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Amanollahi M, Jameie M, Looha MA, A Basti F, Cattarinussi G, Moghaddam HS, Di Camillo F, Akhondzadeh S, Pigoni A, Sambataro F, Brambilla P, Delvecchio G. Machine learning applied to the prediction of relapse, hospitalization, and suicide in bipolar disorder using neuroimaging and clinical data: A systematic review. J Affect Disord 2024; 361:778-797. [PMID: 38908556 DOI: 10.1016/j.jad.2024.06.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 05/22/2024] [Accepted: 06/17/2024] [Indexed: 06/24/2024]
Abstract
BACKGROUND Bipolar disorder (BD) is associated with increased morbidity/mortality. Adverse outcome prediction might help with the management of patients with BD. METHODS We systematically reviewed the performance of machine learning (ML) studies in predicting adverse outcomes (relapse or recurrence, hospital admission, and suicide-related events) in patients with BD. Demographic, clinical, and neuroimaging-related poor outcome predictors were also reviewed. Three databases (PubMed, Scopus, and Web of Science) were explored from inception to July 2023. RESULTS Eighteen studies, accounting for >30,000 patients, were included. Support vector machine, decision trees, random forest, and logistic regression were the most frequently used ML algorithms. ML models' area under the receiver operating characteristic (ROC) curve (AUC), sensitivity, and specificity ranged from 0.71 to 0.98, 72.7-92.8 %, and 59.0-95.2 % for relapse/recurrence prediction (4 studies (3 on relapses and 1 on recurrences). The corresponding values were 0.78-0.88, 21.4-100 %, and 77.0-99.7 % for hospital admissions (3 studies, 21,266 patients), and 0.71-0.99, 44.4-97.9 %, and 38.9-95.0 % for suicide-related events (10 studies, 5558 patients). Also, one study addressed a combination of the interest outcomes. Adverse outcome predictors included early onset BD, BD type I, comorbid psychiatric or substance use disorder, circadian rhythm disruption, hospitalization characteristics, and neuroimaging parameters, including increased dynamic amplitude of low-frequency fluctuation, decreased frontolimbic functional connectivity and aberrant dynamic functional connectivity in corticostriatal circuitry. CONCLUSIONS ML models can predict adverse outcomes of BD with relatively acceptable performance measures. Future studies with larger samples and nested cross-validation validation should be conducted to reach more reliable results.
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Affiliation(s)
- Mobina Amanollahi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Melika Jameie
- Neuroscience Research Center, Iran University of Medical Sciences, Tehran, Iran; Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Azizmohammad Looha
- Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh A Basti
- Islamic Azad University, Tehran Medical Branch, Tehran, Iran
| | - Giulia Cattarinussi
- Department of Neuroscience (DNS), University of Padova, Padua, Italy; Padova Neuroscience Center, University of Padova, Italy
| | - Hossein Sanjari Moghaddam
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran; Psychiatry and Psychology Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fabio Di Camillo
- Department of Neuroscience (DNS), University of Padova, Padua, Italy
| | - Shahin Akhondzadeh
- Psychiatry and Psychology Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alessandro Pigoni
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Fabio Sambataro
- Department of Neuroscience (DNS), University of Padova, Padua, Italy; Padova Neuroscience Center, University of Padova, Italy
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Giuseppe Delvecchio
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
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Belov V, Erwin-Grabner T, Aghajani M, Aleman A, Amod AR, Basgoze Z, Benedetti F, Besteher B, Bülow R, Ching CRK, Connolly CG, Cullen K, Davey CG, Dima D, Dols A, Evans JW, Fu CHY, Gonul AS, Gotlib IH, Grabe HJ, Groenewold N, Hamilton JP, Harrison BJ, Ho TC, Mwangi B, Jaworska N, Jahanshad N, Klimes-Dougan B, Koopowitz SM, Lancaster T, Li M, Linden DEJ, MacMaster FP, Mehler DMA, Melloni E, Mueller BA, Ojha A, Oudega ML, Penninx BWJH, Poletti S, Pomarol-Clotet E, Portella MJ, Pozzi E, Reneman L, Sacchet MD, Sämann PG, Schrantee A, Sim K, Soares JC, Stein DJ, Thomopoulos SI, Uyar-Demir A, van der Wee NJA, van der Werff SJA, Völzke H, Whittle S, Wittfeld K, Wright MJ, Wu MJ, Yang TT, Zarate C, Veltman DJ, Schmaal L, Thompson PM, Goya-Maldonado R. Multi-site benchmark classification of major depressive disorder using machine learning on cortical and subcortical measures. Sci Rep 2024; 14:1084. [PMID: 38212349 PMCID: PMC10784593 DOI: 10.1038/s41598-023-47934-8] [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: 01/23/2023] [Accepted: 11/19/2023] [Indexed: 01/13/2024] Open
Abstract
Machine learning (ML) techniques have gained popularity in the neuroimaging field due to their potential for classifying neuropsychiatric disorders. However, the diagnostic predictive power of the existing algorithms has been limited by small sample sizes, lack of representativeness, data leakage, and/or overfitting. Here, we overcome these limitations with the largest multi-site sample size to date (N = 5365) to provide a generalizable ML classification benchmark of major depressive disorder (MDD) using shallow linear and non-linear models. Leveraging brain measures from standardized ENIGMA analysis pipelines in FreeSurfer, we were able to classify MDD versus healthy controls (HC) with a balanced accuracy of around 62%. But after harmonizing the data, e.g., using ComBat, the balanced accuracy dropped to approximately 52%. Accuracy results close to random chance levels were also observed in stratified groups according to age of onset, antidepressant use, number of episodes and sex. Future studies incorporating higher dimensional brain imaging/phenotype features, and/or using more advanced machine and deep learning methods may yield more encouraging prospects.
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Affiliation(s)
- Vladimir Belov
- Laboratory of Systems Neuroscience and Imaging in Psychiatry (SNIP-Lab), Department of Psychiatry and Psychotherapy, University Medical Center Göttingen (UMG), Georg-August University, Von-Siebold-Str. 5, 37075, Göttingen, Germany
| | - Tracy Erwin-Grabner
- Laboratory of Systems Neuroscience and Imaging in Psychiatry (SNIP-Lab), Department of Psychiatry and Psychotherapy, University Medical Center Göttingen (UMG), Georg-August University, Von-Siebold-Str. 5, 37075, Göttingen, Germany
| | - Moji Aghajani
- Department of Psychiatry, Amsterdam UMC, Amsterdam Neuroscience, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Institute of Education and Child Studies, Section Forensic Family and Youth Care, Leiden University, Leiden, The Netherlands
| | - Andre Aleman
- Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Alyssa R Amod
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Zeynep Basgoze
- Department of Psychiatry and Behavioral Science, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Francesco Benedetti
- Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Bianca Besteher
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Robin Bülow
- Institute for Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Christopher R K Ching
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - Colm G Connolly
- Department of Biomedical Sciences, Florida State University, Tallahassee, FL, USA
| | - Kathryn Cullen
- Department of Psychiatry and Behavioral Science, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Christopher G Davey
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia
| | - Danai Dima
- Department of Psychology, School of Arts and Social Sciences, City, University of London, London, UK
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Annemiek Dols
- Department of Psychiatry, Amsterdam UMC, Amsterdam Neuroscience, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jennifer W Evans
- Experimental Therapeutics and Pathophysiology Branch, National Institute for Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Cynthia H Y Fu
- School of Psychology, University of East London, London, UK
- Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ali Saffet Gonul
- SoCAT Lab, Department of Psychiatry, School of Medicine, Ege University, Izmir, Turkey
| | - Ian H Gotlib
- Department of Psychology, Stanford University, Stanford, CA, USA
| | - Hans J Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - Nynke Groenewold
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - J Paul Hamilton
- Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Center for Medical Imaging and Visualization, Linköping University, Linköping, Sweden
| | - Ben J Harrison
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia
| | - Tiffany C Ho
- Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Benson Mwangi
- Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
- Center Of Excellence On Mood Disorders, Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences at McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Natalia Jaworska
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Neda Jahanshad
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | | | | | - Thomas Lancaster
- Cardiff University Brain Research Imaging Center, Cardiff University, Cardiff, UK
- MRC Center for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Meng Li
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - David E J Linden
- Cardiff University Brain Research Imaging Center, Cardiff University, Cardiff, UK
- MRC Center for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
- School of Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Frank P MacMaster
- Departments of Psychiatry and Pediatrics, University of Calgary, Calgary, AB, Canada
| | - David M A Mehler
- Cardiff University Brain Research Imaging Center, Cardiff University, Cardiff, UK
- MRC Center for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical School, RWTH Aachen University, Aachen, Germany
| | - Elisa Melloni
- Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Bryon A Mueller
- Department of Psychiatry and Behavioral Science, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Amar Ojha
- Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA, USA
- Center for Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mardien L Oudega
- Department of Psychiatry, Amsterdam UMC, Amsterdam Neuroscience, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Brenda W J H Penninx
- Department of Psychiatry, Amsterdam UMC, Amsterdam Neuroscience, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Sara Poletti
- Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Edith Pomarol-Clotet
- FIDMAG Germanes Hospitalàries Research Foundation, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Catalonia, Spain
| | - Maria J Portella
- Sant Pau Mental Health Research Group, Institut de Recerca de L'Hospital de La Santa Creu I Sant Pau, Barcelona, Catalonia, Spain
| | - Elena Pozzi
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Liesbeth Reneman
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Matthew D Sacchet
- Meditation Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Anouk Schrantee
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Kang Sim
- West Region, Institute of Mental Health, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Jair C Soares
- Center Of Excellence On Mood Disorders, Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences at McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Dan J Stein
- SA MRC Research Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Sophia I Thomopoulos
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - Aslihan Uyar-Demir
- SoCAT Lab, Department of Psychiatry, School of Medicine, Ege University, Izmir, Turkey
| | - Nic J A van der Wee
- Leiden Institute for Brain and Cognition, Leiden University Medical Center, Leiden, The Netherlands
| | - Steven J A van der Werff
- Leiden Institute for Brain and Cognition, Leiden University Medical Center, Leiden, The Netherlands
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - Henry Völzke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Sarah Whittle
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, Melbourne, VIC, Australia
| | - Katharina Wittfeld
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/ Greifswald, Greifswald, Germany
| | - Margaret J Wright
- Queensland Brain Institute, The University of Queensland, Brisbane, QLD, Australia
- Centre for Advanced Imaging, The University of Queensland, Brisbane, QLD, Australia
| | - Mon-Ju Wu
- Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
- Center Of Excellence On Mood Disorders, Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences at McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Tony T Yang
- Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Carlos Zarate
- Section on the Neurobiology and Treatment of Mood Disorders, National Institute of Mental Health, Bethesda, MD, USA
| | - Dick J Veltman
- Department of Psychiatry, Amsterdam UMC, Amsterdam Neuroscience, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Lianne Schmaal
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Paul M Thompson
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - Roberto Goya-Maldonado
- Laboratory of Systems Neuroscience and Imaging in Psychiatry (SNIP-Lab), Department of Psychiatry and Psychotherapy, University Medical Center Göttingen (UMG), Georg-August University, Von-Siebold-Str. 5, 37075, Göttingen, Germany.
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3
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Jiang X, Cao B, Li C, Jia L, Jing Y, Cai W, Zhao W, Sun Q, Wu F, Kong L, Tang Y. Identifying misdiagnosed bipolar disorder using support vector machine: feature selection based on fMRI of follow-up confirmed affective disorders. Transl Psychiatry 2024; 14:9. [PMID: 38191549 PMCID: PMC10774279 DOI: 10.1038/s41398-023-02703-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: 03/06/2023] [Revised: 11/27/2023] [Accepted: 12/05/2023] [Indexed: 01/10/2024] Open
Abstract
Nearly a quarter of bipolar disorder (BD) patients were misdiagnosed as major depressive disorder (MDD) patients, which cannot be corrected until mania/hypomania develops. It is important to recognize these obstacles so that the appropriate treatment can be initiated. Thus, we sought to distinguish patients with BD from MDD, especially to identify misdiagnosed BD before mania/hypomania, and further explore potential trait features that allow accurate differential diagnosis independent of state matters. Functional magnetic resonance imaging scans were performed at baseline on 92 MDD patients and 48 BD patients. The MDD patients were then followed up for more than two years. After follow-up, 23 patients transformed into BD (tBD), and 69 patients whose diagnoses remained unchanged were eligible for unipolar depression (UD). A support vector machine classifier was trained on the amygdala-based functional connectivity (FC) of 48 BD and 50 UD patients using a novel region-based feature selection. Then, the classifier was tested on the dataset, encompassing tBD and the remaining UD. It performed well for known BD and UD and can also distinguish tBD from UD with an accuracy of 81%, sensitivity of 82.6%, specificity of 79%, and AUC of 74.6%, respectively. Feature selection results revealed that ten regions within the cortico-limbic neural circuit contributed most to classification. Furthermore, in the FC comparisons among diseases, BD and tBD shared almost overlapped FC patterns in the cortico-limbic neural circuit, and both of them presented pronounced differences in most regions within the circuit compared with UD. The FC values of the most discriminating brain regions had no prominent correlations with the severity of depression, anxiety, and mania/hypomania (FDR correction). It suggests that BD possesses some trait features in the cortico-limbic neural circuit, rendering it dichotomized by the classifier based on known-diagnosis data.
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Affiliation(s)
- Xiaowei Jiang
- Brain Function Research Section, Department of Radiology, The First Hospital of China Medical University, Shenyang, Liaoning, 110001, PR China
| | - Bo Cao
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, T6G 2B7, Canada
| | - Chao Li
- Brain Function Research Section, Department of Radiology, The First Hospital of China Medical University, Shenyang, Liaoning, 110001, PR China
| | - Linna Jia
- Department of Psychiatry, The First Hospital of China Medical University, Shenyang, Liaoning, 110001, PR China
| | - Yi Jing
- Neusoft Research of Intelligent Healthcare Technology, Co. Ltd, Shenyang, Liaoning, 110167, PR China
| | - Wei Cai
- Neusoft Research of Intelligent Healthcare Technology, Co. Ltd, Shenyang, Liaoning, 110167, PR China
| | - Wenhui Zhao
- Department of Psychiatry, The First Hospital of China Medical University, Shenyang, Liaoning, 110001, PR China
| | - Qikun Sun
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, Liaoning, 110001, PR China
| | - Feng Wu
- Department of Psychiatry, The First Hospital of China Medical University, Shenyang, Liaoning, 110001, PR China
| | - Lingtao Kong
- Department of Psychiatry, The First Hospital of China Medical University, Shenyang, Liaoning, 110001, PR China
| | - Yanqing Tang
- Department of Psychiatry, The First Hospital of China Medical University, Shenyang, Liaoning, 110001, PR China.
- Department of Geriatric Medicine, The First Hospital of China Medical University, Shenyang, Liaoning, 110001, PR China.
