Generalizable brain network markers of major depressive disorder across multiple imaging sites

Using dynamic graph convolutional network to identify individuals with major depression disorder

Objective and quantitative neuroimaging biomarkers are crucial for early diagnosis of major depressive disorder (MDD). However, previous studies using machine learning (ML) to distinguish MDD have often used small sample sizes and overlooked MDD's neural connectome and mechanism. To address these gaps, we applied Dynamic Graph Convolutional Nets (DGCNs) to a large multi-site dataset of 2317 resting state functional MRI (RS-fMRI) scans from 1081 MDD patients and 1236 healthy controls from 16 Rest-meta-MDD consortium sites. Our DGCN model combined with the personal whole brain functional connectivity (FC) network achieved an accuracy of 82.5 % (95 % CI:81.6-83.4 %, AUC:0.869), outperforming other universal ML classifiers. The most prominent domains for classification were mainly in the default mode network, fronto-parietal and cingulo-opercular network. Our study supports the stability and efficacy of using DGCN to characterize MDD and demonstrates its potential in enhancing neurobiological comprehension of MDD by detecting clinically related disorders in FC network topologies.

Diagnosis of major depressive disorder using a novel interpretable GCN model based on resting state fMRI

The diagnosis and analysis of major depressive disorder (MDD) faces some intractable challenges such as dataset limitations and clinical variability. Resting-state functional magnetic resonance imaging (Rs-fMRI) can reflect the fluctuation data of brain activity in a resting state, which can find the interrelationships, functional connections, and network characteristics among brain regions of the patients. In this paper, a brain functional connectivity matrix is constructed using Pearson correlation based on the characteristics of multi-site Rs-fMRI data and brain atlas, and an adaptive propagation operator graph convolutional network (APO-GCN) model is designed. The APO-GCN model can automatically adjust the propagation operator in each hidden layer according to the data features to control the expressive power of the model. By adaptively learning effective information in the graph, this model significantly improves its ability to capture complex graph structural patterns. The experimental results on Rs-fMRI data from 1601 participants (830 MDD and 771 HC) and 16 sites of REST-meta-MDD project show that the APO-GCN achieved a classification accuracy of 91.8%, outperforming those of the state-of-the-art classifier methods. The classification process is driven by multiple significant brain regions, and our method further reveals functional connectivity abnormalities between these brain regions, which are important biomarkers of classification. It is worth noting that the brain regions identified by the classifier and the networks involved are consistent with existing research results, which suggest that the pathogenesis of depression may be related to dysfunction of multiple brain networks.

Enhancing prediction of human traits and behaviors through ensemble learning of traditional and novel resting-state fMRI connectivity analyses

Recent advances in cognitive neuroscience have focused on using resting-state functional connectivity (RSFC) data from fMRI scans to more accurately predict human traits and behaviors. Traditional approaches generally analyze RSFC by correlating averaged time-series data across regions of interest (ROIs) or networks, which may overlook important spatial signal patterns. To address this limitation, we introduced a novel linear regression technique that estimates RSFC by predicting spatial brain activity patterns in a target ROI from those in a seed ROI. We applied both traditional and our novel RSFC estimation methods to a large-scale dataset from the Human Connectome Project and the Brain Genomics Superstruct Project, analyzing resting-state fMRI data to predict sex, age, personality traits, and psychological task performance. To enhance prediction accuracy, we developed an ensemble learner that combines these qualitatively different methods using a weighted average approach. Our findings revealed that hierarchical clustering of RSFC patterns using our novel method displays distinct whole-brain grouping patterns compared to the traditional approach. Importantly, the ensemble model, integrating these diverse weak learners, outperformed the traditional RSFC method in predicting human traits and behaviors. Notably, the predictions from the traditional and novel methods showed relatively low similarity, indicating that our novel approach captures unique and previously undetected information about human traits and behaviors through fine-grained local spatial patterns of neural activation. These results highlight the potential of combining traditional and innovative RSFC analysis techniques to enrich our understanding of the neural basis of human traits and behaviors.

The status of MRI databases across the world focused on psychiatric and neurological disorders

Neuroimaging databases for neuro-psychiatric disorders enable researchers to implement data-driven research approaches by providing access to rich data that can be used to study disease, build and validate machine learning models, and even redefine disease spectra. The importance of sharing large, multi-center, multi-disorder databases has gradually been recognized in order to truly translate brain imaging knowledge into real-world clinical practice. Here, we review MRI databases that share data globally to serve multiple psychiatric or neurological disorders. We found 42 datasets consisting of 23,293 samples from patients with psychiatry and neurological disorders and healthy controls; 1245 samples from mood disorders (major depressive disorder and bipolar disorder), 2015 samples from developmental disorders (autism spectrum disorder, attention-deficit hyperactivity disorder), 675 samples from schizophrenia, 1194 samples from Parkinson's disease, 5865 samples from dementia (including Alzheimer's disease), We recognize that large, multi-center databases should include governance processes that allow data to be shared across national boundaries. Addressing technical and regulatory issues of existing databases can lead to better design and implementation and improve data access for the research community. The current trend toward the development of shareable MRI databases will contribute to a better understanding of the pathophysiology, diagnosis and assessment, and development of early interventions for neuropsychiatric disorders.

Generalizable and transportable resting-state neural signatures characterized by functional networks, neurotransmitters, and clinical symptoms in autism

Autism spectrum disorder (ASD) is a lifelong condition with elusive biological mechanisms. The complexity of factors, including inter-site and developmental differences, hinders the development of a generalizable neuroimaging classifier for ASD. Here, we developed a classifier for ASD using a large-scale, multisite resting-state fMRI dataset of 730 Japanese adults, aiming to capture neural signatures that reflect pathophysiology at the functional network level, neurotransmitters, and clinical symptoms of the autistic brain. Our adult ASD classifier was successfully generalized to adults in the United States, Belgium, and Japan. The classifier further demonstrated its successful transportability to children and adolescents. The classifier contained 141 functional connections (FCs) that were important for discriminating individuals with ASD from typically developing controls. These FCs and their terminal brain regions were associated with difficulties in social interaction and dopamine and serotonin, respectively. Finally, we mapped attention-deficit/hyperactivity disorder (ADHD), schizophrenia (SCZ), and major depressive disorder (MDD) onto the biological axis defined by the ASD classifier. ADHD and SCZ, but not MDD, were located proximate to ASD on the biological dimensions. Our results revealed functional signatures of the ASD brain, grounded in molecular characteristics and clinical symptoms, achieving generalizability and transportability applicable to the evaluation of the biological continuity of related diseases.

CI-GNN: A Granger causality-inspired graph neural network for interpretable brain network-based psychiatric diagnosis

There is a recent trend to leverage the power of graph neural networks (GNNs) for brain-network based psychiatric diagnosis, which, in turn, also motivates an urgent need for psychiatrists to fully understand the decision behavior of the used GNNs. However, most of the existing GNN explainers are either post-hoc in which another interpretive model needs to be created to explain a well-trained GNN, or do not consider the causal relationship between the extracted explanation and the decision, such that the explanation itself contains spurious correlations and suffers from weak faithfulness. In this work, we propose a granger causality-inspired graph neural network (CI-GNN), a built-in interpretable model that is able to identify the most influential subgraph (i.e., functional connectivity within brain regions) that is causally related to the decision (e.g., major depressive disorder patients or healthy controls), without the training of an auxillary interpretive network. CI-GNN learns disentangled subgraph-level representations α and β that encode, respectively, the causal and non-causal aspects of original graph under a graph variational autoencoder framework, regularized by a conditional mutual information (CMI) constraint. We theoretically justify the validity of the CMI regulation in capturing the causal relationship. We also empirically evaluate the performance of CI-GNN against three baseline GNNs and four state-of-the-art GNN explainers on synthetic data and three large-scale brain disease datasets. We observe that CI-GNN achieves the best performance in a wide range of metrics and provides more reliable and concise explanations which have clinical evidence. The source code and implementation details of CI-GNN are freely available at GitHub repository (https://github.com/ZKZ-Brain/CI-GNN/).

