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Chan YL, Ho CSH, Tay GWN, Tan TWK, Tang TB. MicroRNA classification and discovery for major depressive disorder diagnosis: Towards a robust and interpretable machine learning approach. J Affect Disord 2024; 360:326-335. [PMID: 38788856 DOI: 10.1016/j.jad.2024.05.066] [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: 02/08/2024] [Revised: 04/08/2024] [Accepted: 05/15/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Major depressive disorder (MDD) is notably underdiagnosed and undertreated due to its complex nature and subjective diagnostic methods. Biomarker identification would help provide a clearer understanding of MDD aetiology. Although machine learning (ML) has been implemented in previous studies to study the alteration of microRNA (miRNA) levels in MDD cases, clinical translation has not been feasible due to the lack of interpretability (i.e. too many miRNAs for consideration) and stability. METHODS This study applied logistic regression (LR) model to the blood miRNA expression profile to differentiate patients with MDD (n = 60) from healthy controls (HCs, n = 60). Embedded (L1-regularised logistic regression) feature selector was utilised to extract clinically relevant miRNAs, and optimized for clinical application. RESULTS Patients with MDD could be differentiated from HCs with the area under the receiver operating characteristic curve (AUC) of 0.81 on testing data when all available miRNAs were considered (which served as a benchmark). Our LR model selected miRNAs up to 5 (known as LR-5 model) emerged as the best model because it achieved a moderate classification ability (AUC = 0.75), relatively high interpretability (feature number = 5) and stability (ϕ̂Z=0.55) compared to the benchmark. The top-ranking miRNAs identified by our model have demonstrated associations with MDD pathways involving cytokine signalling in the immune system, the reelin signalling pathway, programmed cell death and cellular responses to stress. CONCLUSION The LR-5 model, which is optimised based on ML design factors, may lead to a robust and clinically usable MDD diagnostic tool.
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Affiliation(s)
- Yee Ling Chan
- Centre for Intelligent Signal and Imaging Research (CISIR), Universiti Teknologi PETRONAS (UTP), Bandar Seri Iskandar 32610, Perak, Malaysia
| | - Cyrus S H Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117543, Singapore
| | - Gabrielle W N Tay
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117543, Singapore
| | - Trevor W K Tan
- Centre for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117543, Singapore; Centre for Translational MR Research, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117543, Singapore; Department of Electrical and Computer Engineering, National University of Singapore, Singapore 117583, Singapore; N.1 Institute for Health & Institute for Digital Medicine (WisDM), National University of Singapore, Singapore 117456, Singapore; Integrative Sciences and Engineering Programme (ISEP), National University of Singapore, Singapore 119077, Singapore
| | - Tong Boon Tang
- Centre for Intelligent Signal and Imaging Research (CISIR), Universiti Teknologi PETRONAS (UTP), Bandar Seri Iskandar 32610, Perak, Malaysia.
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Poletti S, Mazza MG, Benedetti F. Inflammatory mediators in major depression and bipolar disorder. Transl Psychiatry 2024; 14:247. [PMID: 38851764 PMCID: PMC11162479 DOI: 10.1038/s41398-024-02921-z] [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: 03/01/2023] [Revised: 05/08/2024] [Accepted: 05/10/2024] [Indexed: 06/10/2024] Open
Abstract
Major depressive disorder (MDD) and bipolar disorder (BD) are highly disabling illnesses defined by different psychopathological, neuroimaging, and cognitive profiles. In the last decades, immune dysregulation has received increasing attention as a central factor in the pathophysiology of these disorders. Several aspects of immune dysregulations have been investigated, including, low-grade inflammation cytokines, chemokines, cell populations, gene expression, and markers of both peripheral and central immune activation. Understanding the distinct immune profiles characterizing the two disorders is indeed of crucial importance for differential diagnosis and the implementation of personalized treatment strategies. In this paper, we reviewed the current literature on the dysregulation of the immune response system focusing our attention on studies using inflammatory markers to discriminate between MDD and BD. High heterogeneity characterized the available literature, reflecting the heterogeneity of the disorders. Common alterations in the immune response system include high pro-inflammatory cytokines such as IL-6 and TNF-α. On the contrary, a greater involvement of chemokines and markers associated with innate immunity has been reported in BD together with dynamic changes in T cells with differentiation defects during childhood which normalize in adulthood, whereas classic mediators of immune responses such as IL-4 and IL-10 are present in MDD together with signs of immune-senescence.
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Affiliation(s)
- Sara Poletti
- Psychiatry and Clinical Psychobiology Unit, Division of Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Mario Gennaro Mazza
- Psychiatry and Clinical Psychobiology Unit, Division of Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Benedetti
- Psychiatry and Clinical Psychobiology Unit, Division of Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Huang X, Wang F, Gao Y, Liao Y, Zhang W, Zhang L, Xu Z. Depression recognition using voice-based pre-training model. Sci Rep 2024; 14:12734. [PMID: 38830969 DOI: 10.1038/s41598-024-63556-0] [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] [Received: 11/13/2023] [Accepted: 05/30/2024] [Indexed: 06/05/2024] Open
Abstract
The early screening of depression is highly beneficial for patients to obtain better diagnosis and treatment. While the effectiveness of utilizing voice data for depression detection has been demonstrated, the issue of insufficient dataset size remains unresolved. Therefore, we propose an artificial intelligence method to effectively identify depression. The wav2vec 2.0 voice-based pre-training model was used as a feature extractor to automatically extract high-quality voice features from raw audio. Additionally, a small fine-tuning network was used as a classification model to output depression classification results. Subsequently, the proposed model was fine-tuned on the DAIC-WOZ dataset and achieved excellent classification results. Notably, the model demonstrated outstanding performance in binary classification, attaining an accuracy of 0.9649 and an RMSE of 0.1875 on the test set. Similarly, impressive results were obtained in multi-classification, with an accuracy of 0.9481 and an RMSE of 0.3810. The wav2vec 2.0 model was first used for depression recognition and showed strong generalization ability. The method is simple, practical, and applicable, which can assist doctors in the early screening of depression.