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Zhu T, Liu X, Wang J, Kou R, Hu Y, Yuan M, Yuan C, Luo L, Zhang W. Explainable machine-learning algorithms to differentiate bipolar disorder from major depressive disorder using self-reported symptoms, vital signs, and blood-based markers. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 240:107723. [PMID: 37480646 DOI: 10.1016/j.cmpb.2023.107723] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 06/26/2023] [Accepted: 07/15/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND AND OBJECTIVE Caused by shared genetic risk factors and similar neuropsychological symptoms, bipolar disorder (BD) and major depressive disorder (MDD) are at high risk of misdiagnosis, which is associated with ineffective treatment and worsening of outcomes. We aimed to develop a machine learning (ML)-based diagnostic system, based on electronic medical records (EMR) data, to mimic the clinical reasoning of human physicians to differentiate MDD and BD (especially BD depressive episodes) patients about to be admitted to a hospital and, hence, reduce the misdiagnosis of BD as MDD on admission. In addition, we examined to what extent our ML model could be made interpretable by quantifying and visualizing the features that drive the predictions. METHODS By identifying 16,311 patients admitted to a hospital located in western China between 2009 and 2018 with a recorded main diagnosis of MDD or BD, we established three sub-cohorts with different combinations of features for both the MDD-BD cohort and the MDD-BD depressive episodes cohort, respectively. Four different ML algorithms (logistic regression, extreme gradient boosting (XGBoost), random forest, and support vector machine) and four train-test splits were used to train and validate diagnostic models, and explainable methods (SHAP and Break Down) were utilized to analyze the contribution of each of the features at both population-level and individual-level, including feature importance, feature interaction, and feature effect on prediction decision for a specific subject. RESULTS The XGBoost algorithm provided the best test performance (AUC: 0.838 (0.810-0.867), PPV: 0.810 and NPV: 0.834) for separating patients with BD from those with MDD. Core predictors included symptoms (mood-up, exciting, bad sleep, loss of interest, talking, mood-down, provoke), along with age, job, myocardial enzyme markers (creatine kinase, hydroxybutyrate dehydrogenase), diabetes-associated marker (glucose), bone function marker (alkaline phosphatase), non-enzymatic antioxidant (uric acid), markers of immune/inflammation (white blood cell count, lymphocyte count, basophil percentage, monocyte count), cardiovascular function marker (low density lipoprotein), renal marker (total protein), liver biochemistry marker (indirect bilirubin), and vital signs like pulse. For separating patients with BD depressive episodes from those with MDD, the test AUC was 0.777 (0.732-0.822), with PPV 0.576 and NPV 0.899. Additional validation in models built with self-reported symptoms removed from the feature set, showed test AUC of 0.701 (0.666-0.736) for differentiating BD and MDD, and AUC of 0.564 (0.515-0.614) for detecting patients in BD depressive episodes from MDD patients. Validation in the datasets without removing the patients with comorbidity showed an AUC of 0.826 (0.806-0.846). CONCLUSION The diagnostic system accurately identified patients with BD in various clinical scenarios, and differences in patterns of peripheral markers between BD and MDD could enrich our understanding of potential underlying pathophysiological mechanisms of them.
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Affiliation(s)
- Ting Zhu
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China; Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Xiaofei Liu
- Business School, Sichuan University, Chengdu, China
| | - Junren Wang
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China; Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Ran Kou
- Business School, Sichuan University, Chengdu, China
| | - Yao Hu
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China; Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Minlan Yuan
- Mental Health Center of West China Hospital, Sichuan University, Chengdu, China
| | - Cui Yuan
- Sichuan Provincial Center for Mental Health, The Center of Psychosomatic Medicine of Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Li Luo
- Business School, Sichuan University, Chengdu, China
| | - Wei Zhang
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China; Med-X Center for Informatics, Sichuan University, Chengdu, China; Mental Health Center of West China Hospital, Sichuan University, Chengdu, China.
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5
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Yu H, Ni P, Tian Y, Zhao L, Li M, Li X, Wei W, Wei J, Du X, Wang Q, Guo W, Deng W, Ma X, Coid J, Li T. Association of the plasma complement system with brain volume deficits in bipolar and major depressive disorders. Psychol Med 2023; 53:6102-6112. [PMID: 36285542 DOI: 10.1017/s0033291722003282] [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] [Indexed: 01/10/2023]
Abstract
BACKGROUND Inflammation plays a crucial role in the pathogenesis of major depressive disorder (MDD) and bipolar disorder (BD). This study aimed to examine whether the dysregulation of complement components contributes to brain structural defects in patients with mood disorders. METHODS A total of 52 BD patients, 35 MDD patients, and 53 controls were recruited. The human complement immunology assay was used to measure the levels of complement factors. Whole brain-based analysis was performed to investigate differences in gray matter volume (GMV) and cortical thickness (CT) among the BD, MDD, and control groups, and relationships were explored between neuroanatomical differences and levels of complement components. RESULTS GMV in the medial orbital frontal cortex (mOFC) and middle cingulum was lower in both patient groups than in controls, while the CT of the left precentral gyrus and left superior frontal gyrus were affected differently in the two disorders. Concentrations of C1q, C4, factor B, factor H, and properdin were higher in both patient groups than in controls, while concentrations of C3, C4 and factor H were significantly higher in BD than in MDD. Concentrations of C1q, factor H, and properdin showed a significant negative correlation with GMV in the mOFC at the voxel-wise level. CONCLUSIONS BD and MDD are associated with shared and different alterations in levels of complement factors and structural impairment in the brain. Structural defects in mOFC may be associated with elevated levels of certain complement factors, providing insight into the shared neuro-inflammatory pathogenesis of mood disorders.
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Affiliation(s)
- Hua Yu
- Department of Neurobiology, Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Hangzhou, Zhejiang, China
- NHC and CAMS Key Laboratory of Medical Neurobiology, MOE Frontier Science Center for Brain Science and Brain-machine Integration, School of Brain Science and Brain Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Peiyan Ni
- The Psychiatric Laboratory and Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, P R China
| | - Yang Tian
- The Psychiatric Laboratory and Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, P R China
| | - Liansheng Zhao
- The Psychiatric Laboratory and Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, P R China
| | - Mingli Li
- The Psychiatric Laboratory and Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, P R China
| | - Xiaojing Li
- Department of Neurobiology, Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Hangzhou, Zhejiang, China
- NHC and CAMS Key Laboratory of Medical Neurobiology, MOE Frontier Science Center for Brain Science and Brain-machine Integration, School of Brain Science and Brain Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Wei Wei
- Department of Neurobiology, Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Hangzhou, Zhejiang, China
- NHC and CAMS Key Laboratory of Medical Neurobiology, MOE Frontier Science Center for Brain Science and Brain-machine Integration, School of Brain Science and Brain Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jinxue Wei
- The Psychiatric Laboratory and Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, P R China
| | - Xiangdong Du
- Suzhou Psychiatry Hospital, Affiliated Guangji Hospital of Soochow University, Suzhou, 215137, Jiangsu, China
| | - Qiang Wang
- The Psychiatric Laboratory and Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, P R China
| | - Wanjun Guo
- Department of Neurobiology, Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Hangzhou, Zhejiang, China
- NHC and CAMS Key Laboratory of Medical Neurobiology, MOE Frontier Science Center for Brain Science and Brain-machine Integration, School of Brain Science and Brain Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Wei Deng
- Department of Neurobiology, Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Hangzhou, Zhejiang, China
- NHC and CAMS Key Laboratory of Medical Neurobiology, MOE Frontier Science Center for Brain Science and Brain-machine Integration, School of Brain Science and Brain Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xiaohong Ma
- The Psychiatric Laboratory and Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, P R China
| | - Jeremy Coid
- The Psychiatric Laboratory and Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, P R China
| | - Tao Li
- Department of Neurobiology, Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Hangzhou, Zhejiang, China
- NHC and CAMS Key Laboratory of Medical Neurobiology, MOE Frontier Science Center for Brain Science and Brain-machine Integration, School of Brain Science and Brain Medicine, Zhejiang University, Hangzhou, Zhejiang, China
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Van Rheenen TE, Cotton SM, Dandash O, Cooper RE, Ringin E, Daglas-Georgiou R, Allott K, Chye Y, Suo C, Macneil C, Hasty M, Hallam K, McGorry P, Fornito A, Yücel M, Pantelis C, Berk M. Increased cortical surface area but not altered cortical thickness or gyrification in bipolar disorder following stabilisation from a first episode of mania. Prog Neuropsychopharmacol Biol Psychiatry 2023; 122:110687. [PMID: 36427550 DOI: 10.1016/j.pnpbp.2022.110687] [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: 06/23/2022] [Revised: 11/08/2022] [Accepted: 11/16/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Despite reports of altered brain morphology in established bipolar disorder (BD), there is limited understanding of when these morphological abnormalities emerge. Assessment of patients during the early course of illness can help to address this gap, but few studies have examined surface-based brain morphology in patients at this illness stage. METHODS We completed a secondary analysis of baseline data from a randomised control trial of BD individuals stabilised after their first episode of mania (FEM). The magnetic resonance imaging scans of n = 35 FEM patients and n = 29 age-matched healthy controls were analysed. Group differences in cortical thickness, surface area and gyrification were assessed at each vertex of the cortical surface using general linear models. Significant results were identified at p < 0.05 using cluster-wise correction. RESULTS The FEM group did not differ from healthy controls with regards to cortical thickness or gyrification. However, there were two clusters of increased surface area in the left hemisphere of FEM patients, with peak coordinates falling within the lateral occipital cortex and pars triangularis. CONCLUSIONS Cortical thickness and gyrification appear to be intact in the aftermath of a first manic episode, whilst cortical surface area in the inferior/middle prefrontal and occipitoparietal cortex is increased compared to age-matched controls. It is possible that increased surface area in the FEM group is the outcome of abnormalities in a premorbidly occurring process. In contrast, the findings raise the hypothesis that cortical thickness reductions seen in past studies of individuals with more established BD may be more attributable to post-onset factors.
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Affiliation(s)
- Tamsyn E Van Rheenen
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Melbourne, Australia; Centre for Mental Health, Faculty of Health, Arts and Design, School of Health Sciences, Swinburne University, Melbourne, Australia.
| | - Sue M Cotton
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Orwa Dandash
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Melbourne, Australia; Turner Institute for Brain and Mental Health, School of Psychological Sciences and Monash Biomedical Imaging Facility, Monash University, Australia
| | - Rebecca E Cooper
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Melbourne, Australia
| | - Elysha Ringin
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Melbourne, Australia
| | - Rothanthi Daglas-Georgiou
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Kelly Allott
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Yann Chye
- Turner Institute for Brain and Mental Health, School of Psychological Sciences and Monash Biomedical Imaging Facility, Monash University, Australia
| | - Chao Suo
- Turner Institute for Brain and Mental Health, School of Psychological Sciences and Monash Biomedical Imaging Facility, Monash University, Australia
| | - Craig Macneil
- Orygen Youth Health Clinical Program, Parkville, VIC, Australia
| | - Melissa Hasty
- Orygen Youth Health Clinical Program, Parkville, VIC, Australia
| | - Karen Hallam
- The Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, Australia
| | - Patrick McGorry
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Alex Fornito
- Turner Institute for Brain and Mental Health, School of Psychological Sciences and Monash Biomedical Imaging Facility, Monash University, Australia
| | - Murat Yücel
- Turner Institute for Brain and Mental Health, School of Psychological Sciences and Monash Biomedical Imaging Facility, Monash University, Australia
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Melbourne, Australia; Florey Institute of Neuroscience and Mental Health, Clayton, VIC, Australia
| | - Michael Berk
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia; The Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, Australia; Barwon Health, PO Box 281, Geelong, Victoria, 3220, Australia
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7
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Liu Z, Wong NM, Shao R, Lee SH, Huang CM, Liu HL, Lin C, Lee TM. Classification of Major Depressive Disorder using Machine Learning on brain structure and functional connectivity. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2022. [DOI: 10.1016/j.jadr.2022.100428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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8
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Wei X, Wang L, Yu F, Lee C, Liu N, Ren M, Tu J, Zhou H, Shi G, Wang X, Liu CZ. Identifying the neural marker of chronic sciatica using multimodal neuroimaging and machine learning analyses. Front Neurosci 2022; 16:1036487. [PMID: 36532276 PMCID: PMC9748090 DOI: 10.3389/fnins.2022.1036487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 11/14/2022] [Indexed: 09/02/2023] Open
Abstract
INTRODUCTION Sciatica is a pain disorder often caused by the herniated disk compressing the lumbosacral nerve roots. Neuroimaging studies have identified functional abnormalities in patients with chronic sciatica (CS). However, few studies have investigated the neural marker of CS using brain structure and the classification value of multidimensional neuroimaging features in CS patients is unclear. METHODS Here, structural and resting-state functional magnetic resonance imaging (fMRI) was acquired for 34 CS patients and 36 matched healthy controls (HCs). We analyzed cortical surface area, cortical thickness, amplitude of low-frequency fluctuation (ALFF), regional homogeneity (REHO), between-regions functional connectivity (FC), and assessed the correlation between neuroimaging measures and clinical scores. Finally, the multimodal neuroimaging features were used to differentiate the CS patients and HC individuals by support vector machine (SVM) algorithm. RESULTS Compared to HC, CS patients had a larger cortical surface area in the right banks of the superior temporal sulcus and rostral anterior cingulate; higher ALFF value in the left inferior frontal gyrus; enhanced FCs between somatomotor and ventral attention network. Three FCs values were associated with clinical pain scores. Furthermore, the three multimodal neuroimaging features with significant differences between groups and the SVM algorithm could classify CS patients and HC with an accuracy of 90.00%. DISCUSSION Together, our findings revealed extensive reorganization of local functional properties, surface area, and network metrics in CS patients. The success of patient identification highlights the potential of using artificial intelligence and multimodal neuroimaging markers in chronic pain research.
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Affiliation(s)
- Xiaoya Wei
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture- Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Liqiong Wang
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture- Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Fangting Yu
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture- Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Chihkai Lee
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture- Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Ni Liu
- Department of Radiology, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, Beijing, China
| | - Mengmeng Ren
- Department of Radiology, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, Beijing, China
| | - Jianfeng Tu
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture- Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Hang Zhou
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture- Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Guangxia Shi
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture- Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Xu Wang
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China
| | - Cun-Zhi Liu
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture- Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
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9
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Personalized Diagnosis and Treatment for Neuroimaging in Depressive Disorders. J Pers Med 2022; 12:jpm12091403. [PMID: 36143188 PMCID: PMC9504356 DOI: 10.3390/jpm12091403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/26/2022] [Accepted: 08/26/2022] [Indexed: 01/10/2023] Open
Abstract
Depressive disorders are highly heterogeneous in nature. Previous studies have not been useful for the clinical diagnosis and prediction of outcomes of major depressive disorder (MDD) at the individual level, although they provide many meaningful insights. To make inferences beyond group-level analyses, machine learning (ML) techniques can be used for the diagnosis of subtypes of MDD and the prediction of treatment responses. We searched PubMed for relevant studies published until December 2021 that included depressive disorders and applied ML algorithms in neuroimaging fields for depressive disorders. We divided these studies into two sections, namely diagnosis and treatment outcomes, for the application of prediction using ML. Structural and functional magnetic resonance imaging studies using ML algorithms were included. Thirty studies were summarized for the prediction of an MDD diagnosis. In addition, 19 studies on the prediction of treatment outcomes for MDD were reviewed. We summarized and discussed the results of previous studies. For future research results to be useful in clinical practice, ML enabling individual inferences is important. At the same time, there are important challenges to be addressed in the future.
