
- Department of Medical Sciences, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden
| | - Hannes Bohman
- Department of Medical Sciences, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden
| | - Aivar Päären
- Department of Medical Sciences, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden
| | - Lars von Knorring
- Department of Medical Sciences, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Anne-Liis von Knorring
- Department of Medical Sciences, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden
| | - Ulf Jonsson
- Department of Medical Sciences, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden; Centre of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden; Child and Adolescent Psychiatry, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
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21
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Di Salvo G, Bianco M, Teobaldi E, Maina G, Rosso G. A Psychoanalytic-Derived Brief Psychotherapeutic Approach in the Treatment of Major Depression: Monotherapy Studies. Medicina (B Aires) 2022; 58:medicina58101335. [PMID: 36295496 PMCID: PMC9609679 DOI: 10.3390/medicina58101335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 09/14/2022] [Accepted: 09/19/2022] [Indexed: 11/16/2022] Open
Abstract
Over the years, short term psychodynamic therapy (STPP) has been broadly researched in order to evaluate its efficacy in the treatment of major psychiatric disorders. In particular, a consistent number of studies focused on assessing clinical outcomes of the principal psychodynamic techniques in treating depressive disorders. We conducted a narrative review in which we aimed to evaluate the efficacy of STPP in monotherapy in major depressive disorder and to assess possible features that may correlate with its clinical use. Databases searched were PubMed, Ovid, Scopus, PsycINFO and Cochrane Libraries from inception to July 2022. Our research underlined that STPP in monotherapy is particularly effective in moderately severe depression and in preventing depressive relapses. Moreover, a case-by-case evaluation of its efficacy should be performed when considering STPP for the treatment of major depression with other comorbid psychiatric conditions. Although such key points emerged from scientific evidence, STPP should be better studied in the long-term perspective; further research is needed to define the clinical scenarios in which STPP can be considered a first-line approach as monotherapy in major depressive disorder compared to medications or other types of psychotherapy.
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Affiliation(s)
- Gabriele Di Salvo
- Department of Neurosciences “Rita Levi Montalcini”, University of Turin, 10126 Turin, Italy
- Psychiatric Unit, San Luigi Gonzaga University Hospital, 10043 Turin, Italy
| | - Matteo Bianco
- Department of Neurosciences “Rita Levi Montalcini”, University of Turin, 10126 Turin, Italy
| | - Elena Teobaldi
- Department of Neurosciences “Rita Levi Montalcini”, University of Turin, 10126 Turin, Italy
| | - Giuseppe Maina
- Department of Neurosciences “Rita Levi Montalcini”, University of Turin, 10126 Turin, Italy
- Psychiatric Unit, San Luigi Gonzaga University Hospital, 10043 Turin, Italy
| | - Gianluca Rosso
- Department of Neurosciences “Rita Levi Montalcini”, University of Turin, 10126 Turin, Italy
- Psychiatric Unit, San Luigi Gonzaga University Hospital, 10043 Turin, Italy
- Correspondence: ; Tel.: +39-011-902-6504
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22
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23
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Yan M, Fu X, Ou Y, Liu F, Li H, Guo W. Multiple-Network Alterations in Major Depressive Disorder With Gastrointestinal Symptoms at Rest Revealed by Global Functional Connectivity Analysis. Front Neurosci 2022; 16:897707. [PMID: 35812223 PMCID: PMC9263397 DOI: 10.3389/fnins.2022.897707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/06/2022] [Indexed: 11/29/2022] Open
Abstract
Objective Gastrointestinal (GI) symptoms are prominent in major depressive disorder (MDD) and bring patients lots of complaints and troubles. We aimed to explore whether there were some distinctive brain image alterations in MDD with GI symptoms, which could be used to distinguish MDD with GI symptoms from those without GI symptoms and healthy controls (HCs). Methods A total of 35 outpatients with GI symptoms, 17 outpatients without GI symptoms, and 28 HCs were recruited. All the participants were scanned by a resting-state functional magnetic resonance imaging. Imaging data were analyzed with the global functional connectivity (GFC) and support vector machine methods. Results MDD with GI symptoms showed decreased GFC in the left superior medial prefrontal cortex (MPFC) compared with MDD without GI symptoms. Compared with HCs, MDD with GI symptoms showed decreased GFC in the bilateral middle temporal pole (MTP) and left posterior cingulate cortex/precuneus (PCC/Pcu), and increased GFC in the right insula and bilateral thalamus. SVM analysis showed that an accuracy was 78.85% in differentiating MDD with GI symptoms from MDD without GI symptoms by using the GFC of the left superior MPFC. A combination of GFC of the left PCC/Pcu and bilateral MTP exhibited the highest accuracy (87.30%) in differentiating patients with MDD with GI symptoms from HCs. Conclusion MDD with GI symptoms showed abnormal GFC in multiple networks, including the default mode network and cortico-limbic mood-regulating circuit. Using abnormal GFC might work well to discriminate MDD with GI symptoms from MDD without GI symptoms and HCs.
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Affiliation(s)
- Meiqi Yan
- Department of Psychiatry and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Xiaoya Fu
- Department of Psychiatry and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yangpan Ou
- Department of Psychiatry and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Feng Liu
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Huabing Li
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Wenbin Guo
- Department of Psychiatry and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
- Department of Psychiatry, Qiqihar Medical University, Qiqihar, China
- Department of Psychiatry, The Third People’s Hospital of Foshan, Foshan, China
- *Correspondence: Wenbin Guo,
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24
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Fermin ASR, Friston K, Yamawaki S. An insula hierarchical network architecture for active interoceptive inference. ROYAL SOCIETY OPEN SCIENCE 2022; 9:220226. [PMID: 35774133 PMCID: PMC9240682 DOI: 10.1098/rsos.220226] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 06/09/2022] [Indexed: 05/05/2023]
Abstract
In the brain, the insular cortex receives a vast amount of interoceptive information, ascending through deep brain structures, from multiple visceral organs. The unique hierarchical and modular architecture of the insula suggests specialization for processing interoceptive afferents. Yet, the biological significance of the insula's neuroanatomical architecture, in relation to deep brain structures, remains obscure. In this opinion piece, we propose the Insula Hierarchical Modular Adaptive Interoception Control (IMAC) model to suggest that insula modules (granular, dysgranular and agranular), forming parallel networks with the prefrontal cortex and striatum, are specialized to form higher order interoceptive representations. These interoceptive representations are recruited in a context-dependent manner to support habitual, model-based and exploratory control of visceral organs and physiological processes. We discuss how insula interoceptive representations may give rise to conscious feelings that best explain lower order deep brain interoceptive representations, and how the insula may serve to defend the body and mind against pathological depression.
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Affiliation(s)
- Alan S. R. Fermin
- Center for Brain, Mind and Kansei Sciences Research, Hiroshima University, Hiroshima, Japan
| | - Karl Friston
- The Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, London, England
| | - Shigeto Yamawaki
- Center for Brain, Mind and Kansei Sciences Research, Hiroshima University, Hiroshima, Japan
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25
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Yan M, Chen J, Liu F, Li H, Zhao J, Guo W. Abnormal Default Mode Network Homogeneity in Major Depressive Disorder With Gastrointestinal Symptoms at Rest. Front Aging Neurosci 2022; 14:804621. [PMID: 35431887 PMCID: PMC9009333 DOI: 10.3389/fnagi.2022.804621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 03/01/2022] [Indexed: 12/27/2022] Open
Abstract
Background Gastrointestinal (GI) symptoms are prominent in many patients with major depressive disorder (MDD). However, it remains unclear whether MDD patients with GI symptoms have brain imaging alterations in the default mode network (DMN) regions. Methods A total of 35 MDD patients with GI symptoms, 17 MDD patients without GI symptoms, and 28 healthy controls (HCs) were recruited. All participants underwent resting-state functional magnetic resonance imaging scans. Network homogeneity (NH) and support vector machine (SVM) methods were used to analyze the imaging data. Results Gastrointestinal group showed higher 17-item Hamilton Rating Scale for Depression total scores and factor scores than the non-GI group. Compared with the non-GI group and HCs, the GI group showed decreased NH in the right middle temporal gyrus (MTG) and increased NH in the right precuneus (PCu). The SVM results showed that a combination of NH values of the right PCu and the right MTG exhibited the highest accuracy of 88.46% (46/52) to discriminate MDD patients with GI symptoms from those without GI symptoms. Conclusion Major depressive disorder patients with GI symptoms have more severe depressive symptoms than those without GI symptoms. Distinctive NH patterns in the DMN exist in MDD patients with GI symptoms, which can be applied as a potential brain imaging marker to discriminate MDD patients with GI symptoms from those without GI symptoms.