Few-Shot Domain-Adaptive Anomaly Detection for Cross-Site Brain Images

Early screening is essential for effective intervention and treatment of individuals with mental disorders. Functional magnetic resonance imaging (fMRI) is a noninvasive tool for depicting neural activity and has demonstrated strong potential as a technique for identifying mental disorders. Due to the difficulty in data collection and diagnosis, imaging data from patients are rare at a single site, whereas abundant healthy control data are available from public datasets. However, joint use of these data from multiple sites for classification model training is hindered by cross-domain distribution discrepancy and diverse label spaces. Herein, we propose few-shot domain-adaptive anomaly detection (FAAD) to achieve cross-site anomaly detection of brain images based on only a few labeled samples. We introduce domain adaptation to mitigate cross-domain distribution discrepancy and jointly align the general and conditional feature distributions of imaging data across multiple sites. We utilize fMRI data of healthy subjects in the Human Connectome Project (HCP) as the source domain and fMRI images from six independent sites, including patients with mental disorders and demographically matched healthy controls, as target domains. Experiments showed the superiority of the proposed method compared with binary classification, traditional anomaly detection methods, and several recognized domain adaptation methods.

Manifold alteration between major depressive disorder and healthy control subjects using dynamic mode decomposition in resting-state fMRI data

Background

The World Health Organization has reported that approximately 300 million individuals suffer from the mood disorder known as MDD. Non-invasive measurement techniques have been utilized to reveal the mechanism of MDD, with rsfMRI being the predominant method. The previous functional connectivity and energy landscape studies have shown the difference in the coactivation patterns between MDD and HCs. However, these studies did not consider oscillatory temporal dynamics.

Methods

In this study, the dynamic mode decomposition, a method to compute a set of coherent spatial patterns associated with the oscillation frequency and temporal decay rate, was employed to investigate the alteration of the occurrence of dynamic modes between MDD and HCs. Specifically, The BOLD signals of each subject were transformed into dynamic modes representing coherent spatial patterns and discrete-time eigenvalues to capture temporal variations using dynamic mode decomposition. All the dynamic modes were disentangled into a two-dimensional manifold using t-SNE. Density estimation and density ratio estimation were applied to the two-dimensional manifolds after the two-dimensional manifold was split based on HCs and MDD.

Results

The dynamic modes that uniquely emerged in the MDD were not observed. Instead, we have found some dynamic modes that have shown increased or reduced occurrence in MDD compared with HCs. The reduced dynamic modes were associated with the visual and saliency networks while the increased dynamic modes were associated with the default mode and sensory-motor networks.

Conclusion

To the best of our knowledge, this study showed initial evidence of the alteration of occurrence of the dynamic modes between MDD and HCs. To deepen understanding of how the alteration of the dynamic modes emerges from the structure, it is vital to investigate the relationship between the dynamic modes, cortical thickness, and surface areas.

Electome network factors: Capturing emotional brain networks related to health and disease

Therapeutic development for mental disorders has been slow despite the high worldwide prevalence of illness. Unfortunately, cellular and circuit insights into disease etiology have largely failed to generalize across individuals that carry the same diagnosis, reflecting an unmet need to identify convergent mechanisms that would facilitate optimal treatment. Here, we discuss how mesoscale networks can encode affect and other cognitive processes. These networks can be discovered through electrical functional connectome (electome) analysis, a method built upon explainable machine learning models for analyzing and interpreting mesoscale brain-wide signals in a behavioral context. We also outline best practices for identifying these generalizable, interpretable, and biologically relevant networks. Looking forward, translational electome analysis can span species and various moods, cognitive processes, or other brain states, supporting translational medicine. Thus, we argue that electome analysis provides potential translational biomarkers for developing next-generation therapeutics that exhibit high efficacy across heterogeneous disorders.

Resting-state cerebral blood flow and functional connectivity abnormalities in depressed patients with childhood maltreatment: Potential biomarkers of vulnerability?

AIM

Childhood maltreatment (CM) is an important risk factor for major depressive disorder (MDD). This study aimed to explore the specific effect of CM on cerebral blood flow (CBF) and brain functional connectivity (FC) in MDD patients.

METHODS

A total of 150 subjects were collected including 55 MDD patients with CM, 34 MDD patients without CM, 19 healthy controls (HC) with CM, and 42 HC without CM. All subjects completed MRI scans and neuropsychological tests. Two-way analysis of covariance was used to detect the main and interactive effects of disease and CM on CBF and FC across subjects. Then, partial correlation analyses were conducted to explore the behavioral significance of altered CBF and FC in MDD patients. Finally, a support vector classifier model was applied to differentiate MDD patients.

RESULTS

MDD patients represented increased CBF in bilateral temporal lobe and decreased CBF in right visual cortex. Importantly, significant depression-by-CM interactive effects on CBF were primarily located in the frontoparietal regions, including orbitofrontal cortex (OFC), lateral prefrontal cortex (PFC), and parietal cortex. Moreover, significant FC abnormalities were seen in OFC-PFC and frontoparietal-visual cortex. Notably, the abnormal CBF and FC were significantly associated with behavioral performance. Finally, a combination of altered CBF and FC behaved with a satisfactory classification ability to differentiate MDD patients.

CONCLUSIONS

These results highlight the importance of frontoparietal and visual cortices for MDD with CM experience, proposing a potential neuroimaging biomarker for MDD identification.

Classification of MDD using a Transformer classifier with large-scale multisite resting-state fMRI data

Major depressive disorder (MDD) is one of the most common psychiatric disorders worldwide with high recurrence rate. Identifying MDD patients, particularly those with recurrent episodes with resting-state fMRI, may reveal the relationship between MDD and brain function. We proposed a Transformer-Encoder model, which utilized functional connectivity extracted from large-scale multisite rs-fMRI datasets to classify MDD and HC. The model discarded the Transformer's Decoder part, reducing the model's complexity and decreasing the number of parameters to adapt to the limited sample size and it does not require a complex feature selection process and achieves end-to-end classification. Additionally, our model is suitable for classifying data combined from multiple brain atlases and has an optional unsupervised pre-training module to acquire optimal initial parameters and speed up the training process. The model's performance was tested on a large-scale multisite dataset and identified brain regions affected by MDD using the Grad-CAM method. After conducting five-fold cross-validation, our model achieved an average classification accuracy of 68.61% on a dataset consisting of 1611 samples. For the selected recurrent MDD dataset, the model reached an average classification accuracy of 78.11%. Abnormalities were detected in the frontal gyri and cerebral cortex of MDD patients in both datasets. Furthermore, the identified brain regions in the recurrent MDD dataset generally exhibited a higher contribution to the model's performance.

Accelerated preprocessing of large numbers of brain images by parallel computing on supercomputers

"Preprocessing" is the first step required in brain image analysis that improves the overall quality and reliability of the results. However, it is computationally demanding and time-consuming, particularly to handle and parcellate complicatedly folded cortical ribbons of the human brain. In this study, we aimed to shorten the analysis time for data preprocessing of 1410 brain images simultaneously on one of the world's highest-performing supercomputers, "Fugaku." The FreeSurfer was used as a benchmark preprocessing software for cortical surface reconstruction. All the brain images were processed simultaneously and successfully analyzed in a calculation time of 17.33 h. This result indicates that using a supercomputer for brain image preprocessing allows big data analysis to be completed shortly and flexibly, thus suggesting the possibility of supercomputers being used for expanding large data analysis and parameter optimization of preprocessing in the future.