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Affiliation(s)
- Xiangsheng Huang
- School of Biomedical Engineering, South-Central Minzu University, No.182, Minzu Avenue, Hongshan District, Wuhan City, 430074, Hubei Province, China
| | - Fang Wang
- School of Biomedical Engineering, South-Central Minzu University, No.182, Minzu Avenue, Hongshan District, Wuhan City, 430074, Hubei Province, China
| | - Yuan Gao
- School of Biomedical Engineering, South-Central Minzu University, No.182, Minzu Avenue, Hongshan District, Wuhan City, 430074, Hubei Province, China
| | - Yilong Liao
- School of Biomedical Engineering, South-Central Minzu University, No.182, Minzu Avenue, Hongshan District, Wuhan City, 430074, Hubei Province, China
| | - Wenjing Zhang
- School of Biomedical Engineering, South-Central Minzu University, No.182, Minzu Avenue, Hongshan District, Wuhan City, 430074, Hubei Province, China
| | - Li Zhang
- School of Biomedical Engineering, South-Central Minzu University, No.182, Minzu Avenue, Hongshan District, Wuhan City, 430074, Hubei Province, China.
| | - Zhenrong Xu
- School of Biomedical Engineering, South-Central Minzu University, No.182, Minzu Avenue, Hongshan District, Wuhan City, 430074, Hubei Province, China
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Waszkiewicz N. The Immunoseasonal Theory of Psychiatric Disorders. J Clin Med 2023; 12:4615. [PMID: 37510730 PMCID: PMC10380681 DOI: 10.3390/jcm12144615] [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: 03/03/2023] [Revised: 06/26/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
Although the influence of the weather on the well-being and mental health of psychiatric patients has been widely seen, the relationships between various seasonal weather factors and depressive, manic, anxiety, and psychotic states have not been systematized in the literature. The current article describes the seasonal changes in weather-related immune responses and their impact on the development of episodes of depression, mania, psychosis, and anxiety, highlighting the T-helper 1 (Th1) and Th2 immune balance as their potential trigger. In autumn-winter depression, the hyperactivation of the Th1 system, possibly by microbial/airborne pathogens, may lead to the inflammatory inhibition of prefrontal activity and the subcortical centers responsible for mood, drive, and motivation. Depressive mood periods are present in most people suffering from schizophrenia. In the spring and summertime, when the compensating anti-Th1 property of the Th2 immune system is activated, it decreases the Th1 response. In individuals immunogenetically susceptible to psychosis and mania, the inhibition of Th1 by the Th2 system may be excessive and lead to Th2-related frontal and subcortical hyperactivation and subsequent psychosis. In people suffering from bipolar disorder, hyperintense changes in white matter may be responsible for the partial activation of subcortical areas, preventing full paranoid psychosis. Thus, psychosis may be mood-congruent in affective disorders.
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Affiliation(s)
- Napoleon Waszkiewicz
- Department of Psychiatry, Medical University of Białystok, Wołodyjowskiego 2, 15-272 Białystok, Poland
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Abdulla H, Maalouf M, Jelinek HF. Machine Learning for the Prediction of Depression Progression from Inflammation Markers. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-4. [PMID: 38082683 DOI: 10.1109/embc40787.2023.10340436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Major depressive disorder is one of the major contributors to disability worldwide with an estimated prevalence of 4%. Depression is a heterogeneous disease often characterized by an undefined pathogenesis and multifactorial phenotype that complicate diagnosis and follow-up. Translational research and identification of objective biomarkers including inflammation can assist clinicians in diagnosing depression and disease progression. Investigating inflammation markers using machine learning methods combines recent understanding of the pathogenesis of depression associated with inflammatory changes as part of chronic disease progression that aims to highlight complex interactions. In this paper, 721 patients attending a diabetes health screening clinic (DiabHealth) were classified into no depression (none) to minimal depression (none-minimal), mild depression, and moderate to severe depression (moderate-severe) based on the Patient Health Questionnaire (PHQ-9). Logistic Regression, K-nearest Neighbors, Support Vector Machine, Random Forest, Multi-layer Perceptron, and Extreme Gradient Boosting were applied and compared to predict depression level from inflammatory marker data that included C-reactive protein (CRP), Interleukin (IL)-6, IL-1β, IL-10, Complement Component 5a (C5a), D-Dimer, Monocyte Chemoattractant Protein (MCP)-1, and Insulin-like Growth Factor (IGF)-1. MCP-1 and IL-1β were the most significant inflammatory markers for the classification performance of depression level. Extreme Gradient Boosting outperformed the models achieving the highest accuracy and Area Under the Receiver Operator Curve (AUC) of 0.89 and 0.95, respectively.Clinical Relevance- The findings of this study show the potential of machine learning models to aid in clinical practice, leading to a more objective assessment of depression level based on the involvement of MCP-1 and IL-1β inflammatory markers with disease progression.
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Gao K, Ayati M, Kaye NM, Koyuturk M, Calabrese JR, Ganocy SJ, Lazarus HM, Christian E, Kaplan D. Differences in intracellular protein levels in monocytes and CD4 + lymphocytes between bipolar depressed patients and healthy controls: A pilot study with tyramine-based signal-amplified flow cytometry. J Affect Disord 2023; 328:116-127. [PMID: 36806598 DOI: 10.1016/j.jad.2023.02.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 01/30/2023] [Accepted: 02/13/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND Molecular biomarkers for bipolar disorder (BD) that distinguish it from other manifestations of depressive symptoms remain unknown. The aim of this study was to determine if a very sensitive tyramine-based signal-amplification technology for flow cytometry (CellPrint™) could facilitate the identification of cell-specific analyte expression profiles of peripheral blood cells for bipolar depression (BPD) versus healthy controls (HCs). METHODS The diagnosis of psychiatric disorders was ascertained with Mini International Neuropsychiatric Interview for DSM-5. Expression levels for eighteen protein analytes previously shown to be related to bipolar disorder were assessed with CellPrint™ in CD4+ T cells and monocytes of bipolar patients and HCs. Implementation of protein-protein interaction (PPI) network and pathway analysis was subsequently used to identify new analytes and pathways for subsequent interrogations. RESULTS Fourteen drug-naïve or -free patients with bipolar I or II depression and 17 healthy controls (HCs) were enrolled. The most distinguishable changes in analyte expression based on t-tests included GSK3β, HMGB1, IRS2, phospho-GSK3αβ, phospho-RELA, and TSPO in CD4+ T cells and calmodulin, GSK3β, IRS2, and phospho-HS1 in monocytes. Subsequent PPI and pathway analysis indicated that prolactin, leptin, BDNF, and interleukin-3 signal pathways were significantly different between bipolar patients and HCs. LIMITATION The sample size of the study was small and 2 patients were on medications. CONCLUSION In this pilot study, CellPrint™ was able to detect differences in cell-specific protein levels between BPD patients and HCs. A subsequent study including samples from patients with BPD, major depressive disorder, and HCs is warranted.