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Affiliation(s)
- Meiqi Yan
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Jindong Chen
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Feng Liu
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Huabing Li
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Jingping Zhao
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Wenbin Guo
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
- Department of Psychiatry, The Third People’s Hospital of Foshan, Foshan, China
- *Correspondence: Wenbin Guo,
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He W, Shao L, Wang H, Huang H, Zhang S, Li C, Zhang C, Yi W. Bilateral Anterior Capsulotomy for the Treatment of Refractory Somatic Symptom Disorder: A Case Report. Front Integr Neurosci 2022; 15:721833. [PMID: 35115912 PMCID: PMC8805728 DOI: 10.3389/fnint.2021.721833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 12/10/2021] [Indexed: 11/13/2022] Open
Abstract
Somatic symptom disorder (SSD) is a form of mental illness that causes one or more distressing somatic symptoms leading to a significant disruption to everyday life, characterized by excessive thoughts, feelings, or behaviors related to these symptoms. While SSD is characterized by significant discomfort in some parts of the body, these symptoms are not related to any known medical condition and therefore it cannot be diagnosed using any medical instrument examination. Currently available treatments for SSD, including drug therapy and psychotherapy (such as cognitive behavioral therapy), usually improve psychiatric symptoms, but the results are often disappointing. Furthermore, SSD is often comorbid with anxiety and depression (75.1 and 65.7%, respectively). Importantly, interventions targeting the anterior limb of the internal capsule (ALIC; e.g., deep brain stimulation and thermal ablation) can effectively treat various mental disorders, such as refractory obsessive-compulsive disorder, depression, and eating disorders, suggesting that it may also be effective for treating the depressive symptoms associated with SSD comorbidity. In this report, a 65-year-old woman diagnosed with SSD accompanied with depression and anxiety underwent bilateral anterior capsulotomy. The patient complained of nausea and vomiting, swelling of the hilum of the liver for 14 years, weakness of the limbs for 13 years, and burning pain in the esophagus for 1 year. Psychiatric and neuropsychological assessments were conducted to record the severity of the patients' symptoms and the progression of postoperative symptoms. The patient's somatization, depression, and anxiety symptoms as well as quality of life improved significantly and steadily; thus, anti-depressive and anti-anxiety medication were stopped. However, the patient developed new somatization symptoms, including dizziness, headache, and sternal pain, 10 months after the operation. Therefore, the patient resumed taking flupentixol and melitracen in order to control the new symptoms. This study shows that bilateral anterior capsulotomy appears to be a complementary treatment for refractory SSD with depressive and anxiety symptoms. Furthermore, postoperative use of anxiolytic and antidepressant medications may be useful for controlling future somatization symptoms.
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Affiliation(s)
- Weibin He
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Lingmin Shao
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Huiling Wang
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Huan Huang
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Shudi Zhang
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Chenhui Li
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Chencheng Zhang
- Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Research Center for Brain Science and Brain-Inspired Intelligence, Shanghai, China
- *Correspondence: Wei Yi
| | - Wei Yi
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China
- Chencheng Zhang
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27
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Wu X, Zhu Y, Wu Z, Huang J, Cao L, Wang Y, Su Y, Liu H, Fang M, Yao Z, Wang Z, Wang F, Wang Y, Peng D, Chen J, Fang Y. Identifying the Subtypes of Major Depressive Disorder Based on Somatic Symptoms: A Longitudinal Study Using Latent Profile Analysis. Front Psychiatry 2022; 13:759334. [PMID: 35903631 PMCID: PMC9314656 DOI: 10.3389/fpsyt.2022.759334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 06/06/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Two-thirds of major depressive disorder (MDD) patients initially present with somatic symptoms, yet no study has used approaches based on somatic symptoms to subtype MDD. This study aimed to classify MDD via somatic symptoms and tracked the prognosis of each subtype. METHODS Data were obtained from the study of Algorithm Guided Treatment Strategies for Major Depressive Disorder (AGTs-MDD). We recruited 395 subjects who received monotherapy of mirtazapine or escitalopram and conducted 2-, 4-, 6-, 8-, and 12-week follow-up assessments (n = 311, 278, 251, 199, and 178, respectively). Latent profile analysis (LPA) was performed on somatic symptom items of the depression and somatic symptoms scale (DSSS). Generalized linear mixed models (GLMM) were used to study the longitudinal prognosis of the subtypes classed by LPA. Primary outcome measures were the Hamilton Depression Rating Scale (HAMD), HAMD score reduction rate, as well as somatic and depressive items of DSSS. RESULTS Three subtypes of MDD were found, namely, depression with mild somatic symptoms (68.9%), depression with moderate somatic symptoms (19.2%), and depression with severe somatic symptoms (11.9%). Scores of HAMD (F = 3.175, p = 0.001), somatic (F = 23.594, p < 0.001), and depressive (F = 4.163, p < 0.001) DSSS items throughout the 12-week follow-up showed statistical difference among the three subtypes. The moderate group displayed a higher HAMD-17 score and a lower reduction rate at the 6th week, and more severe depressive symptoms both at the 4th and 6th weeks. CONCLUSION The results indicate that somatic symptoms should be emphasized in patients with MDD, and more attention is needed for those with moderate somatic symptoms, which may be relevant to a worse prognosis.
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Affiliation(s)
- Xiaohui Wu
- Clinical Research Center and Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuncheng Zhu
- Clinical Research Center and Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhiguo Wu
- Clinical Research Center and Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jia Huang
- Clinical Research Center and Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lan Cao
- Clinical Research Center and Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yun Wang
- Clinical Research Center and Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yousong Su
- Clinical Research Center and Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hongmei Liu
- Clinical Research Center and Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | | - Zhijian Yao
- Nanjing Medical University Affiliated Brain Hospital, Nanjing, China
| | - Zuowei Wang
- Department of Psychiatry, Hongkou District Mental Health Center of Shanghai, Shanghai, China
| | - Fan Wang
- Clinical Research Center and Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yong Wang
- Clinical Research Center and Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Daihui Peng
- Clinical Research Center and Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Chen
- Clinical Research Center and Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yiru Fang
- Clinical Research Center and Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai, China.,Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
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28
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Liu PH, Li Y, Zhang AX, Sun N, Li GZ, Chen X, Bai TJ, Bo QJ, Chen GM, Chen NX, Chen TL, Chen W, Cheng C, Cheng YQ, Cui XL, Duan J, Fang YR, Gong QY, Guo WB, Hou ZH, Hu L, Kuang L, Li F, Li KM, Li T, Liu YS, Liu ZN, Long YC, Luo QH, Meng HQ, Peng DH, Qiu HT, Qiu J, Shen YD, Shi YS, Wang F, Wang K, Wang L, Wang X, Wang Y, Wu XP, Wu XR, Xie CM, Xie GR, Xie HY, Xie P, Xu XF, Yang H, Yang J, Yao JS, Yao SQ, Yin YY, Yuan YG, Zhang H, Zhang L, Zhang ZJ, Zhou RB, Zhou YT, Zhu JJ, Zou CJ, Si TM, Zuo XN, Yan CG, Zhang KR. Brain structural alterations in MDD patients with gastrointestinal symptoms: Evidence from the REST-meta-MDD project. Prog Neuropsychopharmacol Biol Psychiatry 2021; 111:110386. [PMID: 34119573 DOI: 10.1016/j.pnpbp.2021.110386] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 06/07/2021] [Accepted: 06/08/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVE While gastrointestinal (GI) symptoms are very common in patients with major depressive disorder (MDD), few studies have investigated the neural basis behind these symptoms. In this study, we sought to elucidate the neural basis of GI symptoms in MDD patients by analyzing the changes in regional gray matter volume (GMV) and gray matter density (GMD) in brain structure. METHOD Subjects were recruited from 13 clinical centers and categorized into three groups, each of which is based on the presence or absence of GI symptoms: the GI symptoms group (MDD patients with at least one GI symptom), the non-GI symptoms group (MDD patients without any GI symptoms), and the healthy control group (HCs). Structural magnetic resonance images (MRI) were collected of 335 patients in the GI symptoms group, 149 patients in the non-GI symptoms group, and 446 patients in the healthy control group. The 17-item Hamilton Depression Rating Scale (HAMD-17) was administered to all patients. Correlation analysis and logistic regression analysis were used to determine if there was a correlation between the altered brain regions and the clinical symptoms. RESULTS There were significantly higher HAMD-17 scores in the GI symptoms group than that of the non-GI symptoms group (P < 0.001). Both GMV and GMD were significant different among the three groups for the bilateral superior temporal gyrus, bilateral middle temporal gyrus, left lingual gyrus, bilateral caudate nucleus, right Fusiform gyrus and bilateral Thalamus (GRF correction, cluster-P < 0.01, voxel-P < 0.001). Compared to the HC group, the GI symptoms group demonstrated increased GMV and GMD in the bilateral superior temporal gyrus, and the non-GI symptoms group demonstrated an increased GMV and GMD in the right superior temporal gyrus, right fusiform gyrus and decreased GMV in the right Caudate nucleus (GRF correction, cluster-P < 0.01, voxel-P < 0.001). Compared to the non-GI symptoms group, the GI symptoms group demonstrated significantly increased GMV and GMD in the bilateral thalamus, as well as decreased GMV in the bilateral superior temporal gyrus and bilateral insula lobe (GRF correction, cluster-P < 0.01, voxel-P < 0.001). While these changed brain areas had significantly association with GI symptoms (P < 0.001), they were not correlated with depressive symptoms (P > 0.05). Risk factors for gastrointestinal symptoms in MDD patients (p < 0.05) included age, increased GMD in the right thalamus, and decreased GMV in the bilateral superior temporal gyrus and left Insula lobe. CONCLUSION MDD patients with GI symptoms have more severe depressive symptoms. MDD patients with GI symptoms exhibited larger GMV and GMD in the bilateral thalamus, and smaller GMV in the bilateral superior temporal gyrus and bilateral insula lobe that were correlated with GI symptoms, and some of them and age may contribute to the presence of GI symptoms in MDD patients.
