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Lee D, Jung YH, Kim S, Lee YI, Ku J, Yoon U, Choi SH. Alterations in cortical thickness of frontoparietal regions in patients with social anxiety disorder. Psychiatry Res Neuroimaging 2024; 340:111804. [PMID: 38460394 DOI: 10.1016/j.pscychresns.2024.111804] [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: 06/29/2023] [Revised: 12/26/2023] [Accepted: 02/20/2024] [Indexed: 03/11/2024]
Abstract
Although functional changes of the frontal and (para)limbic area for emotional hyper-reactivity and emotional dysregulation are well documented in social anxiety disorder (SAD), prior studies on structural changes have shown mixed results. This study aimed to identify differences in cortical thickness between SAD and healthy controls (CON). Thirty-five patients with SAD and forty-two matched CON underwent structural magnetic resonance imaging. A vertex-based whole brain and regional analyses were conducted for between-group comparison. The whole-brain analysis revealed increased cortical thickness in the left insula, left superior parietal lobule, left superior temporal gyrus, and left frontopolar cortex in patients with SAD compared to CON, as well as decreased thickness in the left superior/middle frontal gyrus and left fusiform gyrus in patients (after multiple-correction). The results from the ROI analysis did not align with these findings at the statistically significant level after multiple corrections. Changes in cortical thickness were not correlated with social anxiety symptoms. While consistent results were not obtained from different analysis methods, the results from the whole-brain analysis suggest that patients with SAD exhibit distinct neural deficits in areas involved in salience, attention, and socioemotional processing.
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Affiliation(s)
- Dasom Lee
- Department of Psychiatry, Seoul National University College of Medicine and Institute of Human Behavioral Medicine, SNU-MRC, Seoul, Republic of Korea; Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ye-Ha Jung
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Suhyun Kim
- Department of Biomedical Engineering, Daegu Catholic University, Gyeongsan-si, Gyeongbuk, Republic of Korea
| | - Yoonji Irene Lee
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jeonghun Ku
- Department of Biomedical Engineering, Keimyung University, Gyeongsan-si, Gyeongbuk, Republic of Korea
| | - Uicheul Yoon
- Department of Biomedical Engineering, Daegu Catholic University, Gyeongsan-si, Gyeongbuk, Republic of Korea.
| | - Soo-Hee Choi
- Department of Psychiatry, Seoul National University College of Medicine and Institute of Human Behavioral Medicine, SNU-MRC, Seoul, Republic of Korea; Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea.
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Chen H, Zhan L, Li Q, Meng C, Quan X, Chen X, Hao Z, Li J, Gao Y, Li H, Jia X, Li M, Liang Z. Frequency specific alterations of the degree centrality in patients with acute basal ganglia ischemic stroke: a resting-state fMRI study. Brain Imaging Behav 2024; 18:19-33. [PMID: 37821673 PMCID: PMC10844151 DOI: 10.1007/s11682-023-00806-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2023] [Indexed: 10/13/2023]
Abstract
This study intended to investigate the frequency specific brain oscillation activity in patients with acute basal ganglia ischemic stroke (BGIS) by using the degree centrality (DC) method. A total of 34 acute BGIS patients and 44 healthy controls (HCs) underwent resting-state functional magnetic resonance imaging (rs-fMRI) scanning. The DC values in three frequency bands (conventional band: 0.01-0.08 Hz, slow‑4 band: 0.027-0.073 Hz, slow‑5 band: 0.01-0.027 Hz) were calculated. A two-sample t-test was used to explore the between-group differences in the conventional frequency band. A two-way repeated-measures analysis of variance (ANOVA) was used to analyze the DC differences between groups (BGIS patients, HCs) and bands (slow‑4, slow‑5). Moreover, correlations between DC values and clinical indicators were performed. In conventional band, the DC value in the right middle temporal gyrus was decreased in BGIS patients compared with HCs. Significant differences of DC were observed between the two bands mainly in the bilateral cortical brain regions. Compared with the HCs, the BGIS patients showed increased DC in the right superior temporal gyrus and the left precuneus, but decreased mainly in the right inferior temporal gyrus, right inferior occipital gyrus, right precentral, and right supplementary motor area. Furthermore, the decreased DC in the right rolandic operculum in slow-4 band and the right superior temporal gyrus in slow-5 band were found by post hoc two-sample t-test of main effect of group. There was no significant correlation between DC values and clinical scales after Bonferroni correction. Our findings showed that the DC changes in BGIS patients were frequency specific. Functional abnormalities in local brain regions may help us to understand the underlying pathogenesis mechanism of brain functional reorganization of BGIS patients.
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Affiliation(s)
- Hao Chen
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Linlin Zhan
- Faculty of Western Languages, Heilongjiang University, Heilongjiang, China
| | - Qianqian Li
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Chaoguo Meng
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xuemei Quan
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Department of Neurology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Xiaoling Chen
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Zeqi Hao
- School of Teacher Education, Zhejiang Normal University, Jinhua, China
- Key Laboratory of Intelligent Education Technology and Application of Zhejiang Province, Zhejiang Normal University, Jinhua, China
| | - Jing Li
- School of Teacher Education, Zhejiang Normal University, Jinhua, China
- Key Laboratory of Intelligent Education Technology and Application of Zhejiang Province, Zhejiang Normal University, Jinhua, China
| | - Yanyan Gao
- School of Teacher Education, Zhejiang Normal University, Jinhua, China
- Key Laboratory of Intelligent Education Technology and Application of Zhejiang Province, Zhejiang Normal University, Jinhua, China
| | - Huayun Li
- School of Teacher Education, Zhejiang Normal University, Jinhua, China
- Key Laboratory of Intelligent Education Technology and Application of Zhejiang Province, Zhejiang Normal University, Jinhua, China
| | - Xize Jia
- School of Teacher Education, Zhejiang Normal University, Jinhua, China
- Key Laboratory of Intelligent Education Technology and Application of Zhejiang Province, Zhejiang Normal University, Jinhua, China
| | - Mengting Li
- School of Teacher Education, Zhejiang Normal University, Jinhua, China.
- Key Laboratory of Intelligent Education Technology and Application of Zhejiang Province, Zhejiang Normal University, Jinhua, China.
| | - Zhijian Liang
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.
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Lu H, Song Y, Wang X, Liu J. The neural correlates of perceived social support and its relationship to psychological well-being. Front Behav Neurosci 2024; 17:1295668. [PMID: 38259632 PMCID: PMC10800560 DOI: 10.3389/fnbeh.2023.1295668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 12/19/2023] [Indexed: 01/24/2024] Open
Abstract
Introduction Perceived social support is considered to play a significant role in promoting individuals' health and well-being, and yet the neural correlates of perceived social support were not fully understood. An exploration of the neural correlates of individual differences in the SPS can help us to gain more comprehensive understanding about the neural correlates of perceived social support. What's more, our study will explore the relationship among perceived social support, brain regions, and psychological well-being, which may provide new insights into the neural correlates underlying the relationship between perceived social support and psychological well-being from the perspective of cognitive neuroscience. Methods Herein, we used the Social Provisions Scale to assess individuals' perceived social support, and magnetic resonance imaging was used to measure the gray matter (GM) volume of the whole brain. What's more, we also measured psychological well-being using the Psychological Well-Being Scale, and mediation analysis was used to explore the relationship among perceived social support, brain regions, and psychological well-being. Results The voxel-based morphometry analysis of the whole brain revealed that perceived social support was positively correlated with GM volume of the left middle temporal gyrus (MTG). The finding indicated that a person with greater GM volume in the left MTG perceived more social support. More importantly, the left MTG GM volume observed above was also associated with psychological well-being, and the link between the two was mediated by perceived social support. Discussion These results revealed the importance of MTG for perceived social support and psychological well-being, and also suggested that perceived social support might explain the relationship between MTG and psychological well-being.
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Affiliation(s)
- Huanhua Lu
- School of Marxism, China University of Geosciences, Beijing, China
| | - Yiying Song
- Beijing Key Laboratory of Applied Experimental Psychology, Faculty of Psychology, National Demonstration Center for Experimental Psychology Education, Beijing Normal University, Beijing, China
| | - Xu Wang
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China
| | - Jia Liu
- Tsinghua Laboratory of Brain and Intelligence, Department of Psychology, Tsinghua University, Beijing, China
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Zugman A, Jett L, Antonacci C, Winkler AM, Pine DS. A systematic review and meta-analysis of resting-state fMRI in anxiety disorders: Need for data sharing to move the field forward. J Anxiety Disord 2023; 99:102773. [PMID: 37741177 PMCID: PMC10753861 DOI: 10.1016/j.janxdis.2023.102773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/11/2023] [Accepted: 09/12/2023] [Indexed: 09/25/2023]
Abstract
Anxiety disorders are among the most prevalent psychiatric disorders. Neuroimaging findings remain uncertain, and resting state functional magnetic resonance (rs-fMRI) connectivity is of particular interest since it is a scalable functional imaging modality. Given heterogeneous past findings for rs-fMRI in anxious individuals, we characterize patterns across anxiety disorders by conducting a systematic review and meta-analysis. Studies were included if they contained at the time of scanning both a healthy group and a patient group. Due to insufficient study numbers, the quantitative meta-analysis only included seed-based studies. We performed an activation likelihood estimation (ALE) analysis that compared patients and healthy volunteers. All analyses were corrected for family-wise error with a cluster-level threshold of p < .05. Patients exhibited hypo-connectivity between the amygdala and the medial frontal gyrus, anterior cingulate cortex, and cingulate gyrus. This finding, however, was not robust to potential file-drawer effects. Though limited by strict inclusion criteria, our results highlight the heterogeneous nature of reported findings. This underscores the need for data sharing when attempting to detect reliable patterns of disruption in brain activity across anxiety disorders.