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Affiliation(s)
- Keming Gao
- Department of Psychiatry, University Hospitals Cleveland Medical Center, Cleveland, OH, United States of America; Case Western Reserve University School of Medicine, Cleveland, OH, United States of America.
| | - Marzieh Ayati
- Department of Computer Science, University of Texas Rio Grande Valley, Edinburg, TX, United States of America
| | - Nicholas M Kaye
- CellPrint Biotechnology, Cleveland, OH, United States of America
| | - Mehmet Koyuturk
- Department of Computer and Data Sciences, Center for Proteomics and Bioinformatics, Case Western Reserve University, Cleveland, OH, United States of America
| | - Joseph R Calabrese
- Department of Psychiatry, University Hospitals Cleveland Medical Center, Cleveland, OH, United States of America; Case Western Reserve University School of Medicine, Cleveland, OH, United States of America
| | - Stephen J Ganocy
- Department of Psychiatry, University Hospitals Cleveland Medical Center, Cleveland, OH, United States of America; Case Western Reserve University School of Medicine, Cleveland, OH, United States of America
| | - Hillard M Lazarus
- Case Western Reserve University School of Medicine, Cleveland, OH, United States of America; CellPrint Biotechnology, Cleveland, OH, United States of America; Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, United States of America
| | - Eric Christian
- CellPrint Biotechnology, Cleveland, OH, United States of America
| | - David Kaplan
- CellPrint Biotechnology, Cleveland, OH, United States of America
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Zeng J, Zhang Y, Xiang Y, Liang S, Xue C, Zhang J, Ran Y, Cao M, Huang F, Huang S, Deng W, Li T. Optimizing multi-domain hematologic biomarkers and clinical features for the differential diagnosis of unipolar depression and bipolar depression. NPJ MENTAL HEALTH RESEARCH 2023; 2:4. [PMID: 38609642 PMCID: PMC10955811 DOI: 10.1038/s44184-023-00024-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/01/2023] [Indexed: 04/14/2024]
Abstract
There is a lack of objective features for the differential diagnosis of unipolar and bipolar depression, especially those that are readily available in practical settings. We investigated whether clinical features of disease course, biomarkers from complete blood count, and blood biochemical markers could accurately classify unipolar and bipolar depression using machine learning methods. This retrospective study included 1160 eligible patients (918 with unipolar depression and 242 with bipolar depression). Patient data were randomly split into training (85%) and open test (15%) sets 1000 times, and the average performance was reported. XGBoost achieved the optimal open-test performance using selected biomarkers and clinical features-AUC 0.889, sensitivity 0.831, specificity 0.839, and accuracy 0.863. The importance of features for differential diagnosis was measured using SHapley Additive exPlanations (SHAP) values. The most informative features include (1) clinical features of disease duration and age of onset, (2) biochemical markers of albumin, low density lipoprotein (LDL), and potassium, and (3) complete blood count-derived biomarkers of white blood cell count (WBC), platelet-to-lymphocyte ratio (PLR), and monocytes (MONO). Overall, onset features and hematologic biomarkers appear to be reliable information that can be readily obtained in clinical settings to facilitate the differential diagnosis of unipolar and bipolar depression.
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Affiliation(s)
- Jinkun Zeng
- Hangzhou Seventh People's Hospital, Affiliated Mental Health Center, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yaoyun Zhang
- Alibaba Damo Academy, 969 West Wen Yi Road, Yu Hang District, Hangzhou, Zhejiang, China
| | - Yutao Xiang
- Center for Cognition and Brain Sciences, Unit of Psychiatry, Institute of Translational Medicine, University of Macau, Macao, China
| | - Sugai Liang
- Hangzhou Seventh People's Hospital, Affiliated Mental Health Center, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Chuang Xue
- Hangzhou Seventh People's Hospital, Affiliated Mental Health Center, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Junhang Zhang
- Hangzhou Seventh People's Hospital, Affiliated Mental Health Center, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Ya Ran
- West China Hospital, Sichuan University, Sichuan, China
| | - Minne Cao
- Hangzhou Seventh People's Hospital, Affiliated Mental Health Center, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Fei Huang
- Alibaba Damo Academy, 969 West Wen Yi Road, Yu Hang District, Hangzhou, Zhejiang, China
| | - Songfang Huang
- Alibaba Damo Academy, 969 West Wen Yi Road, Yu Hang District, Hangzhou, Zhejiang, China
| | - Wei Deng
- Department of Neurobiology, Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
- Liangzhu Laboratory, MOE Frontier Science Center for Brain Science and Brain-machine Integration, State Key Laboratory of Brain-machine Intelligence, Zhejiang University, 1369 West Wenyi Road, 311121, Hangzhou, China.
| | - Tao Li
- Department of Neurobiology, Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
- Liangzhu Laboratory, MOE Frontier Science Center for Brain Science and Brain-machine Integration, State Key Laboratory of Brain-machine Intelligence, Zhejiang University, 1369 West Wenyi Road, 311121, Hangzhou, China.
- NHC and CAMS Key Laboratory of Medical Neurobiology, Zhejiang University, 310058, Hangzhou, China.
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Hursitoglu O, Kurutas EB, Strawbridge R, Oner E, Gungor M, Tuman TC, Uygur OF. Serum NOX1 and Raftlin as new potential biomarkers of Major Depressive Disorder: A study in treatment-naive first episode patients. Prog Neuropsychopharmacol Biol Psychiatry 2023; 121:110670. [PMID: 36341844 DOI: 10.1016/j.pnpbp.2022.110670] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Biological factors are known to be important in understanding the pathogenesis of Major Depressive Disorder (MDD). Oxidative stress and neuroinflammation pathways are likely to play a critical role here. METHODS We undertook a study to investigate two novel biomarkers - serum NADPH oxidase 1 (NOX1) and Raftlin levels - in treatment-naive, smoking-free first episode patients with MDD compared to healthy controls (HCs) matched for age, sex and body mass index. RESULTS We found increased NOX1 and Raftlin levels in MDD patients compared to HCs. Both parameters showed very good diagnostic performance in the MDD group. In addition, we found a significant positive correlation between depression severity (HAMD) scores and both biomarker levels in the patient group. CONCLUSION To the best of our knowledge, this is the first human study to evaluate serum NOX1 and Raftlin levels in depression. NOX1, an important source of reactive oxygen species (ROS), and Raftlin, which may play a role in the inflammatory process, represent novel potential biomarkers of MDD. These findings support the implication of oxidative stress and inflammatory processes in patients with MDD, and indicate that the deteriorated ROS-antioxidant balance can be regulated via NOX1 in patients with depression.
