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Sellers KK, Cohen JL, Khambhati AN, Fan JM, Lee AM, Chang EF, Krystal AD. Closed-loop neurostimulation for the treatment of psychiatric disorders. Neuropsychopharmacology 2024; 49:163-178. [PMID: 37369777 PMCID: PMC10700557 DOI: 10.1038/s41386-023-01631-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/31/2023] [Accepted: 06/02/2023] [Indexed: 06/29/2023]
Abstract
Despite increasing prevalence and huge personal and societal burden, psychiatric diseases still lack treatments which can control symptoms for a large fraction of patients. Increasing insight into the neurobiology underlying these diseases has demonstrated wide-ranging aberrant activity and functioning in multiple brain circuits and networks. Together with varied presentation and symptoms, this makes one-size-fits-all treatment a challenge. There has been a resurgence of interest in the use of neurostimulation as a treatment for psychiatric diseases. Initial studies using continuous open-loop stimulation, in which clinicians adjusted stimulation parameters during patient visits, showed promise but also mixed results. Given the periodic nature and fluctuations of symptoms often observed in psychiatric illnesses, the use of device-driven closed-loop stimulation may provide more effective therapy. The use of a biomarker, which is correlated with specific symptoms, to deliver stimulation only during symptomatic periods allows for the personalized therapy needed for such heterogeneous disorders. Here, we provide the reader with background motivating the use of closed-loop neurostimulation for the treatment of psychiatric disorders. We review foundational studies of open- and closed-loop neurostimulation for neuropsychiatric indications, focusing on deep brain stimulation, and discuss key considerations when designing and implementing closed-loop neurostimulation.
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Affiliation(s)
- Kristin K Sellers
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
- Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Joshua L Cohen
- Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
| | - Ankit N Khambhati
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
- Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Joline M Fan
- Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
- Department of Neurology, University of California, San Francisco, CA, USA
| | - A Moses Lee
- Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
| | - Edward F Chang
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
- Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Andrew D Krystal
- Weill Institute for Neurosciences, University of California, San Francisco, CA, USA.
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA.
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Li M, Liu Y, Liu Y, Pu C, Yin R, Zeng Z, Deng L, Wang X. Resting-state EEG-based convolutional neural network for the diagnosis of depression and its severity. Front Physiol 2022; 13:956254. [PMID: 36299253 PMCID: PMC9589234 DOI: 10.3389/fphys.2022.956254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose: The study aimed to assess the value of the resting-state electroencephalogram (EEG)-based convolutional neural network (CNN) method for the diagnosis of depression and its severity in order to better serve depressed patients and at-risk populations. Methods: In this study, we used the resting state EEG-based CNN to identify depression and evaluated its severity. The EEG data were collected from depressed patients and healthy people using the Nihon Kohden EEG-1200 system. Analytical processing of resting-state EEG data was performed using Python and MATLAB software applications. The questionnaire included the Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), Symptom Check-List-90 (SCL-90), and the Eysenck Personality Questionnaire (EPQ). Results: A total of 82 subjects were included in this study, with 41 in the depression group and 41 in the healthy control group. The area under the curve (AUC) of the resting-state EEG-based CNN in depression diagnosis was 0.74 (95%CI: 0.70–0.77) with an accuracy of 66.40%. In the depression group, the SDS, SAS, SCL-90 subscales, and N scores were significantly higher in the major depression group than those in the non-major depression group (p < 0.05). The AUC of the model in depression severity was 0.70 (95%CI: 0.65–0.75) with an accuracy of 66.93%. Correlation analysis revealed that major depression AI scores were significantly correlated with SAS scores (r = 0.508, p = 0.003) and SDS scores (r = 0.765, p < 0.001). Conclusion: Our model can accurately identify the depression-specific EEG signal in terms of depression diagnosis and severity identification. It would eventually provide new strategies for early diagnosis of depression and its severity.