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Affiliation(s)
- André Zugman
- Section on Development and Affective Neuroscience (SDAN), Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States.
| | - Laura Jett
- Section on Development and Affective Neuroscience (SDAN), Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States; Child Emotion Lab, University of Wisconsin, Madison, Madison, WI, United States.
| | - Chase Antonacci
- Section on Development and Affective Neuroscience (SDAN), Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States; Department of Psychology, Stanford University, Stanford, CA, United States.
| | - Anderson M Winkler
- Section on Development and Affective Neuroscience (SDAN), Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States; Division of Human Genetics, School of Medicine, The University of Texas Rio Grande Valley, Brownsville, Texas, United States.
| | - Daniel S Pine
- Section on Development and Affective Neuroscience (SDAN), Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States.
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Jiang J, Li W, Cui H, Zhu Z, Zhang L, Hu Q, Li H, Wang Y, Pang J, Wang J, Li Q, Li C. Feasibility of applying graph theory to diagnosing generalized anxiety disorder using machine learning models. Psychiatry Res Neuroimaging 2023; 333:111656. [PMID: 37224661 DOI: 10.1016/j.pscychresns.2023.111656] [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: 08/20/2022] [Revised: 04/13/2023] [Accepted: 04/24/2023] [Indexed: 05/26/2023]
Abstract
The aim of this study was to investigate whether the alterations of topological properties can facilitate the diagnosis of generalized anxiety disorder (GAD). Twenty first-episode drug-naive Chinese individuals with GAD and twenty age-sex-education-matched healthy controls (HCs) were included in the primary training set, and the results of which were validated using nineteen drug-free patients with GAD and nineteen unmatched HCs. Two 3 T scanners were used to acquire T1, diffusion tensor, and resting-state functional images. Topological properties were altered in the functional cerebral networks among patients with GAD, but not in the structural networks. Using the nodal topological properties in the anti-correlated functional networks, machine learning models distinguished drug-naive GADs from their matched HCs independent of the type of kernels and the amount of features. Although the models built with drug-naive GADs failed to distinguish drug-free GADs from HCs, the features selected for those models could be used to build new models for distinguishing drug-free GADs from HCs. Our findings suggested that it is feasible to utilize the topological characteristics of brain network to facilitate the diagnosis of GAD. However, further research with decent sample sizes, multimodal features, and improved modeling methods are needed to build more robust models.
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Affiliation(s)
- Jiangling Jiang
- Department of Psychiatry, Tongji Hospital of Tongji University, 389 Xincun Road, 200065 Shanghai, China; Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 Wan Ping Nan Road, 200030 Shanghai, China
| | - Wei Li
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 Wan Ping Nan Road, 200030 Shanghai, China
| | - Huiru Cui
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 Wan Ping Nan Road, 200030 Shanghai, China
| | - Zhipei Zhu
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 Wan Ping Nan Road, 200030 Shanghai, China
| | - Li Zhang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 Wan Ping Nan Road, 200030 Shanghai, China
| | - Qiang Hu
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 Wan Ping Nan Road, 200030 Shanghai, China
| | - Hui Li
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 Wan Ping Nan Road, 200030 Shanghai, China
| | - Yiran Wang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 Wan Ping Nan Road, 200030 Shanghai, China
| | - Jiaoyan Pang
- School of Government, Shanghai University of Political Science and Law, 7989 Waiqingsong Road, 201701 Shanghai, China
| | - Jijun Wang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 Wan Ping Nan Road, 200030 Shanghai, China; Institute of Psychology and Behavioral Science, Shanghai Jiao Tong University, 600 Wan Ping Nan Road, 200030 Shanghai, China; Brain Science and Technology Research Center, Shanghai Jiao Tong University, Shanghai, China, 800 Dongchuan Road, 200240 Shanghai, China; Center for Excellence in Brain Science and Intelligence Technology (CEBSIT), Chinese Academy of Science, 320 Yue Yang Road, 200031 Shanghai, China
| | - Qingwei Li
- Department of Psychiatry, Tongji Hospital of Tongji University, 389 Xincun Road, 200065 Shanghai, China.
| | - Chunbo Li
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 Wan Ping Nan Road, 200030 Shanghai, China; Institute of Psychology and Behavioral Science, Shanghai Jiao Tong University, 600 Wan Ping Nan Road, 200030 Shanghai, China; Brain Science and Technology Research Center, Shanghai Jiao Tong University, Shanghai, China, 800 Dongchuan Road, 200240 Shanghai, China; Center for Excellence in Brain Science and Intelligence Technology (CEBSIT), Chinese Academy of Science, 320 Yue Yang Road, 200031 Shanghai, China.
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Mosch B, Hagena V, Herpertz S, Diers M. Brain morphometric changes in fibromyalgia and the impact of psychometric and clinical factors: a volumetric and diffusion-tensor imaging study. Arthritis Res Ther 2023; 25:81. [PMID: 37208755 DOI: 10.1186/s13075-023-03064-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 05/07/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND Previous studies have repeatedly found distinct brain morphometric changes in patients with fibromyalgia (FM), mainly affecting gray and white matter abnormalities in areas related to sensory and affective pain processing. However, few studies have thus far linked different types of structural changes and not much is known about behavioral and clinical determinants that might influence the emergence and progression of such changes. METHODS We used voxel-based morphometry (VBM) and diffusion-tensor imaging (DTI) to detect regional patterns of (micro)structural gray (GM) and white matter (WM) alterations in 23 patients with FM compared to 21 healthy controls (HC), while considering the influence of demographic, psychometric, and clinical variables (age, symptom severity, pain duration, heat pain threshold, depression scores). RESULTS VBM and DTI revealed striking patterns of brain morphometric changes in FM patients. Bilateral middle temporal gyrus (MTG), parahippocampal gyrus, left dorsal anterior cingulate cortex (dACC), right putamen, right caudate nucleus, and left dorsolateral prefrontal cortex (DLPFC) showed significantly decreased GM volumes. In contrast, increased GM volume was observed in bilateral cerebellum and left thalamus. Beyond that, patients displayed microstructural changes of WM connectivity within the medial lemniscus, corpus callosum, and tracts surrounding and connecting the thalamus. Sensory-discriminative aspects of pain (pain severity, pain thresholds) primarily showed negative correlations with GM within bilateral putamen, pallidum, right midcingulate cortex (MCC), and multiple thalamic substructures, whereas the chronicity of pain was negatively correlated with GM volumes within right insular cortex and left rolandic operculum. Affective-motivational aspects of pain (depressive mood, general activity) were related to GM and FA values within bilateral putamen and thalamus. CONCLUSIONS Our results suggest a variety of distinct structural brain changes in FM, particularly affecting areas involved in pain and emotion processing such as the thalamus, putamen, and insula.
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Affiliation(s)
- Benjamin Mosch
- Clinical and Experimental Behavioral Medicine, Alexandrinenstraße 1-3, 44791, Bochum, Germany
| | - Verena Hagena
- Department of Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr University Bochum, Alexandrinenstraße 1-3, 44791, Bochum, Germany
| | - Stephan Herpertz
- Department of Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr University Bochum, Alexandrinenstraße 1-3, 44791, Bochum, Germany
| | - Martin Diers
- Clinical and Experimental Behavioral Medicine, Alexandrinenstraße 1-3, 44791, Bochum, Germany.
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Lucherini Angeletti L, Scalabrini A, Ricca V, Northoff G. Topography of the Anxious Self: Abnormal Rest-Task Modulation in Social Anxiety Disorder. Neuroscientist 2023; 29:221-244. [PMID: 34282680 DOI: 10.1177/10738584211030497] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Social anxiety disorder (SAD) is characterized by social anxiety/fear, self-attention, and interoception. Functional magnetic resonance imaging studies demonstrate increased activity during symptom-sensitive tasks in regions of the default-mode network (DMN), amygdala (AMG), and salience network (SN). What is the source of this task-unspecific symptom-sensitive hyperactivity in DMN? We address this question by probing SAD resting state (rs) changes in DMN including their relation to other regions as possible source of task-unspecific hyperactivity in the same regions. Our findings show the following: (1) rs-hypoconnectivity within-DMN regions; (2) rs-hyperconnectivity between DMN and AMG/SN; (3) task-evoked hyperactivity in the abnormal rs-regions of DMN and AMG/SN during different symptom-sensitive tasks; (4) negative relationship of rest and task changes in especially anterior DMN regions as their rs-hypoconnectivity is accompanied by task-unspecific hyperactivity; (5) abnormal top-down/bottom-up modulation between anterior DMN regions and AMG during rest and task. Findings demonstrate that rs-hypoconnectivity among DMN regions is negatively related to task-unspecific hyperactivity in DMN and AMG/SN. We propose a model of "Topography of the Anxious Self" in SAD (TAS-SAD). Abnormal DMN-AMG/SN topography during rest, as trait feature of an "unstable social self", is abnormally aggravated during SAD-sensitive situations resulting in task-related hyperactivity in the same regions with an "anxious self" as state feature.