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Affiliation(s)
- Onur Hursitoglu
- Department of Psychiatry, Sular Academy Hospital, Kahramanmaras, Turkey.
| | - Ergul Belge Kurutas
- Department of Biochemistry, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - Rebecca Strawbridge
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Erkan Oner
- Department of Biochemistry, Faculty of Pharmacy, Mersin University, Mersin, Turkey
| | - Meltem Gungor
- Department of Medical Biochemistry, Faculty of Medicine, Sanko University, Gaziantep, Turkey
| | - Taha Can Tuman
- Medipol University, Medical Faculty, Department of Psychiatry, İstanbul, Turkey
| | - Omer Faruk Uygur
- Ataturk University, Medical Faculty, Department of Psychiatry, Erzurum, Turkey
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Is SARS-CoV-2 a Risk Factor of Bipolar Disorder?-A Narrative Review. J Clin Med 2022; 11:jcm11206060. [PMID: 36294388 PMCID: PMC9604904 DOI: 10.3390/jcm11206060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 10/10/2022] [Accepted: 10/12/2022] [Indexed: 11/07/2022] Open
Abstract
For 2.5 years we have been facing the coronavirus disease (COVID-19) and its health, social and economic effects. One of its known consequences is the development of neuropsychiatric diseases such as anxiety and depression. However, reports of manic episodes related to COVID-19 have emerged. Mania is an integral part of the debilitating illness-bipolar disorder (BD). Due to its devastating effects, it is therefore important to establish whether SARS-CoV-2 infection is a causative agent of this severe mental disorder. In this narrative review, we discuss the similarities between the disorders caused by SARS-CoV-2 and those found in patients with BD, and we also try to answer the question of whether SARS-CoV-2 infection may be a risk factor for the development of this affective disorder. Our observation shows that disorders in COVID-19 showing the greatest similarity to those in BD are cytokine disorders, tryptophan metabolism, sleep disorders and structural changes in the central nervous system (CNS). These changes, especially intensified in severe infections, may be a trigger for the development of BD in particularly vulnerable people, e.g., with family history, or cause an acute episode in patients with a pre-existing BD.
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Hu X, Yu C, Dong T, Yang Z, Fang Y, Jiang Z. Biomarkers and detection methods of bipolar disorder. Biosens Bioelectron 2022; 220:114842. [DOI: 10.1016/j.bios.2022.114842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 09/16/2022] [Accepted: 10/19/2022] [Indexed: 12/01/2022]
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Jiménez-Fernández S, Gurpegui M, Garrote-Rojas D, Gutiérrez-Rojas L, Carretero MD, Correll CU. Oxidative stress parameters and antioxidants in adults with unipolar or bipolar depression versus healthy controls: Systematic review and meta-analysis. J Affect Disord 2022; 314:211-221. [PMID: 35868596 DOI: 10.1016/j.jad.2022.07.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 07/06/2022] [Accepted: 07/09/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND To study differences in oxidative stress markers and antioxidants among patients with bipolar depression (BPD) and unipolar depression (UPD). METHODS Data sources. Electronic MEDLINE/PubMed/Cochrane Library/Scopus/TripDatabase database search until 30/06/2021. STUDY SELECTION Included were articles comparing antioxidant or oxidative stress markers between adults with BPD or UPD and healthy controls (HCs). DATA EXTRACTION Two authors extracted data independently. Random effects meta-analysis, calculating standardized mean differences for results from ≥3 studies. RESULTS Oxidative stress markers reported in 40 studies -1 published repeatedly- (UPD, studies = 30 n = 3072; their HCs, n = 2856; BPD, studies = 11 n = 393; their HCs, n = 540; with 1 study reporting on both UPD and BPD) included thiobarbituric acid reactive substances (TBARS), antioxidant uric acid and antioxidant-enhancing enzymes superoxide dismutase (SOD), catalase (CAT) and glutathione-peroxidase (GPX). Compared with HCs, UPD and BPD were associated with significantly higher levels of TBARS, without differences between UPD and BPD (P = 0.11). Compared with HCs, UPD and BPD did not differ regarding the activity of the CAT (P = 0.28), SOD (P = 0.87) and GPX (P = 0.25) enzymes. However, uric acid levels were significantly higher vs HCs in BPD than in UPD among adult patients (P = 0.004). Results were heterogenous, which, for some parameters, decreased after stratification by the blood source (serum, plasma red blood cells, whole blood). LIMITATIONS The main limitations are the small number of studies/participants in the BPD subgroup, and heterogeneity of the results. SUMMATIONS Both BPD and UPD may be associated with an impaired oxidative stress balance, with significantly higher uric acid levels vs. HCs in UPD than in BPD.
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Affiliation(s)
- Sara Jiménez-Fernández
- Department of Psychiatry and CTS-549 Research Group, Institute of Neurosciences, University of Granada, Granada, Spain; Child and Adolescent Mental Health Unit, Jaén University Hospital, Jaén, Spain.
| | - Manuel Gurpegui
- Department of Psychiatry and CTS-549 Research Group, Institute of Neurosciences, University of Granada, Granada, Spain
| | | | - Luis Gutiérrez-Rojas
- Department of Psychiatry and CTS-549 Research Group, Institute of Neurosciences, University of Granada, Granada, Spain; Psychiatry Service, San Cecilio University Hospital, Granada, Spain
| | - María D Carretero
- Department of Psychiatry and CTS-549 Research Group, Institute of Neurosciences, University of Granada, Granada, Spain
| | - Christoph U Correll
- Department of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA; Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA; Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY, USA; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany
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Wu X, Niu Z, Zhu Y, Shi Y, Qiu H, Gu W, Liu H, Zhao J, Yang L, Wang Y, Liu T, Xia Y, Yang Y, Chen J, Fang Y. Peripheral biomarkers to predict the diagnosis of bipolar disorder from major depressive disorder in adolescents. Eur Arch Psychiatry Clin Neurosci 2022; 272:817-826. [PMID: 34432143 DOI: 10.1007/s00406-021-01321-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 08/11/2021] [Indexed: 12/26/2022]
Abstract
The onset of bipolar disorder (BD) occurs in childhood or adolescence in half of the patients. Early stages of BD usually present depressive episodes, which makes it difficult to be distinguished from major depressive disorder (MDD). Objective biomarkers for discriminating BD from MDD in adolescent patients are limited. We collected basic demographic data and the information of the first blood examination performed after the admission to psychiatry unit of BD and MDD inpatients during 2009-2018. We recruited 261 adolescents (aged from 10 to 18), including 160 MDD and 101 BD. Forward-Stepwise Selection of binary logistic regression was used to construct predictive models for the total sample and subgroups by gender. Independent external validation was made by 255 matched patients from another hospital in China. Regression models of total adolescents, male and female subgroups showed accuracy of 73.3%, 70.6% and 75.2%, with area under curves (AUC) as 0.785, 0.816 and 0.793, respectively. Age, direct bilirubin (DBIL), lactic dehydrogenase (LDH), free triiodothyronine (FT3) and C-reactive protein (CRP) were final factors included into the models. The discrimination was well at external validation (AUC = 0.714). This study offers the evidence that accessible information of common clinical laboratory examination might be valuable in distinguishing BD form MDD in adolescents. With good diagnostic accuracies and external validation, the total regression equation might potentially be applied to individualized clinical inferences on adolescent BD patients.