Image data harmonization tools for the analysis of post-traumatic epilepsy development in preclinical multisite MRI studies

Preclinical MRI studies have been utilized for the discovery of biomarkers that predict post-traumatic epilepsy (PTE). However, these single site studies often lack statistical power due to limited and homogeneous datasets. Therefore, multisite studies, such as the Epilepsy Bioinformatics Study for Antiepileptogenic Therapy (EpiBioS4Rx), are developed to create large, heterogeneous datasets that can lead to more statistically significant results. EpiBioS4Rx collects preclinical data internationally across sites, including the United States, Finland, and Australia. However, in doing so, there are robust normalization and harmonization processes that are required to obtain statistically significant and generalizable results. This work describes the tools and procedures used to harmonize multisite, multimodal preclinical imaging data acquired by EpiBioS4Rx. There were four main harmonization processes that were utilized, including file format harmonization, naming convention harmonization, image coordinate system harmonization, and diffusion tensor imaging (DTI) metrics harmonization. By using Python tools and bash scripts, the file formats, file names, and image coordinate systems are harmonized across all the sites. To harmonize DTI metrics, values are estimated for each voxel in an image to generate a histogram representing the whole image. Then, the Quantitative Imaging Toolkit (QIT) modules are utilized to scale the mode to a value of one and depict the subsequent harmonized histogram. The standardization of file formats, naming conventions, coordinate systems, and DTI metrics are qualitatively assessed. The histograms of the DTI metrics were generated for all the individual rodents per site. For inter-site analysis, an average of the individual scans was calculated to create a histogram that represents each site. In order to ensure the analysis can be run at the level of individual animals, the sham and TBI cohort were analyzed separately, which depicted the same harmonization factor. The results demonstrate that these processes qualitatively standardize the file formats, naming conventions, coordinate systems, and DTI metrics of the data. This assists in the ability to share data across the study, as well as disseminate tools that can help other researchers to strengthen the statistical power of their studies and analyze data more cohesively.

Subject-specific whole-brain parcellations of nodes and boundaries are modulated differently under 10 Hz rTMS

Repetitive transcranial magnetic stimulation (rTMS) has gained considerable importance in the treatment of neuropsychiatric disorders, including major depression. However, it is not yet understood how rTMS alters brain's functional connectivity. Here we report changes in functional connectivity captured by resting state functional magnetic resonance imaging (rsfMRI) within the first hour after 10 Hz rTMS. We apply subject-specific parcellation schemes to detect changes (1) in network nodes, where the strongest functional connectivity of regions is observed, and (2) in network boundaries, where functional transitions between regions occur. We use support vector machine (SVM), a widely used machine learning algorithm that is robust and effective, for the classification and characterization of time intervals of changes in node and boundary maps. Our results reveal that changes in connectivity at the boundaries are slower and more complex than in those observed in the nodes, but of similar magnitude according to accuracy confidence intervals. These results were strongest in the posterior cingulate cortex and precuneus. As network boundaries are indeed under-investigated in comparison to nodes in connectomics research, our results highlight their contribution to functional adjustments to rTMS.

Sampling inequalities affect generalization of neuroimaging-based diagnostic classifiers in psychiatry

BACKGROUND

The development of machine learning models for aiding in the diagnosis of mental disorder is recognized as a significant breakthrough in the field of psychiatry. However, clinical practice of such models remains a challenge, with poor generalizability being a major limitation.

METHODS

Here, we conducted a pre-registered meta-research assessment on neuroimaging-based models in the psychiatric literature, quantitatively examining global and regional sampling issues over recent decades, from a view that has been relatively underexplored. A total of 476 studies (n = 118,137) were included in the current assessment. Based on these findings, we built a comprehensive 5-star rating system to quantitatively evaluate the quality of existing machine learning models for psychiatric diagnoses.

RESULTS

A global sampling inequality in these models was revealed quantitatively (sampling Gini coefficient (G) = 0.81, p < .01), varying across different countries (regions) (e.g., China, G = 0.47; the USA, G = 0.58; Germany, G = 0.78; the UK, G = 0.87). Furthermore, the severity of this sampling inequality was significantly predicted by national economic levels (β =  - 2.75, p < .001, R²_adj = 0.40; r =  - .84, 95% CI: - .41 to - .97), and was plausibly predictable for model performance, with higher sampling inequality for reporting higher classification accuracy. Further analyses showed that lack of independent testing (84.24% of models, 95% CI: 81.0-87.5%), improper cross-validation (51.68% of models, 95% CI: 47.2-56.2%), and poor technical transparency (87.8% of models, 95% CI: 84.9-90.8%)/availability (80.88% of models, 95% CI: 77.3-84.4%) are prevailing in current diagnostic classifiers despite improvements over time. Relating to these observations, model performances were found decreased in studies with independent cross-country sampling validations (all p < .001, BF₁₀ > 15). In light of this, we proposed a purpose-built quantitative assessment checklist, which demonstrated that the overall ratings of these models increased by publication year but were negatively associated with model performance.

CONCLUSIONS

Together, improving sampling economic equality and hence the quality of machine learning models may be a crucial facet to plausibly translating neuroimaging-based diagnostic classifiers into clinical practice.

Image harmonization: A review of statistical and deep learning methods for removing batch effects and evaluation metrics for effective harmonization

Magnetic resonance imaging and computed tomography from multiple batches (e.g. sites, scanners, datasets, etc.) are increasingly used alongside complex downstream analyses to obtain new insights into the human brain. However, significant confounding due to batch-related technical variation, called batch effects, is present in this data; direct application of downstream analyses to the data may lead to biased results. Image harmonization methods seek to remove these batch effects and enable increased generalizability and reproducibility of downstream results. In this review, we describe and categorize current approaches in statistical and deep learning harmonization methods. We also describe current evaluation metrics used to assess harmonization methods and provide a standardized framework to evaluate newly-proposed methods for effective harmonization and preservation of biological information. Finally, we provide recommendations to end-users to advocate for more effective use of current methods and to methodologists to direct future efforts and accelerate development of the field.

Functional connectivity signatures of major depressive disorder: machine learning analysis of two multicenter neuroimaging studies

The promise of machine learning has fueled the hope for developing diagnostic tools for psychiatry. Initial studies showed high accuracy for the identification of major depressive disorder (MDD) with resting-state connectivity, but progress has been hampered by the absence of large datasets. Here we used regular machine learning and advanced deep learning algorithms to differentiate patients with MDD from healthy controls and identify neurophysiological signatures of depression in two of the largest resting-state datasets for MDD. We obtained resting-state functional magnetic resonance imaging data from the REST-meta-MDD (N = 2338) and PsyMRI (N = 1039) consortia. Classification of functional connectivity matrices was done using support vector machines (SVM) and graph convolutional neural networks (GCN), and performance was evaluated using 5-fold cross-validation. Features were visualized using GCN-Explainer, an ablation study and univariate t-testing. The results showed a mean classification accuracy of 61% for MDD versus controls. Mean accuracy for classifying (non-)medicated subgroups was 62%. Sex classification accuracy was substantially better across datasets (73-81%). Visualization of the results showed that classifications were driven by stronger thalamic connections in both datasets, while nearly all other connections were weaker with small univariate effect sizes. These results suggest that whole brain resting-state connectivity is a reliable though poor biomarker for MDD, presumably due to disease heterogeneity as further supported by the higher accuracy for sex classification using the same methods. Deep learning revealed thalamic hyperconnectivity as a prominent neurophysiological signature of depression in both multicenter studies, which may guide the development of biomarkers in future studies.

Verification of the brain network marker of major depressive disorder: Test-retest reliability and anterograde generalization performance for newly acquired data

BACKGROUND

Recently, we developed a generalizable brain network marker for the diagnosis of major depressive disorder (MDD) across multiple imaging sites using resting-state functional magnetic resonance imaging. Here, we applied this brain network marker to newly acquired data to verify its test-retest reliability and anterograde generalization performance for new patients.