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Affiliation(s)
| | - Andrea Scalabrini
- Department of Psychological Health and Territorial Sciences (DiSPuTer), G. d'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Valdo Ricca
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Georg Northoff
- Mental Health Centre, Zhejiang University School of Medicine, Hangzhou, China.,Centre for Cognition and Brain Disorders, Hangzhou Normal University, Hangzhou, China.,The Royal's Institute of Mental Health Research & University of Ottawa, Ottawa, Ontario, Canada.,Centre for Neural Dynamics, Faculty of Medicine, Brain and Mind Research Institute, University of Ottawa, Ottawa, Ontario, Canada
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Chen J, Gong X, Wang L, Xu M, Zhong X, Peng Z, Song T, Xu L, Lian J, Shao Y, Weng X. Altered Postcentral Connectivity after Sleep Deprivation Correlates to Impaired Risk Perception: A Resting-State Functional Magnetic Resonance Imaging Study. Brain Sci 2023; 13:brainsci13030514. [PMID: 36979324 PMCID: PMC10046171 DOI: 10.3390/brainsci13030514] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/15/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Previous studies revealed that sleep deprivation (SD) impairs risk perception and leads to poor decision-making efficiency. However, how risk perception is related to brain regions' communication after SD has not been elucidated. In this study, we investigated the neuropsychological mechanisms of SD-impaired risk perception. METHODS Nineteen healthy male adults were recruited and underwent resting-state functional magnetic resonance imaging during a state of rested wakefulness and after nearly 36 h of total SD. They then completed the balloon analog risk task, which was used to measure the risk perception ability of risky decision-making. Regional homogeneity (ReHo) and voxel-wise functional connectivity were used to investigate neurobiological changes caused by SD. Correlation analysis was used to investigate the relationship between changes in ReHo, function, and risk perception. RESULTS At the behavioral level, risk perception decreased after 36 h of SD. At the neural level, SD induced a significant increase in ReHo in the right postcentral gyrus and was positively correlated with risk perception changes. The functional connectivity between the right postcentral gyrus, left medial temporal gyrus, and right inferior temporal gyrus was enhanced. Critically, increased right postcentral gyrus and right inferior temporal gyrus connectivity positively correlated with changes in risk perception. CONCLUSIONS SD impairs the risk perception associated with altered postcentral connectivity. The brain requires more energy to process and integrate sensory and perceptual information after SD, which may be one possible reason for decreased risk perception ability after SD.
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Affiliation(s)
- Jie Chen
- School of Psychology, Beijing Sport University, Beijing 100084, China
| | - Xinxin Gong
- School of Psychology, Beijing Sport University, Beijing 100084, China
| | - Letong Wang
- School of Psychology, Beijing Sport University, Beijing 100084, China
| | - Mengmeng Xu
- School of Psychology, Beijing Sport University, Beijing 100084, China
| | - Xiao Zhong
- School of Psychology, Beijing Sport University, Beijing 100084, China
| | - Ziyi Peng
- School of Psychology, Beijing Sport University, Beijing 100084, China
| | - Tao Song
- School of Psychology, Beijing Sport University, Beijing 100084, China
| | - Lin Xu
- School of Psychology, Beijing Sport University, Beijing 100084, China
| | - Jie Lian
- School of Psychology, Beijing Sport University, Beijing 100084, China
| | - Yongcong Shao
- School of Psychology, Beijing Sport University, Beijing 100084, China
- School of Biological Science and Medical Engineering, Beihang University, Beijing 100083, China
| | - Xiechuan Weng
- Department of Neuroscience, Beijing Institute of Basic Medical Sciences, Beijing 100850, China
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9
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Čermaková P, Andrýsková L, Brázdil M, Marečková K. Socioeconomic deprivation in early life and symptoms of depression and anxiety in young adulthood: mediating role of hippocampal connectivity. Psychol Med 2022; 52:2671-2680. [PMID: 33327969 PMCID: PMC9647532 DOI: 10.1017/s0033291720004754] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 10/22/2020] [Accepted: 11/19/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Experience of early-life socioeconomic deprivation (ELSD) may increase the risk of mental disorders in young adulthood. This association may be mediated by structural and functional alterations of the hippocampus. METHODS We conducted a prospective cohort study on 122 participants of the European Longitudinal Study of Pregnancy and Childhood. Information about ELSD was collected via questionnaire from mothers during the first 18 months of participants' lives. At age 23-24, participants underwent examination by structural magnetic resonance imaging, resting-state functional connectivity and assessment of depressive symptoms (Mood and Feelings Questionnaire) and anxiety (Spielberger State-Trait Anxiety Inventory). The association of ELSD with brain outcomes in young adulthood was assessed with correlations, linear regression (adjusting for sex, socioeconomic position and mother's mental health) and moderated mediation analysis. RESULTS Higher ELSD was associated with greater depressive symptoms (B = 0.22; p = 0.001), trait anxiety (B = 0.07; p = 0.02) and lower global connectivity of the right hippocampus (B = -0.01; p = 0.02). These associations persisted when adjusted for covariates. In women, lower global connectivity of the right hippocampus was associated with stronger trait anxiety (B = -4.14; p = 0.01). Global connectivity of the right hippocampus as well as connectivity between the right hippocampus and the left middle temporal gyrus mediated the association between ELSD and trait anxiety in women. Higher ELSD correlated with a lower volume of the right hippocampus in men, but the volume of the right hippocampus was not related to mental health. CONCLUSIONS Early preventive strategies targeted at children from socioeconomically deprived families may yield long-lasting benefits for the mental health of the population.
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Affiliation(s)
- Pavla Čermaková
- Third Faculty of Medicine, Charles University Prague, Prague, Czech Republic
- National Institute of Mental Health, Klecany, Czech Republic
- Second Faculty of Medicine, Charles University Prague, Prague, Czech Republic
| | | | - Milan Brázdil
- Brain and Mind Research, Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Klára Marečková
- Third Faculty of Medicine, Charles University Prague, Prague, Czech Republic
- Brain and Mind Research, Central European Institute of Technology, Masaryk University, Brno, Czech Republic
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10
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Jiang L, Li F, Chen B, Yi C, Peng Y, Zhang T, Yao D, Xu P. The task-dependent modular covariance networks unveiled by multiple-way fusion-based analysis. Int J Neural Syst 2022; 32:2250035. [PMID: 35719086 DOI: 10.1142/s0129065722500356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Lin Jiang
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu 610054, P. R. China
- School of Life Science and Technology, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu 611731, P. R. China
| | - Fali Li
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu 610054, P. R. China
- School of Life Science and Technology, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu 611731, P. R. China
- Research Unit of NeuroInformation, Chinese Academy of Medical Sciences, 2019RU035, Chengdu, P. R. China
| | - Baodan Chen
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu 610054, P. R. China
- School of Life Science and Technology, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu 611731, P. R. China
| | - Chanlin Yi
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu 610054, P. R. China
- School of Life Science and Technology, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu 611731, P. R. China
| | - Yueheng Peng
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu 610054, P. R. China
- School of Life Science and Technology, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu 611731, P. R. China
| | - Tao Zhang
- School of Science, Xihua University, Chengdu 610039, P. R. China
| | - Dezhong Yao
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu 610054, P. R. China
- School of Life Science and Technology, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu 611731, P. R. China
- Research Unit of NeuroInformation, Chinese Academy of Medical Sciences, 2019RU035, Chengdu, P. R. China
- School of Electrical Engineering, Zhengzhou University, Zhengzhou 450001, P. R. China
| | - Peng Xu
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu 610054, P. R. China
- School of Life Science and Technology, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu 611731, P. R. China
- Research Unit of NeuroInformation, Chinese Academy of Medical Sciences, 2019RU035, Chengdu, P. R. China
- Radiation Oncology Key Laboratory of Sichuan Province, Chengdu 610041, P. R. China
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11
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Kim MK, Eom H, Kwon JH, Kyeong S, Kim JJ. Neural effects of a short-term virtual reality self-training program to reduce social anxiety. Psychol Med 2022; 52:1296-1305. [PMID: 32880252 DOI: 10.1017/s0033291720003098] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Social anxiety disorder (SAD) is characterized by anxiety regarding social situations, avoidance of external social stimuli, and negative self-beliefs. Virtual reality self-training (VRS) at home may be a good interim modality for reducing social fears before formal treatment. This study aimed to find neurobiological evidence for the therapeutic effect of VRS. METHODS Fifty-two patients with SAD were randomly assigned to a VRS or waiting list (WL) group. The VRS group received an eight-session VRS program for 2 weeks, whereas the WL group received no intervention. Clinical assessments and functional magnetic resonance imaging scanning with the distress and speech evaluation tasks were repeatedly performed at baseline and after 3 weeks. RESULTS The post-VRS assessment showed significantly decreased anxiety and avoidance scores, distress index, and negative evaluation index for 'self', but no change in the negative evaluation index for 'other'. Patients showed significant responses to the distress task in various regions, including both sides of the prefrontal regions, occipital regions, insula, and thalamus, and to the speech evaluation task in the bilateral anterior cingulate cortex. Among these, significant neuronal changes after VRS were observed only in the right lingual gyrus and left thalamus. CONCLUSIONS VRS-induced improvements in the ability to pay attention to social stimuli without avoidance and even positively modulate emotional cues are based on functional changes in the visual cortices and thalamus. Based on these short-term neuronal changes, VRS can be a first intervention option for individuals with SAD who avoid society or are reluctant to receive formal treatment.
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Affiliation(s)
- Min-Kyeong Kim
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hyojung Eom
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jun Hee Kwon
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sunghyon Kyeong
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jae-Jin Kim
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Korea
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Korea
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12
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Resting-state neuroimaging in social anxiety disorder: a systematic review. Mol Psychiatry 2022; 27:164-179. [PMID: 34035474 DOI: 10.1038/s41380-021-01154-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/21/2021] [Accepted: 04/30/2021] [Indexed: 02/04/2023]
Abstract
There has been a growing interest in resting-state brain alterations in people with social anxiety disorder. However, the evidence has been mixed and contested and further understanding of the neurobiology of this disorder may aid in informing methods to increase diagnostic accuracy and treatment targets. With this systematic review, we aimed to synthesize the findings of the neuroimaging literature on resting-state functional activity and connectivity in social anxiety disorder, and to summarize associations between brain and social anxiety symptoms to further characterize the neurobiology of the disorder. We systematically searched seven databases for empirical research studies. Thirty-five studies met the inclusion criteria, with a total of 1611 participants (795 people with social anxiety disorder and 816 controls). Studies involving resting-state seed-based functional connectivity analyses were the most common. Individuals with social anxiety disorder (vs. controls) displayed both higher and lower connectivity between frontal-amygdala and frontal-parietal regions. Frontal regions were the most consistently implicated across other analysis methods, and most associated with social anxiety symptoms. Small sample sizes and variation in the types of analyses used across studies may have contributed to the inconsistencies in the findings of this review. This review provides novel insights into established neurobiological models of social anxiety disorder and provides an update on what is known about the neurobiology of this disorder in the absence of any overt tasks (i.e., resting state). The knowledge gained from this body of research enabled us to also provide recommendations for a more standardized imaging pre-processing approach to examine resting-state brain activity and connectivity that could help advance knowledge in this field. We believe this is warranted to take the next step toward clinical translation in social anxiety disorder that may lead to better treatment outcomes by informing the identification of neurobiological targets for treatment.
