1
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Schwarz R, Munkholm K, Christensen MS, Kessing LV, Vinberg M. Functioning in patients with major depressive disorder in remission: A systematic review and meta-analysis. J Affect Disord 2024; 363:112-123. [PMID: 39025440 DOI: 10.1016/j.jad.2024.07.054] [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: 03/27/2024] [Revised: 06/18/2024] [Accepted: 07/12/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Major depressive disorder (MDD) is one of the leading causes of burden of disease globally. We aimed to investigate whether global functioning is impaired in patients with MDD in full or partial remission compared to healthy control individuals (HC). METHODS We conducted a systematic review and meta-analysis according to the PRISMA guideline. We searched the databases PubMed, EMBASE and PsycINFO from January 1st 1980 to February 1st 2023. We included studies of adults with a diagnosis/former diagnosis of MDD with assessment of global functioning performed during a state of full or partial remission. The methodological quality was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist. Standardised mean differences (SMD) using random-effects models were calculated as the summary measure. We further performed meta-analyses of the mean raw score in patients with MDD for individual functioning scales. RESULTS Forty-two studies, comprising 17,999 patients with MDD and 35,550 HC, were included, 14 of which included both patients with MDD in full or partial remission and HC. Global functioning was lower in patients with MDD in full or partial remission compared with HC (SMD -2.00, 95 % CI: -0.9 to -3.03, 15 comparisons, I2: 99.8 %). LIMITATIONS Important information about the study participants and setting was not reported for most studies, or the reporting was unclear. CONCLUSION Patients with MDD have lower levels of functioning compared with HC also when in full or partial remission. Assessment of functioning should be an essential component of managing patients with MDD, also during remission.
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Affiliation(s)
- Rasmus Schwarz
- Mental Health Centre Northern Zealand, The Early Multimodular Prevention and Intervention Research Institution (EMPIRI) - Mental Health Services CPH, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Klaus Munkholm
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Frederiksberg, Denmark; Mental Health Centre Copenhagen, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
| | - Mie S Christensen
- Mental Health Centre Northern Zealand, The Early Multimodular Prevention and Intervention Research Institution (EMPIRI) - Mental Health Services CPH, Copenhagen, Denmark
| | - Lars V Kessing
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Frederiksberg, Denmark; Mental Health Centre Copenhagen, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
| | - Maj Vinberg
- Mental Health Centre Northern Zealand, The Early Multimodular Prevention and Intervention Research Institution (EMPIRI) - Mental Health Services CPH, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Frederiksberg, Denmark
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2
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Vivas AB, Hussain-Showaiter SM, Overton PG. Schizophrenia decreases guilt and increases self-disgust: Potential role of altered executive function. APPLIED NEUROPSYCHOLOGY. ADULT 2023; 30:447-457. [PMID: 34348524 DOI: 10.1080/23279095.2021.1956497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Our knowledge of how the more complex self-conscious emotions (SCEs) are affected in schizophrenia is sparse. SCEs, unlike basic emotions, involve sophisticated frontal-lobe-related cognition, impairment of which characterizes the neurocognitive profile of schizophrenia. We investigated, in a cross-sectional study, whether SCEs (shame, guilt and self-disgust) are affected in schizophrenia, and the relationship between changes in SCEs and executive (dys)function. Twenty-nine Greek and thirty Arabic patients with schizophrenia were recruited alongside twenty-two Greek and thirty Arabic matched controls. Participants were administered the Self-Disgust Scale (TOSCA for shame and guilt was also administered to the Greek sample), and the Trail Making and Verbal Fluency Tests to measure executive function (EF). Trait levels of self-disgust and guilt were found to be higher and lower, respectively, in patients with schizophrenia relative to control participants; and poorer EF was related with higher trait levels of SD, but lower trait levels of guilt. The pattern of findings was largely unaffected when controlling for anxiety and depression. Given that altered levels of SCEs are closely related to poorer EF, we suggest that the link between EF and emotion regulation, widely established in basic emotions but under-studied in SCEs, may explain the current findings.