METHODS

We tested the sensitivity and specificity of our brain network marker of MDD using data acquired from 43 new patients with MDD as well as new data from 33 healthy controls (HCs) who participated in our previous study. To examine the test-retest reliability of our brain network marker, we evaluated the intraclass correlation coefficients (ICCs) between the brain network marker-based classifier's output (probability of MDD) in two sets of HC data obtained at an interval of approximately 1 year.

RESULTS

Test-retest correlation between the two sets of the classifier's output (probability of MDD) from HCs exhibited moderate reliability with an ICC of 0.45 (95 % confidence interval,0.13-0.68). The classifier distinguished patients with MDD and HCs with an accuracy of 69.7 % (sensitivity, 72.1 %; specificity, 66.7 %).

LIMITATIONS

The data of patients with MDD in this study were cross-sectional, and the clinical significance of the marker, such as whether it is a state or trait marker of MDD and its association with treatment responsiveness, remains unclear.

CONCLUSIONS

The results of this study reaffirmed the test-retest reliability and generalization performance of our brain network marker for the diagnosis of MDD.

Generalizable neuromarker for autism spectrum disorder across imaging sites and developmental stages: A multi-site study

Autism spectrum disorder (ASD) is a lifelong condition, and its underlying biological mechanisms remain elusive. The complexity of various factors, including inter-site and development-related differences, makes it challenging to develop generalizable neuroimaging-based biomarkers for ASD. This study used a large-scale, multi-site dataset of 730 Japanese adults to develop a generalizable neuromarker for ASD across independent sites (U.S., Belgium, and Japan) and different developmental stages (children and adolescents). Our adult ASD neuromarker achieved successful generalization for the US and Belgium adults (area under the curve [AUC] = 0.70) and Japanese adults (AUC = 0.81). The neuromarker demonstrated significant generalization for children (AUC = 0.66) and adolescents (AUC = 0.71; all P < 0.05 , family-wise-error corrected). We identified 141 functional connections (FCs) important for discriminating individuals with ASD from TDCs. These FCs largely centered on social brain regions such as the amygdala, hippocampus, dorsomedial and ventromedial prefrontal cortices, and temporal cortices. Finally, we mapped schizophrenia (SCZ) and major depressive disorder (MDD) onto the biological axis defined by the neuromarker and explored the biological continuity of ASD with SCZ and MDD. We observed that SCZ, but not MDD, was located proximate to ASD on the biological dimension defined by the ASD neuromarker. The successful generalization in multifarious datasets and the observed relations of ASD with SCZ on the biological dimensions provide new insights for a deeper understanding of ASD.

Evaluation of Risk of Bias in Neuroimaging-Based Artificial Intelligence Models for Psychiatric Diagnosis: A Systematic Review

IMPORTANCE

Neuroimaging-based artificial intelligence (AI) diagnostic models have proliferated in psychiatry. However, their clinical applicability and reporting quality (ie, feasibility) for clinical practice have not been systematically evaluated.

OBJECTIVE

To systematically assess the risk of bias (ROB) and reporting quality of neuroimaging-based AI models for psychiatric diagnosis.

EVIDENCE REVIEW

PubMed was searched for peer-reviewed, full-length articles published between January 1, 1990, and March 16, 2022. Studies aimed at developing or validating neuroimaging-based AI models for clinical diagnosis of psychiatric disorders were included. Reference lists were further searched for suitable original studies. Data extraction followed the CHARMS (Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modeling Studies) and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. A closed-loop cross-sequential design was used for quality control. The PROBAST (Prediction Model Risk of Bias Assessment Tool) and modified CLEAR (Checklist for Evaluation of Image-Based Artificial Intelligence Reports) benchmarks were used to systematically evaluate ROB and reporting quality.

FINDINGS

A total of 517 studies presenting 555 AI models were included and evaluated. Of these models, 461 (83.1%; 95% CI, 80.0%-86.2%) were rated as having a high overall ROB based on the PROBAST. The ROB was particular high in the analysis domain, including inadequate sample size (398 of 555 models [71.7%; 95% CI, 68.0%-75.6%]), poor model performance examination (with 100% of models lacking calibration examination), and lack of handling data complexity (550 of 555 models [99.1%; 95% CI, 98.3%-99.9%]). None of the AI models was perceived to be applicable to clinical practices. Overall reporting completeness (ie, number of reported items/number of total items) for the AI models was 61.2% (95% CI, 60.6%-61.8%), and the completeness was poorest for the technical assessment domain with 39.9% (95% CI, 38.8%-41.1%).

CONCLUSIONS AND RELEVANCE

This systematic review found that the clinical applicability and feasibility of neuroimaging-based AI models for psychiatric diagnosis were challenged by a high ROB and poor reporting quality. Particularly in the analysis domain, ROB in AI diagnostic models should be addressed before clinical application.

Examining the usefulness of the brain network marker program using fMRI for the diagnosis and stratification of major depressive disorder: a non-randomized study protocol

BACKGROUND

Although many studies have reported the biological basis of major depressive disorder (MDD), none have been put into practical use. Recently, we developed a generalizable brain network marker for MDD diagnoses (diagnostic marker) across multiple imaging sites using resting-state functional magnetic resonance imaging (rs-fMRI). We have planned this clinical trial to establish evidence for the practical applicability of this diagnostic marker as a medical device. In addition, we have developed generalizable brain network markers for MDD stratification (stratification markers), and the verification of these brain network markers is a secondary endpoint of this study.

METHODS

This is a non-randomized, open-label study involving patients with MDD and healthy controls (HCs). We will prospectively acquire rs-fMRI data from 50 patients with MDD and 50 HCs and anterogradely verify whether our diagnostic marker can distinguish between patients with MDD and HCs. Furthermore, we will longitudinally obtain rs-fMRI and clinical data at baseline and 6 weeks later in 80 patients with MDD treated with escitalopram and verify whether it is possible to prospectively distinguish MDD subtypes that are expected to be effectively responsive to escitalopram using our stratification markers.

DISCUSSION

In this study, we will confirm that sufficient accuracy of the diagnostic marker could be reproduced for data from a prospective clinical study. Using longitudinally obtained data, we will also examine whether the "brain network marker for MDD diagnosis" reflects treatment effects in patients with MDD and whether treatment effects can be predicted by "brain network markers for MDD stratification". Data collected in this study will be extremely important for the clinical application of the brain network markers for MDD diagnosis and stratification.

TRIAL REGISTRATION

Japan Registry of Clinical Trials ( jRCTs062220063 ). Registered 12/10/2022.

Ensemble graph neural network model for classification of major depressive disorder using whole-brain functional connectivity

Major depressive disorder (MDD) is characterized by impairments in mood and cognitive functioning, and it is a prominent source of global disability and stress. A functional magnetic resonance imaging (fMRI) can aid clinicians in their assessments of individuals for the identification of MDD. Herein, we employ a deep learning approach to the issue of MDD classification. Resting-state fMRI data from 821 individuals with MDD and 765 healthy controls (HCs) is employed for investigation. An ensemble model based on graph neural network (GNN) has been created with the goal of identifying patients with MDD among HCs as well as differentiation between first-episode and recurrent MDDs. The graph convolutional network (GCN), graph attention network (GAT), and GraphSAGE models serve as a base models for the ensemble model that was developed with individual whole-brain functional networks. The ensemble's performance is evaluated using upsampling and downsampling, along with 10-fold cross-validation. The ensemble model achieved an upsampling accuracy of 71.18% and a downsampling accuracy of 70.24% for MDD and HC classification. While comparing first-episode patients with recurrent patients, the upsampling accuracy is 77.78% and the downsampling accuracy is 71.96%. According to the findings of this study, the proposed GNN-based ensemble model achieves a higher level of accuracy and suggests that our model produces can assist healthcare professionals in identifying MDD.