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13
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Wang S, Zhao Y, Wang X, Yang X, Cheng B, Pan N, Suo X, Gong Q. Emotional intelligence mediates the association between middle temporal gyrus gray matter volume and social anxiety in late adolescence. Eur Child Adolesc Psychiatry 2021; 30:1857-1869. [PMID: 33011842 DOI: 10.1007/s00787-020-01651-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 09/18/2020] [Indexed: 12/17/2022]
Abstract
As a common mental health problem, social anxiety refers to the fear and avoidance of interacting in social or performance situations, which plays a crucial role in many health and social problems. Although a growing body of studies has explored the neuroanatomical alterations related to social anxiety in clinical patients, far fewer have examined the association between social anxiety and brain morphology in the general population, which may help us understand the neural underpinnings of social anxiety more comprehensively. Here, utilizing a voxel-based morphometry approach via structural magnetic resonance imaging, we investigated brain gray matter correlates of social anxiety in 231 recent graduates of the same high school grade. We found that social anxiety was positively associated with gray matter volume in the right middle temporal gyrus (MTG), which is a core brain area for cognitive processing of emotions and feelings. Critically, emotional intelligence mediated the impact of right MTG volume on social anxiety. Notably, our results persisted even when controlling for the effects of general anxiety and depression. Altogether, our research reveals right MTG gray matter volume as a neurostructural correlate of social anxiety in a general sample of adolescents and suggests a potential indirect effect of emotional intelligence on the association between gray matter volume and social anxiety.
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Affiliation(s)
- Song Wang
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China.,Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China.,Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Yajun Zhao
- School of Education and Psychology, Southwest Minzu University, Chengdu, China
| | - Xiuli Wang
- Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Xun Yang
- School of Public Affairs, Chongqing University, Chongqing, China
| | - Bochao Cheng
- Department of Radiology, West China Second University Hospital of Sichuan University, Chengdu, China
| | - Nanfang Pan
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China.,Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China
| | - Xueling Suo
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China.,Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China. .,Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China. .,Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu, China.
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14
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Bas-Hoogendam JM, van Steenbergen H, Cohen Kadosh K, Westenberg PM, van der Wee NJA. Intrinsic functional connectivity in families genetically enriched for social anxiety disorder - an endophenotype study. EBioMedicine 2021; 69:103445. [PMID: 34161885 PMCID: PMC8237289 DOI: 10.1016/j.ebiom.2021.103445] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/18/2021] [Accepted: 06/04/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Social anxiety disorder (SAD) is a serious psychiatric condition with a high prevalence, and a typical onset during childhood/adolescence. The condition runs in families, but it is largely unknown which neurobiological characteristics transfer this genetic vulnerability ('endophenotypes'). Using data from the Leiden Family Lab study on SAD, including two generations of families genetically enriched for SAD, we investigated whether social anxiety (SA) co-segregated with changes in intrinsic functional connectivity (iFC), and examined heritability. METHODS Functional MRI data were acquired during resting-state in 109 individuals (56 males; mean age: 31·5, range 9·2-61·5 years). FSL's tool MELODIC was used to perform independent component analysis. Six networks of interest (default mode, dorsal attention, executive control, frontoparietal, limbic and salience) were identified at the group-level and used to generate subject-specific spatial maps. Voxel-wise regression models, with SA-level as predictor and voxel-wise iFC as candidate endophenotypes, were performed to investigate the association with SA, within masks of the networks of interest. Subsequently, heritability was estimated. FINDINGS SA co-segregated with iFC within the dorsal attention network (positive association in left middle frontal gyrus and right postcentral gyrus) and frontoparietal network (positive association within left middle temporal gyrus) (cluster-forming-threshold z>2·3, cluster-corrected extent-threshold p<0·05). Furthermore, iFC of multiple voxels within these clusters was at least moderately heritable. INTERPRETATION These findings provide initial evidence for increased iFC as candidate endophenotype of SAD, particularly within networks involved in attention. These changes might underlie attentional biases commonly present in SAD. FUNDING Leiden University Research Profile 'Health, Prevention and the Human Lifecycle'.
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Affiliation(s)
- Janna Marie Bas-Hoogendam
- Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333, AK, Leiden, the Netherlands; Department of Psychiatry, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, the Netherlands; Leiden Institute for Brain and Cognition, Leiden, the Netherlands.
| | - Henk van Steenbergen
- Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333, AK, Leiden, the Netherlands; Leiden Institute for Brain and Cognition, Leiden, the Netherlands.
| | | | - P Michiel Westenberg
- Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333, AK, Leiden, the Netherlands; Leiden Institute for Brain and Cognition, Leiden, the Netherlands.
| | - Nic J A van der Wee
- Department of Psychiatry, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, the Netherlands; Leiden Institute for Brain and Cognition, Leiden, the Netherlands.
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15
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Chen Y, Herrold AA, Gallagher V, Martinovich Z, Bari S, Vike NL, Vesci B, Mjaanes J, McCloskey LR, Reilly JL, Breiter HC. Preliminary Report: Localized Cerebral Blood Flow Mediates the Relationship between Progesterone and Perceived Stress Symptoms among Female Collegiate Club Athletes after Mild Traumatic Brain Injury. J Neurotrauma 2021; 38:1809-1820. [PMID: 33470158 PMCID: PMC8336258 DOI: 10.1089/neu.2020.7217] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Female athletes are under-studied in the field of concussion research, despite evidence of higher injury prevalence and longer recovery time. Hormonal fluctuations caused by the natural menstrual cycle (MC) or hormonal contraceptive (HC) use impact both post-injury symptoms and neuroimaging findings, but the relationships among hormone, symptoms, and brain-based measures have not been jointly considered in concussion studies. In this preliminary study, we compared cerebral blood flow (CBF) measured with arterial spin labeling between concussed female club athletes 3-10 days after mild traumatic brain injury (mTBI) and demographic, HC/MC matched controls (CON). We tested whether CBF statistically mediates the relationship between progesterone serum levels and post-injury symptoms, which may support a hypothesis for progesterone's role in neuroprotection. We found a significant three-way relationship among progesterone, CBF, and perceived stress score (PSS) in the left middle temporal gyrus for the mTBI group. Higher progesterone was associated with lower (more normative) PSS, as well as higher (more normative) CBF. CBF mediates 100% of the relationship between progesterone and PSS (Sobel p value = 0.017). These findings support a hypothesis for progesterone having a neuroprotective role after concussion and highlight the importance of controlling for the effects of sex hormones in future concussion studies.
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Affiliation(s)
- Yufen Chen
- Center for Translational Imaging, Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Virginia Gallagher
- Warren Wright Adolescent Center, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Zoran Martinovich
- Warren Wright Adolescent Center, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sumra Bari
- Warren Wright Adolescent Center, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Nicole L. Vike
- Warren Wright Adolescent Center, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Brian Vesci
- Northwestern Health Services Sports Medicine, Northwestern University, Evanston, Illinois, USA
| | - Jeffrey Mjaanes
- Northwestern Health Services Sports Medicine, Northwestern University, Evanston, Illinois, USA
| | - Leanne R. McCloskey
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - James L. Reilly
- Warren Wright Adolescent Center, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Hans C. Breiter
- Warren Wright Adolescent Center, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Laboratory of Neuroimaging and Genetics, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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16
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Guo X, Yang F, Fan L, Gu Y, Ma J, Zhang J, Liao M, Zhai T, Zhang Y, Li L, Su L, Dai Z. Disruption of functional and structural networks in first-episode, drug-naïve adolescents with generalized anxiety disorder. J Affect Disord 2021; 284:229-237. [PMID: 33618206 DOI: 10.1016/j.jad.2021.01.088] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/11/2021] [Accepted: 01/31/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Individuals with generalized anxiety disorder (GAD) tend to worry exaggeratedly and uncontrollably about various daily routines. Previous studies have demonstrated that the GAD patients exhibited widespread alternations in both functional networks (FN) and structural networks (SN). However, the simultaneous alternations of the topological organization of FN, SN, as well as their couplings in GAD still remain unknown. METHODS Using multimodal approach, we constructed FN from resting-state functional magnetic imaging (R-fMRI) data and SN from diffusion magnetic resonance imaging (dMRI) data of 32 adolescent GAD patients and 25 healthy controls (HC). Graph theory analysis was employed to investigate the topological properties of FN, SN, and FN-SN coupling. RESULTS Compared to HC, the GAD patients showed disruptions in global (i.e., decreased clustering coefficient, global, and local efficiency) and subnetwork (i.e., reduced intermodular connections, rich club, and feeder connections) levels in FN. Abnormal global level properties (i.e., increased characteristic path length and reduced global efficiency) were also observed in SN. Altered FN-SN couplings in normalized characteristic path length and feeder connections were identified in the GAD patients. The identified network measures were correlated with anxiety severity in the GAD patients. LIMITATIONS The sample size of the current study is small and the cross-sectional nature can not infer causal relationship. CONCLUSIONS Our findings identified GAD-related topological alternations in both FN and SN, together with the couplings between FN and SN, providing us with a novel perspective for understanding the pathophysiological mechanisms of GAD.