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10
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Hao G, Zuo L, Xiong P, Chen L, Liang X, Jing C. Associations of PM2.5 and road traffic noise with mental health: Evidence from UK Biobank. ENVIRONMENTAL RESEARCH 2022; 207:112221. [PMID: 34656633 DOI: 10.1016/j.envres.2021.112221] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 10/06/2021] [Accepted: 10/13/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND The associations of atmospheric particulate matter with diameters of 2.5 μm or less (PM2.5) and road traffic noise with mental disorders in men and women are not well studied. OBJECTIVES We aim to examine the cross-sectional associations of PM2.5 and road traffic noise with mental disorders in men and women. METHODS The baseline data of the UK Biobank study (2006-2010) were used. Mental disorders including symptoms of nerves, anxiety, tension or depression (NATD), major depression, and bipolar disorder were assessed by validated questions. Verified models were used to estimate PM2.5 and road traffic noise. RESULTS A total of 334,986 participants with measurements of NATD and 90,706 participants with measurements of major depression and bipolar disorder were included in the analysis. After adjusting for covariates, the odds for the risk of NATD symptoms increased by 2.31 (95% CI: 2.15-2.50) times per 10 μg/m3 increase in PM2.5. The odds for the risk of major depression and bipolar disorder increased by 2.26 and 4.99 times per 10 μg/m3 increase in PM2.5. On the other hand, higher road traffic noise exposure was significantly associated with a higher risk of NATD symptoms (Decile 6-8 (54.9-57.8 dB), OR: 1.03, 95% CI: 1.01-1.06; Decile 9-10 (≥57.8 dB), OR: 1.04, 95% CI: 1.01-1.07) and bipolar disorder (Decile 2-5 (52.1-54.9 dB), OR: 1.26, 95% CI: 1.00-1.59; Decile 6-8 (54.9-57.8 dB), OR: 1.30, 95% CI: 1.02-1.65; Decile 9-10 (≥57.8 dB), OR: 1.54, 95% CI: 1.21-1.97). Interestingly, a negative association was observed between moderate road traffic noise and major depression (Decile 2-5 (52.1-54.9 dB), OR: 0.95, 95% CI: 0.90-1.00). Interactions between PM2.5 exposure with age, gender, and sleeplessness for NATD symptoms were observed (P < 0.05), while interactions between road traffic noise exposure with age and gender were observed (P < 0.05). CONCLUSIONS We found a positive association between PM2.5 and mental disorders. Meanwhile, we found a positive association of road traffic noise with NATD symptoms and bipolar disorder and a negative association of moderate road traffic noise with major depression. Also, the effect modifications of these associations by age, gender, or sleeplessness may exist.
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Affiliation(s)
- Guang Hao
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, 510632, China; Guangdong Key Laboratory of Environmental Exposure and Health, Jinan University, Guangzhou, China.
| | - Lei Zuo
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, 510632, China
| | - Peng Xiong
- Division of Medical Psychology and Behavioral Sciences, Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Li Chen
- Georgia Prevention Institute, Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Xiaohua Liang
- Clinical Epidemiology and Biostatistics Department, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Key Laboratory of Pediatrics in Chongqing, China International Science and Technology Cooperation Center of Child Development and Critical Disorders, Chongqing, China.
| | - Chunxia Jing
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, 510632, China; Guangdong Key Laboratory of Environmental Exposure and Health, Jinan University, Guangzhou, China.
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Zhang H, Zhou Z, Ding L, Wu C, Qiu M, Huang Y, Jin F, Shen T, Yang Y, Hsu LM, Wang J, Zhang H, Shen D, Peng D. Divergent and convergent imaging markers between bipolar and unipolar depression based on Machine Learning. IEEE J Biomed Health Inform 2022; 26:4100-4110. [PMID: 35412995 DOI: 10.1109/jbhi.2022.3166826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Distinguishing bipolar depression (BD) from unipolar depression (UD) based on symptoms only is challenging. Brain functional connectivity (FC), especially dynamic FC, has emerged as a promising approach to identify possible imaging markers for differentiating BD from UD. However, most of such studies utilized conventional FC and group-level statistical comparisons, which may not be sensitive enough to quantify subtle changes in the FC dynamics between BD and UD. In this paper, we present a more effective individualized differentiation model based on machine learning and the whole-brain high-order functional connectivity (HOFC) network. The HOFC, capturing temporal synchronization among the dynamic FC time series, a more complex chronnectome metric compared to the conventional FC, was used to classify 52 BD, 73 UD, and 76 healthy controls (HC). We achieved a satisfactory accuracy (70.40%) in BD vs. UD differentiation. The resultant contributing features revealed the involvement of the coordinated flexible interactions among sensory (e.g., olfaction, vision, and audition), motor, and cognitive systems. Despite sharing common chronnectome of cognitive and affective impairments, BD and UD also demonstrated unique dynamic FC synchronization patterns. UD is more associated with abnormal visual-somatomotor inter-network connections, while BD is more related to impaired ventral attention-frontoparietal inter-network connections. Moreover, we found that the illness duration modulated the BD vs. UD separation, with the differentiation performance hampered by the secondary disease effects. Our findings suggest that BD and UD may have divergent and convergent neural substrates, which further expand our knowledge of the two different mental disorders.
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12
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Alteration of cortical functional networks in mood disorders with resting-state electroencephalography. Sci Rep 2022; 12:5920. [PMID: 35396563 PMCID: PMC8993886 DOI: 10.1038/s41598-022-10038-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 03/24/2022] [Indexed: 01/10/2023] Open
Abstract
Studies comparing bipolar disorder (BD) and major depressive disorder (MDD) are scarce, and the neuropathology of these disorders is poorly understood. This study investigated source-level cortical functional networks using resting-state electroencephalography (EEG) in patients with BD and MDD. EEG was recorded in 35 patients with BD, 39 patients with MDD, and 42 healthy controls (HCs). Graph theory-based source-level weighted functional networks were assessed via strength, clustering coefficient (CC), and path length (PL) in six frequency bands. At the global level, patients with BD and MDD showed higher strength and CC, and lower PL in the high beta band, compared to HCs. At the nodal level, compared to HCs, patients with BD showed higher high beta band nodal CCs in the right precuneus, left isthmus cingulate, bilateral paracentral, and left superior frontal; however, patients with MDD showed higher nodal CC only in the right precuneus compared to HCs. Although both MDD and BD patients had similar global level network changes, they had different nodal level network changes compared to HCs. Our findings might suggest more altered cortical functional network in patients with BD than in those with MDD.
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13
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Cui L, Li H, Li JB, Zeng H, Zhang Y, Deng W, Zhou W, Cao L. Altered cerebellar gray matter and cerebellar-cortex resting-state functional connectivity in patients with bipolar disorder Ⅰ. J Affect Disord 2022; 302:50-57. [PMID: 35074460 DOI: 10.1016/j.jad.2022.01.073] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/16/2022] [Accepted: 01/18/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Bipolar disorder (BP) is a common psychiatric disorder characterized by extreme fluctuations in mood. Recent studies have indicated the involvement of cerebellum in the pathogenesis of BP. However, no study has focused on the precise role of cerebellum exclusively in patients with bipolar I disorder (BP-I). METHODS Forty-five patients with BP-I and 40 healthy controls were recruited. All subjects underwent clinical evaluation and Magnetic Resonance diffusion Tension Imaging scans. For structural images, we used a spatially unbiased infratentorial template toolbox to isolate the cerebellum and then preformed voxel-based morphometry (VBM) analyses to assess the difference in cerebellar gray matter volume (GMV) between the two groups. For the functional images, we chose the clusters that survived from VBM analysis as seeds and performed functional connectivity (FC) analysis. Between-group differences were assessed using the independent Students t test or the nonparametric Mann-Whitney U Test. For multiple comparisons, the results were further corrected with Gaussian random field (GRF) approach (voxel-level P < 0.001, cluster-level P < 0.05). RESULTS Compared with healthy controls, BP-I patients showed significantly decreased GMV in left lobule V and left lobule VI (P < 0.05, GRF corrected). The FC of cerebellum with bilateral superior temporal gyrus, bilateral insula, bilateral rolandic operculum, right putamen, and left precentral gyrus was disrupted in BP-I patients (P < 0.05, GRF corrected). CONCLUSIONS BP-I patients showed decreased cerebellar GMV and disrupted cerebellar-cortex resting-state FC. This suggests that cerebellar abnormalities may play an important role in the pathogenesis of BP-I.
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Affiliation(s)
- Liqian Cui
- Department of Neurology, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, No.58 Zhongshan Road 2, Guangzhou 510080, China.
| | - Hao Li
- Department of Neurology, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, No.58 Zhongshan Road 2, Guangzhou 510080, China
| | - Jin Biao Li
- Department of Neurology, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, No.58 Zhongshan Road 2, Guangzhou 510080, China
| | - Huixing Zeng
- Department of Neurology, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, No.58 Zhongshan Road 2, Guangzhou 510080, China
| | - Yizhi Zhang
- Guangzhou Huiai, Hospital, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510370, China
| | - Wenhao Deng
- Guangzhou Huiai, Hospital, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510370, China
| | - Wenjin Zhou
- Guangzhou Huiai, Hospital, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510370, China
| | - Liping Cao
- Guangzhou Huiai, Hospital, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510370, China.
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14
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Chen G, Chen P, Gong J, Jia Y, Zhong S, Chen F, Wang J, Luo Z, Qi Z, Huang L, Wang Y. Shared and specific patterns of dynamic functional connectivity variability of striato-cortical circuitry in unmedicated bipolar and major depressive disorders. Psychol Med 2022; 52:747-756. [PMID: 32648539 DOI: 10.1017/s0033291720002378] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Accumulating studies have found structural and functional abnormalities of the striatum in bipolar disorder (BD) and major depressive disorder (MDD). However, changes in intrinsic brain functional connectivity dynamics of striato-cortical circuitry have not been investigated in BD and MDD. This study aimed to investigate the shared and specific patterns of dynamic functional connectivity (dFC) variability of striato-cortical circuitry in BD and MDD. METHODS Brain resting-state functional magnetic resonance imaging data were acquired from 128 patients with unmedicated BD II (current episode depressed), 140 patients with unmedicated MDD, and 132 healthy controls (HCs). Six pairs of striatum seed regions were selected: the ventral striatum inferior (VSi) and the ventral striatum superior (VSs), the dorsal-caudal putamen (DCP), the dorsal-rostral putamen (DRP), and the dorsal caudate and the ventral-rostral putamen (VRP). The sliding-window analysis was used to evaluate dFC for each seed. RESULTS Both BD II and MDD exhibited increased dFC variability between the left DRP and the left supplementary motor area, and between the right VRP and the right inferior parietal lobule. The BD II had specific increased dFC variability between the right DCP and the left precentral gyrus compared with MDD and HCs. The MDD had increased dFC variability between the left VSi and the left medial prefrontal cortex compared with BD II and HCs. CONCLUSIONS The patients with BD and MDD shared common dFC alteration in the dorsal striatal-sensorimotor and ventral striatal-cognitive circuitries. The patients with MDD had specific dFC alteration in the ventral striatal-affective circuitry.
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Affiliation(s)
- Guanmao Chen
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Pan Chen
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - JiaYing Gong
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
- Department of Radiology, Six Affiliated Hospital of Sun Yat-sen University, Guangzhou 510655, China
| | - Yanbin Jia
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Shuming Zhong
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Feng Chen
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Jurong Wang
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Zhenye Luo
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Zhangzhang Qi
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Li Huang
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Ying Wang
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
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15
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Zhu Z, Zhao Y, Wen K, Li Q, Pan N, Fu S, Li F, Radua J, Vieta E, Kemp GJ, Biswa BB, Gong Q. Cortical thickness abnormalities in patients with bipolar disorder: A systematic review and meta-analysis. J Affect Disord 2022; 300:209-218. [PMID: 34971699 DOI: 10.1016/j.jad.2021.12.080] [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: 03/19/2021] [Revised: 10/10/2021] [Accepted: 12/19/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND An increasing number of neuroimaging studies report alterations of cortical thickness (CT) related to the neuropathology of bipolar disorder (BD). We provide here a whole-brain vertex-wise meta-analysis, which may help improve the spatial precision of these identifications. METHODS A comprehensive meta-analysis was performed to investigate the differences in CT between patients with BD and healthy controls (HCs) by using a newly developed mask for CT analysis in seed-based d mapping (SDM) meta-analytic software. We used meta-regression to explore the effects of demographics and clinical characteristics on CT. This meta-review was conducted in accordance with PRISMA guideline. RESULTS We identified 21 studies meeting criteria for the systematic review, of which 11 were eligible for meta-analysis. The meta-analysis comprising 649 BD patients and 818 HCs showed significant cortical thinning in the left insula extending to left Rolandic operculum and Heschl gyrus, the orbital part of left inferior frontal gyrus (IFG), the medial part of left superior frontal gyrus (SFG) as well as bilateral anterior cingulate cortex (ACC) in BD. In meta-regression analyses, mean patient age was negatively correlated with reduced CT in the left insula. LIMITATIONS All enrolled studies were cross-sectional; we could not explore the potential effects of medication and mood states due to the limited data. CONCLUSIONS Our results suggest that BD patients have significantly thinner frontoinsular cortex than HCs, and the results may be helpful in revealing specific neuroimaging biomarkers of BD patients.
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Affiliation(s)
- Ziyu Zhu
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Youjin Zhao
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, Sichuan, China; Functional and Molecular Imaging Key Laboratory of Sichuan Province, Chengdu, Sichuan, China
| | - Keren Wen
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Qian Li
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Nanfang Pan
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Shiqin Fu
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Fei Li
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, Sichuan, China; Functional and Molecular Imaging Key Laboratory of Sichuan Province, Chengdu, Sichuan, China
| | - Joaquim Radua
- Functional and Molecular Imaging Key Laboratory of Sichuan Province, Chengdu, Sichuan, China; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Mental Health Research Networking Center (CIBERSAM), Barcelona, Spain; Department of Clinical Neuroscience, Centre for Psychiatric Research and Education, Karolinska Institutet, Stockholm, Sweden; Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, Northern Ireland United Kingdom
| | - Eduard Vieta
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Mental Health Research Networking Center (CIBERSAM), Barcelona, Spain; Barcelona Bipolar Disorders and Depressive Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | - Graham J Kemp
- Liverpool Magnetic Resonance Imaging Centre (LiMRIC) and Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Bharat B Biswa
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, USA; The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China; Department of Radiology, West China Xiamen Hospital of Sichuan University, Xiamen, Fujian, China.
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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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17
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A neural network approach to optimising treatments for depression using data from specialist and community psychiatric services in Australia, New Zealand and Japan. Neural Comput Appl 2022; 35:11497-11516. [PMID: 35039718 PMCID: PMC8754538 DOI: 10.1007/s00521-021-06710-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 10/27/2021] [Indexed: 01/10/2023]
Abstract
This study investigated the application of a recurrent neural network for optimising pharmacological treatment for depression. A clinical dataset of 458 participants from specialist and community psychiatric services in Australia, New Zealand and Japan were extracted from an existing custom-built, web-based tool called Psynary . This data, which included baseline and self-completed reviews, was used to train and refine a novel algorithm which was a fully connected network feature extractor and long short-term memory algorithm was firstly trained in isolation and then integrated and annealed using slow learning rates due to the low dimensionality of the data. The accuracy of predicting depression remission before processing patient review data was 49.8%. After processing only 2 reviews, the accuracy was 76.5%. When considering a change in medication, the precision of changing medications was 97.4% and the recall was 71.4% . The medications with predicted best results were antipsychotics (88%) and selective serotonin reuptake inhibitors (87.9%). This is the first study that has created an all-in-one algorithm for optimising treatments for all subtypes of depression. Reducing treatment optimisation time for patients suffering with depression may lead to earlier remission and hence reduce the high levels of disability associated with the condition. Furthermore, in a setting where mental health conditions are increasing strain on mental health services, the utilisation of web-based tools for remote monitoring and machine/deep learning algorithms may assist clinicians in both specialist and primary care in extending specialist mental healthcare to a larger patient community.