A systematic review on the potential use of machine learning to classify major depressive disorder from healthy controls using resting state fMRI measures

BACKGROUND

Major Depressive Disorder (MDD) is a psychiatric disorder characterized by functional brain deficits, as documented by resting-state functional magnetic resonance imaging (rs-fMRI) studies.

AIMS

In recent years, some studies used machine learning (ML) approaches, based on rs-fMRI features, for classifying MDD from healthy controls (HC). In this context, this review aims to provide a comprehensive overview of the results of these studies.

DESIGN

The studies research was performed on 3 online databases, examining English-written articles published before August 5, 2022, that performed a two-class ML classification using rs-fMRI features. The search resulted in 20 eligible studies.

RESULTS

The reviewed studies showed good performance metrics, with better performance achieved when the dataset was restricted to a more homogeneous group in terms of disease severity. Regions within the default mode network, salience network, and central executive network were reported as the most important features in the classification algorithms.

LIMITATIONS

The small sample size together with the methodological and clinical heterogeneity limited the generalizability of the findings.

CONCLUSIONS

In conclusion, ML applied to rs-fMRI features can be a valid approach to classify MDD and HC subjects and to discover features that can be used for additional investigation of the pathophysiology of the disease.

Understanding psychiatric illness through natural language processing (UNDERPIN): Rationale, design, and methodology

Introduction

Psychiatric disorders are diagnosed through observations of psychiatrists according to diagnostic criteria such as the DSM-5. Such observations, however, are mainly based on each psychiatrist's level of experience and often lack objectivity, potentially leading to disagreements among psychiatrists. In contrast, specific linguistic features can be observed in some psychiatric disorders, such as a loosening of associations in schizophrenia. Some studies explored biomarkers, but biomarkers have yet to be used in clinical practice.

Aim

The purposes of this study are to create a large dataset of Japanese speech data labeled with detailed information on psychiatric disorders and neurocognitive disorders to quantify the linguistic features of those disorders using natural language processing and, finally, to develop objective and easy-to-use biomarkers for diagnosing and assessing the severity of them.

Methods

This study will have a multi-center prospective design. The DSM-5 or ICD-11 criteria for major depressive disorder, bipolar disorder, schizophrenia, and anxiety disorder and for major and minor neurocognitive disorders will be regarded as the inclusion criteria for the psychiatric disorder samples. For the healthy subjects, the absence of a history of psychiatric disorders will be confirmed using the Mini-International Neuropsychiatric Interview (M.I.N.I.). The absence of current cognitive decline will be confirmed using the Mini-Mental State Examination (MMSE). A psychiatrist or psychologist will conduct 30-to-60-min interviews with each participant; these interviews will include free conversation, picture-description task, and story-telling task, all of which will be recorded using a microphone headset. In addition, the severity of disorders will be assessed using clinical rating scales. Data will be collected from each participant at least twice during the study period and up to a maximum of five times at an interval of at least one month.

Discussion

This study is unique in its large sample size and the novelty of its method, and has potential for applications in many fields. We have some challenges regarding inter-rater reliability and the linguistic peculiarities of Japanese. As of September 2022, we have collected a total of >1000 records from >400 participants. To the best of our knowledge, this data sample is one of the largest in this field.

Clinical Trial Registration

Identifier: UMIN000032141.

Artificial intelligence assisted tools for the detection of anxiety and depression leading to suicidal ideation in adolescents: a review

Epidemiological studies report high levels of anxiety and depression amongst adolescents. These psychiatric conditions and complex interplays of biological, social and environmental factors are important risk factors for suicidal behaviours and suicide, which show a peak in late adolescence and early adulthood. Although deaths by suicide have fallen globally in recent years, suicide deaths are increasing in some countries, such as the US. Suicide prevention is a challenging global public health problem. Currently, there aren't any validated clinical biomarkers for suicidal diagnosis, and traditional methods exhibit limitations. Artificial intelligence (AI) is budding in many fields, including in the diagnosis of medical conditions. This review paper summarizes recent studies (past 8 years) that employed AI tools for the automated detection of depression and/or anxiety disorder and discusses the limitations and effects of some modalities. The studies assert that AI tools produce promising results and could overcome the limitations of traditional diagnostic methods. Although using AI tools for suicidal ideation exhibits limitations, these are outweighed by the advantages. Thus, this review article also proposes extracting a fusion of features such as facial images, speech signals, and visual and clinical history features from deep models for the automated detection of depression and/or anxiety disorder in individuals, for future work. This may pave the way for the identification of individuals with suicidal thoughts.

Artificial intelligence-assisted psychosis risk screening in adolescents: Practices and challenges

Artificial intelligence-based technologies are gradually being applied to psych-iatric research and practice. This paper reviews the primary literature concerning artificial intelligence-assisted psychosis risk screening in adolescents. In terms of the practice of psychosis risk screening, the application of two artificial intelligence-assisted screening methods, chatbot and large-scale social media data analysis, is summarized in detail. Regarding the challenges of psychiatric risk screening, ethical issues constitute the first challenge of psychiatric risk screening through artificial intelligence, which must comply with the four biomedical ethical principles of respect for autonomy, nonmaleficence, beneficence and impartiality such that the development of artificial intelligence can meet the moral and ethical requirements of human beings. By reviewing the pertinent literature concerning current artificial intelligence-assisted adolescent psychosis risk screens, we propose that assuming they meet ethical requirements, there are three directions worth considering in the future development of artificial intelligence-assisted psychosis risk screening in adolescents as follows: nonperceptual real-time artificial intelligence-assisted screening, further reducing the cost of artificial intelligence-assisted screening, and improving the ease of use of artificial intelligence-assisted screening techniques and tools.

Differential Impact of Anxious Misery Psychopathology on Multiple Representations of the Functional Connectome

Background

One aim of characterizing dimensional psychopathology is associating different domains of affective dysfunction with brain circuitry. The functional connectome, as measured by functional magnetic resonance imaging, can be modeled and associated with psychopathology through multiple methods; some methods assess univariate relationships while others summarize broad patterns of activity. It remains unclear whether different dimensions of psychopathology require different representations of the connectome to generate reproducible associations.

Methods

Patients experiencing anxious misery symptomology (depression, anxiety, and trauma; n = 192) received resting-state functional magnetic resonance imaging scans. Three modeling approaches (seed-based correlation analysis, edgewise regression, and brain basis set modeling), each relying on increasingly broader representations of the functional connectome, were used to associate connectivity patterns with six data-driven dimensions of psychopathology: anxiety sensitivity, anxious arousal, rumination, anhedonia, insomnia, and negative affect. To protect against overfitting, 50 participants were held out in a testing dataset, leaving 142 participants as training data.

Results

Different modeling approaches varied in the extent to which they could model different symptom dimensions: seed-based correlation analysis failed to reproducibly model any symptoms, subsets of the connectome (edgewise regression) were sufficient to model insomnia and anxious arousal, and broad representations of the entire connectome (brain basis set modeling) were necessary to model negative affect and ruminative thought.

Conclusions

These results indicate that different methods of representing the functional connectome differ in the degree that they can model different symptom dimensions, highlighting the potential sufficiency of subsets of connections for some dimensions and the necessity of connectome-wide approaches in others.