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Affiliation(s)
- Xiaotong Guo
- Department of Psychology, Sun Yat-sen University, Guangzhou, China
| | - Fan Yang
- Guangdong mental health center, Guangdong general hospital & Guangdong academy of medical sciences, Guangzhou, China
| | - Linlin Fan
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, United States
| | - Yue Gu
- Department of Psychology, Sun Yat-sen University, Guangzhou, China
| | - Junji Ma
- Department of Psychology, Sun Yat-sen University, Guangzhou, China
| | - Jinbo Zhang
- Department of Psychology, Sun Yat-sen University, Guangzhou, China
| | - Mei Liao
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China..
| | - Tianyi Zhai
- Department of Psychiatry, Guangzhou Huiai Hospital, Guangzhou, China
| | - Yan Zhang
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Lingjiang Li
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Linyan Su
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Zhengjia Dai
- Department of Psychology, Sun Yat-sen University, Guangzhou, China.
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17
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Hiser J, Schneider B, Koenigs M. Uncertainty Potentiates Neural and Cardiac Responses to Visual Stimuli in Anxiety Disorders. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2021; 6:725-734. [PMID: 33592312 DOI: 10.1016/j.bpsc.2021.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 02/03/2021] [Accepted: 02/05/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Intolerance of uncertainty and worry about future events are cardinal features of anxiety. However, the neurobiological and physiological mechanisms underlying these characteristics of anxiety remain to be fully elucidated. METHODS Individuals with diagnosed anxiety disorders (n = 29, 22 female) and age-matched comparison subjects (n = 28, 17 female) completed a task in which pictures (aversive or neutral content) were preceded by cues indicating certainty or uncertainty about the emotional valence of the subsequent pictures. We assessed functional magnetic resonance imaging and heart rate activity with respect to the 1) cue period, 2) emotional valence of the pictures, and 3) modulatory effect of uncertainty on responses to subsequent pictures. RESULTS Individuals with anxiety disorders and comparison subjects exhibited similar functional magnetic resonance imaging and cardiac activity during the cue period and for the aversive versus neutral picture contrast. However, individuals with anxiety disorders exhibited greater modulatory effects of uncertainty on their responses to subsequent pictures. Specifically, they displayed greater functional magnetic resonance imaging activity in a number of cortical regions (visual cortex, anterior cingulate cortex, superior temporal gyrus, and anterior insula), as well as significantly reduced cardiac deceleration to pictures preceded by the uncertainty cue. CONCLUSIONS These findings suggest that heightened neural and autonomic reactivity to stimuli during conditions of uncertainty may be a key psychobiological mechanism of anxiety.
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Affiliation(s)
- Jaryd Hiser
- Department of Psychology, University of Wisconsin-Madison, Madison, Wisconsin; Department of Psychiatry, University of Wisconsin-Madison, Madison, Wisconsin.
| | - Brett Schneider
- Department of Psychology, University of Wisconsin-Madison, Madison, Wisconsin; Department of Psychiatry, University of Wisconsin-Madison, Madison, Wisconsin
| | - Michael Koenigs
- Department of Psychiatry, University of Wisconsin-Madison, Madison, Wisconsin
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18
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Bas-Hoogendam JM, Westenberg PM. Imaging the socially-anxious brain: recent advances and future prospects. F1000Res 2020; 9:F1000 Faculty Rev-230. [PMID: 32269760 PMCID: PMC7122428 DOI: 10.12688/f1000research.21214.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/23/2020] [Indexed: 12/20/2022] Open
Abstract
Social anxiety disorder (SAD) is serious psychiatric condition with a genetic background. Insight into the neurobiological alterations underlying the disorder is essential to develop effective interventions that could relieve SAD-related suffering. In this expert review, we consider recent neuroimaging work on SAD. First, we focus on new results from magnetic resonance imaging studies dedicated to outlining biomarkers of SAD, including encouraging findings with respect to structural and functional brain alterations associated with the disorder. Furthermore, we highlight innovative studies in the field of neuroprediction and studies that established the effects of treatment on brain characteristics. Next, we describe novel work aimed to delineate endophenotypes of SAD, providing insight into the genetic susceptibility to develop the disorder. Finally, we outline outstanding questions and point out directions for future research.
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Affiliation(s)
- Janna Marie Bas-Hoogendam
- Developmental and Educational Psychology, Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, c/o LUMC, postzone C2-S, P.O.Box 9600, 2300 RC Leiden, The Netherlands
- Department of Psychiatry, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - P. Michiel Westenberg
- Developmental and Educational Psychology, Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, c/o LUMC, postzone C2-S, P.O.Box 9600, 2300 RC Leiden, The Netherlands
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19
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Kaur A, Chinnadurai V, Chaujar R. Microstates-based resting frontal alpha asymmetry approach for understanding affect and approach/withdrawal behavior. Sci Rep 2020; 10:4228. [PMID: 32144318 PMCID: PMC7060213 DOI: 10.1038/s41598-020-61119-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 02/12/2020] [Indexed: 11/18/2022] Open
Abstract
The role of resting frontal alpha-asymmetry in explaining neural-mechanisms of affect and approach/withdrawal behavior is still debatable. The present study explores the ability of the quasi-stable resting EEG asymmetry information and the associated neurovascular synchronization/desynchronization in bringing more insight into the understanding of neural-mechanisms of affect and approach/withdrawal behavior. For this purpose, a novel frontal alpha-asymmetry based on microstates, that assess quasi-stable EEG scalp topography information, is proposed and compared against standard frontal-asymmetry. Both proposed and standard frontal alpha-asymmetries were estimated from thirty-nine healthy volunteers resting-EEG simultaneously acquired with resting-fMRI. Further, neurovascular mechanisms of these asymmetry measures were estimated through EEG-informed fMRI. Subsequently, the Hemodynamic Lateralization Index (HLI) of the neural-underpinnings of both asymmetry measures was assessed. Finally, the robust correlation of both asymmetry-measures and their HLI’s with PANAS, BIS/BAS was carried out. The standard resting frontal-asymmetry and its HLI yielded no significant correlation with any psychological-measures. However, the microstate resting frontal-asymmetry correlated significantly with negative affect and its neural underpinning’s HLI significantly correlated with Positive/Negative affect and BIS/BAS measures. Finally, alpha-BOLD desynchronization was observed in neural-underpinning whose HLI correlated significantly with negative affect and BIS. Hence, the proposed resting microstate-frontal asymmetry better assesses the neural-mechanisms of affect, approach/withdrawal behavior.
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Affiliation(s)
- Ardaman Kaur
- NMR Research Centre, Institute of Nuclear Medicine and Allied Sciences, Lucknow Road, Timarpur, Delhi, 110054, India.,Department of Applied Physics, Delhi Technological University, Shahbad Daulatpur, Main Bawana Road, Delhi, 110042, India
| | - Vijayakumar Chinnadurai
- NMR Research Centre, Institute of Nuclear Medicine and Allied Sciences, Lucknow Road, Timarpur, Delhi, 110054, India.
| | - Rishu Chaujar
- Department of Applied Physics, Delhi Technological University, Shahbad Daulatpur, Main Bawana Road, Delhi, 110042, India
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20
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Longitudinal changes of resting-state functional connectivity of amygdala following fear learning and extinction. Int J Psychophysiol 2020; 149:15-24. [DOI: 10.1016/j.ijpsycho.2020.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 12/09/2019] [Accepted: 01/06/2020] [Indexed: 12/21/2022]
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21
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Contreras JA, Aslanyan V, Sweeney MD, Sanders LMJ, Sagare AP, Zlokovic BV, Toga AW, Han SD, Morris JC, Fagan A, Massoumzadeh P, Benzinger TL, Pa J. Functional connectivity among brain regions affected in Alzheimer's disease is associated with CSF TNF-α in APOE4 carriers. Neurobiol Aging 2020; 86:112-122. [PMID: 31870643 PMCID: PMC7205323 DOI: 10.1016/j.neurobiolaging.2019.10.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 09/20/2019] [Accepted: 10/22/2019] [Indexed: 01/01/2023]
Abstract
It is now recognized that understanding how neuroinflammation affects brain function may provide new insights into Alzheimer's pathophysiology. Tumor necrosis factor (TNF)-α, an inflammatory cytokine marker, has been implicated in Alzheimer's disease (AD), as it can impair neuronal function through suppression of long-term potentiation. Our study investigated the relationship between cerebrospinal fluid TNF-α and functional connectivity (FC) in a cohort of 64 older adults (μ age = 69.76 years; 30 cognitively normal, 34 mild AD). Higher cerebrospinal fluid TNF-α levels were associated with lower FC among brain regions important for high-level decision-making, inhibitory control, and memory. This effect was moderated by apolipoprotein E-ε4 (APOE4) status. Graph theory metrics revealed there were significant differences between APOE4 carriers at the node level, and by diagnosis at the network level suggesting global brain network dysfunction in participants with AD. These findings suggest proinflammatory mechanisms may contribute to reduced FC in regions important for high-level cognition. Future studies are needed to understand the role of inflammation on brain function and clinical progression, especially in APOE4 carriers.
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Affiliation(s)
- Joey Annette Contreras
- Mark and Mary Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, CA, USA
| | - Vahan Aslanyan
- Mark and Mary Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, CA, USA
| | - Melanie D Sweeney
- Zilkha Neurogenetic Institute, University of Southern California, Los Angeles, CA, USA
| | - Lianne M J Sanders
- Mark and Mary Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, CA, USA; Department of Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Abhay P Sagare
- Zilkha Neurogenetic Institute, University of Southern California, Los Angeles, CA, USA
| | - Berislav V Zlokovic
- Zilkha Neurogenetic Institute, University of Southern California, Los Angeles, CA, USA
| | - Arthur W Toga
- Mark and Mary Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, CA, USA
| | - S Duke Han
- Family Medicine, Neurology, Psychology, and Gerontology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - John C Morris
- Knight Alzheimer's Disease Research Center, Washington University, St. Louis, MO, USA; Department of Neurology, Washington University, St Louis, MO, USA
| | - Anne Fagan
- Knight Alzheimer's Disease Research Center, Washington University, St. Louis, MO, USA; Department of Neurology, Washington University, St Louis, MO, USA
| | - Parinaz Massoumzadeh
- Knight Alzheimer's Disease Research Center, Washington University, St. Louis, MO, USA
| | - Tammie L Benzinger
- Knight Alzheimer's Disease Research Center, Washington University, St. Louis, MO, USA; Department of Radiology and Neurological Surgery, Washington University, St. Louis, MO, USA
| | - Judy Pa
- Mark and Mary Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, CA, USA.
