The regulation of positive and negative emotions through instructed causal attributions in lifetime depression - A functional magnetic resonance imaging study

Neurophysiological Pathways of Unconscious Emotion Processing in Depression: Insights from a simultaneous EEG-fMRI Measurement

BACKGROUND

Major depressive disorder (MDD) is characterized by strong emotional dysregulation. Mechanisms driving the negative affect in depression may be fast processes existing on an unconscious level.

METHODS

A priming task was conducted using simultaneous EEG-fMRI measurement involving presentation of facial expressions (happy, sad, neutral) to examine the neurophysiological pathway of biased unconscious emotion processing in MDD. Priming prior to a target emotion created unconscious (16.7 ms primer) and conscious (150 ms primer) trials. A large sample of N = 126 was recruited, containing healthy controls (HC; n = 66; 37 women) and MDD (n = 60; 31 women).

RESULTS

HC showed a shorter reaction time in happy, but not in sad or neutral trials compared to MDD. N170 amplitudes were lower in trials with unconscious compared to conscious primer presentation. N170 amplitudes correlated with cortical (right fusiform gyrus (FFG), right middle temporal gyrus, right inferior temporal gyrus, left supplementary motor area, right middle frontal gyrus) and subcortical brain regions (right amygdala). The strength of N170 and brain activity correlation increased when the stimulus was consciously presented. Presented emotions did not affect the correlation of N170 values and brain activity.

CONCLUSIONS

Our findings show that MDD may exhibit biased emotion regulation abilities at a behavioral and neurophysiological level. Face-sensitive event-related potentials demonstrate a correlation with heightened brain activity in regions associated with both face recognition (FFG) and emotion processing (amygdala). These findings are evident in both MDD and HC, with lower effect sizes in MDD indicating reduced emotion recognition and processing abilities.

Comparisons of the amplitude of low-frequency fluctuation and functional connectivity in major depressive disorder and social anxiety disorder: A resting-state fMRI study

BACKGROUND

Studies comparing the brain functions of major depressive disorder (MDD) and social anxiety disorder (SAD) at the regional and network levels remain scarce. This study aimed to elucidate their pathogenesis using neuroimaging techniques and explore biomarkers that can differentiate these disorders.

METHODS

Resting-state fMRI data were collected from 48 patients with MDD, 41 patients with SAD, and 82 healthy controls. Differences in the amplitude of low-frequency fluctuations (ALFF) among the three groups were examined to identify regions showing abnormal regional spontaneous activity. A seed-based functional connectivity (FC) analysis was conducted using ALFF results as seeds and different connections were identified between regions showing abnormal local spontaneous activity and other regions. The correlation between abnormal brain function and clinical symptoms was analyzed.

RESULTS

Patients with MDD and SAD exhibited similar abnormal ALFF and FC in several brain regions; notably, FC between the right superior frontal gyrus (SFG) and the right posterior supramarginal gyrus (pSMG) in patients with SAD was negatively correlated with depressive symptoms. Furthermore, patients with MDD showed higher ALFF in the right SFG than HCs and those with SAD.

LIMITATION

Potential effects of medications, comorbidities, and data type could not be ignored.

CONCLUSION

MDD and SAD showed common and distinct aberrant brain function patterns at the regional and network levels. At the regional level, we found that the ALFF in the right SFG was different between patients with MDD and those with SAD. At the network level, we did not find any differences between these disorders.

Aberrant associations between neuronal resting-state fluctuations and working memory-induced activity in major depressive disorder

Previous investigations have revealed performance deficits and altered neural processes during working-memory (WM) tasks in major depressive disorder (MDD). While most of these studies used task-based functional magnetic resonance imaging (fMRI), there is an increasing interest in resting-state fMRI to characterize aberrant network dynamics involved in this and other MDD-associated symptoms. It has been proposed that activity during the resting-state represents characteristics of brain-wide functional organization, which could be highly relevant for the efficient execution of cognitive tasks. However, the dynamics linking resting-state properties and task-evoked activity remain poorly understood. Therefore, the present study investigated the association between spontaneous activity as indicated by the amplitude of low frequency fluctuations (ALFF) at rest and activity during an emotional n-back task. 60 patients diagnosed with an acute MDD episode, and 52 healthy controls underwent the fMRI scanning procedure. Within both groups, positive correlations between spontaneous activity at rest and task-activation were found in core regions of the central-executive network (CEN), whereas spontaneous activity correlated negatively with task-deactivation in regions of the default mode network (DMN). Compared to healthy controls, patients showed a decreased rest-task correlation in the left prefrontal cortex (CEN) and an increased negative correlation in the precuneus/posterior cingulate cortex (DMN). Interestingly, no significant group-differences within those regions were found solely at rest or during the task. The results underpin the potential value and importance of resting-state markers for the understanding of dysfunctional network dynamics and neural substrates of cognitive processing.