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Affiliation(s)
- Xiaohui Wu
- Clinical Research Center and Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Zhiang Niu
- Clinical Research Center and Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Yuncheng Zhu
- Clinical Research Center and Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Yifan Shi
- Clinical Research Center and Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Hong Qiu
- Information and Statistical Department, Shanghai Mental Health Center, Shanghai, 200030, China
| | - Wenjie Gu
- Information and Statistical Department, Shanghai Mental Health Center, Shanghai, 200030, China
| | - Hongmei Liu
- Clinical Research Center and Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Jie Zhao
- Clinical Research Center and Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Lu Yang
- Clinical Research Center and Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Yun Wang
- Clinical Research Center and Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Tiebang Liu
- Shenzhen Mental Health Center, Shenzhen, 518003, China
| | - Yong Xia
- Affiliated Mental Health Center, Zhejiang University School of Medicine, Hangzhou Seventh People's Hospital, Hangzhou, 310013, China
| | - Yan Yang
- Affiliated Mental Health Center, Zhejiang University School of Medicine, Hangzhou Seventh People's Hospital, Hangzhou, 310013, China
| | - Jun Chen
- Clinical Research Center and Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China.
| | - Yiru Fang
- Clinical Research Center and Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China.
- CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai, 200031, China.
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 200118, China.
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13
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Xiang Q, Chen K, Peng L, Luo J, Jiang J, Chen Y, Lan L, Song H, Zhou X. Prediction of the trajectories of depressive symptoms among children in the adolescent brain cognitive development (ABCD) study using machine learning approach. J Affect Disord 2022; 310:162-171. [PMID: 35545159 DOI: 10.1016/j.jad.2022.05.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 03/02/2022] [Accepted: 05/05/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND Depression often first emerges during adolescence and evidence shows that the long-term patterns of depressive symptoms over time are heterogeneous. It is meaningful to predict the trajectory of depressive symptoms in adolescents to find early intervention targets. METHODS Based on the Adolescent Brain Cognitive Development Study, we included 4962 participants aged 9-10 who were followed-up for 2 years. Trajectories of depressive symptoms were identified by Latent Class Growth Analyses (LCGA). Four types of machine learning models were built to predict the identified trajectories and to obtain variables with predictive value based on the best performance model. RESULTS Of all participants, 536 (10.80%) were classified as increasing, 269 (5.42%) as persistently high, 433 (8.73%) as decreasing, and 3724 (75.05%) as persistently low by LCGA. Gradient Boosting Machine (GBM) model got the highest discriminant performance. Sleep quality, parental emotional state and family financial adversities were the most important predictors and three resting state functional magnetic resonance imaging functional connectivity data were also helpful to distinguish trajectories. LIMITATION We only have depressive symptom scores at three time points. Some valuable predictors are not specific to depression. External validation is an important next step. These predictors should not be interpreted as etiology and some variables were reported by parents/caregivers. CONCLUSION Using GBM combined with baseline characteristics, the trajectories of depressive symptoms with two years among adolescents aged 9-10 years can be well predicted, which might further facilitate the identification of adolescents at high risk of depressive symptoms and development of effective early interventions.
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Affiliation(s)
- Qu Xiang
- West China Biomedical Big Data Center, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China; Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Kai Chen
- School of Public Health, University of Texas Health Center at Houston, Houston, TX, USA
| | - Li Peng
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Jiawei Luo
- West China Biomedical Big Data Center, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China; Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Jingwen Jiang
- West China Biomedical Big Data Center, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China; Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Yang Chen
- West China Biomedical Big Data Center, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China; Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Lan Lan
- West China Biomedical Big Data Center, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China; Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Huan Song
- West China Biomedical Big Data Center, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China; Med-X Center for Informatics, Sichuan University, Chengdu, China.
| | - Xiaobo Zhou
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, TX, USA.
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14
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Visual electrophysiology and neuropsychology in bipolar disorders: a review on current state and perspectives. Neurosci Biobehav Rev 2022; 140:104764. [DOI: 10.1016/j.neubiorev.2022.104764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/21/2022] [Accepted: 07/01/2022] [Indexed: 11/21/2022]
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15
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Machine learning approaches for prediction of bipolar disorder based on biological, clinical and neuropsychological markers: a systematic review and meta-analysis. Neurosci Biobehav Rev 2022; 135:104552. [PMID: 35120970 DOI: 10.1016/j.neubiorev.2022.104552] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 01/11/2022] [Accepted: 01/30/2022] [Indexed: 01/10/2023]
Abstract
Applying machine learning (ML) to objective markers may overcome prognosis uncertainty due to the subjective nature of the diagnosis of bipolar disorder (BD). This PRISMA-compliant meta-analysis provides new systematic evidence of the BD classification accuracy reached by different markers and ML algorithms. We focused on neuroimaging, electrophysiological techniques, peripheral biomarkers, genetic data, neuropsychological or clinical measures, and multimodal approaches. PubMed, Embase and Scopus were searched through 3rd December 2020. Meta-analyses were performed using random-effect models. Overall, 81 studies were included in this systematic review and 65 in the meta-analysis (11,336 participants, 3,903 BD). The overall pooled classification accuracy was 0.77 (95%CI[0.75;0.80]). Despite subgroup analyses for diagnostic comparison group, psychiatric disorders, marker, ML algorithm, and validation procedure were not significant, linear discriminant analysis significantly outperformed support vector machine for peripheral biomarkers (p=0.03). Sample size was inversely related to accuracy. Evidence of publication bias was detected. Ultimately, although ML reached a high accuracy in differentiating BD from other psychiatric disorders, best practices in methodology are needed for the advancement of future studies.