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Affiliation(s)
- Ana B Vivas
- Psychology Department, CITY College, The University of Sheffield International Faculty, Thessaloniki, Greece
| | - Shaima M Hussain-Showaiter
- Psychology Department, CITY College, The University of Sheffield International Faculty, Thessaloniki, Greece
| | - Paul G Overton
- Psychology Department, University of Sheffield, Sheffield, UK
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3
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Maralakunte M, Gupta V, Grover S, Ahuja CK, Sahoo S, Kishore K, Vyas S, Garg G, Singh P, Govind V. Cross-sectional analysis of whole-brain microstructural changes in adult patients with bipolar and unipolar depression by diffusion kurtosis imaging. Neuroradiol J 2023; 36:176-181. [PMID: 35817080 PMCID: PMC10034704 DOI: 10.1177/19714009221114446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE AND OBJECTIVES More than half of the bipolar depression (BD) subjects are misdiagnosed as unipolar depression (UD) due to lack of objective diagnostic criteria. We aimed to identify microstructural neuronal changes differentiating BD from UD groups using diffusion kurtosis imaging (DKI). The objective of the study is to identify an objective neuro-imaging marker to differentiate BD from UD. MATERIALS AND METHODS A prospective, cross-sectional study included total of 62 subjects with diagnosis of bipolar depression (n = 21), unipolar depression (n = 21), and healthy controls (n = 20). All subjects underwent diffusion-weighted imaging (b = 0,1000,2000) of the whole brain on 3-Tesla MR scanner. DKI data was analyzed using 189 region whole-brain atlas. Eight diffusion and kurtosis metrics including mean diffusivity (MD), axial diffusivity (AD), radial diffusivity (RD), fractional anisotropy (FA), mean kurtosis (MK), axial kurtosis (AK), radial kurtosis (RK), and kurtosis fractional anisotropy (FKA) were measured against these 189 regions. Principle component analysis (PCA) was utilized to identify the most significant regions of the brain. ANOVA with post hoc tests was used for analyzing these regions. RESULTS BD group showed increased MD, RD, decreased AK at the left amygdala and decreased MK and RK at the right hemi-cerebellum. UD group showed increased MK and RK at the right external capsule; and increased AK, MK, and RK at the right amygdala. CONCLUSION The right and left amygdala, right external capsule, and right hemi-cerebellum showed microstructural abnormalities capable of differentiating BD and UD groups. Diffusion imaging especially DKI can aid in management of depression patients.
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Affiliation(s)
| | - Vivek Gupta
- Interventional Neuroradiology, Fortis Hospital, India
| | | | | | | | | | - Sameer Vyas
- Department of Radiodiagnosis and
Imaging, PGIMER, India
| | - Gaurav Garg
- Department of Radiodiagnosis and
Imaging, PGIMER, India
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4
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Xu Z, Zhu R, Zhang S, Zhang S, Liang Z, Mai X, Liu C. Mortality salience enhances neural activities related to guilt and shame when recalling the past. Cereb Cortex 2022; 32:5145-5162. [PMID: 35102376 DOI: 10.1093/cercor/bhac004] [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: 08/12/2021] [Revised: 12/31/2021] [Accepted: 01/01/2022] [Indexed: 12/27/2022] Open
Abstract
Mortality salience (MS) influences cognition and behavior. However, its effect on emotion (especially moral emotions) and the underlying neural correlates are unclear. We investigated how MS priming modulated guilt and shame in a later recall task using functional magnetic resonance imaging. The behavioral results indicated that MS increased self-reported guilt but not shame. The neural results showed that MS strengthened neural activities related to the psychological processes of guilt and shame. Specifically, for both guilt and shame, MS increased activation in a region associated with self-referential processing (ventral medial prefrontal cortex). For guilt but not shame, MS increased the activation of regions associated with cognitive control (orbitofrontal cortex) and emotion processing (amygdala). For shame but not guilt, MS decreased brain functional connectivity related to self-referential processing. A direct comparison showed that MS more strongly decreased a functional connectivity related to self-referential processing in the shame than in the guilt condition. Additionally, the activation of insula during MS priming was partly predictive of neural activities related to guilt and shame in the subsequent recall task. Our study sheds light on the psychological and neural mechanisms of MS effects on moral emotions and provides theoretical insights for enriching terror management theory.