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Affiliation(s)
- Peng-Hong Liu
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan 030001, China; Department of First Clinical Medicine, Shanxi Medical University, Taiyuan 030001, China
| | - Yan Li
- Department of Clinical Medicine, Fenyang College of Shanxi Medical University, 032200, China
| | - Ai-Xia Zhang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan 030001, China
| | - Ning Sun
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan 030001, China; Department of First Clinical Medicine, Shanxi Medical University, Taiyuan 030001, China
| | - Gai-Zhi Li
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan 030001, China; Department of First Clinical Medicine, Shanxi Medical University, Taiyuan 030001, China
| | - Xiao Chen
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Beijing 100054, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing 100054, China
| | - Tong-Jian Bai
- Anhui Medical University, Hefei, Anhui 230022, China
| | - Qi-Jing Bo
- Beijing Anding Hospital, Capital Medical University, Beijing 100054, China
| | - Guan-Mao Chen
- The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong 510630, China
| | - Ning-Xuan Chen
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Beijing 100054, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing 100054, China
| | - Tao-Lin Chen
- Mental Health Center, West China Hospital, Sichuan University Chengdu, Sichuan 610041, China
| | - Wei Chen
- Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310012, China
| | - Chang Cheng
- The Institute of Mental Health, Second Xiangya Hospital of Central South University, Changsha, Hunan 410008, China
| | - Yu-Qi Cheng
- First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650221, China
| | - Xi-Long Cui
- The Institute of Mental Health, Second Xiangya Hospital of Central South University, Changsha, Hunan 410008, China
| | - Jia Duan
- Department of Psychiatry, First Affiliated Hospital, China Medical University, Shenyang, Liaoning 110001, China
| | - Yi-Ru Fang
- Department of Psychiatry, Shanghai Jiao Tong University School of Medicine, Shanghai 200240, China
| | - Qi-Yong Gong
- Department of Radiology, Huaxi MR Research Center,West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China; Psychoradiology Research Unit of Chinese Academy of Medical Sciences, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
| | - Wen-Bin Guo
- The Institute of Mental Health, Second Xiangya Hospital of Central South University, Changsha, Hunan 410008, China
| | - Zheng-Hua Hou
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Lan Hu
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Li Kuang
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Feng Li
- Anhui Medical University, Hefei, Anhui 230022, China
| | - Kai-Ming Li
- Department of Radiology, Huaxi MR Research Center,West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
| | - Tao Li
- Mental Health Center, West China Hospital, Sichuan University Chengdu, Sichuan 610041, China
| | - Yan-Song Liu
- Department of Clinical Psychology, Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, Jiangsu 215137, China
| | - Zhe-Ning Liu
- The Institute of Mental Health, Second Xiangya Hospital of Central South University, Changsha, Hunan 410008, China
| | - Yi-Cheng Long
- The Institute of Mental Health, Second Xiangya Hospital of Central South University, Changsha, Hunan 410008, China
| | - Qing-Hua Luo
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Hua-Qing Meng
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Dai-Hui Peng
- Department of Psychiatry, Shanghai Jiao Tong University School of Medicine, Shanghai 200240, China
| | - Hai-Tang Qiu
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Jiang Qiu
- Faculty of Psychology, Southwest University, Chongqing 400716, China
| | - Yue-Di Shen
- Department of Diagnostics, Affiliated Hospital, Hangzhou Normal University Medical School, Hangzhou, Zhejiang 311121, China
| | - Yu-Shu Shi
- Mental Health Center, West China Hospital, Sichuan University Chengdu, Sichuan 610041, China
| | - Fei Wang
- Department of Psychiatry, First Affiliated Hospital, China Medical University, Shenyang, Liaoning 110001, China
| | - Kai Wang
- Anhui Medical University, Hefei, Anhui 230022, China
| | - Li Wang
- National Clinical Research Center for Mental Disorders, Peking University Sixth Hospital, Beijing 100191, China; Key Laboratory of Mental Health, Ministry of Health, Peking University, Beijing 100191, China
| | - Xiang Wang
- The Institute of Mental Health, Second Xiangya Hospital of Central South University, Changsha, Hunan 410008, China
| | - Ying Wang
- The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong 510630, China
| | - Xiao-Ping Wu
- Xi'an Central Hospital, Xi'an, Shannxi 710003, China
| | - Xin-Ran Wu
- Faculty of Psychology, Southwest University, Chongqing 400716, China
| | - Chun-Ming Xie
- Department of Neurology, Affiliated ZhongDa Hospital of Southeast University, Nanjing, Jiangsu 210009, China
| | - Guang-Rong Xie
- The Institute of Mental Health, Second Xiangya Hospital of Central South University, Changsha, Hunan 410008, China
| | - Hai-Yan Xie
- Department of Psychiatry, The Fourth Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310058, China
| | - Peng Xie
- Institute of Neuroscience, Chongqing Medical University, Chongqing 400016, China; Chongqing Key Laboratory of Neurobiology, Chongqing, 400016, China; Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Xiu-Feng Xu
- Beijing Anding Hospital, Capital Medical University, Beijing 100054, China
| | - Hong Yang
- Department of Radiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310058, China
| | - Jian Yang
- The First Affiliated Hospital of Xi'an Jiaotong University, Shaanxi 710061, China
| | - Jia-Shu Yao
- Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310012, China
| | - Shu-Qiao Yao
- The Institute of Mental Health, Second Xiangya Hospital of Central South University, Changsha, Hunan 410008, China
| | - Ying-Ying Yin
- Department of Psychosomatics and Psychiatry, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu 210096, China
| | - Yong-Gui Yuan
- Department of Psychosomatics and Psychiatry, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu 210096, China
| | - Hong Zhang
- Xi'an Central Hospital, Xi'an, Shannxi 710003, China
| | - Lei Zhang
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Beijing 100054, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing 100054, China
| | - Zhi-Jun Zhang
- Department of Neurology, Affiliated ZhongDa Hospital of Southeast University, Nanjing, Jiangsu 210009, China
| | - Ru-Bai Zhou
- Department of Psychiatry, Shanghai Jiao Tong University School of Medicine, Shanghai 200240, China
| | - Yi-Ting Zhou
- Mental Health Center, West China Hospital, Sichuan University Chengdu, Sichuan 610041, China
| | - Jun-Juan Zhu
- Department of Psychiatry, Shanghai Jiao Tong University School of Medicine, Shanghai 200240, China
| | - Chao-Jie Zou
- First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650221, China
| | - Tian-Mei Si
- National Clinical Research Center for Mental Disorders, Peking University Sixth Hospital, Beijing 100191, China; Key Laboratory of Mental Health, Ministry of Health, Peking University, Beijing 100191, China
| | - Xi-Nian Zuo
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Beijing 100054, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing 100054, China; Magnetic Resonance Imaging Research Center and Research Center for Lifespan Development of Mind and Brain (CLIMB), Institute of Psychology, Chinese Academy of Sciences, Beijing 100054, China
| | - Chao-Gan Yan
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Beijing 100054, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing 100054, China; Magnetic Resonance Imaging Research Center and Research Center for Lifespan Development of Mind and Brain (CLIMB), Institute of Psychology, Chinese Academy of Sciences, Beijing 100054, China; Department of Child and Adolescent Psychiatry, NYU Langone Medical Center School of Medicine, New York, NY 10016, USA
| | - Ke-Rang Zhang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan 030001, China.
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The effects of music listening on somatic symptoms and stress markers in the everyday life of women with somatic complaints and depression. Sci Rep 2021; 11:24062. [PMID: 34911978 PMCID: PMC8674261 DOI: 10.1038/s41598-021-03374-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 11/30/2021] [Indexed: 12/18/2022] Open
Abstract
Despite a growing body of literature documenting the health-beneficial effects of music, empirical research on the effects of music listening in individuals with psychosomatic disorders is scarce. Using an ambulatory assessment design, we tested whether music listening predicts changes in somatic symptoms, subjective, and biological stress levels, and examined potential mediating processes, in the everyday life of 58 women (M = 27.7 years) with somatic symptom disorder (SSD) and depressive disorders (DEP). Multilevel models revealed that music listening predicted lower subjective stress ratings (p ≤ 0.02) irrespective of mental health condition, which, in turn, predicted lower somatic symptoms (p ≤ 0.03). Moreover, specific music characteristics modulated somatic symptoms (p = 0.01) and autonomic activity (p = 0.03). These findings suggest that music listening might mitigate somatic symptoms predominantly via a reduction in subjective stress in women with SSD and DEP and further inform the development of targeted music interventions applicable in everyday life.
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Liu P, Tu H, Zhang A, Yang C, Liu Z, Lei L, Wu P, Sun N, Zhang K. Brain functional alterations in MDD patients with somatic symptoms: A resting-state fMRI study. J Affect Disord 2021; 295:788-796. [PMID: 34517253 DOI: 10.1016/j.jad.2021.08.143] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 07/22/2021] [Accepted: 08/27/2021] [Indexed: 01/22/2023]
Abstract
OBJECTIVE It has been established that major depressive disorder (MDD) is accompanied by various somatic symptoms that are related to the clinical course and severity of depression. However, the mechanisms of somatic symptoms in MDD have rarely been studied. In this study, we sought to investigate the functional neurological changes in MDD patients with somatic symptoms based off the regional homogeneity (ReHo) and the amplitude of low-frequency fluctuation (ALFF). METHOD Study participants included 74 first-episode, drug naïve MDD patients as well as 70 healthy subjects (HCs). Patients diagnosed with MDD were separated into two groups based on the presence (n=50) or absence (n=24) of somatic symptoms. Functional images were obtained and analyzed. Alterations in ReHo/ALFF and the severity of clinical symptoms were investigated using correlation analysis. RESULTS More severe depressive symptoms were observed in the somatic depression group than that of the pure depression group (P< 0.001). Furthermore, there was a significant reduction in ReHo and ALFF in the bilateral precentral gyrus, bilateral postcentral gyrus, and left paracentral gyrus in the somatic MDD group as compared to the pure depression group (GRF correction, voxel-P< 0.001, cluster-P < 0.01). Pearson correlation analysis revealed a negative correlation between ReHo and ALFF values in these abnomal regions with the severity of somatic and depressive symptoms (P< 0.01). CONCLUSION Somatic depression is more severe than pure depression. The ReHo and ALFF changes in the precentral gyrus, postcentral gyrus, and paracentral gyrus may serve a significant role in the pathophysiology of somatic symptoms in MDD.