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16
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Xu Z, Chen L, Hu Y, Shen T, Chen Z, Tan T, Gao C, Chen S, Chen W, Chen B, Yuan Y, Zhang Z. A Predictive Model of Risk Factors for Conversion From Major Depressive Disorder to Bipolar Disorder Based on Clinical Characteristics and Circadian Rhythm Gene Polymorphisms. Front Psychiatry 2022; 13:843400. [PMID: 35898634 PMCID: PMC9309512 DOI: 10.3389/fpsyt.2022.843400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 06/08/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Bipolar disorder (BD) is easy to be misdiagnosed as major depressive disorder (MDD), which may contribute to a delay in treatment and affect prognosis. Circadian rhythm dysfunction is significantly associated with conversion from MDD to BD. So far, there has been no study that has revealed a relationship between circadian rhythm gene polymorphism and MDD-to-BD conversion. Furthermore, the prediction of MDD-to-BD conversion has not been made by integrating multidimensional data. The study combined clinical and genetic factors to establish a predictive model through machine learning (ML) for MDD-to-BD conversion. METHOD By following up for 5 years, 70 patients with MDD and 68 patients with BD were included in this study at last. Single nucleotide polymorphisms (SNPs) of the circadian rhythm genes were selected for detection. The R software was used to operate feature screening and establish a predictive model. The predictive model was established by logistic regression, which was performed by four evaluation methods. RESULTS It was found that age of onset was a risk factor for MDD-to-BD conversion. The younger the age of onset, the higher the risk of BD. Furthermore, suicide attempts and the number of hospitalizations were associated with MDD-to-BD conversion. Eleven circadian rhythm gene polymorphisms were associated with MDD-to-BD conversion by feature screening. These factors were used to establish two models, and 4 evaluation methods proved that the model with clinical characteristics and SNPs had the better predictive ability. CONCLUSION The risk factors for MDD-to-BD conversion have been found, and a predictive model has been established, with a specific guiding significance for clinical diagnosis.
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Affiliation(s)
- Zhi Xu
- Department of Psychosomatics and Psychiatry, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, China
| | - Lei Chen
- Department of Psychosomatics and Psychiatry, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, China
| | - Yunyun Hu
- Key Laboratory of Developmental Genes and Human Disease, Ministry of Education, Institute of Life Sciences, Southeast University, Nanjing, China
| | - Tian Shen
- Department of Psychosomatics and Psychiatry, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, China
| | - Zimu Chen
- Department of Psychosomatics and Psychiatry, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, China
| | - Tingting Tan
- Department of Psychosomatics and Psychiatry, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, China
| | - Chenjie Gao
- Department of Psychosomatics and Psychiatry, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, China
| | - Suzhen Chen
- Department of Psychosomatics and Psychiatry, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, China
| | - Wenji Chen
- Department of General Practice, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, China
| | - Bingwei Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Southeast University, Nanjing, China
| | - Yonggui Yuan
- Department of Psychosomatics and Psychiatry, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, China.,Key Laboratory of Developmental Genes and Human Disease, Ministry of Education, Institute of Life Sciences, Southeast University, Nanjing, China
| | - Zhijun Zhang
- Department of Neurology, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, China
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17
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Martinuzzi E, Barbosa S, Courtet P, Olié E, Guillaume S, Ibrahim EC, Daoudlarian D, Davidovic L, Glaichenhaus N, Belzeaux R. Blood cytokines differentiate bipolar disorder and major depressive disorder during a major depressive episode: Initial discovery and independent sample replication. Brain Behav Immun Health 2021; 13:100232. [PMID: 34589747 PMCID: PMC8474674 DOI: 10.1016/j.bbih.2021.100232] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 02/24/2021] [Indexed: 01/02/2023] Open
Abstract
Bipolar disorder (BD) diagnosis currently relies on assessment of clinical symptoms, mainly retrospective and subject to memory bias. BD is often misdiagnosed as Major Depressive Disorder (MDD) resulting in ineffective treatment and worsened clinical outcome. The primary purpose of this study was to identify blood biomarkers that discriminate MDD from BD patients when in a depressed state. We have used clinical data and serum samples from two independent naturalistic cohorts of patients with a Major Depressive Episode (MDE) who fulfilled the criteria of either BD or MDD at inclusion. The discovery and replication cohorts consisted of 462 and 133 patients respectively. Patients were clinically assessed using standard diagnostic interviews, and clinical variables including current treatments were recorded. Blood was collected and serum assessed for levels of 31 cytokines using a sensitive multiplex assay. A penalized logistic regression model combined with nonparametric bootstrap was subsequently used to identify cytokines associated with BD. Interleukin (IL)-6, IL-10, IL-15, IL-27 and C-X-C ligand chemokine (CXCL)-10 were positively associated with BD in the discovery cohort. Of the five cytokines identified as discriminant features in the discovery cohort, IL-10, IL-15 and IL-27 were also positively associated with BD in the replication cohort therefore providing an external validation to our finding. Should our results be validated in a prospective cohort, they could provide new insights into the pathophysiological mechanisms of mood disorders.
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Affiliation(s)
- Emanuela Martinuzzi
- Université Côte d'Azur, Centre National de la Recherche Scientifique, Institut de Pharmacologie Moléculaire et Cellulaire, Clinical Research Unit, Valbonne, France
| | - Susana Barbosa
- Université Côte d'Azur, Centre National de la Recherche Scientifique, Institut de Pharmacologie Moléculaire et Cellulaire, Clinical Research Unit, Valbonne, France
| | - Philippe Courtet
- Centre Hospitalier Universitaire de Montpellier, Institut National de la Santé et de la Recherche Médicale, Ho^pital Lapeyronie, Department of Emergency Psychiatry and Acute Care, Montpellier, France
| | - Emilie Olié
- Centre Hospitalier Universitaire de Montpellier, Institut National de la Santé et de la Recherche Médicale, Ho^pital Lapeyronie, Department of Emergency Psychiatry and Acute Care, Montpellier, France
| | - Sébastien Guillaume
- Centre Hospitalier Universitaire de Montpellier, Institut National de la Santé et de la Recherche Médicale, Ho^pital Lapeyronie, Department of Emergency Psychiatry and Acute Care, Montpellier, France
| | | | - Douglas Daoudlarian
- Université Côte d'Azur, Centre National de la Recherche Scientifique, Institut de Pharmacologie Moléculaire et Cellulaire, Clinical Research Unit, Valbonne, France
| | - Laetitia Davidovic
- Université Côte d'Azur, Centre National de la Recherche Scientifique, Institut de Pharmacologie Moléculaire et Cellulaire, Clinical Research Unit, Valbonne, France
| | - Nicolas Glaichenhaus
- Université Côte d'Azur, Centre National de la Recherche Scientifique, Institut de Pharmacologie Moléculaire et Cellulaire, Clinical Research Unit, Valbonne, France.,Fondation FondaMental, France
| | - Raoul Belzeaux
- Aix Marseille Univ, CNRS, Inst Neurosci Timone, Marseille, France.,Assistance Publique Hôpitaux de Marseille, Department of Psychiatry, Marseille, France.,Fondation FondaMental, France
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18
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Richter T, Fishbain B, Richter-Levin G, Okon-Singer H. Machine Learning-Based Behavioral Diagnostic Tools for Depression: Advances, Challenges, and Future Directions. J Pers Med 2021; 11:jpm11100957. [PMID: 34683098 PMCID: PMC8537335 DOI: 10.3390/jpm11100957] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/12/2021] [Accepted: 09/21/2021] [Indexed: 01/05/2023] Open
Abstract
The psychiatric diagnostic procedure is currently based on self-reports that are subject to personal biases. Therefore, the diagnostic process would benefit greatly from data-driven tools that can enhance accuracy and specificity. In recent years, many studies have achieved promising results in detecting and diagnosing depression based on machine learning (ML) analysis. Despite these favorable results in depression diagnosis, which are primarily based on ML analysis of neuroimaging data, most patients do not have access to neuroimaging tools. Hence, objective assessment tools are needed that can be easily integrated into the routine psychiatric diagnostic process. One solution is to use behavioral data, which can be easily collected while still maintaining objectivity. The current paper summarizes the main ML-based approaches that use behavioral data in diagnosing depression and other psychiatric disorders. We classified these studies into two main categories: (a) laboratory-based assessments and (b) data mining, the latter of which we further divided into two sub-groups: (i) social media usage and movement sensors data and (ii) demographic and clinical information. The paper discusses the advantages and challenges in this field and suggests future research directions and implementations. The paper's overarching aim is to serve as a first step in synthetizing existing knowledge about ML-based behavioral diagnosis studies in order to develop interventions and individually tailored treatments in the future.