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Affiliation(s)
- Zhenhua Xu
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing 100875, China.,Center for Collaboration and Innovation in Brain and Learning Sciences, Beijing Normal University, Beijing 100875, China.,Beijing Key Laboratory of Brain Imaging and Connectomics, Beijing Normal University, Beijing 100875, China
| | - Ruida Zhu
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing 100875, China.,Center for Collaboration and Innovation in Brain and Learning Sciences, Beijing Normal University, Beijing 100875, China.,Beijing Key Laboratory of Brain Imaging and Connectomics, Beijing Normal University, Beijing 100875, China.,Business School, Beijing Normal University, Beijing 100875, China
| | - Shen Zhang
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing 100875, China.,Center for Collaboration and Innovation in Brain and Learning Sciences, Beijing Normal University, Beijing 100875, China.,Beijing Key Laboratory of Brain Imaging and Connectomics, Beijing Normal University, Beijing 100875, China
| | - Sihui Zhang
- Department of General Adult Psychiatry, Heidelberg University, Heidelberg 69115, Germany
| | - Zilu Liang
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing 100875, China.,Center for Collaboration and Innovation in Brain and Learning Sciences, Beijing Normal University, Beijing 100875, China.,Beijing Key Laboratory of Brain Imaging and Connectomics, Beijing Normal University, Beijing 100875, China
| | - Xiaoqin Mai
- Department of Psychology, Renmin University of China, Beijing 100872, China
| | - Chao Liu
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing 100875, China.,Center for Collaboration and Innovation in Brain and Learning Sciences, Beijing Normal University, Beijing 100875, China.,Beijing Key Laboratory of Brain Imaging and Connectomics, Beijing Normal University, Beijing 100875, China
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5
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Guilt Feelings in Obsessive Compulsive Disorder: An Investigation between Diagnostic Groups. J Clin Med 2022; 11:jcm11164673. [PMID: 36012911 PMCID: PMC9409889 DOI: 10.3390/jcm11164673] [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: 04/30/2022] [Revised: 07/15/2022] [Accepted: 07/28/2022] [Indexed: 11/16/2022] Open
Abstract
Guilt plays a role in various forms of psychopathology. However, different types of guilt might be involved in different mental disorders. Obsessive-compulsive (OC) patients are prone to a type of guilt in which the violation of an internalized moral norm is necessary and sufficient, whereas data suggest that depression might be linked to more interpersonal types of guilt. However, the extent to which a specific guilt phenomenology is involved in each condition is yet to be determined. Here we assessed the association between different types of guilt and different diagnostic groups. Two clinical samples (33 OCD and 35 non-OCD) filled in the Moral Orientation Guilt Scale (MOGS) along with other OCD and depression measures. Regression was employed to test group differences in the MOGS subscales and to test the influence of MOGS subscales on OCD and depression levels. Results confirm that different types of guilt might be implicated in different psychopathological conditions. Specifically, moral norm violation guilt is more present in OC patients than in other disorders. Depression seems to be associated with different guilt feelings depending on the psychopathological condition, specifically in non-OC patients, with types of guilt involving a “victim”, supporting the accounts viewing interpersonal guilt as involved in the emergence of depressive symptomatology and hyper-altruistic behavior as a vulnerability factor for depression.
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6
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Förster K, Kurtz M, Konrad A, Kanske P. Emotional Reactivity, Emotion Regulation, and Social Emotions in Affective Disorders. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2022. [DOI: 10.1026/1616-3443/a000648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Abstract. Affective disorders, specifically Major Depressive Disorder and Bipolar Disorders, show high prevalence, relapse rates, and a high likelihood to develop a chronic course. For the past two decades, research has investigated the neural correlates of emotion processing and emotion regulation in patients with affective disorders. Putative underlying causal mechanisms of dysregulated affect have been informed by knowledge from the intersection of neuroimaging and clinical psychology. More recent investigations also consider processing the role of mostly negative, self-blaming social emotions, which have been linked to treatment resistance and, hence, provide a prolific target for intervention. Several psychotherapeutic treatment approaches already focus on emotion, and here specific knowledge about the mechanisms underlying persistent changes in affect bears the potential to improve the treatment of affective disorders. In this narrative review, we delineate why and how our insights into the neural correlates of emotion processing and regulation can be applied to the treatment of patients with affective disorders.