Neurometabolic alterations in children and adolescents with functional neurological disorder

OBJECTIVES

In vivo magnetic resonance spectroscopy (MRS) was used to investigate neurometabolic homeostasis in children with functional neurological disorder (FND) in three regions of interest: supplementary motor area (SMA), anterior default mode network (aDMN), and posterior default mode network (dDMN). Metabolites assessed included N-acetyl aspartate (NAA), a marker of neuron function; myo-inositol (mI), a glial-cell marker; choline (Cho), a membrane marker; glutamate plus glutamine (Glx), a marker of excitatory neurotransmission; γ-aminobutyric acid (GABA), a marker of inhibitor neurotransmission; and creatine (Cr), an energy marker. The relationship between excitatory (glutamate and glutamine) and inhibitory (GABA) neurotransmitter (E/I) balance was also examined.

METHODS

MRS data were acquired for 32 children with mixed FND (25 girls, 7 boys, aged 10.00 to 16.08 years) and 41 healthy controls of similar age using both short echo point-resolved spectroscopy (PRESS) and Mescher-Garwood point-resolved spectroscopy (MEGAPRESS) sequences in the three regions of interest.

RESULTS

In the SMA, children with FND had lower NAA/Cr, mI/Cr (trend level), and GABA/Cr ratios. In the aDMN, no group differences in metabolite ratios were found. In the pDMN, children with FND had lower NAA/Cr and mI/Cr (trend level) ratios. While no group differences in E/I balance were found (FND vs. controls), E/I balance in the aDMN was lower in children with functional seizures-a subgroup within the FND group. Pearson correlations found that increased arousal (indexed by higher heart rate) was associated with lower mI/Cr in the SMA and pDMN.

CONCLUSIONS

Our findings of multiple differences in neurometabolites in children with FND suggest dysfunction on multiple levels of the biological system: the neuron (lower NAA), the glial cell (lower mI), and inhibitory neurotransmission (lower GABA), as well as dysfunction in energy regulation in the subgroup with functional seizures.

Influence of medical humanization on patients' attribution in negative medical situations with communication as the mediator: a questionnaire study

Background

Patients' attribution in negative medical situations plays a vital role in reducing medical conflicts and developing high-quality healthcare. The purpose of this study was to investigate the triadic relations among patients' attribution, medical humanization and communication. Furthermore, the mediating effect of communication was tested.

Methods

A cross-sectional study on the relationship between patients' attribution in negative medical situations and medical staff's humanization and communication was conducted, with 3,000 participants totally from 103 hospitals of three different levels in different regions.

Results

There were significant positive correlations among medical staff's humanization, communication and patients' attributional styles (r = 0.112-0.236, p < 0.001 for all). Medical humanization had direct predictive effects on patients' attributional style in negative medical situations (β = 0.14, p < 0.01). Mediation analysis also indicated the indirect predictive effect of medical humanization on patients' attributions through communication (β = 0.02, p < 0.01).

Conclusion

Patients' attribution in negative medical situations is predicted by patients' perception of medical staff's humanization in healthcare and physicians' communication skills. Medical humanization not only affects patients' attributions in negative situations directly, but also influences patients' attributions via communication indirectly. The humanistic care should be included in medical education for healthcare professionals, and professional training on medical staff's humanization and communication skills is strongly needed to establish healthy and harmonious doctor-patient relationship.