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22
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Wang W, Zhornitsky S, Li CSP, Le TM, Joormann J, Li CSR. Social anxiety, posterior insula activation, and autonomic response during self-initiated action in a Cyberball game. J Affect Disord 2019; 255:158-167. [PMID: 31153052 PMCID: PMC6591038 DOI: 10.1016/j.jad.2019.05.046] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 05/22/2019] [Accepted: 05/27/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND An earlier study characterized the neural correlates of self-initiated actions in a Cyberball game in healthy individuals. It remains unclear how social anxiety may influence these neural processes. METHODS We examined regional activations to self-initiated actions in 25 adults with low and 25 with high social anxiety (LA and HA, respectively). Skin conductance was recorded concurrently with fMRI. We followed published routines in the analyses of imaging and skin conductance data. RESULTS We hypothesized that HA as compared to LA individuals would demonstrate increased cortical limbic activations during self-initiated actions (tossing or T > receiving or R trials, to control for motor activities) in social exclusion (EX) vs. fair game (FG) scenario. At a corrected threshold, HA as compared with LA group showed increases in bilateral posterior insula activation during T vs. R trials in EX as compared to FG. Further, HA as compared to LA showed higher skin conductance response to tossing trials during EX as compared to FG. LIMITATIONS With a limited sample size, we did not examine potential sex effects. Further, we cannot rule out the effects of depression on the findings. CONCLUSIONS Together, the results suggest that individuals with more severe social anxiety engaged the somatosensory insula to a greater extent and exhibited higher physiological arousal when initiating ball toss during social exclusion in the Cyberball game. Posterior insula response to self-initiated action may represent a biomarker of social anxiety. It remains to be investigated whether interventions to decrease physiological arousal may alleviate social anxiety.
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Affiliation(s)
- Wuyi Wang
- Department of Psychiatry, Yale University, New Haven, CT 06519
| | | | - Clara S.-P. Li
- Department of Psychiatry, Yale University, New Haven, CT 06519,Phillips Academy, Andover, MA 01810
| | - Thang M. Le
- Department of Psychiatry, Yale University, New Haven, CT 06519
| | - Jutta Joormann
- Department of Psychology, Yale University, New Haven, CT 06520
| | - Chiang-shan R. Li
- Department of Psychiatry, Yale University, New Haven, CT 06519,Department of Neuroscience, Yale University, New Haven, CT 06520,Interdepartmental Neuroscience Program, Yale University, New Haven, CT 06520,Address correspondence to: C.-S. Ray Li, Connecticut Mental Health Center, S112, 34 Park Street, New Haven, CT 06519, U.S.A. Phone: +1 203-974-7354,
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23
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Fachner JC, Maidhof C, Grocke D, Nygaard Pedersen I, Trondalen G, Tucek G, Bonde LO. "Telling me not to worry…" Hyperscanning and Neural Dynamics of Emotion Processing During Guided Imagery and Music. Front Psychol 2019; 10:1561. [PMID: 31402880 PMCID: PMC6673756 DOI: 10.3389/fpsyg.2019.01561] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 06/20/2019] [Indexed: 12/15/2022] Open
Abstract
To analyze how emotions and imagery are shared, processed and recognized in Guided Imagery and Music, we measured the brain activity of an experienced therapist (“Guide”) and client (“Traveler”) with dual-EEG in a real therapy session about potential death of family members. Synchronously with the EEG, the session was video-taped and then micro-analyzed. Four raters identified therapeutically important moments of interest (MOI) and no-interest (MONI) which were transcribed and annotated. Several indices of emotion- and imagery-related processing were analyzed: frontal and parietal alpha asymmetry, frontal midline theta, and occipital alpha activity. Session ratings showed overlaps across all raters, confirming the importance of these MOIs, which showed different cortical activity in visual areas compared to resting-state. MOI 1 was a pivotal moment including an important imagery with a message of hope from a close family member, while in the second MOI the Traveler sent a message to an unborn baby. Generally, results seemed to indicate that the emotions of Traveler and Guide during important moments were not positive, pleasurably or relaxed when compared to resting-state, confirming both were dealing with negative emotions and anxiety that had to be contained in the interpersonal process. However, the temporal dynamics of emotion-related markers suggested shifts in emotional valence and intensity during these important, personally meaningful moments; for example, during receiving the message of hope, an increase of frontal alpha asymmetry was observed, reflecting increased positive emotional processing. EEG source localization during the message suggested a peak activation in left middle temporal gyrus. Interestingly, peaks in emotional markers in the Guide partly paralleled the Traveler's peaks; for example, during the Guide's strong feeling of mutuality in MOI 2, the time series of frontal alpha asymmetries showed a significant cross-correlation, indicating similar emotional processing in Traveler and Guide. Investigating the moment-to-moment interaction in music therapy showed how asymmetry peaks align with the situated cognition of Traveler and Guide along the emotional contour of the music, representing the highs and lows during the therapy process. Combining dual-EEG with detailed audiovisual and qualitative data seems to be a promising approach for further research into music therapy.
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Affiliation(s)
- Jörg C Fachner
- Cambridge Institute for Music Therapy Research, Anglia Ruskin University, Cambridge, United Kingdom.,Josef Ressel Centre for Personalised Music Therapy, IMC University of Applied Sciences Krems, Krems an der Donau, Austria
| | - Clemens Maidhof
- Cambridge Institute for Music Therapy Research, Anglia Ruskin University, Cambridge, United Kingdom.,Josef Ressel Centre for Personalised Music Therapy, IMC University of Applied Sciences Krems, Krems an der Donau, Austria
| | - Denise Grocke
- Melbourne Conservatorium of Music, University of Melbourne, Melbourne, VIC, Australia
| | - Inge Nygaard Pedersen
- Department of Communication and Psychology, The Faculty of Humanities, Aalborg University, Aalborg, Denmark
| | - Gro Trondalen
- Centre for Research in Music and Health, Norwegian Academy of Music, Oslo, Norway
| | - Gerhard Tucek
- Josef Ressel Centre for Personalised Music Therapy, IMC University of Applied Sciences Krems, Krems an der Donau, Austria
| | - Lars O Bonde
- Department of Communication and Psychology, The Faculty of Humanities, Aalborg University, Aalborg, Denmark.,Centre for Research in Music and Health, Norwegian Academy of Music, Oslo, Norway
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24
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Makovac E, Mancini M, Fagioli S, Watson DR, Meeten F, Rae CL, Critchley HD, Ottaviani C. Network abnormalities in generalized anxiety pervade beyond the amygdala-pre-frontal cortex circuit: Insights from graph theory. Psychiatry Res Neuroimaging 2018; 281:107-116. [PMID: 30290286 DOI: 10.1016/j.pscychresns.2018.09.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 09/26/2018] [Accepted: 09/26/2018] [Indexed: 12/30/2022]
Abstract
Generalized anxiety disorder (GAD) has excessive anxiety and uncontrollable worry as core symptoms. Abnormal cerebral functioning underpins the expression and perhaps pathogenesis of GAD:. Studies implicate impaired communication between the amygdala and the pre-frontal cortex (PFC). Our aim was to longitudinally investigate whether such network abnormalities are spatially restricted to this circuit or if the integrity of functional brain networks is globally disrupted in GAD. We acquired resting-state functional magnetic resonance imaging data from 16 GAD patients and 16 matched controls at baseline and after 1 year. Using network modeling and graph-theory, whole-brain connectivity was characterized from local and global perspectives. Overall lower global efficiency, indicating sub-optimal brain-wide organization and integration, was present in patients with GAD compared to controls. The amygdala and midline cortices showed higher betweenness centrality, reflecting functional dominance of these brain structures. Third, lower betweenness centrality and lower degree emerged for PFC, suggesting weakened inhibitory control. Overall, network organization showed impairments consistent with neurobiological models of GAD (involving amygdala, PFC, and cingulate cortex) and further pointed to an involvement of temporal regions. Such impairments tended to progress over time and predict anxiety symptoms. A graph-analytic approach represents a powerful approach to deepen our understanding of GAD.
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Affiliation(s)
- Elena Makovac
- Centre for Neuroimaging Science, Kings College London, London, UK; Clinical Imaging Sciences Centre, Brighton and Sussex Medical School, University of Sussex, Falmer, UK; Neuroimaging Laboratory, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Matteo Mancini
- Neuroimaging Laboratory, IRCCS Santa Lucia Foundation, Rome, Italy; Centre for Medical Image Computing, University College London, London, UK
| | - Sabrina Fagioli
- Neuroimaging Laboratory, IRCCS Santa Lucia Foundation, Rome, Italy; Department of Education, University of Roma Tre, Rome, Italy
| | - David R Watson
- Clinical Imaging Sciences Centre, Brighton and Sussex Medical School, University of Sussex, Falmer, UK
| | - Frances Meeten
- Clinical Imaging Sciences Centre, Brighton and Sussex Medical School, University of Sussex, Falmer, UK; Department of Psychology, Kings College London, London, UK
| | - Charlotte L Rae
- Clinical Imaging Sciences Centre, Brighton and Sussex Medical School, University of Sussex, Falmer, UK; Sackler Centre for Consciousness Science, University of Sussex, Falmer, UK
| | - Hugo D Critchley
- Clinical Imaging Sciences Centre, Brighton and Sussex Medical School, University of Sussex, Falmer, UK; Sackler Centre for Consciousness Science, University of Sussex, Falmer, UK; Psychiatry, BSMS Department of Neuroscience, Brighton and Sussex Medical School (BSMS), University of Sussex, Falmer, UK
| | - Cristina Ottaviani
- Neuroimaging Laboratory, IRCCS Santa Lucia Foundation, Rome, Italy; Department of Psychology, Sapienza University of Rome, Rome, Italy.