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Affiliation(s)
- Katharina Förster
- Clinical Psychology and Behavioral Neuroscience, Faculty of Psychology, Technische Universität Dresden (TU Dresden), Germany
| | - Marcel Kurtz
- Clinical Psychology and Behavioral Neuroscience, Faculty of Psychology, Technische Universität Dresden (TU Dresden), Germany
- Social Psychology, Faculty of Psychology, Technische Universität Dresden (TU Dresden), Germany
| | - Annika Konrad
- Clinical Psychology and Behavioral Neuroscience, Faculty of Psychology, Technische Universität Dresden (TU Dresden), Germany
| | - Philipp Kanske
- Clinical Psychology and Behavioral Neuroscience, Faculty of Psychology, Technische Universität Dresden (TU Dresden), Germany
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7
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Reuber M, Roberts NA, Levita L, Gray C, Myers L. Shame in patients with psychogenic nonepileptic seizure: A narrative review. Seizure 2021; 94:165-175. [PMID: 34844847 DOI: 10.1016/j.seizure.2021.10.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/02/2021] [Accepted: 10/21/2021] [Indexed: 10/20/2022] Open
Abstract
Psychogenic Nonepileptic Seizures (PNES) have been linked to dysregulated emotions and arousal. However, the question which emotions may be most relevant has received much less attention. In this multidisciplinary narrative review, we argue that the self-conscious emotion of shame is likely to be of particular importance for PNES. We summarize current concepts of the development of shame processing and its relationship with other emotional states. We demonstrate the potential of acute shame to cause a sudden disruption of normal cognitive function and trigger powerful behavioral, cognitive, physiological and secondary emotional responses which closely resemble key components of PNES. These responses may lead to the development of shame avoidance strategies which can become disabling in themselves. We discuss how excessive shame proneness and shame dysregulation are linked to several psychopathologies often associated with PNES (including depression and PTSD) and how they may predispose to, precipitate and perpetuate PNES disorders, not least by interacting with stigma. We consider current knowledge of the neurobiological underpinnings of shame and PNES. We explore how shame could be the link between PNES and a heterogeneous range of possible etiological factors, and how it may link historical aversive experiences with individual PNES events occurring much later and without apparent external trigger. We argue that, in view of the potential direct links between shame and PNES, the well-documented associations of shame with common comorbidities of this seizure disorder and the well-characterized relationship between chronic shame and stigma, there is a compelling case to pay greater attention to shame in relation to PNES. Its role in the treatment of patients with PNES is discussed in a separate, linked review incorporating case vignettes to highlight the complex interactions of different but interlinked shame-related issues in individual patients.
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Affiliation(s)
- M Reuber
- Academic Neurology Unit, University of Sheffield, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF, United Kingdom.
| | - Nicole A Roberts
- School of Social and Behavioral Sciences, Arizona State University, Phoenix, AZ, USA
| | - Liat Levita
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - Cordelia Gray
- Specialist Psychotherapist, Neurology Psychotherapy Service, Sheffield Teaching Hospital, Academic Neurology Unit, University of Sheffield, Sheffield, UK
| | - Lorna Myers
- Director, Northeast Regional Epilepsy Group, New York, United States
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8
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Báez-Mendoza R, Vázquez Y, Mastrobattista EP, Williams ZM. Neuronal Circuits for Social Decision-Making and Their Clinical Implications. Front Neurosci 2021; 15:720294. [PMID: 34658766 PMCID: PMC8517320 DOI: 10.3389/fnins.2021.720294] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 09/09/2021] [Indexed: 11/13/2022] Open
Abstract
Social living facilitates individual access to rewards, cognitive resources, and objects that would not be otherwise accessible. There are, however, some drawbacks to social living, particularly when competing for scarce resources. Furthermore, variability in our ability to make social decisions can be associated with neuropsychiatric disorders. The neuronal mechanisms underlying social decision-making are beginning to be understood. The momentum to study this phenomenon has been partially carried over by the study of economic decision-making. Yet, because of the similarities between these different types of decision-making, it is unclear what is a social decision. Here, we propose a definition of social decision-making as choices taken in a context where one or more conspecifics are involved in the decision or the consequences of it. Social decisions can be conceptualized as complex economic decisions since they are based on the subjective preferences between different goods. During social decisions, individuals choose based on their internal value estimate of the different alternatives. These are complex decisions given that conspecifics beliefs or actions could modify the subject's internal valuations at every choice. Here, we first review recent developments in our collective understanding of the neuronal mechanisms and circuits of social decision-making in primates. We then review literature characterizing populations with neuropsychiatric disorders showing deficits in social decision-making and the underlying neuronal circuitries associated with these deficits.
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Affiliation(s)
- Raymundo Báez-Mendoza
- Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Yuriria Vázquez
- Laboratory of Neural Systems, The Rockefeller University, New York, NY, United States
| | - Emma P. Mastrobattista
- Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Ziv M. Williams
- Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
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9
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Mancini F, Gangemi A. Deontological and Altruistic Guilt Feelings: A Dualistic Thesis. Front Psychol 2021; 12:651937. [PMID: 34239480 PMCID: PMC8258242 DOI: 10.3389/fpsyg.2021.651937] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/10/2021] [Indexed: 11/21/2022] Open
Abstract
In this paper we argue in favor of the existence of two different guilt feelings: altruistic guilt (AG) and deontological guilt (DG). AG arises from having harmed, through one's own action or omission, an innocent victim, while DG arises from the transgression of an internalized norm. In most daily experiences of guilt feelings both types are present, but we argue that they are not traceable to each other and that each can be present without the other. We show that the two guilt feelings can be distinguished with reference to behavioral, cognitive, and neurophysiological aspects. Moreover, we demonstrate that they are differently related to other processes and emotions. AG is connected with pain, empathy and ToM. DG is strongly related to disgust. We briefly illustrate some implications for moral psychology and clinical psychology.