Prediction of remission among patients with a major depressive disorder based on the resting-state functional connectivity of emotion regulation networks

The prediction of antidepressant response is critical for psychiatrists to select the initial antidepressant drug for patients with major depressive disorders (MDD). The implicated brain networks supporting emotion regulation (ER) are critical in the pathophysiology of MDD and the prediction of antidepressant response. Therefore, the primary aim of the current study was to identify the neuroimaging biomarkers for the prediction of remission in patients with MDD based on the resting-state functional connectivity (rsFC) of the ER networks. A total of 81 unmedicated adult MDD patients were investigated and they underwent resting-state functional magnetic resonance imagining (fMRI) scans. The patients were treated with escitalopram for 12 weeks. The 17-item Hamilton depression rating scale was used for assessing remission. The 36 seed regions from predefined ER networks were selected and the rsFC matrix was caculated for each participant. The support vector machine algorithm was employed to construct prediction model, which separated the patients with remission from those with non-remission. And leave-one-out cross-validation and the area under the curve (AUC) of the receiver operating characteristic were used for evaluating the performance of the model. The accuracy of the prediction model was 82.08% (sensitivity = 71.43%, specificity = 89.74%, AUC = 0.86). The rsFC between the left medial superior frontal gyrus and the right inferior frontal gyrus as well as the precuneus were the features with the highest discrimination ability in predicting remission from escitalopram among the MDD patients. Results from our study demonstrated that rsFC of the ER brain networks are potential predictors for the response of antidepressant drugs. The trial name: appropriate technology study of MDD diagnosis and treatment based on objective indicators and measurement. URL: http://www.chictr.org.cn/showproj.aspx?proj=21377 . Registration number: ChiCTR-OOC-17012566.

Personalized Diagnosis and Treatment for Neuroimaging in Depressive Disorders

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.

Mapping effective connectivity of human amygdala subdivisions with intracranial stimulation

The primate amygdala is a complex consisting of over a dozen nuclei that have been implicated in a host of cognitive functions, individual differences, and psychiatric illnesses. These functions are implemented through distinct connectivity profiles, which have been documented in animals but remain largely unknown in humans. Here we present results from 25 neurosurgical patients who had concurrent electrical stimulation of the amygdala with intracranial electroencephalography (electrical stimulation tract-tracing; es-TT), or fMRI (electrical stimulation fMRI; es-fMRI), methods providing strong inferences about effective connectivity of amygdala subdivisions with the rest of the brain. We quantified functional connectivity with medial and lateral amygdala, the temporal order of these connections on the timescale of milliseconds, and also detail second-order effective connectivity among the key nodes. These findings provide a uniquely detailed characterization of human amygdala functional connectivity that will inform functional neuroimaging studies in healthy and clinical populations.

The alterations of brain functional connectivity networks in major depressive disorder detected by machine learning through multisite rs-fMRI data

BACKGROUND

The current diagnosis of major depressive disorder (MDD) is mainly based on the patient's self-report and clinical symptoms. Machine learning methods are used to identify MDD using resting-state functional magnetic resonance imaging (rs-fMRI) data. However, due to large site differences in multisite rs-fMRI data and the difficulty of sample collection, most of the current machine learning studies use small sample sizes of rs-fMRI datasets to detect the alterations of functional connectivity (FC) or network attribute (NA), which may affect the reliability of the experimental results.

METHODS

Multisite rs-fMRI data were used to increase the size of the sample, and then we extracted the functional connectivity (FC) and network attribute (NA) features from 1611 rs-fMRI data (832 patients with MDD (MDDs) and 779 healthy controls (HCs)). ComBat algorithm was used to harmonize the data variances caused by the multisite effect, and multivariate linear regression was used to remove age and sex covariates. Two-sample t-test and wrapper-based feature selection methods (support vector machine recursive feature elimination with cross-validation (SVM-RFECV) and LightGBM's "feature_importances_" function) were used to select important features. The Shapley additive explanations (SHAP) method was used to assign the contribution of features to the best classification effect model.

RESULTS

The best result was obtained from the LinearSVM model trained with the 136 important features selected by SVMRFE-CV. In the nested five-fold cross-validation (consisting of an outer and an inner loop of five-fold cross-validation) of 1611 data, the model achieved the accuracy, sensitivity, and specificity of 68.90 %, 71.75 %, and 65.84 %, respectively. The 136 important features were tested in a small dataset and obtained excellent classification results after balancing the ratio between patients with depression and HCs.

CONCLUSIONS

The combined use of FC and NA features is effective for classifying MDDs and HCs. The important FC and NA features extracted from the large sample dataset have some generalization performance and may be used as a reference for the altered brain functional connectivity networks in MDD.

Brain connectivity changes of propofol-induced altered states of consciousness using High-Density EEG Source Estimation

Through source estimation, high-density electroencephalogram (EEG) signals at scalp level can be converted into signals at cerebral cortex level, which helps to measure cortical activity during anesthesia induced changes in consciousness level to explore the mechanism. In this research, the high-density EEG of propofol-induced consciousness states alterations in 20 healthy adults were converted into cortical signals of 68 regions of interest (ROI), after alpha bandpass filtering, the pairwise orthogonal power envelope connectivity (PEC) was calculated. Then, due to the number of PECs was huge, the least absolute shrinkage and selection operator (LASSO) was used to select as few PECs as possible as the indicators to distinguish baseline (BS) and moderate sedation (MD) states. The results show that most PECs that can be used as indicators are related to ROI related to default mode network (DMN). At the same time, changes of thalamocortical connectivity and frontal-parietal connectivity could be observed, similar to the neuroimaging method of directly measuring cerebral cortical activity. By extracting the PEC as a classifier to classify the BS and MD States, the accuracy could reach more than 70%. Therefore, this method can not only reflect the mechanism of cortical activity alterations induced by anesthetics, but also provide a new idea for monitoring the depth of anesthesia in the future. Clinical Relevance - This shows that the high-density EEG of scalp level can be converted into cortical signals by source estimation, which is similar to the neuroimaging method of directly measuring cortical activity.

An insight into diagnosis of depression using machine learning techniques: a systematic review

BACKGROUND

In this modern era, depression is one of the most prevalent mental disorders from which millions of individuals are affected today. The symptoms of depression are heterogeneous and often coincide with other disorders such as bipolar disorder, Parkinson's, schizophrenia, etc. It is a serious mental illness that may lead to other health problems if left untreated. Currently, identifying individuals with depression is totally based on the expertise of the clinician's experience. In order to assist clinicians in identifying the characteristics and classifying depressed people, different types of data modalities and machine learning techniques have been incorporated by researchers in this field. This study aims to find the answers to some important questions related to the trend of publications, data modality, machine learning models, dataset usage, pre-processing techniques and feature extraction and selection techniques that are prevalent and guide the direction of future research on depression diagnosis.

METHODS

This systematic review was conducted using a broad range of articles from two major databases: IEEE Xplore and PubMed. Studies ranging from the years 2011 to April 2021 were retrieved from the databases resulting in a total of 590 articles (53 articles from the IEEE Xplore database and 537 articles from the PubMed database). Out of those, the articles which satisfied the defined inclusion criteria were investigated for further analysis.

RESULTS

A total of 135 articles were identified and analysed for this review. High growth in the number of publications has been observed in recent years. Furthermore, significant diversity in the use of data modalities and machine learning classifiers has also been noted in this study. fMRI data with an SVM classifier was found to be the most popular choice among researchers. In most of the studies, data scarcity and small sample size, particularly for neuroimaging data are major concerns. The use of identical data pre-processing tools for similar data modalities can be seen. This study also provides statistical analysis of the current framework with respect to the modality, machine learning classifier, sample size and accuracy by applying one-way ANOVA and the Tukey - Kramer test.

CONCLUSION

The results indicate that an effective fusion of machine learning techniques with a potential data modality has a promising future for assisting clinicians in automatic depression diagnosis.