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Affiliation(s)
- Mengqian Li
- Department of Psychosomatic Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yuan Liu
- Department of Psychosomatic Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yan Liu
- Second Clinical Medical College, Nanchang University, Nanchang, China
| | - Changqin Pu
- Queen Mary College, Nanchang University, Nanchang, China
| | - Ruocheng Yin
- Queen Mary College, Nanchang University, Nanchang, China
| | - Ziqiang Zeng
- Jiangxi Provincial Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University, Nanchang, China
- School of Public Health, Nanchang University, Nanchang, China
| | - Libin Deng
- Jiangxi Provincial Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University, Nanchang, China
- *Correspondence: Libin Deng, ; Xing Wang,
| | - Xing Wang
- School of Life Sciences, Nanchang University, Nanchang, China
- Clinical Medical Experiment Center, Nanchang University, Nanchang, China
- *Correspondence: Libin Deng, ; Xing Wang,
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Provenza NR, Sheth SA, Dastin-van Rijn EM, Mathura RK, Ding Y, Vogt GS, Avendano-Ortega M, Ramakrishnan N, Peled N, Gelin LFF, Xing D, Jeni LA, Ertugrul IO, Barrios-Anderson A, Matteson E, Wiese AD, Xu J, Viswanathan A, Harrison MT, Bijanki KR, Storch EA, Cohn JF, Goodman WK, Borton DA. Long-term ecological assessment of intracranial electrophysiology synchronized to behavioral markers in obsessive-compulsive disorder. Nat Med 2021; 27:2154-2164. [PMID: 34887577 PMCID: PMC8800455 DOI: 10.1038/s41591-021-01550-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 09/22/2021] [Indexed: 01/02/2023]
Abstract
Detection of neural signatures related to pathological behavioral states could enable adaptive deep brain stimulation (DBS), a potential strategy for improving efficacy of DBS for neurological and psychiatric disorders. This approach requires identifying neural biomarkers of relevant behavioral states, a task best performed in ecologically valid environments. Here, in human participants with obsessive-compulsive disorder (OCD) implanted with recording-capable DBS devices, we synchronized chronic ventral striatum local field potentials with relevant, disease-specific behaviors. We captured over 1,000 h of local field potentials in the clinic and at home during unstructured activity, as well as during DBS and exposure therapy. The wide range of symptom severity over which the data were captured allowed us to identify candidate neural biomarkers of OCD symptom intensity. This work demonstrates the feasibility and utility of capturing chronic intracranial electrophysiology during daily symptom fluctuations to enable neural biomarker identification, a prerequisite for future development of adaptive DBS for OCD and other psychiatric disorders.
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Affiliation(s)
- Nicole R Provenza
- Brown University School of Engineering, Providence, RI, USA
- Charles Stark Draper Laboratory, Cambridge, MA, USA
| | - Sameer A Sheth
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | | | - Raissa K Mathura
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Yaohan Ding
- Intelligent Systems Program, University of Pittsburgh, Pittsburgh, PA, USA
| | - Gregory S Vogt
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Michelle Avendano-Ortega
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Nithya Ramakrishnan
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Noam Peled
- MGH/HST Martinos Center for Biomedical Imaging, Charlestown, MA, USA
- Harvard Medical School, Cambridge, MA, USA
| | | | - David Xing
- Brown University School of Engineering, Providence, RI, USA
| | - Laszlo A Jeni
- Robotics Institute, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Itir Onal Ertugrul
- Department of Cognitive Science and Artificial Intelligence, Tilburg University, Tilburg, the Netherlands
| | | | - Evan Matteson
- Brown University School of Engineering, Providence, RI, USA
| | - Andrew D Wiese
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- Department of Psychology, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Junqian Xu
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Ashwin Viswanathan
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | | | - Kelly R Bijanki
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Jeffrey F Cohn
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Wayne K Goodman
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - David A Borton
- Brown University School of Engineering, Providence, RI, USA.
- Carney Institute for Brain Science, Brown University, Providence, RI, USA.
- Center for Neurorestoration and Neurotechnology, Rehabilitation R&D Service, Department of Veterans Affairs, Providence, RI, USA.
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Ertugrul IO, Cohn JF, Jeni LA, Zhang Z, Yin L, Ji Q. Crossing Domains for AU Coding: Perspectives, Approaches, and Measures. IEEE TRANSACTIONS ON BIOMETRICS, BEHAVIOR, AND IDENTITY SCIENCE 2020; 2:158-171. [PMID: 32377637 PMCID: PMC7202467 DOI: 10.1109/tbiom.2020.2977225] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Facial action unit (AU) detectors have performed well when trained and tested within the same domain. How well do AU detectors transfer to domains in which they have not been trained? We review literature on cross-domain transfer and conduct experiments to address limitations of prior research. We evaluate generalizability in four publicly available databases. EB+ (an expanded version of BP4D+), Sayette GFT, DISFA and UNBC Shoulder Pain (SP). The databases differ in observational scenarios, context, participant diversity, range of head pose, video resolution, and AU base rates. In most cases performance decreased with change in domain, often to below the threshold needed for behavioral research. However, exceptions were noted. Deep and shallow approaches generally performed similarly and average results were slightly better for deep model compared to shallow one. Occlusion sensitivity maps revealed that local specificity was greater for AU detection within than cross domains. The findings suggest that more varied domains and deep learning approaches may be better suited for generalizability and suggest the need for more attention to characteristics that vary between domains. Until further improvement is realized, caution is warranted when applying AU classifiers from one domain to another.