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Affiliation(s)
- Francesco Mancini
- Scuola di Specializzazione in Psicoterapia Cognitiva (SPC), Rome, Italy.,Department of Human Sciences, Guglielmo Marconi University, Rome, Italy
| | - Amelia Gangemi
- Department of Cognitive Science, University of Messina, Messina, Italy
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10
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Feelings of shame and guilt are associated with distinct neural activation in youth. Biol Psychol 2021; 159:108025. [PMID: 33484753 DOI: 10.1016/j.biopsycho.2021.108025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 12/15/2020] [Accepted: 01/12/2021] [Indexed: 11/20/2022]
Abstract
Shame and guilt are moral emotions that play an important role in social functioning. There is limited knowledge about the neural underpinnings of these emotions, particularly in young people. In the current study, 36 healthy females (mean age 18.8 ± 1.9 years) underwent functional Magnetic Resonance Imaging, during which they reflected on their decisions about social moral dilemmas, and subsequently received negative or positive peer feedback. Ratings of shame and guilt were used as parametric modulators of brain activity. Shame was associated with decreased activity in the superior temporal sulcus and precentral gyrus during reflection. Guilt was associated with decreased activity in the precuneus during positive feedback, and in the hippocampus and supramarginal gyrus during negative feedback. Results suggest that shame and guilt are associated with activity in brain regions involved in social cognition and emotion regulation; however, they have distinct underlying neural circuitry that may be differentiated based on social evaluation.
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11
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Göttlich M, Westermair AL, Beyer F, Bußmann ML, Schweiger U, Krämer UM. Neural basis of shame and guilt experience in women with borderline personality disorder. Eur Arch Psychiatry Clin Neurosci 2020; 270:979-992. [PMID: 32382793 PMCID: PMC7599192 DOI: 10.1007/s00406-020-01132-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 04/27/2020] [Indexed: 11/17/2022]
Abstract
Borderline personality disorder (BPD) is characterized by instability of affect, emotion dysregulation, and interpersonal dysfunction. Especially shame and guilt, so-called self-conscious emotions, are of central clinical relevance to BPD. However, only few experimental studies have focused on shame or guilt in BPD and none investigated their neurobiological underpinnings. In the present functional magnetic resonance imaging study, we took a scenario-based approach to experimentally induce feelings of shame, guilt, and disgust with neutral scenarios as control condition. We included 19 women with BPD (age 26.4 ± 5.8 years; DSM-IV diagnosed; medicated) and 22 healthy female control subjects (age 26.4 ± 4.6 years; matched for age and verbal IQ). Compared to controls, women with BPD reported more intense feelings when being confronted with affective scenarios, especially higher levels of shame, guilt, and fear. We found increased amygdala reactivity in BPD compared to controls for shame and guilt, but not for disgust scenarios (p = 0.05 FWE corrected at the cluster level; p < 0.0001 cluster defining threshold). Exploratory analyses showed that this was caused by a diminished habituation in women with BPD relative to control participants. This effect was specific to guilt and shame scenarios as both groups showed amygdala habituation to disgust scenarios. Our work suggests that heightened shame and guilt experience in BPD is not related to increased amygdala activity per se, but rather to decreased habituation to self-conscious emotions. This provides an explanation for the inconsistencies in previous imaging work on amygdala involvement in BPD as well as the typically slow progress in the psychotherapy of dysfunctional self-conscious emotions in this patient group.
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Affiliation(s)
- Martin Göttlich
- Department of Neurology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Anna Lisa Westermair
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Frederike Beyer
- School of Biological and Chemical Sciences, Queen Mary University of London, London, UK
| | - Marie Luise Bußmann
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Ulrich Schweiger
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Ulrike M Krämer
- Department of Neurology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
- Institute for Psychology II, University of Lübeck, Lübeck, Germany.