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25
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Amorim L, Magalhães R, Coelho A, Moreira PS, Portugal-Nunes C, Castanho TC, Marques P, Sousa N, Santos NC. Poor Sleep Quality Associates With Decreased Functional and Structural Brain Connectivity in Normative Aging: A MRI Multimodal Approach. Front Aging Neurosci 2018; 10:375. [PMID: 30524267 PMCID: PMC6257343 DOI: 10.3389/fnagi.2018.00375] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 10/29/2018] [Indexed: 12/19/2022] Open
Abstract
Sleep is a ubiquitous phenomenon, essential to the organism homeostasis. Notwithstanding, there has been an increasing concern with its disruption, not only within the context of pathological conditions, such as neurologic and psychiatric diseases, but also in health. In fact, sleep complaints are becoming particularly common, especially in middle-aged and older adults, which may suggest an underlying susceptibility to sleep quality loss and/or its consequences. Thus, a whole-brain modeling approach to study the shifts in the system can cast broader light on sleep quality mechanisms and its associated morbidities. Following this line, we sought to determine the association between the standard self-reported measure of sleep quality, the Pittsburgh Sleep Quality Index (PSQI) and brain correlates in a normative aging cohort. To this purpose, 86 participants (age range 52–87 years) provided information regarding sociodemographic parameters, subjective sleep quality and associated psychological variables. A multimodal magnetic resonance imaging (MRI) approach was used, with whole-brain functional and structural connectomes being derived from resting-state functional connectivity (FC) and probabilistic white matter tractography (structural connectivity, SC). Brain regional volumes and white matter properties associations were also explored. Results show that poor sleep quality was associated with a decrease in FC and SC of distinct networks, overlapping in right superior temporal pole, left middle temporal and left inferior occipital regions. Age displayed important associations with volumetric changes in the cerebellum cortex and white matter, thalamus, hippocampus, right putamen, left supramarginal and left lingual regions. Overall, results suggest that not only the PSQI global score may act as a proxy of changes in FC/SC in middle-aged and older individuals, but also that the age-related regional volumetric changes may be associated to an adjustment of brain connectivity. These findings may also represent a step further in the comprehension of the role of sleep disturbance in disease, since the networks found share regions that have been shown to be affected in pathologies, such as depression and Alzheimer's disease.
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Affiliation(s)
- Liliana Amorim
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Braga, Portugal.,Clinical Academic Center-Braga, Braga, Portugal
| | - Ricardo Magalhães
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Braga, Portugal.,Clinical Academic Center-Braga, Braga, Portugal
| | - Ana Coelho
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Braga, Portugal.,Clinical Academic Center-Braga, Braga, Portugal
| | - Pedro Silva Moreira
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Braga, Portugal.,Clinical Academic Center-Braga, Braga, Portugal
| | - Carlos Portugal-Nunes
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Braga, Portugal.,Clinical Academic Center-Braga, Braga, Portugal
| | - Teresa Costa Castanho
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Braga, Portugal.,Clinical Academic Center-Braga, Braga, Portugal
| | - Paulo Marques
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Braga, Portugal.,Clinical Academic Center-Braga, Braga, Portugal
| | - Nuno Sousa
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Braga, Portugal.,Clinical Academic Center-Braga, Braga, Portugal
| | - Nadine Correia Santos
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Braga, Portugal.,Clinical Academic Center-Braga, Braga, Portugal
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26
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Sierk A, Daniels JK, Manthey A, Kok JG, Leemans A, Gaebler M, Lamke JP, Kruschwitz J, Walter H. White matter network alterations in patients with depersonalization/derealization disorder. J Psychiatry Neurosci 2018; 43:170110. [PMID: 29877178 PMCID: PMC6158023 DOI: 10.1503/jpn.170110] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 12/01/2017] [Accepted: 01/21/2018] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Depersonalization/derealization disorder (DPD) is a chronic and distressing condition characterized by detachment from oneself and/or the external world. Neuroimaging studies have associated DPD with structural and functional alterations in a variety of distinct brain regions. Such local neuronal changes might be mediated by altered interregional white matter connections. However, to our knowledge, no research on network characteristics in this patient population exists to date. METHODS We explored the structural connectome in 23 individuals with DPD and 23 matched, healthy controls by applying graph theory to diffusion tensor imaging data. Mean interregional fractional anisotropy (FA) was used to define the network weights. Group differences were assessed using network-based statistics and a link-based controlling procedure. RESULTS Our main finding refers to lower FA values within left temporal and right temporoparietal regions in individuals with DPD than in healthy controls when using a link-based controlling procedure. These links were also associated with dissociative symptom severity and could not be explained by anxiety or depression scores. Using network-based statistics, no significant results emerged. However, we found a trend for 1 subnetwork that may support the model of frontolimbic dysbalance suggested to underlie DPD symptomatology. LIMITATIONS To ensure ecological validity, patients with certain comorbidities or psychotropic medication were included in the study. Confirmatory replications are necessary to corroborate the results of this explorative investigation. CONCLUSION In patients with DPD, the structural connectivity between brain regions crucial for multimodal integration and emotion regulation may be altered. Aberrations in fibre tract communication seem to be not solely a secondary effect of local grey matter volume loss, but may present a primary pathophysiology in patients with DPD.
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Affiliation(s)
- Anika Sierk
- From the Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany (Sierk, Manthey, Lamke, Kruschwitz, Walter); the Institute of Cognitive Neuroscience, University College London, London, UK (Sierk); the Department of Clinical Psychology, University of Groningen, Groningen, The Netherlands (Daniels); the Department of Neurology, University of Groningen, University Medical Center Groningen, The Netherlands (Kok); the PROVIDI Lab, University Medical Center Utrecht, Utrecht, the Netherlands (Leemans); and the Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (Gaebler)
| | - Judith K Daniels
- From the Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany (Sierk, Manthey, Lamke, Kruschwitz, Walter); the Institute of Cognitive Neuroscience, University College London, London, UK (Sierk); the Department of Clinical Psychology, University of Groningen, Groningen, The Netherlands (Daniels); the Department of Neurology, University of Groningen, University Medical Center Groningen, The Netherlands (Kok); the PROVIDI Lab, University Medical Center Utrecht, Utrecht, the Netherlands (Leemans); and the Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (Gaebler)
| | - Antje Manthey
- From the Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany (Sierk, Manthey, Lamke, Kruschwitz, Walter); the Institute of Cognitive Neuroscience, University College London, London, UK (Sierk); the Department of Clinical Psychology, University of Groningen, Groningen, The Netherlands (Daniels); the Department of Neurology, University of Groningen, University Medical Center Groningen, The Netherlands (Kok); the PROVIDI Lab, University Medical Center Utrecht, Utrecht, the Netherlands (Leemans); and the Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (Gaebler)
| | - Jelmer G Kok
- From the Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany (Sierk, Manthey, Lamke, Kruschwitz, Walter); the Institute of Cognitive Neuroscience, University College London, London, UK (Sierk); the Department of Clinical Psychology, University of Groningen, Groningen, The Netherlands (Daniels); the Department of Neurology, University of Groningen, University Medical Center Groningen, The Netherlands (Kok); the PROVIDI Lab, University Medical Center Utrecht, Utrecht, the Netherlands (Leemans); and the Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (Gaebler)
| | - Alexander Leemans
- From the Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany (Sierk, Manthey, Lamke, Kruschwitz, Walter); the Institute of Cognitive Neuroscience, University College London, London, UK (Sierk); the Department of Clinical Psychology, University of Groningen, Groningen, The Netherlands (Daniels); the Department of Neurology, University of Groningen, University Medical Center Groningen, The Netherlands (Kok); the PROVIDI Lab, University Medical Center Utrecht, Utrecht, the Netherlands (Leemans); and the Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (Gaebler)
| | - Michael Gaebler
- From the Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany (Sierk, Manthey, Lamke, Kruschwitz, Walter); the Institute of Cognitive Neuroscience, University College London, London, UK (Sierk); the Department of Clinical Psychology, University of Groningen, Groningen, The Netherlands (Daniels); the Department of Neurology, University of Groningen, University Medical Center Groningen, The Netherlands (Kok); the PROVIDI Lab, University Medical Center Utrecht, Utrecht, the Netherlands (Leemans); and the Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (Gaebler)
| | - Jan-Peter Lamke
- From the Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany (Sierk, Manthey, Lamke, Kruschwitz, Walter); the Institute of Cognitive Neuroscience, University College London, London, UK (Sierk); the Department of Clinical Psychology, University of Groningen, Groningen, The Netherlands (Daniels); the Department of Neurology, University of Groningen, University Medical Center Groningen, The Netherlands (Kok); the PROVIDI Lab, University Medical Center Utrecht, Utrecht, the Netherlands (Leemans); and the Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (Gaebler)
| | - Johann Kruschwitz
- From the Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany (Sierk, Manthey, Lamke, Kruschwitz, Walter); the Institute of Cognitive Neuroscience, University College London, London, UK (Sierk); the Department of Clinical Psychology, University of Groningen, Groningen, The Netherlands (Daniels); the Department of Neurology, University of Groningen, University Medical Center Groningen, The Netherlands (Kok); the PROVIDI Lab, University Medical Center Utrecht, Utrecht, the Netherlands (Leemans); and the Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (Gaebler)
| | - Henrik Walter
- From the Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany (Sierk, Manthey, Lamke, Kruschwitz, Walter); the Institute of Cognitive Neuroscience, University College London, London, UK (Sierk); the Department of Clinical Psychology, University of Groningen, Groningen, The Netherlands (Daniels); the Department of Neurology, University of Groningen, University Medical Center Groningen, The Netherlands (Kok); the PROVIDI Lab, University Medical Center Utrecht, Utrecht, the Netherlands (Leemans); and the Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (Gaebler)
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27
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Wang X, Cheng B, Luo Q, Qiu L, Wang S. Gray Matter Structural Alterations in Social Anxiety Disorder: A Voxel-Based Meta-Analysis. Front Psychiatry 2018; 9:449. [PMID: 30298028 PMCID: PMC6160565 DOI: 10.3389/fpsyt.2018.00449] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 08/30/2018] [Indexed: 02/05/2023] Open
Abstract
The current insight into the neurobiological pathogenesis underlying social anxiety disorder (SAD) is still rather limited. We implemented a meta-analysis to explore the neuroanatomical basis of SAD. We undertook a systematic search of studies comparing gray matter volume (GMV) differences between SAD patients and healthy controls (HC) using a whole-brain voxel-based morphometry (VBM) approach. The anisotropic effect size version of seed-based d mapping (AES-SDM) meta-analysis was conducted to explore the GMV differences of SAD patients compared with HC. We included eleven studies with 470 SAD patients and 522 HC in the current meta-analysis. In the main meta-analysis, relative to HC, SAD patients showed larger GMVs in the left precuneus, right middle occipital gyrus (MOG) and supplementary motor area (SMA), as well as smaller GMV in the left putamen. In the subgroup analyses, compared with controls, adult patients (age ≥ 18 years) with SAD exhibited larger GMVs in the left precuneus, right superior frontal gyrus (SFG), angular gyrus, middle temporal gyrus (MTG), MOG and SMA, as well as a smaller GMV in the left thalamus; SAD patients without comorbid depressive disorder exhibited larger GMVs in the left superior parietal gyrus and precuneus, right inferior temporal gyrus, fusiform gyrus, MTG and superior temporal gyrus (STG), as well as a smaller GMV in the bilateral thalami; and currently drug-free patients with SAD exhibited a smaller GMV in the left thalamus compared with HC while no larger GMVs were found. For SAD patients with different clinical features, our study revealed directionally consistent larger cortical GMVs and smaller subcortical GMVs, including locationally consistent larger precuneus and thalamic deficits in the left brain. Age, comorbid depressive disorder and concomitant medication use of the patients might be potential confounders of SAD at the neuroanatomical level.