Depression Classification Using Frequent Subgraph Mining Based on Pattern Growth of Frequent Edge in Functional Magnetic Resonance Imaging Uncertain Network

The brain network structure is highly uncertain due to the noise in imaging signals and evaluation methods. Recent works have shown that uncertain brain networks could capture uncertain information with regards to functional connections. Most of the existing research studies covering uncertain brain networks used graph mining methods for analysis; for example, the mining uncertain subgraph patterns (MUSE) method was used to mine frequent subgraphs and the discriminative feature selection for uncertain graph classification (DUG) method was used to select discriminant subgraphs. However, these methods led to a lack of effective discriminative information; this reduced the classification accuracy for brain diseases. Therefore, considering these problems, we propose an approximate frequent subgraph mining algorithm based on pattern growth of frequent edge (unFEPG) for uncertain brain networks and a novel discriminative feature selection method based on statistical index (dfsSI) to perform graph mining and selection. Results showed that compared with the conventional methods, the unFEPG and dfsSI methods achieved a higher classification accuracy. Furthermore, to demonstrate the efficacy of the proposed method, we used consistent discriminative subgraph patterns based on thresholding and weighting approaches to compare the classification performance of uncertain networks and certain networks in a bidirectional manner. Results showed that classification performance of the uncertain network was superior to that of the certain network within a defined sparsity range. This indicated that if a better classification performance is to be achieved, it is necessary to select a certain brain network with a higher threshold or an uncertain brain network model. Moreover, if the uncertain brain network model was selected, it is necessary to make full use of the uncertain information of its functional connection.

Using graph convolutional network to characterize individuals with major depressive disorder across multiple imaging sites

BACKGROUND

Establishing objective and quantitative neuroimaging biomarkers at individual level can assist in early and accurate diagnosis of major depressive disorder (MDD). However, most previous studies using machine learning to identify MDD were based on small sample size and did not account for the brain connectome that is associated with the pathophysiology of MDD. Here, we addressed these limitations by applying graph convolutional network (GCN) in a large multi-site MDD dataset.

METHODS

Resting-state functional MRI scans of 1586 participants (821 MDD vs. 765 controls) across 16 sites of Rest-meta-MDD consortium were collected. GCN model was trained with individual whole-brain functional network to identify MDD patients from controls, characterize the most salient regions contributing to classification, and explore the relationship between topological characteristics of salient regions and clinical measures.

FINDINGS

GCN achieved an accuracy of 81·5% (95%CI: 80·5-82·5%, AUC: 0·865), which was higher than other common machine learning classifiers. The most salient regions contributing to classification were primarily identified within the default mode, fronto-parietal, and cingulo-opercular networks. Nodal topologies of the left inferior parietal lobule and left dorsolateral prefrontal cortex were associated with depressive severity and illness duration, respectively.

INTERPRETATION

These findings based on a large, multi-site dataset support the feasibility and effectiveness of GCN in characterizing MDD, and also illustrate the potential utility of GCN for enhancing understanding of the neurobiology of MDD by detecting clinically-relevant disruption in functional network topology.

FUNDING

This study was supported by the National Natural Science Foundation of China (Grant Nos. 81621003, 82027808, 81820108018).

Depressive symptoms reduce when dorsolateral prefrontal cortex-precuneus connectivity normalizes after functional connectivity neurofeedback

Depressive disorders contribute heavily to global disease burden; This is possibly because patients are often treated homogeneously, despite having heterogeneous symptoms with differing underlying neural mechanisms. A novel treatment that can directly influence the neural circuit relevant to an individual patient's subset of symptoms might more precisely and thus effectively aid in the alleviation of their specific symptoms. We tested this hypothesis in a proof-of-concept study using fMRI functional connectivity neurofeedback. We targeted connectivity between the left dorsolateral prefrontal cortex/middle frontal gyrus and the left precuneus/posterior cingulate cortex, because this connection has been well-established as relating to a specific subset of depressive symptoms. Specifically, this connectivity has been shown in a data-driven manner to be less anticorrelated in patients with melancholic depression than in healthy controls. Furthermore, a posterior cingulate dominant state-which results in a loss of this anticorrelation-is expected to specifically relate to an increase in rumination symptoms such as brooding. In line with predictions, we found that, with neurofeedback training, the more a participant normalized this connectivity (restored the anticorrelation), the more related (depressive and brooding symptoms), but not unrelated (trait anxiety), symptoms were reduced. Because these results look promising, this paradigm next needs to be examined with a greater sample size and with better controls. Nonetheless, here we provide preliminary evidence for a correlation between the normalization of a neural network and a reduction in related symptoms. Showing their reproducibility, these results were found in two experiments that took place several years apart by different experimenters. Indicative of its potential clinical utility, effects of this treatment remained one-two months later.Clinical trial registration: Both experiments reported here were registered clinical trials (UMIN000015249, jRCTs052180169).

Multidimensional Analysis of Major Depression: Association Between BDNF Methylation, Psychosocial and Cognitive Domains

Major Depression is a complex disorder with a growing incidence worldwide and multiple variables have been associated with its etiology. Nonetheless, its diagnosis is continually changing and the need to understand it from a multidimensional perspective is clear. The purpose of this study was to identify risk factors for depression in a case-control study with 100 depressive inpatients and 87 healthy controls. A multivariate logistic regression analysis was performed including psychosocial factors, cognitive maladaptive schema domains, and specific epigenetic marks (BDNF methylation levels at five CpG sites in promoter IV). A family history of depression, the cognitive schemas of impaired autonomy/performance, impaired limits, other-directedness, and the methylation level of a specific CpG site were identified as predictors. Interestingly, we found a mediating effect of those cognitive schemas in the relationship between childhood maltreatment and depression. Also, we found that depressive patients exhibited hypomethylation in a CpG site of BDNF promoter IV, which adds to the current discussion about the role of methylation in depression. We highlight that determining the methylation of a specific region of a single gene offers the possibility of accessing a highly informative an easily measurable variable, which represents benefits for diagnosis. Following complete replication and validation on larger samples, models like ours could be applicable as additional diagnostic tools in the clinical context.

Hippocampus- and Thalamus-Related Fiber-Specific White Matter Reductions in Mild Cognitive Impairment

Early diagnosis of mild cognitive impairment (MCI) fascinates screening high-risk Alzheimer's disease (AD). White matter is found to degenerate earlier than gray matter and functional connectivity during MCI. Although studies reveal white matter degenerates in the limbic system for MCI, how other white matter degenerates during MCI remains unclear. In our method, regions of interest with a high level of resting-state functional connectivity with hippocampus were selected as seeds to track fibers based on diffusion tensor imaging (DTI). In this way, hippocampus-temporal and thalamus-related fibers were selected, and each fiber's DTI parameters were extracted. Then, statistical analysis, machine learning classification, and Pearson's correlations with behavior scores were performed between MCI and normal control (NC) groups. Results show that: 1) the mean diffusivity of hippocampus-temporal and thalamus-related fibers are significantly higher in MCI and could be used to classify 2 groups effectively. 2) Compared with normal fibers, the degenerated fibers detected by the DTI indexes, especially for hippocampus-temporal fibers, have shown significantly higher correlations with cognitive scores. 3) Compared with the hippocampus-temporal fibers, thalamus-related fibers have shown significantly higher correlations with depression scores within MCI. Our results provide novel biomarkers for the early diagnoses of AD.

Dimensional distribution of cortical abnormality across antipsychotics treatment-resistant and responsive schizophrenia

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Different etiology is assumed in treatment-resistant and responsive schizophrenia.

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Patients with treatment-resistant schizophrenia were classified from controls.

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Patients with non-treatment-resistant schizophrenia were classified from controls.

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Two classifications reached area under the curve as high as 0.69 and 0.85.

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Area under the curve remained as high as 0.69 when two classifiers were swapped.

Background

One-third of patients with schizophrenia are treatment-resistant to non-clozapine antipsychotics (TRS), while the rest respond (NTRS). Examining whether TRS and NTRS represent different pathophysiologies is an important step toward precision medicine.