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12
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Williams K, Elliott R, McKie S, Zahn R, Barnhofer T, Anderson IM. Changes in the neural correlates of self-blame following mindfulness-based cognitive therapy in remitted depressed participants. Psychiatry Res Neuroimaging 2020; 304:111152. [PMID: 32717664 DOI: 10.1016/j.pscychresns.2020.111152] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 04/08/2020] [Accepted: 07/21/2020] [Indexed: 12/18/2022]
Abstract
Mindfulness-Based-Cognitive-Therapy (MBCT) reduces vulnerability for relapse into depression by helping individuals to counter tendencies to engage in maladaptive repetitive patterns of thinking and respond more compassionately to negative self-judgment. However, little is known about the neural correlates underlying these effects. To elucidate these correlates, we investigated fMRI brain activation during a task eliciting feelings of blaming oneself or others. Sixteen participants in remission from major depressive disorder (MDD) completed fMRI assessments before and after MBCT, alongside self-reported levels of self-compassion, mindfulness, and depression symptoms. Analyses of self-blame versus other-blame contrasts showed a reduction in activation in the bilateral dorsal anterior cingulate/medial superior frontal gyrus after MBCT compared to baseline. Further, exploratory analyses showed that increases in self-kindness after MBCT correlated with reduced activation in the posterior cingulate cortex (PCC)/precuneus in self-blame versus rest contrasts. These findings suggest that MBCT is associated with a reduction in activations in cortical midline regions to self-blame which may be mediated by increasing self-kindness. However, this is a small, uncontrolled study with 16 participants and therefore our results will need confirmation in a controlled study.
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Affiliation(s)
- Kate Williams
- Neuroscience and Psychiatry Unit, University of Manchester, M13 9PT, UK.
| | - Rebecca Elliott
- Neuroscience and Psychiatry Unit, University of Manchester, M13 9PT, UK
| | - Shane McKie
- Neuroscience and Psychiatry Unit, University of Manchester, M13 9PT, UK
| | - Roland Zahn
- Centre for Affective Disorders, King's College London, SE5 8AF, UK
| | | | - Ian M Anderson
- Neuroscience and Psychiatry Unit, University of Manchester, M13 9PT, UK
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13
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Piretti L, Pappaianni E, Lunardelli A, Zorzenon I, Ukmar M, Pesavento V, Rumiati RI, Job R, Grecucci A. The Role of Amygdala in Self-Conscious Emotions in a Patient With Acquired Bilateral Damage. Front Neurosci 2020; 14:677. [PMID: 32733192 PMCID: PMC7360725 DOI: 10.3389/fnins.2020.00677] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 06/02/2020] [Indexed: 11/25/2022] Open
Abstract
Shame plays a fundamental role in the regulation of our social behavior. One intriguing question is whether amygdala might play a role in processing this emotion. In the present single-case study, we tested a patient with acquired damage of bilateral amygdalae and surrounding areas as well as healthy controls on shame processing and other social cognitive tasks. Results revealed that the patient's subjective experience of shame, but not of guilt, was more reduced than in controls, only when social standards were violated, while it was not different than controls in case of moral violations. The impairment in discriminating between normal social situations and violations also emerged. Taken together, these findings suggest that the role of the amygdala in processing shame might reflect its relevance in resolving ambiguity and uncertainty, in order to correctly detect social violations and to generate shame feelings.
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Affiliation(s)
- Luca Piretti
- Clinical and Affective Neuroscience Lab, Department of Psychology and Cognitive Sciences, University of Trento, Rovereto, Italy
- Marica De Vincenzi Onlus Foundation, Rovereto, Italy
| | - Edoardo Pappaianni
- Clinical and Affective Neuroscience Lab, Department of Psychology and Cognitive Sciences, University of Trento, Rovereto, Italy
| | | | - Irene Zorzenon
- Radiology Department, Ospedali Riuniti di Trieste, Trieste, Italy
| | - Maja Ukmar
- Radiology Department, Ospedali Riuniti di Trieste, Trieste, Italy
| | | | - Raffaella Ida Rumiati
- Neuroscience and Society Lab, Neuroscience Area, International School for Advanced Studies (SISSA), Trieste, Italy
| | - Remo Job
- Clinical and Affective Neuroscience Lab, Department of Psychology and Cognitive Sciences, University of Trento, Rovereto, Italy
- Marica De Vincenzi Onlus Foundation, Rovereto, Italy
| | - Alessandro Grecucci
- Clinical and Affective Neuroscience Lab, Department of Psychology and Cognitive Sciences, University of Trento, Rovereto, Italy
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14
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Fjermestad-Noll J, Ronningstam E, Bach BS, Rosenbaum B, Simonsen E. Perfectionism, Shame, and Aggression in Depressive Patients With Narcissistic Personality Disorder. J Pers Disord 2020; 34:25-41. [PMID: 32186981 DOI: 10.1521/pedi.2020.34.supp.25] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Depressive symptoms are known to co-occur in patients with narcissistic personality disorder (NPD). From a psychodynamic perspective, perfectionism, shame, and aggression are regarded as prominent in depressed patients. The authors investigated the occurrence of perfectionism, shame, and aggression in patients with NPD, and whether shame is a mediating or a moderating factor for aggression. Two groups of patients with depression, 61 diagnosed with NPD and no other personality disorders (PD) were compared with 56 without any PD, using the SCID screening questionnaire and a semistructured interview. All participants were administered the Multidimensional Perfectionism Scale, the Internalized Shame Scale, and the Buss-Perry Aggression Questionnaire. The NPD group showed significantly higher scores for self-oriented and socially prescribed perfectionism, shame, and aggression (i.e., physical, verbal, anger, and hostility). Shame was found to act as a mediating factor, reducing levels of aggression in patients with perfectionistic traits.