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Affiliation(s)
- Xiuli Wang
- Department of Clinical Psychology, the Fourth People's Hospital of Chengdu, Chengdu, China
| | - Bochao Cheng
- Department of Radiology, West China Second University Hospital of Sichuan University, Chengdu, China
| | - Qiang Luo
- Department of Radiology, Huaxi MR Research Center, West China Hospital of Sichuan University, Chengdu, China
| | - Lihua Qiu
- Department of Radiology, the Second People's Hospital of Yibin, Yibin, China
| | - Song Wang
- Department of Clinical Psychology, the Fourth People's Hospital of Chengdu, Chengdu, China.,Department of Radiology, Huaxi MR Research Center, West China Hospital of Sichuan University, Chengdu, China
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28
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Jung YH, Shin JE, Lee YI, Jang JH, Jo HJ, Choi SH. Altered Amygdala Resting-State Functional Connectivity and Hemispheric Asymmetry in Patients With Social Anxiety Disorder. Front Psychiatry 2018; 9:164. [PMID: 29755374 PMCID: PMC5932339 DOI: 10.3389/fpsyt.2018.00164] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 04/11/2018] [Indexed: 01/03/2023] Open
Abstract
Background: The amygdala plays a key role in emotional hyperreactivity in response to social threat in patients with social anxiety disorder (SAD). We investigated resting-state functional connectivity (rs-FCN) of the left and right amygdala with various brain regions and functional lateralization in patients with SAD. Methods: A total of 36 patients with SAD and 42 matched healthy controls underwent functional magnetic resonance imaging (fMRI) at rest. Using the left and right amygdala as seed regions, we compared the strength of the rs-FCN in the patient and control groups. Furthermore, we investigated group differences in the hemispheric asymmetry of the functional connectivity maps of the left and right amygdala. Results: Compared with healthy controls, the rs-FCN between the left amygdala and the dorsolateral prefrontal cortex was reduced in patients with SAD, whereas left amygdala connectivity with the fusiform gyrus, anterior insula, supramarginal gyrus, and precuneus was increased or positively deflected in the patient group. Additionally, the strength rs-FCN between the left amygdala and anterior insula was positively associated with the severity of the fear of negative evaluation in patients with SAD (r = 0.338, p = 0.044). The rs-FCN between the right amygdala and medial frontal gyrus was decreased in patients with SAD compared with healthy controls, whereas connectivity with the parahippocampal gyrus was greater in the patient group than in the control group. The hemispheric asymmetry patterns in the anterior insula, intraparietal sulcus (IPS), and inferior frontal gyrus of the patient group were opposite those of the control group, and functional lateralization of the connectivity between the amygdala and the IPS was associated with the severity of social anxiety symptoms (r = 0.365, p = 0.037). Conclusion: Our findings suggest that in addition to impaired fronto-amygdala communication, the functional lateralization of amygdala function plays a central role in the pathophysiology of SAD.
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Affiliation(s)
- Ye-Ha Jung
- Department of Psychiatry, Seoul National University Hospital, Seoul, South Korea
| | - Jung E Shin
- Department of Psychiatry, Seoul National University Hospital, Seoul, South Korea
| | - Yoonji I Lee
- Department of Psychiatry, Seoul National University Hospital, Seoul, South Korea
| | - Joon H Jang
- Department of Psychiatry, Seoul National University Hospital, Seoul, South Korea.,Department of Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Hang J Jo
- Department of Neurology, Mayo Clinic, Rochester, MN, United States.,Department of Neurosurgery, Mayo Clinic, Rochester, MN, United States
| | - Soo-Hee Choi
- Department of Psychiatry, Seoul National University Hospital, Seoul, South Korea.,Department of Psychiatry, Institute of Human Behavioral Medicine in SNU-MRC, Seoul National University College of Medicine, Seoul, South Korea
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Coppola G, Petolicchio B, Di Renzo A, Tinelli E, Di Lorenzo C, Parisi V, Serrao M, Calistri V, Tardioli S, Cartocci G, Ambrosini A, Caramia F, Di Piero V, Pierelli F. Cerebral gray matter volume in patients with chronic migraine: correlations with clinical features. J Headache Pain 2017; 18:115. [PMID: 29322264 PMCID: PMC5762618 DOI: 10.1186/s10194-017-0825-z] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Accepted: 11/21/2017] [Indexed: 12/23/2022] Open
Abstract
Background To date, few MRI studies have been performed in patients affected by chronic migraine (CM), especially in those without medication overuse. Here, we performed magnetic resonance imaging (MRI) voxel-based morphometry (VBM) analyses to investigate the gray matter (GM) volume of the whole brain in patients affected by CM. Our aim was to investigate whether fluctuations in the GM volumes were related to the clinical features of CM. Methods Twenty untreated patients with CM without a past medical history of medication overuse underwent 3-Tesla MRI scans and were compared to a group of 20 healthy controls (HCs). We used SPM12 and the CAT12 toolbox to process the MRI data and to perform VBM analyses of the structural T1-weighted MRI scans. The GM volume of patients was compared to that of HCs with various corrected and uncorrected thresholds. To check for possible correlations, patients’ clinical features and GM maps were regressed. Results Initially, we did not find significant differences in the GM volume between patients with CM and HCs (p < 0.05 corrected for multiple comparisons). However, using more-liberal uncorrected statistical thresholds, we noted that compared to HCs, patients with CM exhibited clusters of regions with lower GM volumes including the cerebellum, left middle temporal gyrus, left temporal pole/amygdala/hippocampus/pallidum/orbitofrontal cortex, and left occipital areas (Brodmann areas 17/18). The GM volume of the cerebellar hemispheres was negatively correlated with the disease duration and positively correlated with the number of tablets taken per month. Conclusion No gross morphometric changes were observed in patients with CM when compared with HCs. However, using more-liberal uncorrected statistical thresholds, we observed that CM is associated with subtle GM volume changes in several brain areas known to be involved in nociception/antinociception, multisensory integration, and analgesic dependence. We speculate that these slight morphometric impairments could lead, at least in a subgroup of patients, to the development and continuation of maladaptive acute medication usage. Electronic supplementary material The online version of this article (10.1186/s10194-017-0825-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gianluca Coppola
- Research Unit of Neurophysiology of Vision and Neurophthalmology, G.B. Bietti Foundation-IRCCS, Via Livenza 3, 00198, Rome, Italy.
| | - Barbara Petolicchio
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Antonio Di Renzo
- Research Unit of Neurophysiology of Vision and Neurophthalmology, G.B. Bietti Foundation-IRCCS, Via Livenza 3, 00198, Rome, Italy
| | - Emanuele Tinelli
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | | | - Vincenzo Parisi
- Research Unit of Neurophysiology of Vision and Neurophthalmology, G.B. Bietti Foundation-IRCCS, Via Livenza 3, 00198, Rome, Italy
| | - Mariano Serrao
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino, Latina, Italy
| | - Valentina Calistri
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Stefano Tardioli
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Gaia Cartocci
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | | | - Francesca Caramia
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Vittorio Di Piero
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Francesco Pierelli
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino, Latina, Italy.,IRCCS-Neuromed, Pozzilli, IS, Italy
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