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18
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Guo X, Wang W, Kang L, Shu C, Bai H, Tu N, Bu L, Gao Y, Wang G, Liu Z. Abnormal degree centrality in first-episode medication-free adolescent depression at rest: A functional magnetic resonance imaging study and support vector machine analysis. Front Psychiatry 2022; 13:926292. [PMID: 36245889 PMCID: PMC9556654 DOI: 10.3389/fpsyt.2022.926292] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 07/28/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Depression in adolescents is more heterogeneous and less often diagnosed than depression in adults. At present, reliable approaches to differentiating between adolescents who are and are not affected by depression are lacking. This study was designed to assess voxel-level whole-brain functional connectivity changes associated with adolescent depression in an effort to define an imaging-based biomarker associated with this condition. MATERIALS AND METHODS In total, 71 adolescents affected by major depressive disorder (MDD) and 71 age-, sex-, and education level-matched healthy controls were subjected to resting-state functional magnetic resonance imaging (rs-fMRI) based analyses of brain voxel-wise degree centrality (DC), with a support vector machine (SVM) being used for pattern classification analyses. RESULTS DC patterns derived from 16-min rs-fMRI analyses were able to effectively differentiate between adolescent MDD patients and healthy controls with 95.1% accuracy (136/143), and with respective sensitivity and specificity values of 92.1% (70/76) and 98.5% (66/67) based upon DC abnormalities detected in the right cerebellum. Specifically, increased DC was evident in the bilateral insula and left lingual area of MDD patients, together with reductions in the DC values in the right cerebellum and bilateral superior parietal lobe. DC values were not significantly correlated with disease severity or duration in these patients following correction for multiple comparisons. CONCLUSION These results suggest that whole-brain network centrality abnormalities may be present in many brain regions in adolescent depression patients. Accordingly, these DC maps may hold value as candidate neuroimaging biomarkers capable of differentiating between adolescents who are and are not affected by MDD, although further validation of these results will be critical.
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Affiliation(s)
- Xin Guo
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, Hubei, China.,Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College of London, London, United Kingdom
| | - Wei Wang
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Lijun Kang
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Chang Shu
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Hanpin Bai
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Ning Tu
- PET/CT/MRI and Molecular Imaging Center, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Lihong Bu
- PET/CT/MRI and Molecular Imaging Center, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Yujun Gao
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Gaohua Wang
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Zhongchun Liu
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
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19
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Montano CB, Jackson WC, Vanacore D, Weisler RH. Practical Advice for Primary Care Clinicians on the Safe and Effective Use of Vortioxetine for Patients with Major Depressive Disorder (MDD). Neuropsychiatr Dis Treat 2022; 18:867-879. [PMID: 35440869 PMCID: PMC9013418 DOI: 10.2147/ndt.s337703] [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: 09/09/2021] [Accepted: 03/04/2022] [Indexed: 01/10/2023] Open
Abstract
Primary care clinicians have a vital role to play in the diagnosis and management of patients with major depressive disorder (MDD). This includes screening for MDD as well as identifying other possible psychiatric disorders including bipolar disorder and/or other comorbidities. Once MDD is confirmed, partnering with patients in the shared decision-making process while considering different treatment options and best management of MDD over the course of their illness is recommended. Vortioxetine has been approved for the treatment of adults with MDD since 2013, and subsequent US label updates indicate that vortioxetine may be particularly beneficial for specific populations of patients with MDD, including those with treatment-emergent sexual dysfunction and patients experiencing certain cognitive symptoms. Given these recent label updates, this prescribing guide for vortioxetine aims to provide clear and practical guidance for primary care clinicians on the safe and effective use of vortioxetine for the treatment of MDD, including how to identify appropriate patients for treatment.
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Affiliation(s)
- C Brendan Montano
- Montano Wellness LLC, Cromwell, CT, USA.,Department of Family Medicine, University of Connecticut Medical School, Farmington, CT, USA
| | - W Clay Jackson
- Department of Psychiatry and Family Medicine, West Cancer Center, Germantown, TN, USA.,Department of Psychiatry and Family Medicine, University of Tennessee College of Medicine, Memphis, TN, USA
| | - Denise Vanacore
- Department of Nursing, Messiah University, Mechanicsburg, PA, USA
| | - Richard H Weisler
- Richard H. Weisler MD, P.A. & Associates, Raleigh, NC, USA.,Department of Psychiatry, Duke University and the University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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20
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Liu Y, Chen K, Luo Y, Wu J, Xiang Q, Peng L, Zhang J, Zhao W, Li M, Zhou X. Distinguish bipolar and major depressive disorder in adolescents based on multimodal neuroimaging: Results from the Adolescent Brain Cognitive Development study ®. Digit Health 2022; 8:20552076221123705. [PMID: 36090673 PMCID: PMC9452797 DOI: 10.1177/20552076221123705] [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: 08/11/2022] [Accepted: 08/16/2022] [Indexed: 01/10/2023] Open
Abstract
Background Major depressive disorder and bipolar disorder in adolescents are prevalent and are associated with cognitive impairment, executive dysfunction, and increased mortality. Early intervention in the initial stages of major depressive disorder and bipolar disorder can significantly improve personal health. Methods We collected 309 samples from the Adolescent Brain Cognitive Development study, including 116 adolescents with bipolar disorder, 64 adolescents with major depressive disorder, and 129 healthy adolescents, and employed a support vector machine to develop classification models for identification. We developed a multimodal model, which combined functional connectivity of resting-state functional magnetic resonance imaging and four anatomical measures of structural magnetic resonance imaging (cortical thickness, area, volume, and sulcal depth). We measured the performances of both multimodal and single modality classifiers. Results The multimodal classifiers showed outstanding performance compared with all five single modalities, and they are 100% for major depressive disorder versus healthy controls, 100% for bipolar disorder versus healthy control, 98.5% (95% CI: 95.4–100%) for major depressive disorder versus bipolar disorder, 100% for major depressive disorder versus depressed bipolar disorder and the leave-one-site-out analysis results are 77.4%, 63.3%, 79.4%, and 81.7%, separately. Conclusions The study shows that multimodal classifiers show high classification performances. Moreover, cuneus may be a potential biomarker to differentiate major depressive disorder, bipolar disorder, and healthy adolescents. Overall, this study can form multimodal diagnostic prediction workflows for clinically feasible to make more precise diagnose at the early stage and potentially reduce loss of personal pain and public society.
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Affiliation(s)
- Yujun Liu
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
- Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Kai Chen
- School of Public Health, University of Texas Health Science Center at Houston, Houston, USA
| | - Yangyang Luo
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
- Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Jiqiu Wu
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Qu Xiang
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
- Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Li Peng
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
- Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Jian Zhang
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
- Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Weiling Zhao
- Center for Computational Systems Medicine, School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, USA
| | - Mingliang Li
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
- Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Xiaobo Zhou
- Center for Computational Systems Medicine, School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, USA
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21
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Woo Y, Kang W, Kang Y, Kim A, Han KM, Tae WS, Ham BJ. Cortical Thickness and Surface Area Abnormalities in Bipolar I and II Disorders. Psychiatry Investig 2021; 18:850-863. [PMID: 34500506 PMCID: PMC8473857 DOI: 10.30773/pi.2021.0074] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 07/11/2021] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE Although bipolar II disorder (BD II) is not simply a mitigated form of bipolar I disorder (BD I), their neurobiological differences have not been elucidated. The present study aimed to explore cortical thickness (CT) and surface area (SA) in patients with BD I and BD II and healthy controls (HCs) to investigate the shared and unique neurobiological mechanisms of BD subtypes. METHODS We enrolled 30 and 44 patients with BD I and BD II, respectively, and 100 HCs. We evaluated CT and SA using FreeSurfer and estimated differences in CT and SA among the three groups (BD I vs. BD II vs. HC). We adjusted for age, sex, educational level, and intracranial volume as confounding factors. RESULTS We found widespread cortical thinning in the bilateral frontal, temporal, and occipital regions; cingulate gyrus; and insula in patients with BD. Alterations in SA, including increased SA of the pars triangularis and decreased SA of the insula, were noted in patients with BD. Overall, we found BD II patients demonstrated decreased SA in the right long insula compared to BD I patients. CONCLUSION Our results suggest that decreased SA in the right long insula is crucial for differentiating BD subtypes.
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Affiliation(s)
- Yoonmi Woo
- Department of Psychiatry, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Wooyoung Kang
- Department of Biomedical Sciences, Korea University College of Medicine, Seoul, Republic of Korea
| | - Youbin Kang
- Department of Biomedical Sciences, Korea University College of Medicine, Seoul, Republic of Korea
| | - Aram Kim
- Department of Biomedical Sciences, Korea University College of Medicine, Seoul, Republic of Korea
| | - Kyu-Man Han
- Department of Psychiatry, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Woo-Suk Tae
- Brain Convergence Research Center, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Byung-Joo Ham
- Department of Psychiatry, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
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22
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Tang G, Chen P, Chen G, Zhong S, Gong J, Zhong H, Ye T, Chen F, Wang J, Luo Z, Qi Z, Jia Y, Wang Y, Huang L. Inflammation is correlated with abnormal functional connectivity in unmedicated bipolar depression: an independent component analysis study of resting-state fMRI. Psychol Med 2021; 52:1-11. [PMID: 33602352 DOI: 10.1017/s003329172100009x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Inflammation might play a role in bipolar disorder (BD), but it remains unclear the relationship between inflammation and brain structural and functional abnormalities in patients with BD. In this study, we focused on the alterations of functional connectivity (FC), peripheral pro-inflammatory cytokines and their correlations to investigate the role of inflammation in FC in BD depression. METHODS In this study, 42 unmedicated patients with BD II depression and 62 healthy controls (HCs) were enrolled. Resting-state-functional magnetic resonance imaging was performed in all participants and independent component analysis was used. Serum levels of Interleukin-6 (IL-6) and Interleukin-8 (IL-8) were measured in all participants. Correlation between FC values and IL-6 and IL-8 levels in BD was calculated. RESULTS Compared with the HCs, BD II patients showed decreased FC in the left orbitofrontal cortex (OFC) implicating the limbic network and the right precentral gyrus implicating the somatomotor network. BD II showed increased IL-6 (p = 0.039), IL-8 (p = 0.002) levels. Moreover, abnormal FC in the right precentral gyrus were inversely correlated with the IL-8 (r = -0.458, p = 0.004) levels in BD II. No significant correlation was found between FC in the left OFC and cytokines levels. CONCLUSIONS Our findings that serum IL-8 levels are associated with impaired FC in the right precentral gyrus in BD II patients suggest that inflammation might play a crucial role in brain functional abnormalities in BD.
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Affiliation(s)
- Guixian Tang
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou510630, China
- Institute of Molecular and Functional Imaging, Jinan University, Guangzhou510630, China
| | - Pan Chen
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou510630, China
- Institute of Molecular and Functional Imaging, Jinan University, Guangzhou510630, China
| | - Guanmao Chen
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou510630, China
- Institute of Molecular and Functional Imaging, Jinan University, Guangzhou510630, China
| | - Shuming Zhong
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou510630, China
| | - JiaYing Gong
- Institute of Molecular and Functional Imaging, Jinan University, Guangzhou510630, China
- Department of Radiology, Six Affiliated Hospital of Sun Yat-sen University, Guangzhou510655, China
| | - Hui Zhong
- Biomedical Translational Research Institute, Jinan University, Guangzhou510630, China
| | - Tao Ye
- Clinical Laboratory Center, First Affiliated Hospital of Jinan University, Guangzhou510630, China
| | - Feng Chen
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou510630, China
- Institute of Molecular and Functional Imaging, Jinan University, Guangzhou510630, China
| | - Jurong Wang
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou510630, China
- Institute of Molecular and Functional Imaging, Jinan University, Guangzhou510630, China
| | - Zhenye Luo
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou510630, China
- Institute of Molecular and Functional Imaging, Jinan University, Guangzhou510630, China
| | - Zhangzhang Qi
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou510630, China
- Institute of Molecular and Functional Imaging, Jinan University, Guangzhou510630, China
| | - Yanbin Jia
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou510630, China
| | - Ying Wang
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou510630, China
- Institute of Molecular and Functional Imaging, Jinan University, Guangzhou510630, China
| | - Li Huang
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou510630, China
- Institute of Molecular and Functional Imaging, Jinan University, Guangzhou510630, China
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23
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Heyman-Kantor R, Rizk M, Sublette ME, Rubin-Falcone H, Fard YY, Burke AK, Oquendo MA, Sullivan GM, Milak MS, Zanderigo F, Mann JJ, Miller JM. Examining the relationship between gray matter volume and a continuous measure of bipolarity in unmedicated unipolar and bipolar depression. J Affect Disord 2021; 280:105-113. [PMID: 33207282 DOI: 10.1016/j.jad.2020.10.071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 09/10/2020] [Accepted: 10/31/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND It has been argued that unipolar major depressive disorder (MDD) and bipolar disorder (BD) exist on a continuous spectrum, given their overlapping symptomatology and genetic diatheses. The Bipolarity Index (BI) is a scale that considers bipolarity as a continuous construct and was developed to assess confidence in bipolar diagnosis. Here we investigated whether BI scores correlate with gray matter volume (GMV) in a sample of unmedicated unipolar and bipolar depressed individuals. METHODS 158 subjects (139 with MDD, 19 with BD) in a major depressive episode at time of scan were assigned BI scores. T1-weighted Magnetic Resonance Imaging scans were obtained and processed with Voxel-Based Morphometry using SPM12 (CAT12 toolbox) to assess GMV. Regression was performed at the voxel level to identify clusters of voxels whose GMV was associated with BI score, (p<0.001, family-wise error-corrected cluster-level p<0.05), with age, sex and total intracranial volume as covariates. RESULTS GMV was inversely correlated with BI score in four clusters located in left lateral occipital cortex, bilateral angular gyri and right frontal pole. Clusters were no longer significant after controlling for diagnosis. GMV was not correlated with BI score within the MDD cohort alone. LIMITATIONS Incomplete clinical data required use of a modified BI scale. CONCLUSION BI scores were inversely correlated with GMV in unmedicated subjects with MDD and BD, but these correlations appeared driven by categorical diagnosis. Future work will examine other imaging modalities and focus on elements of the BI scale most likely to be related to brain structure and function.
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Affiliation(s)
- Reuben Heyman-Kantor
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine
| | - Mina Rizk
- Molecular Imaging and Neuropathology Area, New York State Psychiatric Institute; Department of Psychiatry, Columbia University
| | - M Elizabeth Sublette
- Molecular Imaging and Neuropathology Area, New York State Psychiatric Institute; Department of Psychiatry, Columbia University
| | | | | | - Ainsley K Burke
- Molecular Imaging and Neuropathology Area, New York State Psychiatric Institute; Department of Psychiatry, Columbia University
| | - Maria A Oquendo
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania
| | | | - Matthew S Milak
- Molecular Imaging and Neuropathology Area, New York State Psychiatric Institute; Department of Psychiatry, Columbia University
| | - Francesca Zanderigo
- Molecular Imaging and Neuropathology Area, New York State Psychiatric Institute; Department of Psychiatry, Columbia University
| | - J John Mann
- Molecular Imaging and Neuropathology Area, New York State Psychiatric Institute; Department of Psychiatry, Columbia University
| | - Jeffrey M Miller
- Molecular Imaging and Neuropathology Area, New York State Psychiatric Institute; Department of Psychiatry, Columbia University.