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Affiliation(s)
| | - Jeffrey F Cohn
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - László A Jeni
- Robotics Institute, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Zheng Zhang
- Department of Computer Science, State University of New York at Binghamton, USA
| | - Lijun Yin
- Department of Computer Science, State University of New York at Binghamton, USA
| | - Qiang Ji
- Rensselaer Polytechnic Institute, Troy, NY, USA
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Goodman WK, Storch EA, Cohn JF, Sheth SA. Deep Brain Stimulation for Intractable Obsessive-Compulsive Disorder: Progress and Opportunities. Am J Psychiatry 2020; 177:200-203. [PMID: 32114787 PMCID: PMC7239379 DOI: 10.1176/appi.ajp.2020.20010037] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Wayne K Goodman
- From the Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston (Goodman, Storch); the Department of Psychology, University of Pittsburgh (Cohn); and the Department of Neurosurgery, Baylor College of Medicine, Houston (Sheth)
| | - Eric A Storch
- From the Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston (Goodman, Storch); the Department of Psychology, University of Pittsburgh (Cohn); and the Department of Neurosurgery, Baylor College of Medicine, Houston (Sheth)
| | - Jeffrey F Cohn
- From the Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston (Goodman, Storch); the Department of Psychology, University of Pittsburgh (Cohn); and the Department of Neurosurgery, Baylor College of Medicine, Houston (Sheth)
| | - Sameer A Sheth
- From the Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston (Goodman, Storch); the Department of Psychology, University of Pittsburgh (Cohn); and the Department of Neurosurgery, Baylor College of Medicine, Houston (Sheth)
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Ertugrul IO, Yang L, Jeni LA, Cohn JF. D-PAttNet: Dynamic Patch-Attentive Deep Network for Action Unit Detection. FRONTIERS IN COMPUTER SCIENCE 2019; 1:11. [PMID: 31930192 PMCID: PMC6953909 DOI: 10.3389/fcomp.2019.00011] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Facial action units (AUs) relate to specific local facial regions. Recent efforts in automated AU detection have focused on learning the facial patch representations to detect specific AUs. These efforts have encountered three hurdles. First, they implicitly assume that facial patches are robust to head rotation; yet non-frontal rotation is common. Second, mappings between AUs and patches are defined a priori, which ignores co-occurrences among AUs. And third, the dynamics of AUs are either ignored or modeled sequentially rather than simultaneously as in human perception. Inspired by recent advances in human perception, we propose a dynamic patch-attentive deep network, called D-PAttNet, for AU detection that (i) controls for 3D head and face rotation, (ii) learns mappings of patches to AUs, and (iii) models spatiotemporal dynamics. D-PAttNet approach significantly improves upon existing state of the art.
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Affiliation(s)
- Itir Onal Ertugrul
- Robotics Institute, Carnegie Mellon University, Pittsburgh, PA, United States
| | - Le Yang
- School of Computer Science, Northwestern Polytechnical University, Xian, China
| | - László A. Jeni
- Robotics Institute, Carnegie Mellon University, Pittsburgh, PA, United States
| | - Jeffrey F. Cohn
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, United States
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Ertugrul IO, Jeni LA, Ding W, Cohn JF. AFAR: A Deep Learning Based Tool for Automated Facial Affect Recognition. PROCEEDINGS OF THE ... INTERNATIONAL CONFERENCE ON AUTOMATIC FACE AND GESTURE RECOGNITION. IEEE INTERNATIONAL CONFERENCE ON AUTOMATIC FACE & GESTURE RECOGNITION 2019; 2019. [PMID: 31762712 DOI: 10.1109/fg.2019.8756623] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
| | - László A Jeni
- Robotics Institute, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Wanqiao Ding
- Department of Psychology, University of Pittsburgh, PA, USA
| | - Jeffrey F Cohn
- Department of Psychology, University of Pittsburgh, PA, USA
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Ertugrul IO, Cohn JF, Jeni LA, Zhang Z, Yin L, Ji Q. Cross-domain AU Detection: Domains, Learning Approaches, and Measures. PROCEEDINGS OF THE ... INTERNATIONAL CONFERENCE ON AUTOMATIC FACE AND GESTURE RECOGNITION. IEEE INTERNATIONAL CONFERENCE ON AUTOMATIC FACE & GESTURE RECOGNITION 2019; 2019:10.1109/FG.2019.8756543. [PMID: 31749665 PMCID: PMC6867108 DOI: 10.1109/fg.2019.8756543] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Facial action unit (AU) detectors have performed well when trained and tested within the same domain. Do AU detectors transfer to new domains in which they have not been trained? To answer this question, we review literature on cross-domain transfer and conduct experiments to address limitations of prior research. We evaluate both deep and shallow approaches to AU detection (CNN and SVM, respectively) in two large, well-annotated, publicly available databases, Expanded BP4D+ and GFT. The databases differ in observational scenarios, participant characteristics, range of head pose, video resolution, and AU base rates. For both approaches and databases, performance decreased with change in domain, often to below the threshold needed for behavioral research. Decreases were not uniform, however. They were more pronounced for GFT than for Expanded BP4D+ and for shallow relative to deep learning. These findings suggest that more varied domains and deep learning approaches may be better suited for promoting generalizability. Until further improvement is realized, caution is warranted when applying AU classifiers from one domain to another.
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Affiliation(s)
| | - Jeffrey F Cohn
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - László A Jeni
- Robotics Institute, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Zheng Zhang
- Department of Computer Science, State University of New York at Binghamton, USA
| | - Lijun Yin
- Department of Computer Science, State University of New York at Binghamton, USA
| | - Qiang Ji
- Rensselaer Polytechnic Institute, Troy, NY, USA
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