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Affiliation(s)
- Penghong Liu
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan 030001, PR China; Shanxi Medical University, Taiyuan 030001, PR China
| | - Hongwei Tu
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan 030001, PR China; Shanxi Medical University, Taiyuan 030001, PR China
| | - Aixia Zhang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan 030001, PR China
| | - Chunxia Yang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan 030001, PR China
| | - Zhifen Liu
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan 030001, PR China
| | - Lei Lei
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan 030001, PR China; Department of Psychiatry, Second Hospital of Shanxi Medical University, Taiyuan 030001, PR China
| | - Peiyi Wu
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan 030001, PR China; Shanxi Medical University, Taiyuan 030001, PR China
| | - Ning Sun
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan 030001, PR China.
| | - Kerang Zhang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan 030001, PR China.
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Liu Y, Ou Y, Zhao J, Guo W. Abnormal interhemispheric homotopic functional connectivity is correlated with gastrointestinal symptoms in patients with major depressive disorder. J Psychiatr Res 2021; 144:234-240. [PMID: 34700211 DOI: 10.1016/j.jpsychires.2021.10.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 09/06/2021] [Accepted: 10/18/2021] [Indexed: 10/20/2022]
Abstract
The severity of major depressive disorder (MDD) can be aggravated by gastrointestinal (GI) symptoms, but the neuroimaging mechanism underlying GI symptoms still remains unclear. In this study, we recruited 52 medication-free and first-episode MDD patients (35 with GI symptoms and 17 without GI symptoms) and 28 age-, sex-, and education-matched healthy controls to explore the inter-group differences in neuroimaging findings. All the participants underwent resting-state functional magnetic resonance imaging (fMRI) scan, and the functional connectivities that were reported to be abnormal in MDD were our focus of exploration. Voxel-mirrored homotopic connectivity (VMHC) method was used to explore the interhemispheric homotopic functional connectivity of all the subjects. Patients with MDD showed significantly different VMHC in brain regions in the default mode network (DMN), including the middle frontal gyrus, precuneus, inferior parietal lobule, and posterior cingulate cortex. Patients with GI symptoms exhibited significantly decreased interhemispheric homotopic functional connectivity in the middle frontal gyrus and superior frontal gyrus, compared with patients without GI symptoms. These results suggested that the DMN is involved in the neuropathology of MDD. Interhemispheric homotopic connectivity in specific regions could be applied as a biomarker to distinguish MDD patients with GI symptoms from those without GI symptoms.
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Affiliation(s)
- Yi Liu
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Yangpan Ou
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Jingping Zhao
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Wenbin Guo
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China.
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Renna ME, O'Toole MS, Fresco DM, Heimberg RG, Mennin DS. From psychological to physical health: Exploring temporal precedence throughout emotion regulation therapy. J Anxiety Disord 2021; 80:102403. [PMID: 33901929 PMCID: PMC8141041 DOI: 10.1016/j.janxdis.2021.102403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 03/18/2021] [Accepted: 04/13/2021] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Generalized anxiety disorder (GAD) is characterized, in part, by physical symptoms such as muscle tension and gastrointestinal (GI) distress. To date, little research has examined how changes in psychological symptoms associated with GAD may impact physical symptoms. This study investigated if reductions in worry, anxiety, and depression precede changes in muscle tension and GI distress throughout psychotherapy. METHODS Participants with GAD (N = 85) completed 20 weeks of emotion regulation therapy (ERT) in addition to assessments pre, mid, and post treatment. They completed a physical symptom questionnaire, evaluating muscle tension and GI distress. Participants also completed psychological symptoms questionnaires, including the State Trait Anxiety Inventory (STAI-7), Penn State Worry Questionnaire (PSWQ), and Beck Depression Inventory (BDI-II). Control participants (N = 44) completed these measures at baseline. RESULTS Participants with GAD had significantly greater muscle tension (p < .001) and GI distress (p < .001) compared to control participants without GAD. Reductions in worry, depression, and trait anxiety did not precede changes in muscle tension (range of effect size (r): .05-.12). Reductions in both depression (p = 0.04) and trait anxiety (p < 0.01) preceded reductions in GI distress. Reductions in worry did not precede reductions in GI distress (p = 0.25). CONCLUSION These data provide preliminary evidence for the temporal effect of reductions in psychological symptoms on reductions in GI distress in GAD, highlighting the potential of psychotherapy to improve physical outcomes.
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Affiliation(s)
- Megan E Renna
- The Ohio State University College of Medicine, Comprehensive Cancer Center & Institute for Behavioral Medicine Research, Columbus, OH, USA.
| | - Mia S O'Toole
- Aarhus University, Department of Psychology and Behavioral Sciences, Aarhus, Denmark
| | - David M Fresco
- University of Michigan, Department of Psychiatry & Institute for Social Research, Ann Arbor, MI, USA
| | | | - Douglas S Mennin
- Teachers College, Columbia University, Department of Clinical and Counseling Psychology, New York, NY, USA
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Kleinstäuber M, Exner A, Lambert MJ, Terluin B. Validation of the Four-Dimensional Symptom Questionnaire (4DSQ) in a mental health setting. PSYCHOL HEALTH MED 2021; 26:1-19. [PMID: 33835880 DOI: 10.1080/13548506.2021.1883685] [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] [Indexed: 10/21/2022]
Abstract
Mental health problems are highly prevalent in primary care. Validated tools to detect mental disorders in general practice are needed. The Four-Dimensional Symptom Questionnaire (4DSQ) was designed to help GPs differentiating between psychological distress and psychopathological conditions (depression, anxiety, somatization). The aim of the current study was to examine psychometric properties of the 4DSQ in a mental health setting. Reliability, factorial, construct, and criterion validity of the English translation of the 4DSQ were analyzed in an American sample of 159 patients attending a psychotherapy outpatient clinic. Measurement equivalence across languages was determined by analyzing differential item functioning (DIF) and differential test functioning (DTF) in the American sample and a Dutch mental health sample, matched by age and sex. A confirmatory factor analysis confirmed all 4DSQ subscales to be unidimensional. All 4DSQ subscales revealed excellent reliability (Cronbach's alpha and McDonald omega ≥.90) and high correlations with a symptom distress subscale of an instrument that is commonly used to monitor psychotherapy progress, the Outcome Questionnaire-45. Eight items were flagged with DIF. The Depression subscale was free of DIF. DTF analyses showed an impact of DIF on scale level for the lower cutoff score of the Distress scale. The 4DSQ Distress score was the best predictor of a mood disorder diagnosis and the Anxiety score outperformed other 4DSQ scales to predict an anxiety disorder. In conclusion, the 4DSQ demonstrates excellent reliability and validity in a mental health setting. Further research is needed to determine reliable cutoff values on 4DSQ subscales to predict psychiatric diagnoses.
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Affiliation(s)
- Maria Kleinstäuber
- Department of Psychological Medicine, University of Otago, Dunedin, New Zealand.,Department of Clinical Psychology and Psychotherapy, Philipps-University, Marburg, Germany
| | - Anna Exner
- Department of Education Studies and Psychology, University of Siegen, Siegen, Germany
| | | | - Berend Terluin
- Department of General Practice and Elderly Care Medicine, Amsterdam UMC, VU University, Amsterdam, The Netherlands
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Characteristics of somatic symptoms among Chinese patients diagnosed with major depressive episode. Arch Psychiatr Nurs 2021; 35:27-33. [PMID: 33593512 DOI: 10.1016/j.apnu.2020.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 10/02/2020] [Accepted: 11/08/2020] [Indexed: 11/22/2022]
Abstract
PURPOSE This study aimed to describe the clinical features of somatic symptoms among Chinese patients diagnosed with major depressive episode (MDE). METHODS A total of 213 inpatients with MDE from two mental health hospitals were recruited and investigated using the Somatic Symptom Inventory (SSI), Hamilton rating scale for depression, Hamilton rating scale for anxiety, and a demographic questionnaire. RESULTS The participants included 142 patients with unipolar depression and 71 patients with bipolar depression. The mean SSI score of all participants was 49.30 (SD = 14.80). "Feeling fatigued, weak, or tired all over" was found to be the most common somatic symptom (61.0% reported moderate levels or above), followed by "feeling of being not in as good physical health as most of your friends" (56.3%), and "feeling weak in parts of the body" (49.3%). "Headache" and "soreness in muscles" were common painful symptoms. Both patients with unipolar and bipolar depression had similar somatic symptoms, including painful and non-painful ones. The somatic symptoms of all participants were closely correlated with the severity of depression and anxiety (P < 0.01). Patients with anxiety, older age, low education, and negative life events in the last year had more somatic symptoms. CONCLUSIONS Inpatients with MDE of somatic symptoms are common, which were significantly correlated with the severity of depression and anxiety. Further efforts should focus on early recognition and integrated care model management of patients based on their characteristics to improve their quality of life and treatment outcomes.
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Can changes in multidimensional self-reported interoception be considered as outcome predictors in severely depressed patients? A moderation and mediation analysis. J Psychosom Res 2021; 141:110331. [PMID: 33338695 DOI: 10.1016/j.jpsychores.2020.110331] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 12/05/2020] [Accepted: 12/06/2020] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Somatic complaints (e.g. pain) and abnormal self-reported interoception (e.g. maladaptive bodily self-focus) are common features of major depressive disorder (MDD) with sex-specific manifestations. Whereas somatic symptoms are associated with adverse clinical outcomes (e.g. residual symptoms), studies are scarce investigating the role of interoception as an outcome predictor for specific hospital treatment of MDD. Therefore, multivariate associations between changes in multidimensional self-reported interoception, somatic symptoms, and clinical improvements are explored by hypothesizing interactions with sex and an interoceptive mechanism. METHODS In this naturalistic study, 87 hospitalized participants suffering from MDD completed questionnaires at pre- and post-treatment assessing multidimensional self-reported interoception (MAIA-2), somatic symptom burden (SCL-90-S® SOMA), and depression severity (BDI-II). We performed a multiple hierarchical regression analysis to test for interaction effects. The mediation hypothesis was path-analytically tested in a parallel mediation model by bootstrapping confidence intervals for (in)direct effects. RESULTS Improvements in self-reported interoception independently predicted positive treatment response, ΔRadj2=8.61%, ΔF(8, 74) = 3.23, p < .01. Prediction effects were moderated by sex, ΔRadj2=5.54%, ΔF(8, 66) = 2.22, p < .05. Post-hoc analyses revealed significant effects of body confidence in women, B = -4.26, t(28) = -2.78, p < .01, and of self-regulation in men, B = -3.21, t(17) = -2.27, p < .05. Effects of somatic symptom relief on treatment outcome were partially mediated by self-reported interoception, total indirect = 2.94 [95% BCa CI 0.99, 5.69]. CONCLUSION Interoception patterns changed significantly and predicted outcome of hospital treatment in severely depressed patients. Our study could imply the need to consider body sensations additionally as a target for antidepressive treatments. The development of tailored interoceptive interventions in depressive patients represents a promising vision for the future.