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24
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Shared and specific dynamics of brain segregation and integration in bipolar disorder and major depressive disorder: A resting-state functional magnetic resonance imaging study. J Affect Disord 2021; 280:279-286. [PMID: 33221713 DOI: 10.1016/j.jad.2020.11.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 10/31/2020] [Accepted: 11/05/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND When bipolar disorder (BD) presents as the depressive state, it is often misdiagnosed as major depressive disorder (MDD). However, few studies have focused on dynamic differences in local brain activity and connectivity between BD and MDD. Therefore, the present study explored shared and specific patterns of abnormal dynamic brain segregation and integration in BD and MDD patients. METHODS BD Patients (n = 106), MDD patients (n = 114), and 130 healthy controls (HCs) underwent resting state functional magnetic resonance imaging (fMRI). We first used a sliding window analysis to evaluate the dynamic amplitude of low-frequency fluctuations (dALFF) and, based on the altered dALFF, further analyzed the dynamic functional connectivity (dFC) using a seed-based approach. RESULTS Both the BD and MDD groups showed decreased temporal variability of the dALFF (less dynamic segregation) in the bilateral posterior cingulate cortex (PCC)/precuneus compared with the HCs. The MDD group showed increased temporal variability of the dALFF (more dynamic segregation) in the left putamen compared with the controls, but there was no significant difference between the BD and HCs. The dFC analysis also showed that both the BD and MDD groups had reduced dFC (less dynamic integration) between the bilateral PCC/ precuneus and the left inferior parietal lobule compared with the HCs. LIMITATIONS This study was cross-sectional and did not examine data from remitted BD and MDD patients. CONCLUSION Our findings indicated disrupted dynamic balance between segregation and integration within the default mode network in both BD and MDD. Moreover, we found MDD-specific abnormal brain dynamics in the putamen.
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25
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Jiang X, Wang X, Jia L, Sun T, Kang J, Zhou Y, Wei S, Wu F, Kong L, Wang F, Tang Y. Structural and functional alterations in untreated patients with major depressive disorder and bipolar disorder experiencing first depressive episode: A magnetic resonance imaging study combined with follow-up. J Affect Disord 2021; 279:324-333. [PMID: 33096331 DOI: 10.1016/j.jad.2020.09.133] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 09/16/2020] [Accepted: 09/28/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) could assist in identifying objective biomarkers and follow-up study could effectively improve subjective diagnostic accuracy. By combining MRI with follow-up, this study aims to determine the shared and distinct alterations between major depressive disorder (MDD) and bipolar disorder (BD). METHODS Untreated patients with MDD experiencing the first episode were subjected to MRI and subsequent follow-up. Fifteen patients with mania or hypomania were regrouped into BD group. Twenty patients were still grouped as MDD after an average of 37.95 months follow-up. Thirty healthy controls (HCs) were recruited to match the patients. Gray matter volume (GMV) and amygdala-seed functional connectivity (FC) in the whole brain were detected and compared among the three groups. RESULTS GMV analysis revealed that the MDD and BD groups presented reduced GMV predominantly in the parietal, occipital, and frontal regions in the bilateral cerebrum compared with the HCs. The BD group had reduced GMV predominantly in the parietal, temporal, insular regions and the Rolandic operculum in the right-side cerebrum compared with MDD and HC groups. FC analysis revealed that the MDD and BD patients displayed increased FC values mainly in the bilateral parietal, and left occipital regions. Only the BD group displayed increased FC values in the temporal, occipital, parietal and limbic regions in the right-side cerebrum relative to HCs. LIMITATIONS The main limitation is the relatively small sample size. CONCLUSIONS Alterations in the cortical regions and cortico-limbic neural system may provide the scientific basis for differential diagnosis in affective disorders.
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Affiliation(s)
- Xiaowei Jiang
- Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, PR China; Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, PR China; Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, PR China
| | - Xinrui Wang
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, PR China
| | - Linna Jia
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, PR China
| | - Ting Sun
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, PR China
| | - Jiahui Kang
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, PR China
| | - Yifang Zhou
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, PR China; Department of Geriatric Medicine, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, PR China
| | - Shengnan Wei
- Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, PR China; Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, PR China
| | - Feng Wu
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, PR China
| | - Lingtao Kong
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, PR China
| | - Fei Wang
- Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, PR China; Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, PR China; Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, PR China.
| | - Yanqing Tang
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, PR China; Department of Geriatric Medicine, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, PR China.
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Wang J, Liu P, Zhang A, Yang C, Liu S, Wang J, Xu Y, Sun N. Specific Gray Matter Volume Changes of the Brain in Unipolar and Bipolar Depression. Front Hum Neurosci 2021; 14:592419. [PMID: 33505257 PMCID: PMC7829967 DOI: 10.3389/fnhum.2020.592419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 12/08/2020] [Indexed: 01/10/2023] Open
Abstract
To identify the common and specific structural basis of bipolar depression (BD) and unipolar depression (UD) is crucial for clinical diagnosis. In this study, a total of 85 participants, including 22 BD patients, 36 UD patients, and 27 healthy controls, were enrolled. A voxel-based morphology method was used to identify the common and specific changes of the gray matter volume (GMV) to determine the structural basis. Significant differences in GMV were found among the three groups. Compared with healthy controls, UD patients showed decreased GMV in the orbital part of the left inferior frontal gyrus, whereas BD patients showed decreased GMV in the orbital part of the left middle frontal gyrus. Compared with BD, UD patients have increased GMV in the left supramarginal gyrus and middle temporal gyrus. Our results revealed different structural changes in UD and BD patients suggesting BD and UD have different neurophysiological underpinnings. Our study contributes toward the biological determination of morphometric changes, which could help to discriminate between UD and BD.
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Affiliation(s)
- Junyan Wang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China.,Laboratory of Artificial Intelligence Assisted Diagnosis and Treatment for Mental Disorder, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Penghong Liu
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Aixia Zhang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Chunxia Yang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Sha Liu
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Jizhi Wang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Yong Xu
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China.,Laboratory of Artificial Intelligence Assisted Diagnosis and Treatment for Mental Disorder, First Hospital of Shanxi Medical University, Taiyuan, China.,Department of Mental Health, Shanxi Medical University, Taiyuan, China
| | - Ning Sun
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China.,Department of Mental Health, Shanxi Medical University, Taiyuan, China
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Najafpour Z, Fatemi A, Goudarzi Z, Goudarzi R, Shayanfard K, Noorizadeh F. Cost-effectiveness of neuroimaging technologies in management of psychiatric and insomnia disorders: A meta-analysis and prospective cost analysis. J Neuroradiol 2021; 48:348-358. [PMID: 33383065 DOI: 10.1016/j.neurad.2020.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/12/2020] [Accepted: 12/15/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND The optimal diagnostic strategy for patients with psychiatric and insomnia disorders has not been established yet. PURPOSE The purpose of this study was to perform cost-effectiveness analysis of six neuroimaging technologies in diagnosis of patients with psychiatric and insomnia disorders. METHODS An economic evaluation study was conducted in three parts, including a systematic review for determining diagnostic accuracy, a descriptive cross-sectional study with Activity-Based Costing (ABC) technique for tracing resource consumption, and a cost-effectiveness analysis using a short-term decision-analytic model. RESULTS In the first phase, 93 diagnostic accuracy studies were included in the systematic review. The accumulated results (meta-analysis) showed that the highest diagnostic accuracy for psychiatric and insomnia disorders was attributed to PET (sensitivity of 90% and specificity of 80%) and MRI (sensitivity of 76% and specificity of 78%) respectively. In the second phase of the study, we calculated the cost of each technology. The results showed that MRI has the lowest cost. Based on the results in the model of cost-effectiveness sMRI ($ 50.08 per accurate diagnosis) and MRI ($ 58.54 per accurate diagnosis) were more cost-effective neuroimaging technologies. CONCLUSION In psychiatric disorders, no single strategy was characterized by both low cost and high accuracy. However, MRI and PET scan had lower cost and higher accuracy for psychiatric disorders, respectively. MRI was the least costly with the highest diagnostic accuracy in insomnia disorders. Based on our model, sMRI in psychiatric disorders and MRI in insomnia disorders were the most cost-effective technologies.
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Affiliation(s)
- Zhila Najafpour
- Department of Health Care Management, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Asieh Fatemi
- Dpartment of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Faculty of Paramedical sciences, Rafsanjan University of Medical Sciences, Iran.
| | - Zahra Goudarzi
- Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
| | - Reza Goudarzi
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
| | | | - Farsad Noorizadeh
- Basir Eye Health Research Center, Exceptional Talents Development Center, Tehran University of Medical Sciences, Tehran, Iran.
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28
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Scaini G, Valvassori SS, Diaz AP, Lima CN, Benevenuto D, Fries GR, Quevedo J. Neurobiology of bipolar disorders: a review of genetic components, signaling pathways, biochemical changes, and neuroimaging findings. ACTA ACUST UNITED AC 2020; 42:536-551. [PMID: 32267339 PMCID: PMC7524405 DOI: 10.1590/1516-4446-2019-0732] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 12/27/2019] [Indexed: 01/10/2023]
Abstract
Bipolar disorder (BD) is a chronic mental illness characterized by changes in mood that alternate between mania and hypomania or between depression and mixed states, often associated with functional impairment. Although effective pharmacological and non-pharmacological treatments are available, several patients with BD remain symptomatic. The advance in the understanding of the neurobiology underlying BD could help in the identification of new therapeutic targets as well as biomarkers for early detection, prognosis, and response to treatment in BD. In this review, we discuss genetic, epigenetic, molecular, physiological and neuroimaging findings associated with the neurobiology of BD. Despite the advances in the pathophysiological knowledge of BD, the diagnosis and management of the disease are still essentially clinical. Given the complexity of the brain and the close relationship between environmental exposure and brain function, initiatives that incorporate genetic, epigenetic, molecular, physiological, clinical, environmental data, and brain imaging are necessary to produce information that can be translated into prevention and better outcomes for patients with BD.
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Affiliation(s)
- Giselli Scaini
- Translational Psychiatry Program Louis A. Faillace, Department of Psychiatry and Behavioral Sciences at McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Samira S Valvassori
- Laboratório de Psiquiatria Translacional, Programa de Pós-Graduação em Ciências da Saúde, Universidade do Extremo Sul Catarinense (UNESC), Criciúma, SC, Brazil
| | - Alexandre P Diaz
- Translational Psychiatry Program Louis A. Faillace, Department of Psychiatry and Behavioral Sciences at McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.,Center of Excellence on Mood Disorders Louis A. Faillace, Department of Psychiatry and Behavioral Sciences at McGovern Medical School, UTHealth, Houston, TX, USA
| | - Camila N Lima
- Translational Psychiatry Program Louis A. Faillace, Department of Psychiatry and Behavioral Sciences at McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Deborah Benevenuto
- Translational Psychiatry Program Louis A. Faillace, Department of Psychiatry and Behavioral Sciences at McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Gabriel R Fries
- Translational Psychiatry Program Louis A. Faillace, Department of Psychiatry and Behavioral Sciences at McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.,Center for Precision Health, School of Biomedical Informatics, UTHealth, Houston, TX, USA.,Neuroscience Graduate Program, Graduate School of Biomedical Sciences, The University of Texas MD Anderson Cancer Center, UTHealth, Houston, TX, USA
| | - Joao Quevedo
- Translational Psychiatry Program Louis A. Faillace, Department of Psychiatry and Behavioral Sciences at McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.,Laboratório de Psiquiatria Translacional, Programa de Pós-Graduação em Ciências da Saúde, Universidade do Extremo Sul Catarinense (UNESC), Criciúma, SC, Brazil.,Center of Excellence on Mood Disorders Louis A. Faillace, Department of Psychiatry and Behavioral Sciences at McGovern Medical School, UTHealth, Houston, TX, USA.,Neuroscience Graduate Program, Graduate School of Biomedical Sciences, The University of Texas MD Anderson Cancer Center, UTHealth, Houston, TX, USA
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29
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Espinoza Oyarce DA, Shaw ME, Alateeq K, Cherbuin N. Volumetric brain differences in clinical depression in association with anxiety: a systematic review with meta-analysis. J Psychiatry Neurosci 2020; 45:406-429. [PMID: 32726102 PMCID: PMC7595741 DOI: 10.1503/jpn.190156] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Structural differences associated with depression have not been confirmed in brain regions apart from the hippocampus. Comorbid anxiety has been inconsistently assessed, and may explain discrepancies in previous findings. We investigated the link between depression, comorbid anxiety and brain structure. METHODS We followed Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines (PROSPERO CRD42018089286). We searched the Cochrane Library, MEDLINE, PsycInfo, PubMed and Scopus, from database inception to Sept. 13, 2018, for MRI case-control studies that reported brain volumes in healthy adults and adults with clinical depression. We summarized mean volumetric differences using meta-analyses, and we assessed demographics, depression factors and segmentation procedure as moderators using meta-regressions. RESULTS We included 112 studies in the meta-analyses, assessing 4911 healthy participants and 5934 participants with depression (mean age 49.8 yr, 68.2% female). Volume effects were greater in late-onset depression and in multiple episodes of depression. Adults with depression and no comorbidity showed significantly lower volumes in the putamen, pallidum and thalamus, as well as significantly lower grey matter volume and intracranial volume; the largest effects were in the hippocampus (6.8%, p < 0.001). Adults with depression and comorbid anxiety showed significantly higher volumes in the amygdala (3.6%, p < 0.001). Comorbid anxiety lowered depression effects by 3% on average. Sex moderated reductions in intracranial volume. LIMITATIONS High heterogeneity in hippocampus effects could not be accounted for by any moderator. Data on symptom severity and medication were sparse, but other factors likely made significant contributions. CONCLUSION Depression-related differences in brain structure were modulated by comorbid anxiety, chronicity of symptoms and onset of illness. Early diagnosis of anxiety symptomatology will prove crucial to ensuring effective, tailored treatments for improving long-term mental health and mitigating cognitive problems, given the effects in the hippocampus.
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Affiliation(s)
- Daniela A Espinoza Oyarce
- From the Centre for Research on Ageing, Health and Wellbeing, The Australian National University, Canberra, ACT, Australia (Espinoza Oyarce, Alateeq, Cherbuin); and the College of Engineering and Computer Science, The Australian National University, Canberra, ACT, Australia (Shaw)
| | - Marnie E Shaw
- From the Centre for Research on Ageing, Health and Wellbeing, The Australian National University, Canberra, ACT, Australia (Espinoza Oyarce, Alateeq, Cherbuin); and the College of Engineering and Computer Science, The Australian National University, Canberra, ACT, Australia (Shaw)
| | - Khawlah Alateeq
- From the Centre for Research on Ageing, Health and Wellbeing, The Australian National University, Canberra, ACT, Australia (Espinoza Oyarce, Alateeq, Cherbuin); and the College of Engineering and Computer Science, The Australian National University, Canberra, ACT, Australia (Shaw)
| | - Nicolas Cherbuin
- From the Centre for Research on Ageing, Health and Wellbeing, The Australian National University, Canberra, ACT, Australia (Espinoza Oyarce, Alateeq, Cherbuin); and the College of Engineering and Computer Science, The Australian National University, Canberra, ACT, Australia (Shaw)
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30
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Rashid B, Calhoun V. Towards a brain-based predictome of mental illness. Hum Brain Mapp 2020; 41:3468-3535. [PMID: 32374075 PMCID: PMC7375108 DOI: 10.1002/hbm.25013] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 04/06/2020] [Accepted: 04/06/2020] [Indexed: 01/10/2023] Open
Abstract
Neuroimaging-based approaches have been extensively applied to study mental illness in recent years and have deepened our understanding of both cognitively healthy and disordered brain structure and function. Recent advancements in machine learning techniques have shown promising outcomes for individualized prediction and characterization of patients with psychiatric disorders. Studies have utilized features from a variety of neuroimaging modalities, including structural, functional, and diffusion magnetic resonance imaging data, as well as jointly estimated features from multiple modalities, to assess patients with heterogeneous mental disorders, such as schizophrenia and autism. We use the term "predictome" to describe the use of multivariate brain network features from one or more neuroimaging modalities to predict mental illness. In the predictome, multiple brain network-based features (either from the same modality or multiple modalities) are incorporated into a predictive model to jointly estimate features that are unique to a disorder and predict subjects accordingly. To date, more than 650 studies have been published on subject-level prediction focusing on psychiatric disorders. We have surveyed about 250 studies including schizophrenia, major depression, bipolar disorder, autism spectrum disorder, attention-deficit hyperactivity disorder, obsessive-compulsive disorder, social anxiety disorder, posttraumatic stress disorder, and substance dependence. In this review, we present a comprehensive review of recent neuroimaging-based predictomic approaches, current trends, and common shortcomings and share our vision for future directions.