A comparison of uni- and multi-variate methods for identifying brain networks activated by cognitive tasks using intracranial EEG

Cognitive tasks are commonly used to identify brain networks involved in the underlying cognitive process. However, inferring the brain networks from intracranial EEG data presents several challenges related to the sparse spatial sampling of the brain and the high variability of the EEG trace due to concurrent brain processes. In this manuscript, we use a well-known facial emotion recognition task to compare three different ways of analyzing the contrasts between task conditions: permutation cluster tests, machine learning (ML) classifiers, and a searchlight implementation of multivariate pattern analysis (MVPA) for intracranial sparse data recorded from 13 patients undergoing presurgical evaluation for drug-resistant epilepsy. Using all three methods, we aim at highlighting the brain structures with significant contrast between conditions. In the absence of ground truth, we use the scientific literature to validate our results. The comparison of the three methods’ results shows moderate agreement, measured by the Jaccard coefficient, between the permutation cluster tests and the machine learning [0.33 and 0.52 for the left (LH) and right (RH) hemispheres], and 0.44 and 0.37 for the LH and RH between the permutation cluster tests and MVPA. The agreement between ML and MVPA is higher: 0.65 for the LH and 0.62 for the RH. To put these results in context, we performed a brief review of the literature and we discuss how each brain structure’s involvement in the facial emotion recognition task.

Neural substrates of rewarding and punishing self representations in depressed suicide-attempting adolescents

Adolescence is a period of plasticity in neural substrates underpinning self-processing. Such substrates are worth studying in depressed youth at risks for suicide because altered neurobiology of self-processing might partially explain differences between suicide attempting youth versus youth who contemplate but do not attempt suicide. Understanding altered substrates of self-processing among depressed adolescents with suicide attempts is critical for developing targeted prevention and treatment. Healthy youth (N = 40), youth with depression and low (N = 33) or high suicide ideation (N = 28), and youth with depression and past suicide attempt (N = 28) heard positive or negative self-descriptors during fMRI and evaluated them from their own, their mother's, classmates', and best friend's perspectives. Lower bilateral caudate activity during positive self-processing distinguished suicide attempting adolescents from all other youth. Higher bilateral caudate activity during negatively valenced self-processing tended to distinguish youth with depression. Blunted reward circuitry during positive vs. negative self-related material tended to distinguish suicide attempting youth, reflecting potentially enhanced behavioral preparedness for punishing vs. rewarding self-relevant cues.

Regulating negative emotions of others reduces own stress: Neurobiological correlates and the role of individual differences in empathy: Regulating others reduces own stress

BACKGROUND

While witnessing the suffering of other people results in personal distress, it is not clear whether regulating others' emotions in such situations also comes at an emotional cost for the observer.

METHODS

this novel study included 62 subjects and used a newly developed functional Magnetic Resonance Imaging (fMRI) paradigm to investigate mechanisms of self and other emotion regulation via reappraisal while the subject and an interaction partner outside the scanner were facing the same distressing situation simultaneously. The relationship between distress levels and individual differences in emotional and cognitive empathy were also assessed.

RESULTS

We found that individuals exhibited especially high levels of personal distress when relating with a partner while both being exposed to aversive photographs and that especially highly empathetic individuals were prone to such personal distress. Moreover, when engaging in social emotion regulation, personal distress was reduced in the observer at a similar rate as in self emotion regulation. FMRI analyses revealed increased activation for other vs. self emotion regulation in the precuneus and the left temporo-parietal junction, which are commonly engaged in social cognition. Furthermore, this activation was associated with lower self-reported stress and decreased sympathetic autonomic activity. While regulating others, precuneus activation exhibited a distinctive functional connectivity profile with parietal emotion regulation regions.

CONCLUSIONS

This study demonstrates benefits of actively regulating another person's emotions for reducing one's own distress and identifies the precuneus as an important node for social emotion regulation. Given the novelty of the study design, the results are of exploratory and preliminary nature.

Impact of OXTR Polymorphisms on Subjective Well-Being: The Intermediary Role of Attributional Style

Polymorphisms in the oxytocin receptor (OXTR) gene are related to individual differences in negative emotions, such as depressive symptoms and anxiety. However, it remains unclear what the potential roles of OXTR polymorphisms are in subjective well-being (SWB), which is negatively correlated with depressive symptoms. We examined attributional styles as mediator between SWB and five polymorphisms of the oxytocin receptor gene (OXTR rs53576, rs2254298, rs1042778, rs2268494, and rs2268490) among 627 full-time college freshmen (M_age = 20.90, SD = 0.82 for male; M_age = 20.81, SD = 0.92 for female) using structural equation modeling. The results showed that individuals with the OXTR rs2254298 AA genotype and rs53576 AA/GA genotype reported higher scores on SWB, which suggested that individuals with this genotype experienced more happiness. Moreover, external attributional style partially mediated the association between OXTR rs2254298 polymorphism and SWB (β = 0.019, 95%CI [0.001, 0.036], p = 0.035). In conclusion, our findings demonstrated that the genetic variations of OXTR played a role in the individual differences of SWB, and external attribution style could mediate the association.