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Affiliation(s)
- Thalia Richter
- Department of Psychology, School of Psychological Sciences, University of Haifa, Haifa 3498838, Israel; (G.R.-L.); (H.O.-S.)
- Correspondence:
| | - Barak Fishbain
- Faculty of Civil and Environmental Engineering, Technion—Israel Institute of Technology, Haifa 3200003, Israel;
| | - Gal Richter-Levin
- Department of Psychology, School of Psychological Sciences, University of Haifa, Haifa 3498838, Israel; (G.R.-L.); (H.O.-S.)
| | - Hadas Okon-Singer
- Department of Psychology, School of Psychological Sciences, University of Haifa, Haifa 3498838, Israel; (G.R.-L.); (H.O.-S.)
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Dionisie V, Filip GA, Manea MC, Movileanu RC, Moisa E, Manea M, Riga S, Ciobanu AM. Neutrophil-to-Lymphocyte Ratio, a Novel Inflammatory Marker, as a Predictor of Bipolar Type in Depressed Patients: A Quest for Biological Markers. J Clin Med 2021; 10:1924. [PMID: 33946871 PMCID: PMC8125288 DOI: 10.3390/jcm10091924] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/25/2021] [Accepted: 04/26/2021] [Indexed: 12/27/2022] Open
Abstract
(1) Background: Recent research suggests inflammation as a factor involved in the pathophysiology of mood disorders. Neutrophil-to-lymphocyte (NLR), monocyte-to-lymphocyte (MLR), platelet-to-lymphocyte (PLR), and systemic immune-inflammatory (SII) index ratios have been studied as peripheral markers of inflammation in bipolar and major depressive disorders. The purpose of this study is to comparatively analyze these inflammatory ratios among manic episodes of bipolar disorder, bipolar depression and unipolar depression. (2) Methods: 182 patients were retrospectively included in the study and divided into three groups: 65 manic patients, 34 patients with bipolar depression, and 83 unipolar depressive patients. White blood cells, neutrophils, monocytes, lymphocytes, and platelets were retrieved from the patients' database. NLR, MLR, PLR, and SII index were calculated using these parameters. (3) Results: Patients with manic episodes had elevated NLR (p < 0.001), MLR (p < 0.01), PLR (p < 0.05), and SII index (p < 0.001) compared to unipolar depression and increased NLR (p < 0.05) and SII index (p < 0.05) when compared to bipolar depression. NLR (p < 0.01) and SII index (p < 0.05) were higher in the bipolar depression than unipolar depression. NLR is an independent predictor of the bipolar type of depression in depressive patients. (4) Conclusions: The results confirm the role of inflammation in the pathophysiology of mood disorders and suggest the ability of NLR as a marker for the differentiation of bipolar from unipolar depression.
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Affiliation(s)
- Vlad Dionisie
- Department of Psychiatry and Psychology, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Department of Psychiatry, ‘Prof. Dr. Alexandru Obregia’ Clinical Hospital of Psychiatry, 041914 Bucharest, Romania; (R.C.M.); (A.M.C.)
| | - Gabriela Adriana Filip
- Department of Physiology, ‘Iuliu Hatieganu’ University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania;
| | - Mihnea Costin Manea
- Department of Psychiatry and Psychology, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Department of Psychiatry, ‘Prof. Dr. Alexandru Obregia’ Clinical Hospital of Psychiatry, 041914 Bucharest, Romania; (R.C.M.); (A.M.C.)
| | - Robert Constantin Movileanu
- Department of Psychiatry, ‘Prof. Dr. Alexandru Obregia’ Clinical Hospital of Psychiatry, 041914 Bucharest, Romania; (R.C.M.); (A.M.C.)
| | - Emanuel Moisa
- Department of Orthopaedics, Anaesthesia and Intensive Care Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- ‘Elias’ University Emergency Hospital, 011461 Bucharest, Romania
| | - Mirela Manea
- Department of Psychiatry and Psychology, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Department of Psychiatry, ‘Prof. Dr. Alexandru Obregia’ Clinical Hospital of Psychiatry, 041914 Bucharest, Romania; (R.C.M.); (A.M.C.)
| | - Sorin Riga
- Department of Stress Research and Prophylaxis, ‘Prof. Dr. Alexandru Obregia’ Clinical Hospital of Psychiatry, 041914 Bucharest, Romania;
- Romanian Academy of Medical Sciences, 927180 Bucharest, Romania
| | - Adela Magdalena Ciobanu
- Department of Psychiatry, ‘Prof. Dr. Alexandru Obregia’ Clinical Hospital of Psychiatry, 041914 Bucharest, Romania; (R.C.M.); (A.M.C.)
- Neuroscience Department, Discipline of Psychiatry, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
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20
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Wollenhaupt-Aguiar B, Kapczinski F, Pfaffenseller B. Biological Pathways Associated with Neuroprogression in Bipolar Disorder. Brain Sci 2021; 11:brainsci11020228. [PMID: 33673277 PMCID: PMC7918818 DOI: 10.3390/brainsci11020228] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 02/06/2021] [Accepted: 02/08/2021] [Indexed: 02/06/2023] Open
Abstract
There is evidence suggesting clinical progression in a subset of patients with bipolar disorder (BD). This progression is associated with worse clinical outcomes and biological changes. Molecular pathways and biological markers of clinical progression have been identified and may explain the progressive changes associated with this disorder. The biological basis for clinical progression in BD is called neuroprogression. We propose that the following intertwined pathways provide the biological basis of neuroprogression: inflammation, oxidative stress, impaired calcium signaling, endoplasmic reticulum and mitochondrial dysfunction, and impaired neuroplasticity and cellular resilience. The nonlinear interaction of these pathways may worsen clinical outcomes, cognition, and functioning. Understanding neuroprogression in BD is crucial for identifying novel therapeutic targets, preventing illness progression, and ultimately promoting better outcomes.