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Yan M, Chen J, Liu F, Li H, Huang R, Tang Y, Zhao J, Guo W. Disrupted Regional Homogeneity in Major Depressive Disorder With Gastrointestinal Symptoms at Rest. Front Psychiatry 2021; 12:636820. [PMID: 34122171 PMCID: PMC8187583 DOI: 10.3389/fpsyt.2021.636820] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 04/19/2021] [Indexed: 12/27/2022] Open
Abstract
Background: Gastrointestinal (GI) symptoms are prominent in patients with major depressive disorder (MDD). Previous studies have reported brain structural and functional changes in both MDD and digestive system diseases but it remains unclear whether MDD patients with GI symptoms have brain imaging changes. Methods: We recruited 35 MDD patients with GI symptoms, 17 MDD patients without GI symptoms and 28 age-, gender-, and education-matched healthy controls. All participants were scanned by resting-state functional magnetic resonance imaging (fMRI). Imaging data were analyzed with regional homogeneity (ReHo). Results: The GI group showed higher total HRSD-17 scores, anxiety/somatization, weight loss, and sleep disturbance scores compared to the non-GI group. We found increased ReHo in the right inferior parietal gyrus (IPL), bilateral supplementary motor area (SMA), bilateral cerebellum Crus II, left inferior frontal gyrus (IFG), and bilateral superior medial frontal cortex (SMFC) and decreased ReHo in the right posterior cingulate cortex (PCC), bilateral cuneus, and left middle occipital gyrus (MOG) in patients with GI symptoms relative to the HCs. The GI group showed higher ReHo values in the bilateral precuneus than the non-GI group. Conclusion: MDD patients with GI symptoms showed a greater severity of symptoms than MDD patients without GI symptoms, particularly in terms of anxiety/somatization, weight loss, and sleep disturbances. Increased activity in the default-mode network might be associated with GI symptoms in MDD patients.
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Affiliation(s)
- Meiqi Yan
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Jindong Chen
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Feng Liu
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Huabing Li
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Renzhi Huang
- Hunan Key Laboratory of Children's Psychological Development and Brain Cognitive Science, Changsha, China
| | - Yanqing Tang
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Jingping Zhao
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Wenbin Guo
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China.,Department of Psychiatry, The Third People's Hospital of Foshan, Foshan, China
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Köhler-Forsberg O, Petersen L, Ishtiak-Ahmed K, Østergaard SD, Gasse C. Medical diseases prior to first-time depression diagnosis and subsequent risk of admissions for depression: A nationwide study of 117,585 patients. J Affect Disord 2020; 276:1030-1037. [PMID: 32763587 DOI: 10.1016/j.jad.2020.07.057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 02/02/2020] [Accepted: 07/05/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Medical diseases and depression frequently co-occur, but it remains uncertain whether specific medical diseases or the disease load, affect the clinical course of depression. METHODS We identified all adults (≥18 years) at their first hospital-based diagnosis of unipolar depression in Denmark between 1996 and 2015. All medical hospital contacts since 1977 and all drug prescriptions during the previous year were identified. We followed patients for up to five years regarding hospital admissions with depression and performed adjusted Cox regression analyses calculating hazard rate ratios (HRR) including 95%-confidence intervals (CI) to test the association between medical diseases and depression admission following the index depressive episode. RESULTS Among 117,585 patients with depression (444,696 person-years follow-up), any prior medical hospital contact (N = 114,206; 97.1%) was associated with increased risks of admission for depression among individuals aged 18-30 (HRR=1.50; 95%CI=1.15-1.95), 31-65 (HRR=1.69; 95%CI=1.28-2.21), and >65 years (HRR=1.38; 95%CI=1.10-1.75), fitting a dose-response relationship (p<0.005) with increasing number of prior medical diseases among those aged <65. All specific medical diseases were associated with increased risks of admission for depression, particularly among individuals aged<65 (HRR ranging from 1.57 to 2.38). Drug prescriptions and medical hospital contacts in the year before the depression diagnosis were associated with reduced risks of admission. CONCLUSION The medical load seems to be associated with an increased risk for depression admission, particularly among individuals aged <65. The lower risk for people in medical care during the previous year may indicate better compliance and care/treatment.
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Affiliation(s)
- Ole Köhler-Forsberg
- Department of Affective Disorders, Aarhus University Hospital - Psychiatry, Aarhus, Denmark; Psychosis Research Unit, Aarhus University Hospital - Psychiatry, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University Hospital - Psychiatry, Aarhus, Denmark.
| | - Liselotte Petersen
- National Centre for Register-based Research, Aarhus University, Denmark; Centre for Integrated Register-Based Research (CIRRAU), Aarhus University, Aarhus, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH
| | - Kazi Ishtiak-Ahmed
- Department of Affective Disorders, Aarhus University Hospital - Psychiatry, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University Hospital - Psychiatry, Aarhus, Denmark
| | - Søren Dinesen Østergaard
- Department of Affective Disorders, Aarhus University Hospital - Psychiatry, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University Hospital - Psychiatry, Aarhus, Denmark
| | - Christiane Gasse
- Department of Affective Disorders, Aarhus University Hospital - Psychiatry, Aarhus, Denmark; Psychosis Research Unit, Aarhus University Hospital - Psychiatry, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University Hospital - Psychiatry, Aarhus, Denmark
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Lamela D, Soreira C, Matos P, Morais A. Systematic review of the factor structure and measurement invariance of the patient health questionnaire-9 (PHQ-9) and validation of the Portuguese version in community settings. J Affect Disord 2020; 276:220-233. [PMID: 32697702 DOI: 10.1016/j.jad.2020.06.066] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 05/19/2020] [Accepted: 06/14/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND This research sought to review studies that examined the factor structure of the PHQ-9 using a confirmatory factor analysis approach (Study 1); to review studies that tested the measurement invariance of the PHQ-9 (Study 2); to examine the psychometric properties of the European Portuguese version in the general population (Study 3). METHODS Using PRISMA guidelines, a search was performed on Web of Science, PsycINFO, and Scopus from 2001 to August 2019. Assessment of eligibility criteria and data extraction were conducted by two independent researchers (Studies 1 and 2). In Study 3, data were collected from 1479 Portuguese adults, using a cross-sectional design. The BDI-II and the GDS-15 were administered to examine convergent validity. RESULTS The systematic review identified four-factor models of the PHQ-9 (Study 1). Nineteen studies supported a one-factor model, whereas 12 found evidence for a two-factor model. Both models were supported in general, clinical, psychiatric, and international samples. Study 2 identified ten studies that examined PHQ-9 measurement invariance across 18 groups. The PHQ-9 measurement invariance was fully supported across studies. Study 3 revealed that a two-factor model showed a close fit to data in the European Portuguese version of the PHQ-9. Measurement invariance, reliability, and convergent and divergent validity were also established. LIMITATIONS Study 3 did not include a gold standard measure of depression to evaluate PHQ-9 diagnostic properties. CONCLUSIONS Conceptual implications of the findings are discussed, and recommendations for using the Portuguese version of the PHQ-9 as a screening measure in community settings are also highlighted.
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Affiliation(s)
- Diogo Lamela
- Digital Human-Environment Interaction Lab, Lusófona University of Porto, Portugal.
| | - Cátia Soreira
- Digital Human-Environment Interaction Lab, Lusófona University of Porto, Portugal
| | - Paula Matos
- Digital Human-Environment Interaction Lab, Lusófona University of Porto, Portugal
| | - Ana Morais
- Digital Human-Environment Interaction Lab, Lusófona University of Porto, Portugal
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Madjar N, Mansbach-Kleinfeld I, Daeem R, Farbstein I, Apter A, Fennig S, Elias R, Shoval G. Discrepancies in adolescent-mother dyads' reports of core depression symptoms: Association with adolescents' help-seeking in school and their somatic complaints. J Psychosom Res 2020; 137:110222. [PMID: 32841758 DOI: 10.1016/j.jpsychores.2020.110222] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 08/09/2020] [Accepted: 08/13/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Parents of adolescents with mental problems do not always recognize the symptoms in their children, particularly regarding depression, and therefore do not seek professional help. Adolescents themselves tend to seek help from school personnel for their emotional or social difficulties. In contrast, adolescents do report somatic complaints and parents are likely to seek help for these problems. The current study explored whether the divergence between maternal and child reports of depression symptoms is associated with child's help-seeking in school and patterns of somatic complaints. METHOD A sample of 9th grade students (N = 693; 56% girls; mean age = 15.1) and their mothers representing the Muslim and Druze populations in northern Israel were interviewed simultaneously and independently. Maternal reports were classified either as underestimating, matching, or overestimating their own child self-report of three core symptoms of depression (depressed mood, anhedonia, and irritability). Adolescents reported whether they had consulted school staff and were classified into clusters based on self-reported somatic complaints. RESULTS Maternal misidentification of their child's depression symptoms was associated with increased help-seeking in school, particularly by boys if depressed mood or irritability were misidentified and particularly by girls if anhedonia was misidentified. Hierarchical cluster analysis indicated that the number and severity of somatic complaints was higher among adolescents whose depression symptoms were not identified, regardless of gender. CONCLUSION Mental health professionals, educators and parents should be aware that adolescents may attempt to communicate their emotional difficulties through somatic complaints and by seeking help in school.