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Affiliation(s)
| | | | - Bo S Bach
- Center for Personality Disorder Research, Psychiatric Research Unit, Region Zealand, Denmark
| | - Bent Rosenbaum
- Institute of Psychology, University of Copenhagen, Denmark
| | - Erik Simonsen
- Psychiatric Research Unit, Region Zealand and Department of Clinical Medicine, University of Copenhagen
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15
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Angulo J, Fleury V, Péron JA, Penzenstadler L, Zullino D, Krack P. Shame in Parkinson'S Disease: A Review. JOURNAL OF PARKINSON'S DISEASE 2019; 9:489-499. [PMID: 31081792 PMCID: PMC6700625 DOI: 10.3233/jpd-181462] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Shame is a self-conscious emotion marked by an intensely negative self-evaluation. It is exhibited by an individual upon realizing that she/he has violated an important (usually social) norm. Shame can be a source of emotional distress leading to social withdrawal and depression, with a significant negative impact on quality of life. In Parkinson’s disease (PD), shame is rarely addressed. Based on reports of persons affected with Parkinson’s disease (PwP) as well as a literature review, this article describes PD-related shame. PD-related shame may emerge from motor and non-motor symptoms, from self-perception of inadequacy due to loss of autonomy and need for help, or from perceived deterioration of body image. The neurobiology of shame delineates neuronal networks involved in cognitive and emotions regulation, self-representation and representation of the others mental states. Although this hypothesis remains to be demonstrated, these substrates could be modulated, at least partially, by dopaminergic depletion related to PD, which may open a window for pharmacotherapy. Owing to the negative impact that shame can produce, shame should be actively explored and addressed in the individual PwP. Teaching PwP how to develop resilience to shame may be a useful strategy in preventing the vicious circle of shame. The paucity of existing data on prevalence and management of PD-specific shame contrasts with the manifold reported situations inducing suffering from shame. There is a crucial need for further investigations of shame in PD and the development of interventions to reduce its impact on PwP’s quality of life.
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Affiliation(s)
- Julio Angulo
- Morningview Place, Lake Oswego, OR, USA.,Persons with Parkinson's Advisory Council, Parkinson Foundation, Miami-New York, USA.,Program Design Committee 2019 World Parkinson's Congress, World Parkinson's Coalition, NY, USA
| | - Vanessa Fleury
- Department of Neurology, Geneva University Hospital, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, CMU, Geneva, Switzerland
| | - Julie Anne Péron
- Department of Psychology and Swiss Center for Affective Sciences, Neuroscience of Emotion and Affective Dynamics laboratory, University of Geneva, Geneva, Switzerland.,Department of Neurology, Neuropsychology Unit, University Hospitals of Geneva, Geneva, Switzerland
| | | | - Daniele Zullino
- Department of Psychiatry, Geneva University Hospital, Geneva, Switzerland
| | - Paul Krack
- Department of Neurology, Geneva University Hospital, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, CMU, Geneva, Switzerland
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16
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Sun D, Phillips RD, Mulready HL, Zablonski ST, Turner JA, Turner MD, McClymond K, Nieuwsma JA, Morey RA. Resting-state brain fluctuation and functional connectivity dissociate moral injury from posttraumatic stress disorder. Depress Anxiety 2019; 36:442-452. [PMID: 30690812 PMCID: PMC6488394 DOI: 10.1002/da.22883] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 01/07/2019] [Accepted: 01/12/2019] [Indexed: 02/04/2023] Open
Abstract
Moral injury is closely associated with posttraumatic stress disorder (PTSD) and characterized by disturbances in social and moral cognition. Little is known about the neural underpinnings of moral injury, and whether the neural correlates are different between moral injury and PTSD. A sample of 26 U.S. military veterans (two females: 28-55 years old) were investigated to determine how subjective appraisals of morally injurious events measured by Moral Injury Event Scale (MIES) and PTSD symptoms are differentially related to spontaneous fluctuations indexed by amplitude of low frequency fluctuation (ALFF) as well as functional connectivity during resting-state functional magnetic resonance imaging scanning. ALFF in the left inferior parietal lobule (L-IPL) was positively associated with MIES subscores of transgressions, negatively associated with subscores of betrayals, and not related with PTSD symptoms. Moreover, functional connectivity between the L-IPL and bilateral precuneus was positively related with PTSD symptoms and negatively related with MIES total scores. Our results provide the first evidence that morally injurious events and PTSD symptoms have dissociable neural underpinnings, and behaviorally distinct subcomponents of morally injurious events are different in neural responses. The findings increase our knowledge of the neural distinctions between moral injury and PTSD and may contribute to developing nosology and interventions for military veterans afflicted by moral injury.