Emotion Regulation by Psychological Distance and Level of Abstraction: Two Meta-Analyses

Self-reflection is suggested to attenuate feelings, yet researchers disagree on whether adopting a distant or near perspective, or processing the experience abstractly or concretely, is more effective. Given the relationship between psychological distance and level of abstraction, we suggest the "construal-matching hypothesis": Psychological distance and abstraction differently influence emotion intensity, depending on whether the emotion's appraisal involves low-level or high-level construal. Two meta-analyses tested the effects of psychological distance (k = 230) and level-of-abstraction (k = 98) manipulations on emotional experience. A distant perspective attenuated emotional experience (g = 0.52) but with weaker effects for high-level (g = 0.29; for example, self-conscious emotions) than low-level emotions (g= 0.64; for example, basic emotions). Level of abstraction only attenuated the experience of low-level emotions (g = 0.2) and showed a reverse (nonsignificant) effect for high-level emotions (g = -0.13). These results highlight differences between distancing and level-of-abstraction manipulations and the importance of considering the type of emotion experienced in emotion regulation.

Bills, babies, and (language) barriers: Associations among economic strain, parenting, and primary language during the newborn period

OBJECTIVE

The goal of this study was to examine associations among economic strain, parenting self-efficacy, parenting satisfaction, and parent primary language in a universally low-income sample of parents with newborns.

BACKGROUND

Previous research links increased economic strain to lower levels of parenting self-efficacy and parenting satisfaction among socioeconomically diverse parents with older children. Little research has examined whether primary language shapes the associations among economic strain, parenting self-efficacy, and parenting satisfaction.

METHOD

Parents (n = 194, M _age = 30.91) completed self-report surveys measuring economic strain, parenting self-efficacy, and parenting satisfaction. Parents' ethnic self-identification and primary language were used to stratify parents into three groups: Latinx Spanish speakers, Latinx English speakers, and non-Latinx English speakers.

RESULTS

Regression analyses revealed that economic strain was negatively associated with both parenting self-efficacy and parenting satisfaction. Further, the negative association between economic strain and parenting self-efficacy was stronger for Latinx Spanish speakers.

CONCLUSION

Economic strain may negatively influence parenting self-efficacy and parenting satisfaction during the newborn period. Parents whose primary language is Spanish may be disproportionately affected by economic strain.

IMPLICATIONS

Parents of newborns may benefit from increased economic supports in linguistically responsive pediatric care and social service settings.

Diurnal mood variation symptoms in major depressive disorder associated with evening chronotype: Evidence from a neuroimaging study

BACKGROUND

Major depressive disorder (MDD) is often accompanied with classic diurnal mood variation (DMV) symptoms. Patients with DMV symptoms feel a mood improvement and prefer activities at dusk or in the evening, which is consistent with the evening chronotype. Their neural alterations are unclear. In this study, we aimed to explore the neuropathological mechanisms underlying the circadian rhythm of mood and the association with chronotype in MDD.

METHODS

A total of 126 depressed patients, including 48 with DMV, 78 without, and 67 age/gender-matched healthy controls (HC) were recruited and underwent a resting-state functional magnetic resonance imaging. Spontaneous neural activity was investigated using amplitude of low-frequency fluctuation (ALFF) and region of interest (ROI)-based functional connectivity (FC) analyses were conducted. The Morningness-Eveningness Questionnaire (MEQ) was utilized to evaluate participant chronotypes and Pearson correlations were calculated between altered ALFF/FC values and MEQ scores in patients with MDD.