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Affiliation(s)
- Nir Madjar
- School of Education, Bar-Ilan University, Ramat-Gan, Israel.
| | | | | | | | - Alan Apter
- Schneider Medical Center for Children in Israel, Petach Tikvah, Israel; Ruppin Academic Center, Netanya, Israel; Inter-Disciplinary Center, Herzliya, Israel
| | - Silvana Fennig
- Schneider Medical Center for Children in Israel, Petach Tikvah, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Gal Shoval
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Geha Mental Health Center, Petach Tikvah, Israel
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Liu P, Li G, Zhang A, Yang C, Liu Z, Sun N, Kerang Z. Brain structural and functional alterations in MDD patient with gastrointestinal symptoms: A resting-state MRI study. J Affect Disord 2020; 273:95-105. [PMID: 32421626 DOI: 10.1016/j.jad.2020.03.107] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 01/30/2020] [Accepted: 03/28/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE It is common for major depressive disorder (MDD) to be accompanied by gastrointestinal (GI) symptoms, which are known to negatively impact the course and severity of the disease. Although previous studies have attempted to explore the neuropathology of MDD, few studies have focused on the pathogenesis of GI symptoms in MDD. In this study, we investigated the changes in regional gray matter volume (GMV) and regional homogeneity (ReHo) present in MDD accompanied by GI symptoms. METHOD The following images were obtained and analyzed: Structural and functional magnetic resonance images (MRI) of 36 patients with MDD accompanied by GI symptoms (GI symptoms group), 22 patients without GI symptoms (Non-GI symptoms group), and 27 healthy controls (HC. The 24-item Hamilton Depression Rating Scale (HAMD) was administered. A correlation analysis was used to identify the possible associations between altered regional GMV, ReHo symptoms, GI symptoms, and depressive symptoms. RESULTS The total scores from the HAMD-24 in the GI symptoms group were significantly higher than in the Non-GI symptoms group (P<0.05). Significant differences in both GMV and ReHo were observed among the three groups for the right parahippocampal gyrus, left precentral gyrus, left middle frontal gyrus, right superior frontal gyrus, right middle frontal gyrus, and left inferior orbitofrontal gyrus (AlphaSim correction, P <0.001). The GI symptoms group exhibited significantly decreased GMV and ReHo in the left middle frontal gyrus, precentral gyrus, right superior frontal gyrus, and middle frontal gyrus. Additionally, the GI symptoms group exhibited increased ReHo in the left superior temporal gyrus at a higher level than the non-GI symptoms group. (AlphaSim correction, P <0.001). These altered brain areas were correlated with GI symptoms (P<0.001) but not depressive symptoms (P>0.05). CONCLUSION Patients with MDD accompanied by GI symptoms have more severe depressive symptoms. The structural and functional changes of the brain may be the pathogenesis for the GI symptoms in patients with MDD.
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Affiliation(s)
- Penghong Liu
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, PR China, 030001; Shanxi Medical University, Taiyuan, PR China, 030001.
| | - Gaizhi Li
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, PR China, 030001.
| | - Aixia Zhang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, PR China, 030001.
| | - Chunxia Yang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, PR China, 030001.
| | - Zhifen Liu
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, PR China, 030001
| | - Ning Sun
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, PR China, 030001.
| | - Zhang Kerang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, PR China, 030001.
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Lin CY, Guu TW, Lai HC, Peng CY, Chiang JYJ, Chen HT, Li TC, Yang SY, Su KP, Chang JPC. Somatic pain associated with initiation of interferon-alpha (IFN-α) plus ribavirin (RBV) therapy in chronic HCV patients: A prospective study. Brain Behav Immun Health 2020; 2:100035. [PMID: 34589826 PMCID: PMC8474510 DOI: 10.1016/j.bbih.2019.100035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 12/21/2019] [Accepted: 12/28/2019] [Indexed: 12/12/2022] Open
Abstract
Objective This study is aimed to investigate the association between interferon-alpha (IFN-α) plus ribavirin (RBV) treatment and emergence of somatic pain symptoms in patients with hepatitis C virus (HCV) over a 24-week treatment. Method In this prospective cohort study, 297 patients with HCV were evaluated at baseline and 2nd, 4th, 8th, 12th, 16th, 20th, and 24th week with structured Mini-International Neuropsychiatric Interview for Major Depressive Disorder (MDD) diagnosis and the Neurotoxicity Rating Scale (NRS) for somatic symptoms. Results Eighty-seven out of the 297 patients (29%) developed IFN-α induced depression and had significantly higher somatic pain symptoms as early as the 2nd week and at all the assessment time points (p < .001). Most depressed patients perceived greatest somatic pain at the 8th week of treatment. Moreover, NRS somatic pain scores after initial therapy strongly correlated with NRS somatic pain scores at all other assessment time points (p < .001). Conclusion IFN-α therapy induce significant somatic pain as early as the 2nd week of treatment in HCV patients who later developed MDD. Thus, initial NRS somatic pain score after initiation of IFN-α treatment may serve as a reference for the susceptibility of the individual to IFN-α induced depression.
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Affiliation(s)
- Chih Ying Lin
- School of Medicine, China Medical University (CMU), Taichung, Taiwan
- Mind-Body Interface Lab (MBI-Lab) and Department of Psychiatry, CMUH, Taichung, Taiwan
| | - Ta-Wei Guu
- Department Psychiatry, CMU Beigang Hospital, Yunlin, Taiwan
- Mind-Body Interface Lab (MBI-Lab) and Department of Psychiatry, CMUH, Taichung, Taiwan
| | - Hsueh-Chou Lai
- School of Medicine, China Medical University (CMU), Taichung, Taiwan
- Departement of Hepatogastroenterology, China Medial University Hospital, Taichung, Taiwan
| | - Cheng-Yuan Peng
- School of Medicine, China Medical University (CMU), Taichung, Taiwan
- Departement of Hepatogastroenterology, China Medial University Hospital, Taichung, Taiwan
| | - Jill Yi-Ju Chiang
- Mind-Body Interface Lab (MBI-Lab) and Department of Psychiatry, CMUH, Taichung, Taiwan
| | - Hui-Ting Chen
- Mind-Body Interface Lab (MBI-Lab) and Department of Psychiatry, CMUH, Taichung, Taiwan
| | - Tsai-Chung Li
- School of Medicine, China Medical University (CMU), Taichung, Taiwan
- China Medical University Graduate Institute of Biostatistics, Taiwan
| | - Shing-Yu Yang
- School of Medicine, China Medical University (CMU), Taichung, Taiwan
- China Medical University Graduate Institute of Biostatistics, Taiwan
| | - Kuan-Pin Su
- School of Medicine, China Medical University (CMU), Taichung, Taiwan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Mind-Body Interface Lab (MBI-Lab) and Department of Psychiatry, CMUH, Taichung, Taiwan
| | - Jane Pei-Chen Chang
- School of Medicine, China Medical University (CMU), Taichung, Taiwan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Mind-Body Interface Lab (MBI-Lab) and Department of Psychiatry, CMUH, Taichung, Taiwan
- Corresponding author. Department of Psychiatry, China Medical University Hospital, No. 2 Yu-Der Road, Taichung, 404, Taiwan.
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Graham K, Searle A, Van Hooff M, Lawrence-Wood E, McFarlane A. The Value of Physical Symptoms in Screening For Posttraumatic Stress Disorder in the Military. Assessment 2019; 27:1139-1150. [PMID: 31328529 DOI: 10.1177/1073191119864662] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Physical symptoms are highly comorbid with posttraumatic stress disorder (PTSD). As PTSD is underdiagnosed, this study explored the value of self-reported physical symptoms in screening for 30-day PTSD in military personnel. Two physical symptom scales were constructed using items from a 67-item health symptom checklist, clinical interviews were used as the diagnostic reference standard, and diagnostic utility of physical symptoms was compared with the current gold standard screen, the PTSD checklist (PCL). Receiver operating characteristic analyses showed that both a 9-item and a 10-item physical symptom scale were of value in predicting PTSD (areas under the curve 0.81 and 0.85). Importantly, two thirds of PTSD positive personnel missed by the PCL were captured with physical symptoms scales, and when physical symptoms were added to the PCL, prediction was improved (areas under the curve 0.90 to 0.92). Our findings highlight the value of including assessing physical symptoms in PTSD screening.
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Affiliation(s)
- Kristin Graham
- The University of Adelaide, Adelaide, South Australia, Australia
| | - Amelia Searle
- The University of Adelaide, Adelaide, South Australia, Australia
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Resting-State Functional Connectivity Between Centromedial Amygdala and Insula as Related to Somatic Symptoms in Depressed Patients: A Preliminary Study. Psychosom Med 2019; 81:434-440. [PMID: 31008903 DOI: 10.1097/psy.0000000000000697] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Somatic symptoms are prevalent in patients with depression. The centromedial amygdala (CMA) is a key brain region that mediates autonomic and somatic responses. Abnormal function in the CMA may contribute to the development of somatic symptoms in depressed patients. METHODS We compared the resting-state functional connectivity (RSFC) based on the seed of the left and right CMA between 37 patients with depression and 30 healthy controls. The severity of depressive and somatic symptoms was assessed using the Hamilton Depression Rating Scale (HDRS) and the 15-item somatic symptom severity scale of the Patient Health Questionnaire (PHQ-15). Correlation analysis was performed to investigate the relationship between the RSFC and clinical variables (HDRS and PHQ-15) in depressed patients. RESULTS Compared with healthy controls, patients with depression exhibited decreased RSFC between the CMA and insula, and superior temporal gyrus. In addition, functional connectivity between the left CMA and left insula was negatively correlated with PHQ-15 (r = -0.348, p = .037) in depressed patients. No significant relation was found between the RSFC and HDRS in depressed patients. CONCLUSIONS Functional connectivity between the CMA and insula is reduced in depressive patients, which is associated with the severity of somatic symptoms. Our findings may provide a potential neural substrate to interpret the co-occurrence of depression with somatic symptoms.