Methods

Focusing on cortical thickness (CT), we analyzed international multi-site cross-sectional datasets of magnetic resonance imaging comprising 110 patients with schizophrenia (NTRS = 46, TRS = 64) and 52 healthy controls (HCs). We utilized a logistic regression with L1-norm regularization to find brain regions related to either NTRS or TRS. We conducted nested 10-fold cross-validation and computed the accuracy and area under the curve (AUC). Then, we applied the NTRS classifier to patients with TRS, and vice versa.

Results

Patients with NTRS and TRS were classified from HCs with 65% and 78% accuracies and with the AUC of 0.69 and 0.85 (p = 0.014 and < 0.001, corrected), respectively. The left planum temporale (PT) and left anterior insula/inferior frontal gyrus (IFG) contributed to both NTRS and TRS classifiers. The left supramarginal gyrus only contributed to NTRS and right superior temporal sulcus and right lateral orbitofrontal cortex only to the TRS. The NTRS classifiers successfully distinguished those with TRS from HCs with the AUC of 0.78 (p < 0.001), while the TRS classifiers classified those with NTRS from HCs with the AUC of 0.69 (p = 0.015).

Conclusion

Both NTRS and TRS could be distinguished from HCs on the basis of CT. The CT pathological basis of NTRS and TRS has commonalities, and TRS presents unique CT features.

Identifying Internet Addiction and Evaluating the Efficacy of Treatment Based on Functional Connectivity Density: A Machine Learning Study

Although mounting neuroimaging studies have greatly improved our understanding of the neurobiological mechanism underlying internet addiction (IA), the results based on traditional group-level comparisons are insufficient in guiding individual clinical practice directly. Specific neuroimaging biomarkers are urgently needed for IA diagnosis and the evaluation of therapy efficacy. Therefore, this study aimed to develop support vector machine (SVM) models to identify IA and assess the efficacy of cognitive behavior therapy (CBT) based on unbiased functional connectivity density (FCD). Resting-state fMRI data were acquired from 27 individuals with IA before and after 8-week CBT sessions and 30 demographically matched healthy controls (HCs). The discriminative FCDs were computed as the features of the support vector classification (SVC) model to identify individuals with IA from HCs, and the changes in these discriminative FCDs after treatment were further used as features of the support vector regression (SVR) model to evaluate the efficacy of CBT. Based on the informative FCDs, our SVC model successfully differentiated individuals with IA from HCs with an accuracy of 82.5% and an area under the curve (AUC) of 0.91. Our SVR model successfully evaluated the efficacy of CBT using the FCD change ratio with a correlation efficient of 0.59. The brain regions contributing to IA classification and CBT efficacy assessment were the left inferior frontal cortex (IFC), middle frontal cortex (MFC) and angular gyrus (AG), the right premotor cortex (PMC) and middle cingulate cortex (MCC), and the bilateral cerebellum, orbitofrontal cortex (OFC) and superior frontal cortex (SFC). These findings confirmed the FCDs of hyperactive impulsive habit system, hypoactive reflecting system and sensitive interoceptive reward awareness system as potential neuroimaging biomarkers for IA, which might provide objective indexes for the diagnosis and efficacy evaluation of IA.

Multiple clustering for identifying subject clusters and brain sub-networks using functional connectivity matrices without vectorization

In neuroscience, the functional magnetic resonance imaging (fMRI) is a vital tool to non-invasively access brain activity. Using fMRI, the functional connectivity (FC) between brain regions can be inferred, which has contributed to a number of findings of the fundamental properties of the brain. As an important clinical application of FC, clustering of subjects based on FC recently draws much attention, which can potentially reveal important heterogeneity in subjects such as subtypes of psychiatric disorders. In particular, a multiple clustering method is a powerful analytical tool, which identifies clustering patterns of subjects depending on their FC in specific brain areas. However, when one applies an existing multiple clustering method to fMRI data, there is a need to simplify the data structure, independently dealing with elements in a FC matrix, i.e., vectorizing a correlation matrix. Such a simplification may distort the clustering results. To overcome this problem, we propose a novel multiple clustering method based on Wishart mixture models, which preserves the correlation matrix structure without vectorization. The uniqueness of this method is that the multiple clustering of subjects is based on particular networks of nodes (or regions of interest, ROIs), optimized in a data-driven manner. Hence, it can identify multiple underlying pairs of associations between a subject cluster solution and a ROI sub-network. The key assumption of the method is independence among sub-networks, which is effectively addressed by whitening correlation matrices. We applied the proposed method to synthetic and fMRI data, demonstrating the usefulness and power of the proposed method.

Brain/MINDS beyond human brain MRI project: A protocol for multi-level harmonization across brain disorders throughout the lifespan

Psychiatric and neurological disorders are afflictions of the brain that can affect individuals throughout their lifespan. Many brain magnetic resonance imaging (MRI) studies have been conducted; however, imaging-based biomarkers are not yet well established for diagnostic and therapeutic use. This article describes an outline of the planned study, the Brain/MINDS Beyond human brain MRI project (BMB-HBM, FY2018 ~ FY2023), which aims to establish clinically-relevant imaging biomarkers with multi-site harmonization by collecting data from healthy traveling subjects (TS) at 13 research sites. Collection of data in psychiatric and neurological disorders across the lifespan is also scheduled at 13 sites, whereas designing measurement procedures, developing and analyzing neuroimaging protocols, and databasing are done at three research sites. A high-quality scanning protocol, Harmonization Protocol (HARP), was established for five high-quality 3 T scanners to obtain multimodal brain images including T1 and T2-weighted, resting-state and task functional and diffusion-weighted MRI. Data are preprocessed and analyzed using approaches developed by the Human Connectome Project. Preliminary results in 30 TS demonstrated cortical thickness, myelin, functional connectivity measures are comparable across 5 scanners, suggesting sensitivity to subject-specific connectome. A total of 75 TS and more than two thousand patients with various psychiatric and neurological disorders are scheduled to participate in the project, allowing a mixed model statistical harmonization. The HARP protocols are publicly available online, and all the imaging, demographic and clinical information, harmonizing database will also be made available by 2024. To the best of our knowledge, this is the first project to implement a prospective, multi-level harmonization protocol with multi-site TS data. It explores intractable brain disorders across the lifespan and may help to identify the disease-specific pathophysiology and imaging biomarkers for clinical practice.

Common Brain Networks Between Major Depressive-Disorder Diagnosis and Symptoms of Depression That Are Validated for Independent Cohorts

Large-scale neuroimaging data acquired and shared by multiple institutions are essential to advance neuroscientific understanding of pathophysiological mechanisms in psychiatric disorders, such as major depressive disorder (MDD). About 75% of studies that have applied machine learning technique to neuroimaging have been based on diagnoses by clinicians. However, an increasing number of studies have highlighted the difficulty in finding a clear association between existing clinical diagnostic categories and neurobiological abnormalities. Here, using resting-state functional magnetic resonance imaging, we determined and validated resting-state functional connectivity related to depression symptoms that were thought to be directly related to neurobiological abnormalities. We then compared the resting-state functional connectivity related to depression symptoms with that related to depression diagnosis that we recently identified. In particular, for the discovery dataset with 477 participants from 4 imaging sites, we removed site differences using our recently developed harmonization method and developed a brain network prediction model of depression symptoms (Beck Depression Inventory-II [BDI] score). The prediction model significantly predicted BDI score for an independent validation dataset with 439 participants from 4 different imaging sites. Finally, we found 3 common functional connections between those related to depression symptoms and those related to MDD diagnosis. These findings contribute to a deeper understanding of the neural circuitry of depressive symptoms in MDD, a hetero-symptomatic population, revealing the neural basis of MDD.