RESULTS

Compared with NMV, DMV group exhibited lower MEQ scores, and increased ALFF values in the right orbital superior frontal gyrus (oSFG). We observed that increased FC between the left suprachiasmatic nucleus (SCN) and supramarginal gyrus (SMG). ALFF in the oSFG and FC of rSCN-SMG were negatively correlated with MEQ scores.

LIMITATION

Some people's chronotypes information is missing.

CONCLUSION

Patients with DMV tended to be evening type and exhibited abnormal brain functions in frontal lobes. The synergistic changes between frontotemporal lobe, SCN-SMG maybe the characteristic of patients with DMV symptoms.

Altered resting-state neural networks in children and adolescents with functional neurological disorder

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FND in children commonly involves presentation with multiple neurological symptoms.

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Children with FND show wide-ranging connectivity changes in resting-state neural networks.

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Aberrant neural-networks changes are greater in children whose FND includes functional seizures.

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Subjective distress, autonomic arousal, and HPA dysregulation contribute to network changes.

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Children with FND (vs controls) report more subjective distress and more ACEs across the lifespan.

Objectives

Previous studies with adults suggest that aberrant communication between neural networks underpins functional neurological disorder (FND). The current study adopts a data-driven approach to investigate the extent that functional resting-state networks are disrupted in a pediatric mixed-FND cohort.

Methods

31 children with mixed FND and 33 age- and sex-matched healthy controls completed resting-state fMRI scans. Whole-brain independent component analysis (pFWE < 0.05) was then used to identify group differences in resting-state connectivity. Self-report measures included the Depression, Anxiety and Stress Scale (DASS-21) and Early Life Stress Questionnaire (ELSQ). Resting-state heart rate (HR) and cortisol-awakening response (CAR) were available in a subset.

Results

Children with FND showed wide-ranging connectivity changes in eight independent components corresponding to eight resting-state neural networks: language networks (IC6 and IC1), visual network, frontoparietal network, salience network, dorsal attention network, cerebellar network, and sensorimotor network. Children whose clinical presentation included functional seizures (vs children with other FND symptoms) showed greater connectivity decreases in the frontoparietal and dorsal attentional networks. Subjective distress (total DASS score), autonomic arousal (indexed by HR), and HPA dysregulation (attenuated/reversed CAR) contributed to changes in neural network connectivity. Children with FND (vs controls) reported more subjective distress (total DASS score) and more adverse childhood experiences (ACEs) across their lifespan.

Conclusions

Children with FND demonstrate changes in resting-state connectivity. Identified network alterations underpin a broad range of functions typically disrupted in children with FND. This study complements the adult literature by suggesting that FND in children and adolescents emerges in the context of their lived experience and that it reflects aberrant communication across neural networks.

Prefrontal cortex and depression

The prefrontal cortex (PFC) has emerged as one of the regions most consistently impaired in major depressive disorder (MDD). Although functional and structural PFC abnormalities have been reported in both individuals with current MDD as well as those at increased vulnerability to MDD, this information has not translated into better treatment and prevention strategies. Here, we argue that dissecting depressive phenotypes into biologically more tractable dimensions - negative processing biases, anhedonia, despair-like behavior (learned helplessness) - affords unique opportunities for integrating clinical findings with mechanistic evidence emerging from preclinical models relevant to depression, and thereby promises to improve our understanding of MDD. To this end, we review and integrate clinical and preclinical literature pertinent to these core phenotypes, while emphasizing a systems-level approach, treatment effects, and whether specific PFC abnormalities are causes or consequences of MDD. In addition, we discuss several key issues linked to cross-species translation, including functional brain homology across species, the importance of dissecting neural pathways underlying specific functional domains that can be fruitfully probed across species, and the experimental approaches that best ensure translatability. Future directions and clinical implications of this burgeoning literature are discussed.