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Otheman Y, Fakir A, Kadiri M, Bichra MZ. [Frequency of physical symptoms in anxiety-depressive disorders: cross-sectional study in a population of 202 psychiatric consultants]. Pan Afr Med J 2019; 31:149. [PMID: 31037209 PMCID: PMC6462355 DOI: 10.11604/pamj.2018.31.149.15738] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 10/12/2018] [Indexed: 11/25/2022] Open
Abstract
Introduction les symptômes physiques associés aux troubles anxio-dépressifs ont fait l'objet de plusieurs études depuis plusieurs décennies, vu leurs fréquences et leurs conséquences. Le but de notre étude est de préciser la fréquence des principaux symptômes physiques dans les troubles anxieux: trouble panique (TP), trouble anxiété généralisée (TAG) et troubles phobiques (TPh), ainsi que dans les troubles dépressifs: épisode dépressif majeur (EDM) dans le cadre d'un trouble dépressif. Méthodes nous avons mené une étude transversale à visée descriptive, réalisée sur un échantillon de 202 consultants dans un service de psychiatrie. Résultats l'âge moyen des patients est de 42 ans (19 à 70 ans), avec une légère prédominance féminine: 118 (58%). Les troubles anxio-dépressifs constatés sont: l'EDM: 113(56%), le TP: 61 (30.2%), le TAG: 55 (27.2%) et les TPh: 30 (14.9%). La fréquence des patients présentant de 2 à 5, et plus de 5 symptômes était respectivement de 15.9% et 39.6% dans les troubles dépressifs, et de 9.5% et 62.9% dans les troubles anxieux. Les symptômes les plus rapportés sont d'ordre cardiopulmonaire (75%), général (73.8%) et neurologique (65.8%). Conclusion les symptômes physiques qui accompagnent les troubles anxio-dépressifs sont variables et souvent nombreux. Ils peuvent aggraver le pronostic de ces troubles psychiatriques en rendant difficile leur prise en charge. Un dépistage précoce de ces troubles, en portant une attention particulière à ces symptômes physiques, permettra de prévenir ces complications.
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Affiliation(s)
- Yassine Otheman
- Service de Psychiatrie, Hôpital Militaire d'Instruction Mohammed-V, Faculté de Médecine et de Pharmacie, Université Mohammed-V de Rabat, Maroc
| | - Asmaa Fakir
- Service de Psychiatrie, Hôpital Militaire d'Instruction Mohammed-V, Faculté de Médecine et de Pharmacie, Université Mohammed-V de Rabat, Maroc
| | - Mohamed Kadiri
- Service de Psychiatrie, Hôpital Militaire d'Instruction Mohammed-V, Faculté de Médecine et de Pharmacie, Université Mohammed-V de Rabat, Maroc
| | - Mohamed Zakariya Bichra
- Service de Psychiatrie, Hôpital Militaire d'Instruction Mohammed-V, Faculté de Médecine et de Pharmacie, Université Mohammed-V de Rabat, Maroc
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Altered regional homogeneity in patients with somatic depression: A resting-state fMRI study. J Affect Disord 2019; 246:498-505. [PMID: 30599374 DOI: 10.1016/j.jad.2018.12.066] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 11/27/2018] [Accepted: 12/20/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Somatic symptoms are common among patients with major depressive disorder (MDD), and are known to negatively impact the course and severity of the disease. Although previous studies have attempted to explore the neuropathology of MDD, little is known regarding the neural basis of somatic symptoms in MDD. METHODS Resting-state functional magnetic resonance images of 28 MDD patients with somatic symptoms (somatic depression, SD), 30 patients without somatic symptoms (non-somatic depression, NSD) and 30 healthy controls (HC) were obtained. We investigated the neural basis of MDD with somatic symptoms based on the measure of regional homogeneity (ReHo). We also investigated whether the altered regional homogeneity may be correlated to any clinical features of depression. These comparison were also carried out in female and male subjects respectively. RESULTS The SD exhibited higher ReHo in the bilateral parahippocampus and left lingual gyrus than HC, as well as lower ReHo in the right frontal gyrus. Relative to NSD, the SD exhibited lower ReHo in the right middle frontal gyrus and left precentral gyrus. Furthermore, in the SD, ReHo in the left precentral gyrus was positively correlated with cognitive factor scores of the HAMD-17. In female subjects, SD exhibited increased ReHo in the right STG and decreased ReHo in the right MFG, relative to women of the NSD group. CONCLUSIONS Our preliminary findings indicated that abnormal ReHo in the frontal and temporal regions may play an important role in the neural basis of somatic depression.
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Maehder K, Löwe B, Härter M, Heddaeus D, Scherer M, Weigel A. Management of comorbid mental and somatic disorders in stepped care approaches in primary care: a systematic review. Fam Pract 2019; 36:38-52. [PMID: 30535053 DOI: 10.1093/fampra/cmy122] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Stepped care models comprise a graded treatment intensity and a systematic monitoring. For an effective implementation, stepped care models have to account for the high rates of mental and somatic comorbidity in primary care. OBJECTIVES The aim of the systematic review was to take stock of whether present stepped care models take comorbidities into consideration. A further aim was to give an overview on treatment components and involved health care professionals. METHODS A systematic literature search was performed using the databases PubMed, PsycINFO, Cochrane Library and Web of Science. Selection criteria were a randomized controlled trial of a primary-care-based stepped care intervention, adult samples, publication between 2000 and 2017 and English or German language. RESULTS Of 1009 search results, 39 studies were eligible. One-third of the trials were conceived for depressive disorders only, one-third for depression and further somatic and/or mental comorbidity and one-third for conditions other than depression. In 39% of the studies comorbidities were explicitly integrated in treatment, mainly via transdiagnostic self-management support, interprofessional collaboration and digital approaches for treatment, monitoring and communication. Most care teams were composed of a primary care physician, a care manager and a psychiatrist and/or psychologist. Due to the heterogeneity of the addressed disorders, no meta-analysis was performed. CONCLUSIONS Several stepped care models in primary care already account for comorbidities, with depression being the predominant target disorder. To determine their efficacy, the identified strategies to account for comorbidities should be investigated within stepped care models for a broader range of disorders.
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Affiliation(s)
- Kerstin Maehder
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Germany
| | - Daniela Heddaeus
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Germany
| | - Martin Scherer
- Department of General Practice/Primary Care, University Medical Center Hamburg-Eppendorf, Germany
| | - Angelika Weigel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany
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Huang J, Zhou FC, Guan B, Zhang N, Wang A, Yu P, Zhou L, Wang CY, Wang C. Predictors of Remission of Early-Onset Poststroke Depression and the Interaction Between Depression and Cognition During Follow-Up. Front Psychiatry 2019; 9:738. [PMID: 30670990 PMCID: PMC6331416 DOI: 10.3389/fpsyt.2018.00738] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 12/13/2018] [Indexed: 01/24/2023] Open
Abstract
Objectives: This study aimed to examine the rate of remission in individuals experiencing early-onset poststroke depression (PSD) in China and to identify predictors of remission during a 3-month follow-up. This study also explored the interaction between cognitive impairment and depression. Methods: A total of 820 patients with PSD from a massive multicenter prospective cohort project in China (PRIOD) were included in the present study. Depressive symptoms were measured with the Hamilton Depression Rating Scale (17 Items, HDRS-17) at 2 weeks and the endpoint of the 3-month follow-up. The cut-off score of HDRS-17 (< 8) was used to define remission of depression at the endpoint. The Mini-Mental State Exam (MMSE) was used to evaluate the cognitive impairment of the patients (at the 2-week follow-up and 3-month endpoint). The National Institutes of Health Stroke Scale (NIHSS) was used to measure the severity of stroke. Results: (1) Six hundred and forty-two patients completed the 3-month follow-up, and 332 (51.7%) patients remitted by the end of the study. Univariate analyses indicated that there was a higher proportion of patients who had hypertension, frontal lobe lesion, basal ganglia lesion, poor outcome at 2 weeks, high scores on the NIHSS at 2 weeks, major life events within 3 months, and major medical diseases within 3 months in the nonremission group. In stepwise multiple logistic regression analyses, remission was significantly predicted by lower NIHSS scores at 2 weeks (p = 0.001, OR = 1.086, 95% CI 1.035-1.139), fewer major life events (p = 0.036, OR = 5.195, 95% CI 1.111-27.283), fewer major medical comorbidities (p = 0.015, OR = 2.434, 95% CI 1.190-4.979), and fewer frontal lobe lesions (p = 0.042, OR = 1.717, 95% CI 1.019-2.891). (2) After controlling for confounding variables, repeated measures analysis of variance revealed a significant interaction between time (2 weeks vs. 3 months) and group (remitters vs. nonremitters) on MMSE scores [F (1, 532) = 20.2, p < 0.001]. Conclusions: Early-onset PSD patients with milder neurological impairment, fewer major life events, fewer major medical comorbidities and no frontal lobe lesion at baseline were more likely to achieve remission 3 months after stroke. Only remitters of PSD improved significantly in cognitive impairment after stroke. The PRIOD trial is registered at http://www.isrctn.com/, number ISRCTN62169508.