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Affiliation(s)
- Barnaly Rashid
- Department of PsychiatryHarvard Medical SchoolBostonMassachusettsUSA
| | - Vince Calhoun
- Tri‐Institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS)Georgia State University, Georgia Institute of Technology, and Emory UniversityAtlantaGeorgiaUSA
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31
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Song H, Chon MW, Ryu V, Yu R, Lee DK, Lee H, Lee W, Lee JH, Park DY. Cortical Volumetric Correlates of Childhood Trauma, Anxiety, and Impulsivity in Bipolar Disorder. Psychiatry Investig 2020; 17:627-635. [PMID: 32571005 PMCID: PMC7385221 DOI: 10.30773/pi.2019.0305] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 03/17/2020] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE More recently, attention has turned to the linkage between childhood trauma and emotional dysregulation, but the evidence in bipolar disorder (BD) is limited. To determine neurobiological relationships between childhood trauma, current anxiety, and impulsivity, we investigated cortical volumetric correlates of these clinical factors in BD. METHODS We studied 36 patients with DSM-5 BD and 29 healthy controls. Childhood trauma, coexisting anxiety, and impulsivity were evaluated with the Korean version-Childhood Trauma Questionnaire (CTQ), the Korean version-Beck Anxiety Inventory (BAI), and the Korean version-Barratt Impulsiveness Scale (BIS). Voxel-based morphometry (VBM) was used to assess gray matter volume (GMV) alterations on the brain magnetic resonance imaging (MRI). Partial correlation analyses were conducted to examine associations between the GMV and each scale in the BD group. RESULTS Childhood trauma, anxiety, and impulsivity were interrelated in BD. BD patients revealed significant inverse correlations between the GMV in the right precentral gyrus and CTQ scores (r=-0.609, p<0.0003); between the GMV in the left middle frontal gyrus and BAI scores (r=-0.363, p=0.044). Moreover, patients showed similar tendency of negative correlations between the GMV in the right precentral gyrus and BIS scores; between the GMV in the left middle frontal gyrus and CTQ scores. CONCLUSION The present study provides evidence for a neural basis between childhood trauma and affect regulations in BD. The GMV alterations in multiple frontal lobe areas may represent neurobiological markers for anticipating the course of BD.
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Affiliation(s)
- Hyehyun Song
- Department of Psychiatry, National Center for Mental Health, Seoul, Republic of Korea
| | - Myong-Wuk Chon
- Department of Psychiatry, National Center for Mental Health, Seoul, Republic of Korea
| | - Vin Ryu
- Department of Mental Health Research, National Center for Mental Health, Seoul, Republic of Korea
| | - Rina Yu
- Department of Mental Health Research, National Center for Mental Health, Seoul, Republic of Korea
| | - Dong-Kyun Lee
- Department of Mental Health Research, National Center for Mental Health, Seoul, Republic of Korea
| | - Hyeongrae Lee
- Department of Mental Health Research, National Center for Mental Health, Seoul, Republic of Korea
| | - Wonhye Lee
- Department of Clinical Psychology, National Center for Mental Health, Seoul, Republic of Korea
| | - Jung Hyun Lee
- Department of Psychiatry, National Center for Mental Health, Seoul, Republic of Korea
| | - Dong Yeon Park
- Department of Mood Disorders, National Center for Mental Health, Seoul, Republic of Korea
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32
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Claude LA, Houenou J, Duchesnay E, Favre P. Will machine learning applied to neuroimaging in bipolar disorder help the clinician? A critical review and methodological suggestions. Bipolar Disord 2020; 22:334-355. [PMID: 32108409 DOI: 10.1111/bdi.12895] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES The existence of anatomofunctional brain abnormalities in bipolar disorder (BD) is now well established by magnetic resonance imaging (MRI) studies. To create diagnostic and prognostic tools, as well as identifying biologically valid subtypes of BD, research has recently turned towards the use of machine learning (ML) techniques. We assessed both supervised ML and unsupervised ML studies in BD to evaluate their robustness, reproducibility and the potential need for improvement. METHOD We systematically searched for studies using ML algorithms based on MRI data of patients with BD until February 2019. RESULT We identified 47 studies, 45 using supervised ML techniques and 2 including unsupervised ML analyses. Among supervised studies, 43 focused on diagnostic classification. The reported accuracies for classification of BD ranged between (a) 57% and 100%, for BD vs healthy controls; (b) 49.5% and 93.1% for BD vs patients with major depressive disorder; and (c) 50% and 96.2% for BD vs patients with schizophrenia. Reported accuracies for discriminating subjects genetically at risk for BD (either from control or from patients with BD) ranged between 64.3% and 88.93%. CONCLUSIONS Although there are strong methodological limitations in previous studies and an important need for replication in large multicentric samples, the conclusions of our review bring hope of future computer-aided diagnosis of BD and pave the way for other applications, such as treatment response prediction. To reinforce the reliability of future results we provide methodological suggestions for good practice in conducting and reporting MRI-based ML studies in BD.
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Affiliation(s)
- Laurie-Anne Claude
- APHP, Mondor University Hospitals, DMU IMPACT Psychiatry and Addictology, UPEC, Créteil, France.,Neurospin, CEA, Université Paris-Saclay, Gif-sur-Yvette, France.,INSERM Unit U955, IMRB, Team 15, "Neurotranslational Psychiatry", Créteil, France.,FondaMental Foundation, Créteil, France
| | - Josselin Houenou
- APHP, Mondor University Hospitals, DMU IMPACT Psychiatry and Addictology, UPEC, Créteil, France.,Neurospin, CEA, Université Paris-Saclay, Gif-sur-Yvette, France.,INSERM Unit U955, IMRB, Team 15, "Neurotranslational Psychiatry", Créteil, France.,FondaMental Foundation, Créteil, France
| | | | - Pauline Favre
- Neurospin, CEA, Université Paris-Saclay, Gif-sur-Yvette, France.,INSERM Unit U955, IMRB, Team 15, "Neurotranslational Psychiatry", Créteil, France.,FondaMental Foundation, Créteil, France
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33
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Vai B, Parenti L, Bollettini I, Cara C, Verga C, Melloni E, Mazza E, Poletti S, Colombo C, Benedetti F. Predicting differential diagnosis between bipolar and unipolar depression with multiple kernel learning on multimodal structural neuroimaging. Eur Neuropsychopharmacol 2020; 34:28-38. [PMID: 32238313 DOI: 10.1016/j.euroneuro.2020.03.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 01/24/2020] [Accepted: 03/06/2020] [Indexed: 01/10/2023]
Abstract
One of the greatest challenges in providing early effective treatment in mood disorders is the early differential diagnosis between major depression (MDD) and bipolar disorder (BD). A remarkable need exists to identify reliable biomarkers for these disorders. We integrate structural neuroimaging techniques (i.e. Tract-based Spatial Statistics, TBSS, and Voxel-based morphometry) in a multiple kernel learning procedure in order to define a predictive function of BD against MDD diagnosis in a sample of 148 patients. We achieved a balanced accuracy of 73.65% with a sensitivity for BD of 74.32% and specificity for MDD of 72.97%. Mass-univariates analyses showed reduced grey matter volume in right hippocampus, amygdala, parahippocampal, fusiform gyrus, insula, rolandic and frontal operculum and cerebellum, in BD compared to MDD. Volumes in these regions and in anterior cingulate cortex were also reduced in BD compared to healthy controls (n = 74). TBSS analyses revealed widespread significant effects of diagnosis on fractional anisotropy, axial, radial, and mean diffusivity in several white matter tracts, suggesting disruption of white matter microstructure in depressed patients compared to healthy controls, with worse pattern for MDD. To best of our knowledge, this is the first study combining grey matter and diffusion tensor imaging in predicting BD and MDD diagnosis. Our results prompt brain quantitative biomarkers and multiple kernel learning as promising tool for personalized treatment in mood disorders.
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Affiliation(s)
- Benedetta Vai
- Division of Neuroscience, Psychiatry and Clinical Psychobiology Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy; University Vita-Salute San Raffaele, Milano, Italy; Fondazione Centro San Raffaele, Milano, Italy.
| | - Lorenzo Parenti
- Division of Neuroscience, Psychiatry and Clinical Psychobiology Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Irene Bollettini
- Division of Neuroscience, Psychiatry and Clinical Psychobiology Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Cristina Cara
- Division of Neuroscience, Psychiatry and Clinical Psychobiology Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Chiara Verga
- Division of Neuroscience, Psychiatry and Clinical Psychobiology Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Elisa Melloni
- Division of Neuroscience, Psychiatry and Clinical Psychobiology Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Elena Mazza
- Division of Neuroscience, Psychiatry and Clinical Psychobiology Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy; University Vita-Salute San Raffaele, Milano, Italy
| | - Sara Poletti
- Division of Neuroscience, Psychiatry and Clinical Psychobiology Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy; University Vita-Salute San Raffaele, Milano, Italy
| | - Cristina Colombo
- Division of Neuroscience, Psychiatry and Clinical Psychobiology Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy; University Vita-Salute San Raffaele, Milano, Italy
| | - Francesco Benedetti
- Division of Neuroscience, Psychiatry and Clinical Psychobiology Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy; University Vita-Salute San Raffaele, Milano, Italy
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34
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Achalia R, Sinha A, Jacob A, Achalia G, Kaginalkar V, Venkatasubramanian G, Rao NP. A proof of concept machine learning analysis using multimodal neuroimaging and neurocognitive measures as predictive biomarker in bipolar disorder. Asian J Psychiatr 2020; 50:101984. [PMID: 32143176 DOI: 10.1016/j.ajp.2020.101984] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 02/18/2020] [Accepted: 02/24/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Concomitant use of complementary, multimodal imaging measures and neurocognitive measures is reported to have higher accuracy as a biomarker in Alzheimer's dementia. However, such an approach has not been examined to differentiate healthy individuals from Bipolar disorder. In this study, we examined the utility of support vector machine (SVM) technique to differentiate bipolar disorder patients and healthy using structural, functional and diffusion tensor images of brain and neurocognitive measures. METHODS 30 patients with Bipolar disorder-I and 30 age, sex matched individuals participated in the study. Structural MRI, resting state functional MRI and diffusion tensor images were obtained using a 1.5 T scanner. All participants were administered neuropsychological tests to measure executive functions. SVM, a supervised machine learning technique was applied to differentiate patients and healthy individuals with k-fold cross validation over 10 trials. RESULTS The composite marker consisting of both neuroimaging and neuropsychological measures, had an accuracy of 87.60 %, sensitivity of 82.3 % and specificity of 92.7 %. The performance of composite marker was better compared to that of individual markers on classificatory. CONCLUSIONS We were able to achieve a high accuracy for machine learning technique in distinguishing BD from HV using a combination of multimodal neuroimaging and neurocognitive measures. Findings of this proof of concept study, if replicated in larger samples, could have potential clinical applications.
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Affiliation(s)
| | - Anannya Sinha
- National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Arpitha Jacob
- National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Garimaa Achalia
- Achalia Neuropsychiatry Hospital, Aurangabad, Maharashtra, India
| | | | | | - Naren P Rao
- National Institute of Mental Health and Neurosciences, Bangalore, India.
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35
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Wollenhaupt-Aguiar B, Librenza-Garcia D, Bristot G, Przybylski L, Stertz L, Kubiachi Burque R, Ceresér KM, Spanemberg L, Caldieraro MA, Frey BN, Fleck MP, Kauer-Sant'Anna M, Passos IC, Kapczinski F. Differential biomarker signatures in unipolar and bipolar depression: A machine learning approach. Aust N Z J Psychiatry 2020; 54:393-401. [PMID: 31789053 DOI: 10.1177/0004867419888027] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE This study used machine learning techniques combined with peripheral biomarker measurements to build signatures to help differentiating (1) patients with bipolar depression from patients with unipolar depression, and (2) patients with bipolar depression or unipolar depression from healthy controls. METHODS We assessed serum levels of interleukin-2, interleukin-4, interleukin-6, interleukin-10, tumor necrosis factor-α, interferon-γ, interleukin-17A, brain-derived neurotrophic factor, lipid peroxidation and oxidative protein damage in 54 outpatients with bipolar depression, 54 outpatients with unipolar depression and 54 healthy controls, matched by sex and age. Depressive symptoms were assessed using the Hamilton Depression Rating Scale. Variable selection was performed with recursive feature elimination with a linear support vector machine kernel, and the leave-one-out cross-validation method was used to test and validate our model. RESULTS Bipolar vs unipolar depression classification achieved an area under the receiver operating characteristics (ROC) curve (AUC) of 0.69, with 0.62 sensitivity and 0.66 specificity using three selected biomarkers (interleukin-4, thiobarbituric acid reactive substances and interleukin-10). For the comparison of bipolar depression vs healthy controls, the model retained five variables (interleukin-6, interleukin-4, thiobarbituric acid reactive substances, carbonyl and interleukin-17A), with an AUC of 0.70, 0.62 sensitivity and 0.7 specificity. Finally, unipolar depression vs healthy controls comparison retained seven variables (interleukin-6, Carbonyl, brain-derived neurotrophic factor, interleukin-10, interleukin-17A, interleukin-4 and tumor necrosis factor-α), with an AUC of 0.74, a sensitivity of 0.68 and 0.70 specificity. CONCLUSION Our findings show the potential of machine learning models to aid in clinical practice, leading to more objective assessment. Future studies will examine the possibility of combining peripheral blood biomarker data with other biological data to develop more accurate signatures.