Extending the "resting state hypothesis of depression" - dynamics and topography of abnormal rest-task modulation

Major depressive disorder (MDD) is characterized by changes in both rest and task states as manifested in temporal dynamics (EEG) and spatial patterns (fMRI). Are rest and task changes related to each other? Extending the "Resting state hypothesis of depression" (RSHD) (Northoff et al., 2011), we, using multimodal imaging, take a tripartite approach: (i) we conduct a review of EEG studies in MDD combining both rest and task states; (ii) we present our own EEG data in MDD on brain dynamics, i.e., intrinsic neural timescales as measured by the autocorrelation window (ACW); and (iii) we review fMRI studies in MDD to probe whether different regions exhibit different rest-task modulation. Review of EEG data shows reduced rest-task change in MDD in different measures of temporal dynamics like peak frequency (and others). Notably, our own EEG data show decreased rest-task change as measured by ACW in frontal electrodes of MDD. The fMRI data reveal that different regions exhibit different rest-task relationships (normal rest-abnormal task, abnormal rest-normal task, abnormal rest-abnormal task) in MDD. Together, we demonstrate altered spatiotemporal dynamics of rest-task modulation in MDD; this further supports and extends the key role of the spontaneous activity in MDD as proposed by the RSHD.

Increased activation of the caudate nucleus and parahippocampal gyrus in Parkinson's disease patients with dysphagia after repetitive transcranial magnetic stimulation: a case-control study

Repetitive transcranial magnetic stimulation (rTMS) has been shown to effectively improve impaired swallowing in Parkinson's disease (PD) patients with dysphagia. However, little is known about how rTMS affects the corresponding brain regions in this patient group. In this case-control study, we examined data from 38 PD patients with dysphagia who received treatment at Beijing Rehabilitation Medicine Academy, Capital Medical University. The patients received high-frequency rTMS of the motor cortex once per day for 10 successive days. Changes in brain activation were compared via functional magnetic resonance imaging in PD patients with dysphagia and healthy controls. The results revealed that before treatment, PD patients with dysphagia showed greater activation in the precentral gyrus, supplementary motor area, and cerebellum compared with healthy controls, and this enhanced activation was weakened after treatment. Furthermore, before treatment, PD patients with dysphagia exhibited decreased activation in the parahippocampal gyrus, caudate nucleus, and left thalamus compared with healthy controls, and this activation increased after treatment. In addition, PD patients with dysphagia reported improved subjective swallowing sensations after rTMS. These findings suggest that swallowing function in PD patients with dysphagia improved after rTMS of the motor cortex. This may have been due to enhanced activation of the caudate nucleus and parahippocampal gyrus. The study protocol was approved by the Ethics Committee of Beijing Rehabilitation Hospital of Capital Medical University (approval No. 2018bkky017) on March 6, 2018 and was registered with Chinese Clinical Trial Registry (registration No. ChiCTR 1800017207) on July 18, 2018.

Cannabis use and posttraumatic stress disorder comorbidity: Epidemiology, biology and the potential for novel treatment approaches

Cannabis use is increasing among some demographics in the United States and is tightly linked to anxiety, trauma, and stress reactivity at the epidemiological and biological level. Stress-coping motives are highly cited reasons for cannabis use. However, with increased cannabis use comes the increased susceptibility for cannabis use disorder (CUD). Indeed, CUD is highly comorbid with posttraumatic stress disorder (PTSD). Importantly, endogenous cannabinoid signaling systems play a key role in the regulation of stress reactivity and anxiety regulation, and preclinical data suggest deficiencies in this signaling system could contribute to the development of stress-related psychopathology. Furthermore, endocannabinoid deficiency states, either pre-existing or induced by trauma exposure, could provide explanatory insights into the high rates of comorbid cannabis use in patients with PTSD. Here we review clinical and preclinical literature related to the cannabis use-PTSD comorbidity, the role of endocannabinoids in the regulation of stress reactivity, and potential therapeutic implications of recent work in this area.

The Value of Neuroimaging Techniques in the Translation and Transdiagnostic Validation of Psychiatric Diagnoses - Selective Review

Psychiatric diagnosis has long been perceived as more of an art than a science since its foundations lie within the observation, and the self-report of the patients themselves and objective diagnostic biomarkers are lacking. Furthermore, the diagnostic tools in use not only stray away from the conventional medical framework but also remain invalidated with evidence-based concepts. However, neuroscience, as a source of valid objective knowledge has initiated the process of a paradigm shift underlined by the main concept of psychiatric disorders being "brain disorders". It is also a bridge closing the explanatory gap among the different fields of medicine via the translation of the knowledge within a multidisciplinary framework. The contemporary neuroimaging methods, such as fMRI provide researchers with an entirely new set of tools to reform the current status quo by creating an opportunity to define and validate objective biomarkers that can be translated into clinical practice. Combining multiple neuroimaging techniques with the knowledge of the role of genetic factors, neurochemical imbalance and neuroinflammatory processes in the etiopathophysiology of psychiatric disorders is a step towards a comprehensive biological explanation of psychiatric disorders and a final differentiation of psychiatry as a well-founded medical science. In addition, the neuroscientific knowledge gained thus far suggests a necessity for directional change to exploring multidisciplinary concepts, such as multiple causality and dimensionality of psychiatric symptoms and disorders. A concomitant viewpoint transition of the notion of validity in psychiatry with a focus on an integrative validatory approach may facilitate the building of a collaborative bridge above the wall existing between the scientific fields analyzing the mind and those studying the brain.