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Affiliation(s)
- Jing Huang
- Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center of Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Fu-Chun Zhou
- Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Beijing Institute for Brain Disorders Center of Schizophrenia, Beijing Anding Hospital, Capital Medical University, Beijing, China
- The National Clinical Research Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Boyuan Guan
- Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center of Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Ning Zhang
- Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center of Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Anxin Wang
- Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center of Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Ping Yu
- Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center of Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Lei Zhou
- Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center of Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Chuan-Yue Wang
- Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Beijing Institute for Brain Disorders Center of Schizophrenia, Beijing Anding Hospital, Capital Medical University, Beijing, China
- The National Clinical Research Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Chunxue Wang
- Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center of Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
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Liu P, Li G, Zhang A, Sun N, Kang L, Yang C, Wang Y, Zhang K. The prognosis and changes of regional brain gray matter volume in MDD with gastrointestinal symptoms. Neuropsychiatr Dis Treat 2019; 15:1181-1191. [PMID: 31190826 PMCID: PMC6514124 DOI: 10.2147/ndt.s197351] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 04/08/2019] [Indexed: 12/12/2022] Open
Abstract
Objective: It is common that major depressive disorder (MDD) is accompanied by gastrointestinal (GI) symptoms. However, few studies have focused on the clinical characteristics and its possible mechanism, while brain gray matter (GM) structure is important in the pathogenesis of GI symptoms. In this study, we aimed to investigate the basic clinical characteristics and regional GM volume changes in MDD accompanied by GI symptoms. Method: Patients with MDD (n=49) and age, gender, and educational level-matched healthy controls (n=30) were recruited. Patients with MDD were divided into two groups based on the GI status: MDD with (n=27) and without (n=22) GI symptoms. The 24-item Hamilton Depression Rating Scale (HAMD) was administered. T1-weighted anatomical images were obtained and analyzed. Correlation analysis was used to identify the possible associations between changed regional GM volume and GI symptoms and depressive symptoms. Results: The HAMD reductive ratio for 2 weeks of treatment in the GI symptoms group was significantly higher than the non-GI symptoms group (P<0.05). The regional GM volume showed significant differences among the three groups (Gaussian Random Field [GRF] correction, voxel-P<0.01, cluster-P <0.05). Compared with non-GI symptoms group, GI symptoms group exhibited significantly increased GM volume in the left hippocampus, left parahippocampal gyrus, right parahippocampal gyrus; and decreased GM volume in the right middle frontal gyrus, right precentral gyrus, right cuneus, right precuneus, right superior occipital gyrus (GRF correction, voxel-P <0.01, cluster-P <0.05). These altered brain areas were correlated with the GI symptoms, not depressive symptoms. Conclusion: The changed regional brain GM volume in GI-MDD group may be the pathogenesis for the GI symptoms. In addition, the GI symptoms may predict the prognosis of MDD.
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Affiliation(s)
- Penghong Liu
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan 030001, People's Republic of China.,Department of Psychiatry, Shanxi Medical University, Taiyuan, 030001, People's Republic of China
| | - Gaizhi Li
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan 030001, People's Republic of China
| | - Aixia Zhang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan 030001, People's Republic of China
| | - Ning Sun
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan 030001, People's Republic of China
| | - Lijun Kang
- Department of Psychiatry, Shanxi Medical University, Taiyuan, 030001, People's Republic of China
| | - Chunxia Yang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan 030001, People's Republic of China
| | - Yanfang Wang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan 030001, People's Republic of China
| | - Kerang Zhang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan 030001, People's Republic of China
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49
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Li J, Gong H, Xu H, Ding Q, He N, Huang Y, Jin Y, Zhang C, Voon V, Sun B, Yan F, Zhan S. Abnormal Voxel-Wise Degree Centrality in Patients With Late-Life Depression: A Resting-State Functional Magnetic Resonance Imaging Study. Front Psychiatry 2019; 10:1024. [PMID: 32082198 PMCID: PMC7005207 DOI: 10.3389/fpsyt.2019.01024] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 12/24/2019] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Late-life depression (LLD) has negative impacts on somatic, emotional and cognitive domains of the lives of patients. Elucidating the abnormality in the brain networks of LLD patients could help to strengthen the understanding of LLD pathophysiology, however, the studies exploring the spontaneous brain activity in LLD during the resting state remain limited. This study aimed at identifying the voxel-level whole-brain functional connectivity changes in LLD patients. METHODS Fifty patients with late-life depression (LLD) and 33 healthy controls were recruited. All participants underwent a resting-state functional magnetic resonance imaging scan to assess the voxel-wise degree centrality (DC) changes in the patients. Furthermore, DC was compared between two patient subgroups, the late-onset depression (LOD) and the early-onset depression (EOD). RESULTS Compared with the healthy controls, LLD patients showed increased DC in the inferior parietal lobule, parahippocampal gyrus, brainstem and cerebellum (p < 0.05, AlphaSim-corrected). LLD patients also showed decreased DC in the somatosensory and motor cortices and cerebellum (p < 0.05, AlphaSim-corrected). Compared with EOD patients, LOD patients showed increased centrality in the superior and middle temporal gyrus and decreased centrality in the occipital region (p < 0.05, AlphaSim-corrected). No significant correlation was found between the DC value and the symptom severity or disease duration in the patients after the correction for multiple comparisons. CONCLUSIONS These findings indicate that the intrinsic abnormality of network centrality exists in a wide range of brain areas in LLD patients. LOD patients differ with EOD patients in cortical network centrality. Our study might help to strengthen the understanding of the pathophysiology of LLD and the potential neural substrates underlie related emotional and cognitive impairments observed in the patients.
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Affiliation(s)
- Jun Li
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hengfen Gong
- Department of Psychiatry, Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, China
| | - Hongmin Xu
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qiong Ding
- Neural and Intelligence Engineering Center, Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Naying He
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ying Huang
- Department of Psychiatry, Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, China
| | - Ying Jin
- Department of Psychiatry, Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, China
| | - Chencheng Zhang
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Valerie Voon
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Bomin Sun
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fuhua Yan
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shikun Zhan
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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50
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Zhao D, Wu Z, Zhang H, Mellor D, Ding L, Wu H, Wu C, Huang J, Hong W, Peng D, Fang Y. Somatic symptoms vary in major depressive disorder in China. Compr Psychiatry 2018; 87:32-37. [PMID: 30195098 DOI: 10.1016/j.comppsych.2018.08.013] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 07/30/2018] [Accepted: 08/20/2018] [Indexed: 10/28/2022] Open
Abstract
PURPOSE This study aimed to investigate the clinical characteristics of somatic symptoms of patients in China who suffer from major depressive disorder (MDD). METHOD 3273 patients who met the diagnostic criteria of Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) MDD were recruited from 16 general hospitals and 16 mental health centers in China. Physicians and patients completed complementary customized depression disorder symptomatology questionnaires assessing the clinical characteristics of patients with MDD. RESULT 1. In this study we analyzed physician-recorded data. The major somatic symptoms in patients with MDD in China were insomnia (64.6%), pre-verbal physical complaints (46.9%), weight loss (38.5%), low appetite (37.6%), circulatory system complaints (31.3%), headache (31.3%), hyposexuality (31.0%), gastrointestinal symptom complaints (29.6%), and respiratory system complaints (29.6%). 2. Compared with MDD patients who sought medical help from mental health centers, MDD patients who sought medical help from general hospitals were more likely to suffer from urinary system complaints, headache, sensory system complaints, trunk pain, and nervous system complaints. A lower prevalence rate of insomnia and hyposexuality was also observed among MDD patients who visited general hospitals (p < .05). 3. Patients aged from 40 to 54 had the highest probability of pre-verbal physical complaints, respiratory system complaints, trunk pain, hyposexuality, limb pain and other pain conditions, while patients over 55 years of age had the lowest prevalence respiratory system complaints, hyposexuality, and other pain conditions, and they also had the highest rate of low appetite and insomnia. 4. Female patients appeared to exhibit higher rates of pre-verbal physical complaints, low appetite, and insomnia than male patients, but had fewer urinary systems complaints than male patients (p < .05). CONCLUSION The major somatic symptoms in patients with MDD in China are insomnia, pre-verbal physical complaints, weight loss, low appetite, circulatory system complaints, headache, hyposexuality, gastrointestinal system complaints, and respiratory system complaints. These symptoms vary by the type of medical setting to which patients present, and well as by age, and gender.
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Affiliation(s)
- Dongmei Zhao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, No.600, South Wanping Road, Xuhui District, 200030 Shanghai, PR China; Shanghai Changning Mental Health Center, No 229, Xiehe Road, Changning District, Shanghai 200042, PR China
| | - Zhiguo Wu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, No.600, South Wanping Road, Xuhui District, 200030 Shanghai, PR China
| | - Huifeng Zhang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, No.600, South Wanping Road, Xuhui District, 200030 Shanghai, PR China
| | - David Mellor
- School of Psychology, Deakin University, Melbourne, Australia
| | - Lei Ding
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, No.600, South Wanping Road, Xuhui District, 200030 Shanghai, PR China
| | - Haiyan Wu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, No.600, South Wanping Road, Xuhui District, 200030 Shanghai, PR China
| | - Chuangxin Wu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, No.600, South Wanping Road, Xuhui District, 200030 Shanghai, PR China
| | - Jia Huang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, No.600, South Wanping Road, Xuhui District, 200030 Shanghai, PR China
| | - Wu Hong
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, No.600, South Wanping Road, Xuhui District, 200030 Shanghai, PR China
| | - Daihui Peng
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, No.600, South Wanping Road, Xuhui District, 200030 Shanghai, PR China.
| | - Yiru Fang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, No.600, South Wanping Road, Xuhui District, 200030 Shanghai, PR China; Shanghai Key Laboratory of Psychotic Disorders, PR China; CAS Center for Excellence in Brain Science and Intelligence Technology, PR China.
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