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Affiliation(s)
- Bianca Wollenhaupt-Aguiar
- Department of Psychiatry and Behavioural Neurosciences, McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.,Bipolar Disorder Program, Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Diego Librenza-Garcia
- Department of Psychiatry and Behavioural Neurosciences, McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.,Bipolar Disorder Program, Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.,Graduation Program in Psychiatry, Department of Psychiatry, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Giovana Bristot
- Bipolar Disorder Program, Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.,Graduate Program in Biological Sciences: Biochemistry, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Laura Przybylski
- Graduation Program in Medicine, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Laura Stertz
- Bipolar Disorder Program, Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.,Graduate Program in Biological Sciences: Biochemistry, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Renan Kubiachi Burque
- Bipolar Disorder Program, Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Keila Mendes Ceresér
- Bipolar Disorder Program, Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.,Graduation Program in Psychiatry, Department of Psychiatry, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Lucas Spanemberg
- Graduation Program in Psychiatry, Department of Psychiatry, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Mood Disorders Program, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Neuroscience Training Center, School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil.,Section of Negative Affect and Social Processes, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Marco Antônio Caldieraro
- Graduation Program in Psychiatry, Department of Psychiatry, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Mood Disorders Program, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.,Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Marcelo P Fleck
- Graduation Program in Psychiatry, Department of Psychiatry, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Mood Disorders Program, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Department of Legal Medicine and Psychiatry, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Marcia Kauer-Sant'Anna
- Bipolar Disorder Program, Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.,Graduation Program in Psychiatry, Department of Psychiatry, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Graduate Program in Biological Sciences: Biochemistry, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Department of Legal Medicine and Psychiatry, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Ives Cavalcante Passos
- Bipolar Disorder Program, Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.,Graduation Program in Psychiatry, Department of Psychiatry, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Department of Legal Medicine and Psychiatry, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Flavio Kapczinski
- Department of Psychiatry and Behavioural Neurosciences, McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.,Bipolar Disorder Program, Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.,Graduation Program in Psychiatry, Department of Psychiatry, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Department of Legal Medicine and Psychiatry, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
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Using structural MRI to identify bipolar disorders - 13 site machine learning study in 3020 individuals from the ENIGMA Bipolar Disorders Working Group. Mol Psychiatry 2020; 25:2130-2143. [PMID: 30171211 PMCID: PMC7473838 DOI: 10.1038/s41380-018-0228-9] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 06/11/2018] [Accepted: 07/24/2018] [Indexed: 01/10/2023]
Abstract
Bipolar disorders (BDs) are among the leading causes of morbidity and disability. Objective biological markers, such as those based on brain imaging, could aid in clinical management of BD. Machine learning (ML) brings neuroimaging analyses to individual subject level and may potentially allow for their diagnostic use. However, fair and optimal application of ML requires large, multi-site datasets. We applied ML (support vector machines) to MRI data (regional cortical thickness, surface area, subcortical volumes) from 853 BD and 2167 control participants from 13 cohorts in the ENIGMA consortium. We attempted to differentiate BD from control participants, investigated different data handling strategies and studied the neuroimaging/clinical features most important for classification. Individual site accuracies ranged from 45.23% to 81.07%. Aggregate subject-level analyses yielded the highest accuracy (65.23%, 95% CI = 63.47-67.00, ROC-AUC = 71.49%, 95% CI = 69.39-73.59), followed by leave-one-site-out cross-validation (accuracy = 58.67%, 95% CI = 56.70-60.63). Meta-analysis of individual site accuracies did not provide above chance results. There was substantial agreement between the regions that contributed to identification of BD participants in the best performing site and in the aggregate dataset (Cohen's Kappa = 0.83, 95% CI = 0.829-0.831). Treatment with anticonvulsants and age were associated with greater odds of correct classification. Although short of the 80% clinically relevant accuracy threshold, the results are promising and provide a fair and realistic estimate of classification performance, which can be achieved in a large, ecologically valid, multi-site sample of BD participants based on regional neurostructural measures. Furthermore, the significant classification in different samples was based on plausible and similar neuroanatomical features. Future multi-site studies should move towards sharing of raw/voxelwise neuroimaging data.
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Jiang X, Fu S, Yin Z, Kang J, Wang X, Zhou Y, Wei S, Wu F, Kong L, Wang F, Tang Y. Common and distinct neural activities in frontoparietal network in first-episode bipolar disorder and major depressive disorder: Preliminary findings from a follow-up resting state fMRI study. J Affect Disord 2020; 260:653-659. [PMID: 31542559 DOI: 10.1016/j.jad.2019.09.063] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 09/05/2019] [Accepted: 09/11/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND It is difficult to distinguish bipolar disorder (BD) from major depressive disorder (MDD), especially with the initial depressive episode. In this study, we compared neural activities of BD and MDD patients during the first-episode (FE) to investigate common and distinct neural activities and further explore predictive indicators in the two diseases. METHODS FE-MDD patients were performed resting state functional magnetic resonance imaging and followed up after scanning. After follow-up, FE-MDD patients were regrouped into FE-BD and FE-MDD patients. The study included 24 FE-BD patients, 28 FE-MDD patients, and 30 age- and sex-matched healthy controls (HC) to investigate neural activities with regional homogeneity (ReHo) analysis among the 3 groups. RESULTS Compared to HC, FE-BD patients displayed significantly higher ReHo values in the superior frontal gyrus, the medial superior frontal gyrus within right-side cerebral hemisphere than FE-MDD patients and HC. Compared to HC, FE-BD and FE-MDD patients displayed significant decreased ReHo values in the paracentral lobule, the precuneus and the median cingulate and paracingulate gyrus within bilateral cerebral hemisphere, and the postcentral gyrus and the precentral gyrus within the right-side. FE-BD displayed significant lower ReHo values than FE-MDD patients in these regions. LIMITATIONS The potential effects of medicine, age, course of disease and handedness on results could not be ignored. CONCLUSIONS Abnormal neural activities of frontoparietal network may provide common and distinct markers to affective disorders and scientific basis for further prediction researches of affective disorders.
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Affiliation(s)
- Xiaowei Jiang
- Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, China; Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, China; Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, China
| | - Shinan Fu
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, China
| | - Zhiyang Yin
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, China
| | - Jiahui Kang
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, China
| | - Xinrui Wang
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, China
| | - Yifang Zhou
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, China; Department of Geriatric Medicine, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, China
| | - Shengnan Wei
- Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, China; Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, China
| | - Feng Wu
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, China
| | - Lingtao Kong
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, China
| | - Fei Wang
- Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, China; Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, China; Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, China.
| | - Yanqing Tang
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, China; Department of Geriatric Medicine, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, China.
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Squarcina L, Dagnew TM, Rivolta MW, Bellani M, Sassi R, Brambilla P. Automated cortical thickness and skewness feature selection in bipolar disorder using a semi-supervised learning method. J Affect Disord 2019; 256:416-423. [PMID: 31229930 DOI: 10.1016/j.jad.2019.06.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 03/26/2019] [Accepted: 06/07/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Bipolar disorder (BD) broadly affects brain structure, in particular areas involved in emotion processing and cognition. In the last years, the psychiatric field's interest in machine learning approaches has been steadily growing, thanks to the potentiality of automatically discriminating patients from healthy controls. METHODS In this work, we employed cortical thickness of 58 regions of interest obtained from magnetic resonance imaging scans of 41 BD patients and 34 healthy controls, to automatically identify the regions which are mostly involved with the disease. We used a semi-supervised method, addressing the criticisms on supervised methods, related to the fact that the diagnosis is not unaffected by uncertainty. RESULTS Our results confirm findings in previous studies, with a classification accuracy of about 75% when mean thickness and skewness of up to five regions are considered. We obtained that the parietal lobe and some areas in the temporal sulcus were the regions which were the most involved with BD. LIMITATIONS The major limitation of our work is the limited size or our dataset, but in line with other recent machine learning works in the field. Moreover, we considered chronic patients, whose brain characteristics may thus be affected. CONCLUSIONS The automatic selection of the brain regions most involved in BD may be of great importance when dealing with the pathogenesis of the disorder. Our method selected regions which are known to be involved with BD, indicating that damage to the identified areas can be considered as a marker of disease.
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Affiliation(s)
- L Squarcina
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
| | - T M Dagnew
- Department of Computer Science, University of Milan, Milan, Italy.
| | - M W Rivolta
- Department of Computer Science, University of Milan, Milan, Italy
| | - M Bellani
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Italy
| | - R Sassi
- Department of Computer Science, University of Milan, Milan, Italy
| | - P Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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J M Bogie B, Persaud MR, Smith D, Kapczinski FP, Frey BN. Explicit emotional memory biases in mood disorders: A systematic review. Psychiatry Res 2019; 278:162-172. [PMID: 31200195 DOI: 10.1016/j.psychres.2019.06.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 06/02/2019] [Accepted: 06/03/2019] [Indexed: 01/10/2023]
Abstract
Research suggests that major depressive disorder (MDD) and bipolar disorder (BD) are both associated with unique emotional memory (EM) biases. To better elucidate the EM phenotypes of these disorders, we systematically reviewed the literature on non-autobiographical explicit EM biases in individuals with MDD and BD compared to healthy controls. The following databases were searched: Cochrane, Embase, HAPI, LILACs, Medline, PsycInfo and Web of Science. Grey literature and hand searches were also performed. Fourteen studies met full eligibility criteria. Eleven studies included data from an MDD sample (10 during acute depression, 1 during euthymia) and 3 studies included data from a BD sample (2 during acute mood episodes, 1 during euthymia). Only 3 of the studies in acute depression revealed a negative explicit EM bias. One study in MDD during euthymia revealed an EM deficit for negative stimuli. One of the two studies in BD (type I; BD-I) during an acute mood episode revealed a positive explicit EM bias, while the other showed no bias. One study in BD during euthymia showed an EM deficit for negative stimuli. Overall, this review concludes that current empirical evidence does not readily support the existence of an explicit EM bias in MDD during acute depression. The identification and implications of potential moderating factors on explicit EM performance in MDD and BD during both illness stages are discussed.
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Affiliation(s)
- Bryce J M Bogie
- Neuroscience Graduate Program, McMaster University, Hamilton, Ontario, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada; Mood Disorders Program, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Monisha R Persaud
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Denise Smith
- Health Sciences Library, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Flávio P Kapczinski
- Neuroscience Graduate Program, McMaster University, Hamilton, Ontario, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada; Mood Disorders Program, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada; Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Benicio N Frey
- Neuroscience Graduate Program, McMaster University, Hamilton, Ontario, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada; Mood Disorders Program, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada; Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada.
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Abstract
BACKGROUND This paper aims to synthesise the literature on machine learning (ML) and big data applications for mental health, highlighting current research and applications in practice. METHODS We employed a scoping review methodology to rapidly map the field of ML in mental health. Eight health and information technology research databases were searched for papers covering this domain. Articles were assessed by two reviewers, and data were extracted on the article's mental health application, ML technique, data type, and study results. Articles were then synthesised via narrative review. RESULTS Three hundred papers focusing on the application of ML to mental health were identified. Four main application domains emerged in the literature, including: (i) detection and diagnosis; (ii) prognosis, treatment and support; (iii) public health, and; (iv) research and clinical administration. The most common mental health conditions addressed included depression, schizophrenia, and Alzheimer's disease. ML techniques used included support vector machines, decision trees, neural networks, latent Dirichlet allocation, and clustering. CONCLUSIONS Overall, the application of ML to mental health has demonstrated a range of benefits across the areas of diagnosis, treatment and support, research, and clinical administration. With the majority of studies identified focusing on the detection and diagnosis of mental health conditions, it is evident that there is significant room for the application of ML to other areas of psychology and mental health. The challenges of using ML techniques are discussed, as well as opportunities to improve and advance the field.
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Affiliation(s)
- Adrian B R Shatte
- Federation University, School of Science, Engineering & Information Technology,Melbourne,Australia
| | - Delyse M Hutchinson
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health,Geelong,Australia
| | - Samantha J Teague
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health,Geelong,Australia
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Mitelman SA. Transdiagnostic neuroimaging in psychiatry: A review. Psychiatry Res 2019; 277:23-38. [PMID: 30639090 DOI: 10.1016/j.psychres.2019.01.026] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 01/07/2019] [Accepted: 01/07/2019] [Indexed: 01/10/2023]
Abstract
Transdiagnostic approach has a long history in neuroimaging, predating its recent ascendance as a paradigm for new psychiatric nosology. Various psychiatric disorders have been compared for commonalities and differences in neuroanatomical features and activation patterns, with different aims and rationales. This review covers both structural and functional neuroimaging publications with direct comparison of different psychiatric disorders, including schizophrenia, bipolar disorder, major depressive disorder, autism spectrum disorder, obsessive-compulsive disorder, attention-deficit/hyperactivity disorder, conduct disorder, anorexia nervosa, and bulimia nervosa. Major findings are systematically presented along with specific rationales for each comparison.
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Affiliation(s)
- Serge A Mitelman
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA; Department of Psychiatry, Division of Child and Adolescent Psychiatry, Elmhurst Hospital Center, 79-01 Broadway, Elmhurst, NY 11373, USA.
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42
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Lin X, Li X. Image Based Brain Segmentation: From Multi-Atlas Fusion to Deep Learning. Curr Med Imaging 2019; 15:443-452. [DOI: 10.2174/1573405614666180817125454] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 07/28/2018] [Accepted: 08/07/2018] [Indexed: 01/10/2023]
Abstract
Background:
This review aims to identify the development of the algorithms for brain
tissue and structure segmentation in MRI images.
Discussion:
Starting from the results of the Grand Challenges on brain tissue and structure segmentation
held in Medical Image Computing and Computer-Assisted Intervention (MICCAI), this
review analyses the development of the algorithms and discusses the tendency from multi-atlas label
fusion to deep learning. The intrinsic characteristics of the winners’ algorithms on the Grand
Challenges from the year 2012 to 2018 are analyzed and the results are compared carefully.
Conclusion:
Although deep learning has got higher rankings in the challenge, it has not yet met the
expectations in terms of accuracy. More effective and specialized work should be done in the future.
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Affiliation(s)
- Xiangbo Lin
- Faculty of Electronic Information and Electrical Engineering, School of Information and Communication Engineering, Dalian University of Technology, Dalian, LiaoNing Province, China
| | - Xiaoxi Li
- Faculty of Electronic Information and Electrical Engineering, School of Information and Communication Engineering, Dalian University of Technology, Dalian, LiaoNing Province, China
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Drobinin V, Slaney C, Garnham J, Propper L, Uher R, Alda M, Hajek T. Larger right inferior frontal gyrus volume and surface area in participants at genetic risk for bipolar disorders. Psychol Med 2019; 49:1308-1315. [PMID: 30058502 DOI: 10.1017/s0033291718001903] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Larger grey matter volume of the inferior frontal gyrus (IFG) is among the most replicated biomarkers of genetic risk for bipolar disorders (BD). However, the IFG is a heterogeneous prefrontal region, and volumetric findings can be attributable to changes in cortical thickness (CT), surface area (SA) or gyrification. Here, we investigated the morphometry of IFG in participants at genetic risk for BD. METHODS We quantified the IFG cortical grey matter volume in 29 affected, 32 unaffected relatives of BD probands, and 42 controls. We then examined SA, CT, and cortical folding in subregions of the IFG. RESULTS We found volumetric group differences in the right IFG, with the largest volumes in unaffected high-risk and smallest in control participants (F2,192 = 3.07, p = 0.01). The volume alterations were localized to the pars triangularis of the IFG (F2,97 = 4.05, p = 0.02), with no differences in pars opercularis or pars orbitalis. Pars triangularis volume was highly correlated with its SA [Pearson r(101) = 0.88, p < 0.001], which significantly differed between the groups (F2,97 = 4.45, p = 0.01). As with volume, the mean SA of the pars triangularis was greater in unaffected (corrected p = 0.02) and affected relatives (corrected p = 0.05) compared with controls. We did not find group differences in pars triangularis CT or gyrification. CONCLUSIONS These findings strengthen prior knowledge about the volumetric findings in this region and provide a new insight into the localization and topology of IFG alterations. The unique nature of rIFG morphology in BD, with larger volume and SA early in the course of illness, could have practical implications for detection of participants at risk for BD.