Task MRI-Based Functional Brain Network of Major Depression

This chapter will focus on task magnetic resonance imaging (MRI) to understand the biological mechanisms and pathophysiology of brain in major depressive disorder (MDD), which would have minor alterations in the brain function. Therefore, the functional study, such as task MRI functional connectivity, would play a crucial role to explore the brain function in MDD. Different kinds of tasks would determine the alterations in functional connectivity in task MRI studies of MDD. The emotion-related tasks are linked with alterations in anterior cingulate cortex, insula, and default mode network. The emotional memory task is linked with amygdala-hippocampus alterations. The reward-related task would be related to the reward circuit alterations, such as fronto-straital. The cognitive-related tasks would be associated with frontal-related functional connectivity alterations, such as the dorsolateral prefrontal cortex, anterior cingulate cortex, and other frontal regions. The visuo-sensory characteristics of tasks might be associated with the parieto-occipital alterations. The frontolimbic regions might be major components of task MRI-based functional connectivity in MDD. However, different scenarios and tasks would influence the representations of results.

The Association Between Vulnerable/Grandiose Narcissism and Emotion Regulation

Narcissism has been widely discussed in the context of career success and leadership. Besides several adaptive traits, narcissism has been characterized by difficulties in emotion regulation. However, despite its essential role in mental health, there is little research on emotion regulation processes in narcissism. Specifically, the investigation of not only the habitual use of specific regulation strategies but also the actual ability to regulate is needed due to diverging implications for treatment approaches. Thereby it is important to differentiate between vulnerable and grandiose narcissism as these two phenotypes might be related differently to regulation deficits. The aim of this study was to examine the association between grandiose and vulnerable narcissism and emotion regulation in healthy individuals (30f/30m) focusing on the strategy reappraisal. Additionally, potential sex effects have been explored. Narcissism was assessed using self-report measures and emotion regulation with self-report questionnaires as well as an experimental regulation task. During this task, participants were presented with pictures of sad/happy faces with the instruction to indicate their subjective emotions via button press. Depending on the condition, participants either indicated their natural response or applied cognitive control strategies to regulate their own subjective emotions. Results indicate no relationship between grandiose and vulnerable narcissism and emotion regulation ability, irrespective of sex. Individuals high on vulnerable narcissism use the maladaptive regulation strategy suppression more frequently than individuals with low expressions. Individuals high on grandiose narcissism, in contrast, seem to avoid the suppression of positive emotions and do not express negative emotions in an uncontrolled manner. Interestingly, while grandiose narcissism was not associated with depressive symptoms, vulnerable narcissism correlated positively with depressive symptoms and anhedonia. Findings of this study underline the need to differentiate between grandiose and vulnerable manifestations of narcissism. Against our expectation, narcissism was not related to emotion regulation performance. In line with previous research, grandiose narcissism seems less harmful for mental health, while vulnerable narcissism is associated with psychological problems and the use of rather maladaptive emotion regulation strategies, i.e., suppression. Future research should investigate the relationship between pathological narcissism and emotion regulation also by extending the scope to other relevant regulation strategies.