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Affiliation(s)
- Bianca Wollenhaupt-Aguiar
- Department of Psychiatry and Behavioural Neuroscience, McMaster University, Hamilton, ON L8N 3K7, Canada; (B.W.-A.); (F.K.)
- Mood Disorders Program, St. Joseph’s Healthcare Hamilton, Hamilton, ON L8N 3K7, Canada
| | - Flavio Kapczinski
- Department of Psychiatry and Behavioural Neuroscience, McMaster University, Hamilton, ON L8N 3K7, Canada; (B.W.-A.); (F.K.)
- Mood Disorders Program, St. Joseph’s Healthcare Hamilton, Hamilton, ON L8N 3K7, Canada
- Neuroscience Graduate Program, McMaster University, Hamilton, ON L8S 4L8, Canada
- Instituto Nacional de Ciência e Tecnologia Translacional em Medicina (INCT-TM), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre 90035-903, Brazil
- Department of Psychiatry, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre 90035-003, Brazil
| | - Bianca Pfaffenseller
- Department of Psychiatry and Behavioural Neuroscience, McMaster University, Hamilton, ON L8N 3K7, Canada; (B.W.-A.); (F.K.)
- Mood Disorders Program, St. Joseph’s Healthcare Hamilton, Hamilton, ON L8N 3K7, Canada
- Correspondence:
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21
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Huang KL, Chen MH, Hsu JW, Tsai SJ, Bai YM. Using classification and regression tree modeling to investigate appetite hormones and proinflammatory cytokines as biomarkers to differentiate bipolar I depression from major depressive disorder. CNS Spectr 2021:1-7. [PMID: 33563365 DOI: 10.1017/s109285292100016x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Altered immunity and metabolic profiles have been compared between bipolar depression (BD) and major depressive disorder (MDD). This study aimed at developing a composite predictor of appetite hormones and proinflammatory cytokines to differentiate BD from MDD. METHODS This cross-sectional study enrolled patients with BD and those with MDD aged 20 to 59 years and displaying depressive episodes. Clinical characteristics (age, sex, body mass index, and depression severity), cytokines (C-reactive protein, interleukin [IL]-2, IL-6, tumor necrosis factor [TNF]-α, P-selectin, and monocyte chemoattractant protein), and appetite hormones (leptin, adiponectin, ghrelin, and insulin) were assessed as potential predictors using a classification and regression tree (CRT) model for differentiating BD from MDD. RESULTS The predicted probability of a composite predictor of ghrelin and TNF-α was significantly greater (for BD: area under curve = 0.877; for MDD: area under curve = 0.914) than that of any one marker (all P > .05) to distinguish BD from MDD. The most powerful predictors for diagnosing BD were high ghrelin and TNF-α levels, whereas those for MDD were low ghrelin and TNF-α levels. CONCLUSION A composite predictor of ghrelin and TNF-α driven by CRT could assist in the differential diagnosis of BD from MDD with high specificity. Further clinical studies are warranted to validate our results and to explore underlying mechanisms.
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Affiliation(s)
- Kai-Lin Huang
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Mu-Hong Chen
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ju-Wei Hsu
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shih-Jen Tsai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ya-Mei Bai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Personalized Medicine Using Neuroimmunological Biomarkers in Depressive Disorders. J Pers Med 2021; 11:jpm11020114. [PMID: 33578686 PMCID: PMC7916349 DOI: 10.3390/jpm11020114] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/08/2021] [Accepted: 02/08/2021] [Indexed: 02/07/2023] Open
Abstract
Major depressive disorder (MDD) is associated with increased suicidal risk and reduced productivity at work. Neuroimmunology, the study of the immune system and nervous system, provides further insight into the pathogenesis and outcome of MDD. Cytokines are the main modulators of neuroimmunology, and their levels are somewhat entangled in depressive disorders as they affect depressive symptoms and are affected by antidepressant treatment. The use of cytokine-derived medication as a treatment option for MDD is currently a topic of interest. Although not very promising, cytokines are also considered as possible prognostic or diagnostic markers for depression. The machine learning approach is a powerful tool for pattern recognition and has been used in psychiatry for finding useful patterns in data that have translational meaning and can be incorporated in daily clinical practice. This review focuses on the current knowledge of neuroimmunology and depression and the possible use of machine learning to widen our understanding of the topic.
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23
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Sonkurt HO, Altınöz AE, Çimen E, Köşger F, Öztürk G. The role of cognitive functions in the diagnosis of bipolar disorder: A machine learning model. Int J Med Inform 2020; 145:104311. [PMID: 33202371 DOI: 10.1016/j.ijmedinf.2020.104311] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 10/05/2020] [Accepted: 10/20/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Considering the clinical heterogeneity of the bipolar disorder, difficulties are encountered in making the correct diagnosis. Although a number of common findings have been found in studies on the neurocognitive profile of bipolar disorder, the search for a neurocognitive endophenotype has failed. The aim of this study is to separate bipolar disorder patients from healthy controls with higher accuracy by using a broader neurocognitive evaluation and a novel machine-learning algorithm. METHODS Individuals who presented to the Bipolar Outpatient Clinic of the Medical Faculty of Eskişehir Osmangazi University and met the inclusion criteria of the research are included in the study. Six neurocognitive tests from the CANTAB test battery were used for neurocognitive evaluation, Polyhedral Conic Functions algorithm was used to classify the participants. RESULTS Bipolar disorder patients differentiated from healthy controls with an accuracy of 78 %. DISCUSSION Our study presents a prediction algorithm that separates bipolar disorder from healthy controls with high accuracy by using CANTAB neurocognitive battery.
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Affiliation(s)
| | - Ali Ercan Altınöz
- Department of Psychiatry, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey.
| | - Emre Çimen
- Computational Intelligence and Optimization Laboratory, Department of Industrial Engineering, Eskisehir Technical University, Eskisehir, Turkey
| | - Ferdi Köşger
- Department of Psychiatry, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Gürkan Öztürk
- Computational Intelligence and Optimization Laboratory, Department of Industrial Engineering, Eskisehir Technical University, Eskisehir, Turkey
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24
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Tamura JK, McIntyre RS. Current and Future Vistas in Bipolar Disorder. Curr Behav Neurosci Rep 2020. [DOI: 10.1007/s40473-020-00202-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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