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Affiliation(s)
- V Drobinin
- Department of Psychiatry,Dalhousie University,Halifax,Canada
| | - C Slaney
- Department of Psychiatry,Dalhousie University,Halifax,Canada
| | - J Garnham
- Department of Psychiatry,Dalhousie University,Halifax,Canada
| | - L Propper
- Department of Psychiatry,Dalhousie University,Halifax,Canada
| | - R Uher
- Department of Psychiatry,Dalhousie University,Halifax,Canada
| | - M Alda
- Department of Psychiatry,Dalhousie University,Halifax,Canada
| | - T Hajek
- Department of Psychiatry,Dalhousie University,Halifax,Canada
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Perspective on Etiology and Treatment of Bipolar Disorders in China: Clinical Implications and Future Directions. Neurosci Bull 2019; 35:608-612. [PMID: 31098937 DOI: 10.1007/s12264-019-00389-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 02/16/2019] [Indexed: 01/10/2023] Open
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Differentiating between bipolar and unipolar depression in functional and structural MRI studies. Prog Neuropsychopharmacol Biol Psychiatry 2019; 91:20-27. [PMID: 29601896 DOI: 10.1016/j.pnpbp.2018.03.022] [Citation(s) in RCA: 125] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 03/25/2018] [Accepted: 03/25/2018] [Indexed: 01/10/2023]
Abstract
Distinguishing depression in bipolar disorder (BD) from unipolar depression (UD) solely based on clinical clues is difficult, which has led to the exploration of promising neural markers in neuroimaging measures for discriminating between BD depression and UD. In this article, we review structural and functional magnetic resonance imaging (MRI) studies that directly compare UD and BD depression based on neuroimaging modalities including functional MRI studies on regional brain activation or functional connectivity, structural MRI on gray or white matter morphology, and pattern classification analyses using a machine learning approach. Numerous studies have reported distinct functional and structural alterations in emotion- or reward-processing neural circuits between BD depression and UD. Different activation patterns in neural networks including the amygdala, anterior cingulate cortex (ACC), prefrontal cortex (PFC), and striatum during emotion-, reward-, or cognition-related tasks have been reported between BD and UD. A stronger functional connectivity pattern in BD was pronounced in default mode and in frontoparietal networks and brain regions including the PFC, ACC, parietal and temporal regions, and thalamus compared to UD. Gray matter volume differences in the ACC, hippocampus, amygdala, and dorsolateral prefrontal cortex (DLPFC) have been reported between BD and UD, along with a thinner DLPFC in BD compared to UD. BD showed reduced integrity in the anterior part of the corpus callosum and posterior cingulum compared to UD. Several studies performed pattern classification analysis using structural and functional MRI data to distinguish between UD and BD depression using a supervised machine learning approach, which yielded a moderate level of accuracy in classification.
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Yalin N, Saricicek A, Hidiroglu C, Zugman A, Direk N, Ada E, Cavusoglu B, Er A, Isik G, Ceylan D, Tunca Z, Kempton MJ, Ozerdem A. Cortical thickness and surface area as an endophenotype in bipolar disorder type I patients and their first-degree relatives. Neuroimage Clin 2019; 22:101695. [PMID: 30738374 PMCID: PMC6370861 DOI: 10.1016/j.nicl.2019.101695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 01/14/2019] [Accepted: 01/27/2019] [Indexed: 01/10/2023]
Abstract
OBJECTIVES So far, few studies have investigated cortical thickness (CT) and surface area (SA) measures in bipolar disorder type I (BDI) in comparison to a high genetic risk group such as first-degree relatives (FR). This study aimed to examine CT and SA differences between BDI, FR and healthy controls (HC). METHODS 3D T1 magnetic resonance images were acquired from 27 euthymic BDI patients, 24 unaffected FR and 29 HC. CT and SA measures were obtained with FreeSurfer version 5.3.0. Generalized estimating equations were used to compare CT and SA between groups. Group comparisons were repeated with restricting the FR group to 17 siblings (FR-SB) only. RESULTS \Mean age in years was 36.3 ± 9.5 for BDI, 32.1 ± 10.9 for FR, 34.7 ± 9.8 for FR-SB and 33.1 ± 9.0 for HC group respectively. BDI patients revealed larger SA of left pars triangularis (LPT) compared to HC (p = .001). In addition, increased SA in superior temporal cortex (STC) in FR-SB group compared to HC was identified (p = .0001). CONCLUSIONS Our result of increased SA in LPT of BDI could be a disease marker and increased SA in STC of FR-SB could be a marker related with resilience to illness.
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Affiliation(s)
- Nefize Yalin
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Department of Neuroscience, Institute of Health Sciences, Dokuz Eylul University, Izmir, Turkey.
| | - Aybala Saricicek
- Department of Neuroscience, Institute of Health Sciences, Dokuz Eylul University, Izmir, Turkey; Department of Psychiatry, Faculty of Medicine, Katip Celebi University, Izmir, Turkey
| | - Ceren Hidiroglu
- Department of Psychology, Faculty of Arts, Dokuz Eylul University, Izmir, Turkey
| | - Andre Zugman
- Interdisciplinary Laboratory of Clinical Neuroscience (LINC), Department of Psychiatry, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Nese Direk
- Department of Psychiatry, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Emel Ada
- Department of Radiology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Berrin Cavusoglu
- Department of Neuroscience, Institute of Health Sciences, Dokuz Eylul University, Izmir, Turkey
| | - Ayşe Er
- Department of Neuroscience, Institute of Health Sciences, Dokuz Eylul University, Izmir, Turkey
| | - Gizem Isik
- Department of Neuroscience, Institute of Health Sciences, Dokuz Eylul University, Izmir, Turkey
| | - Deniz Ceylan
- Department of Neuroscience, Institute of Health Sciences, Dokuz Eylul University, Izmir, Turkey
| | - Zeliha Tunca
- Department of Psychiatry, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Matthew J Kempton
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Aysegul Ozerdem
- Department of Neuroscience, Institute of Health Sciences, Dokuz Eylul University, Izmir, Turkey; Department of Psychiatry, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
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Suh JS, Schneider MA, Minuzzi L, MacQueen GM, Strother SC, Kennedy SH, Frey BN. Cortical thickness in major depressive disorder: A systematic review and meta-analysis. Prog Neuropsychopharmacol Biol Psychiatry 2019; 88:287-302. [PMID: 30118825 DOI: 10.1016/j.pnpbp.2018.08.008] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 07/30/2018] [Accepted: 08/13/2018] [Indexed: 01/10/2023]
Abstract
Neuroimaging studies assessing neurobiological differences between patients with major depressive disorder (MDD) and healthy controls (HC) are often hindered by small sample sizes and heterogeneity of the patient sample. We performed a comprehensive literature search for studies assessing cortical thickness between patient and control groups, including studies investigating treatment effects on cortical thickness. We identified 34 studies meeting criteria for the systematic review and used Seed-based d Mapping to meta-analyze 24 of those that met additional criteria. Analysis of the full sample of subjects (MDD = 1073; HC = 936) revealed significant thinning in the MDD group in the bilateral orbitofrontal gyrus (BA 11), left pars opercularis (BA 45) and left calcarine fissure/lingual gyrus (BA 17), as well as an area of significant thickening in the left supramarginal gyrus (BA 40). These results support other imaging modalities that report disruptions in various frontal and temporal areas in MDD and identify additional areas in all major cerebral lobes likely to be significant when parsing for biomarkers of treatment or relapse.
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Affiliation(s)
- Jee Su Suh
- MiNDS Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada; Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare, Hamilton, ON, Canada
| | - Maiko Abel Schneider
- Department of Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Luciano Minuzzi
- MiNDS Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada; Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare, Hamilton, ON, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Glenda M MacQueen
- Department of Psychiatry, Mathison Centre for Mental Health Research and Education, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, AB, Canada
| | - Stephen C Strother
- Rotman Research Institute, Baycrest and Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Sidney H Kennedy
- Canadian Biomarker Integration Network for Depression, St. Michael's Hospital, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Arthur Sommer Rotenberg Chair in Suicide & Depression Studies, St. Michael's Hospital, Toronto, ON, Canada
| | - Benicio N Frey
- MiNDS Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada; Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare, Hamilton, ON, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.
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Vai B, Bertocchi C, Benedetti F. Cortico-limbic connectivity as a possible biomarker for bipolar disorder: where are we now? Expert Rev Neurother 2019; 19:159-172. [PMID: 30599797 DOI: 10.1080/14737175.2019.1562338] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The fronto-limbic network has been suggested as a key circuitry in the pathophysiology and maintenance of bipolar disorder. In the past decade, a disrupted connectivity within prefrontal-limbic structures was identified as a promising candidate biomarker for the disorder. Areas Covered: In this review, the authors examine current literature in terms of the structural, functional and effective connectivity in bipolar disorder, integrating recent findings of imaging genetics and machine learning. This paper profiles the current knowledge and identifies future perspectives to provide reliable and usable neuroimaging biomarkers for bipolar psychopathology in clinical practice. Expert Opinion: The replication and the translation of acquired knowledge into useful and usable tools represents one of the current greatest challenges in biomarker research applied to psychiatry.
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Affiliation(s)
- Benedetta Vai
- a Psychiatry & Clinical Psychobiology , Division of Neuroscience, Scientific Institute Ospedale San Raffaele , Milano , Italy.,b University Vita-Salute San Raffaele , Milano , Italy
| | - Carlotta Bertocchi
- a Psychiatry & Clinical Psychobiology , Division of Neuroscience, Scientific Institute Ospedale San Raffaele , Milano , Italy
| | - Francesco Benedetti
- a Psychiatry & Clinical Psychobiology , Division of Neuroscience, Scientific Institute Ospedale San Raffaele , Milano , Italy.,b University Vita-Salute San Raffaele , Milano , Italy
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Peng D, Yao Z. Neuroimaging Advance in Depressive Disorder. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1180:59-83. [DOI: 10.1007/978-981-32-9271-0_3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Lin K, Shao R, Geng X, Chen K, Lu R, Gao Y, Bi Y, Lu W, Guan L, Kong J, Xu G, So KF. Illness, at-risk and resilience neural markers of early-stage bipolar disorder. J Affect Disord 2018; 238:16-23. [PMID: 29852342 DOI: 10.1016/j.jad.2018.05.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 04/06/2018] [Accepted: 05/15/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND Current knowledge on objective and specific neural markers for bipolar risk and resilience-related processes is lacking, partly due to not subdividing high-risk individuals manifesting different levels of subclinical symptoms who possibly possess different levels of resilience. METHODS We delineated grey matter markers for bipolar illness, genetic high risk (endophenotype) and resilience, through comparing across 42 young non-comorbid bipolar patients, 42 healthy controls, and 72 diagnosis-free, medication-naive high-genetic-risk individuals subdivided into a combined-high-risk group who additionally manifested bipolar risk-relevant subsyndromes (N = 38), and an asymptomatic high-risk group (N = 34). Complementary analyses assessed the additional predictive and classification values of grey matter markers beyond those of clinical scores, through using logistic regression and support vector machine analyses. RESULTS Illness-related effects manifested as reduced grey matter volumes of bilateral temporal limbic-striatal and cerebellar regions, which significantly differentiated bipolar patients from healthy controls and improved clinical classification specificity by 20%. Reduced bilateral cerebellar grey matter volume emerged as a potential endophenotype and (along with parieto-occipital grey matter changes) separated combined-high-risk individuals from healthy and high-risk individuals, and increased clinical classification specificity by approximately 10% and 27%, respectively, while the relatively normalized cerebellar grey matter volumes in the high-risk sample may confer resilience. LIMITATIONS The cross-validation procedure was not performed on an independent sample using independently-derived features. The BD group had different age and sex distributions than some other groups which may not be fully addressable statistically. CONCLUSIONS Our framework can be applied in other measurement domains to derive complete profiles for bipolar patients and at-risk individuals, towards forming strategies for promoting resilience and preclinical intervention.
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Affiliation(s)
- Kangguang Lin
- Department of Affective Disorders, Guangzhou Brain Hospital, The Affiliated Hospital of Guangzhou Medical University, 36 Mingxin Road, Guangzhou, Guangdong 510370, China; Laboratory of Emotion and Cognition, The Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; GMH Institute of CNS Regeneration, Jinan University, Guangzhou, China; GMU-HKU Mood and Brain Science Center, Guangzhou, China.
| | - Robin Shao
- Department of Affective Disorders, Guangzhou Brain Hospital, The Affiliated Hospital of Guangzhou Medical University, 36 Mingxin Road, Guangzhou, Guangdong 510370, China; Laboratory of Emotion and Cognition, The Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; GMU-HKU Mood and Brain Science Center, Guangzhou, China; The State Key Laboratory of Brain and Cognitive Sciences and Department of Ophthalmology, The University of Hong Kong, Hong Kong; Laboratory of Neuropsychology and Laboratory of Social Cognitive Affective Neuroscience, Department of Psychology, University of Hong Kong, Hong Kong
| | - Xiujuan Geng
- The State Key Laboratory of Brain and Cognitive Sciences and Department of Ophthalmology, The University of Hong Kong, Hong Kong; Laboratory of Neuropsychology and Laboratory of Social Cognitive Affective Neuroscience, Department of Psychology, University of Hong Kong, Hong Kong
| | - Kun Chen
- Department of Affective Disorders, Guangzhou Brain Hospital, The Affiliated Hospital of Guangzhou Medical University, 36 Mingxin Road, Guangzhou, Guangdong 510370, China; Laboratory of Emotion and Cognition, The Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Rui Lu
- Department of Affective Disorders, Guangzhou Brain Hospital, The Affiliated Hospital of Guangzhou Medical University, 36 Mingxin Road, Guangzhou, Guangdong 510370, China
| | - Yanling Gao
- Department of Affective Disorders, Guangzhou Brain Hospital, The Affiliated Hospital of Guangzhou Medical University, 36 Mingxin Road, Guangzhou, Guangdong 510370, China; Laboratory of Emotion and Cognition, The Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yanan Bi
- Department of Affective Disorders, Guangzhou Brain Hospital, The Affiliated Hospital of Guangzhou Medical University, 36 Mingxin Road, Guangzhou, Guangdong 510370, China; Laboratory of Emotion and Cognition, The Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Weicong Lu
- Department of Affective Disorders, Guangzhou Brain Hospital, The Affiliated Hospital of Guangzhou Medical University, 36 Mingxin Road, Guangzhou, Guangdong 510370, China; Laboratory of Emotion and Cognition, The Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Lijie Guan
- Department of Affective Disorders, Guangzhou Brain Hospital, The Affiliated Hospital of Guangzhou Medical University, 36 Mingxin Road, Guangzhou, Guangdong 510370, China; Laboratory of Emotion and Cognition, The Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jiehua Kong
- Department of Affective Disorders, Guangzhou Brain Hospital, The Affiliated Hospital of Guangzhou Medical University, 36 Mingxin Road, Guangzhou, Guangdong 510370, China; Laboratory of Emotion and Cognition, The Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Guiyun Xu
- Department of Affective Disorders, Guangzhou Brain Hospital, The Affiliated Hospital of Guangzhou Medical University, 36 Mingxin Road, Guangzhou, Guangdong 510370, China; Laboratory of Emotion and Cognition, The Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; GMU-HKU Mood and Brain Science Center, Guangzhou, China
| | - Kwok-Fai So
- GMH Institute of CNS Regeneration, Jinan University, Guangzhou, China; GMU-HKU Mood and Brain Science Center, Guangzhou, China; The State Key Laboratory of Brain and Cognitive Sciences and Department of Ophthalmology, The University of Hong Kong, Hong Kong
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