Predicting Antidepressant Citalopram Treatment Response via Changes in Brain Functional Connectivity After Acute Intravenous Challenge

Introduction: The early and therapy-specific prediction of treatment success in major depressive disorder is of paramount importance due to high lifetime prevalence, and heterogeneity of response to standard medication and symptom expression. Hence, this study assessed the predictability of long-term antidepressant effects of escitalopram based on the short-term influence of citalopram on functional connectivity. Methods: Twenty nine subjects suffering from major depression were scanned twice with resting-state functional magnetic resonance imaging under the influence of intravenous citalopram and placebo in a randomized, double-blinded cross-over fashion. Symptom factors were identified for the Hamilton depression rating scale (HAM-D) and Beck's depression inventory (BDI) taken before and after a median of seven weeks of escitalopram therapy. Predictors were calculated from whole-brain functional connectivity, fed into robust regression models, and cross-validated. Results: Significant predictive power could be demonstrated for one HAM-D factor describing insomnia and the total score (r = 0.45-0.55). Remission and response could furthermore be predicted with an area under the receiver operating characteristic curve of 0.73 and 0.68, respectively. Functional regions with high influence on the predictor were located especially in the ventral attention, fronto-parietal, and default mode networks. Conclusion: It was shown that medication-specific antidepressant symptom improvements can be predicted using functional connectivity measured during acute pharmacological challenge as an easily assessable imaging marker. The regions with high influence have previously been related to major depression as well as the response to selective serotonin reuptake inhibitors, corroborating the advantages of the current approach of focusing on treatment-specific symptom improvements.

The peripartum human brain: Current understanding and future perspectives

The peripartum period offers a unique opportunity to improve our understanding of how dramatic fluctuations in endogenous ovarian hormones affect the human brain and behavior. This notwithstanding, peripartum depression remains an underdiagnosed and undertreated disorder. Here, we review recent neuroimaging findings with respect to the neuroplastic changes in the maternal brain during pregnancy and the postpartum period. We seek to provide an overview of multimodal neuroimaging designs of current peripartum depression models of hormone withdrawal, changes in monoaminergic signaling, and maladaptive neuroplasticity, which likely lead to the development of a condition that puts the lives of mother and infant at risk. We discuss the need to effectively integrate the available information on psychosocial and neurobiological risk factors contributing to individual vulnerability. Finally, we propose a systematic approach to neuroimaging the peripartum brain that acknowledges important co-morbidities and variation in disease onset.

Neurocognitive working mechanisms of the prevention of relapse in remitted recurrent depression (NEWPRIDE): protocol of a randomized controlled neuroimaging trial of preventive cognitive therapy

BACKGROUND

Major Depressive Disorder (MDD) is a psychiatric disorder with a highly recurrent character, making prevention of relapse an important clinical goal. Preventive Cognitive Therapy (PCT) has been proven effective in preventing relapse, though not for every patient. A better understanding of relapse vulnerability and working mechanisms of preventive treatment may inform effective personalized intervention strategies. Neurocognitive models of MDD suggest that abnormalities in prefrontal control over limbic emotion-processing areas during emotional processing and regulation are important in understanding relapse vulnerability. Whether changes in these neurocognitive abnormalities are induced by PCT and thus play an important role in mediating the risk for recurrent depression, is currently unclear. In the Neurocognitive Working Mechanisms of the Prevention of Relapse In Depression (NEWPRIDE) study, we aim to 1) study neurocognitive factors underpinning the vulnerability for relapse, 2) understand the neurocognitive working mechanisms of PCT, 3) predict longitudinal treatment effects based on pre-treatment neurocognitive characteristics, and 4) validate the pupil dilation response as a marker for prefrontal activity, reflecting emotion regulation capacity and therapy success.

METHODS

In this randomized controlled trial, 75 remitted recurrent MDD (rrMDD) patients will be included. Detailed clinical and cognitive measurements, fMRI scanning and pupillometry will be performed at baseline and three-month follow-up. In the interval, 50 rrMDD patients will be randomized to eight sessions of PCT and 25 rrMDD patients to a waiting list. At baseline, 25 healthy control participants will be additionally included to objectify cross-sectional residual neurocognitive abnormalities in rrMDD. After 18 months, clinical assessments of relapse status are performed to investigate which therapy induced changes predict relapse in the 50 patients allocated to PCT.

DISCUSSION

The present trial is the first to study the neurocognitive vulnerability factors underlying relapse and mediating relapse prevention, their value for predicting PCT success and whether pupil dilation acts as a valuable marker in this regard. Ultimately, a deeper understanding of relapse prevention could contribute to the development of better targeted preventive interventions.

TRIAL REGISTRATION

Trial registration: Netherlands Trial Register, August 18, 2015, trial number NL5219.