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Affiliation(s)
- Delin Sun
- Duke-UNC Brain Imaging and Analysis Center, Duke University, Durham, North Carolina,VA Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC), Durham, North Carolina
| | - Rachel D. Phillips
- Duke-UNC Brain Imaging and Analysis Center, Duke University, Durham, North Carolina,VA Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC), Durham, North Carolina
| | - Hannah L. Mulready
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC), Durham, North Carolina
| | - Stephen T. Zablonski
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC), Durham, North Carolina
| | - Jessica A. Turner
- Department of Psychology, Georgia State University, Atlanta, Georgia
| | - Matthew D. Turner
- Department of Psychology, Georgia State University, Atlanta, Georgia
| | - Kathryn McClymond
- Department of Religious Studies, Georgia State University, Atlanta, Georgia
| | - Jason A. Nieuwsma
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC), Durham, North Carolina,Department of Psychiatry & Behavioral Sciences, School of Medicine, Duke University, Durham, North Carolina
| | - Rajendra A. Morey
- Duke-UNC Brain Imaging and Analysis Center, Duke University, Durham, North Carolina,VA Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC), Durham, North Carolina,Department of Psychiatry & Behavioral Sciences, School of Medicine, Duke University, Durham, North Carolina
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17
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Zhu R, Feng C, Zhang S, Mai X, Liu C. Differentiating guilt and shame in an interpersonal context with univariate activation and multivariate pattern analyses. Neuroimage 2019; 186:476-486. [DOI: 10.1016/j.neuroimage.2018.11.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 10/15/2018] [Accepted: 11/09/2018] [Indexed: 01/02/2023] Open
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18
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Gifuni AJ, Kendal A, Jollant F. Neural mapping of guilt: a quantitative meta-analysis of functional imaging studies. Brain Imaging Behav 2018; 11:1164-1178. [PMID: 27704409 DOI: 10.1007/s11682-016-9606-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Guilt is a self-conscious emotion associated with the negative appraisal of one's behavior. In recent years, several neuroimaging studies have investigated the neural correlates of guilt, but no meta-analyses have yet identified the most robust activation patterns. A systematic review of literature found 16 functional magnetic resonance imaging studies with whole-brain analyses meeting the inclusion criteria, for a total of 325 participants and 135 foci of activation. A meta-analysis was then conducted using activation likelihood estimation. Additionally, Meta-Analytic Connectivity Modeling (MACM) analysis was conducted to investigate the functional connectivity of significant clusters. The analysis revealed 12 significant clusters of brain activation (voxel-based FDR-corrected p < 0.05) located in the prefrontal, temporal and parietal regions, mainly in the left hemisphere. Only the left dorsal cingulate cluster survived stringent FWE correction (voxel-based p < 0.05). Secondary analyses (voxel-based FDR-corrected p < 0.05) on the 7 studies contrasting guilt with another emotional condition showed an association with clusters in the left precuneus, the anterior cingulate, the left medial frontal gyrus, the right superior frontal gyrus and the left superior temporal gyrus. MACM demonstrated that regions associated with guilt are highly interconnected. Our analysis identified a distributed neural network of left-lateralized regions associated with guilt. While voxel-based FDR-corrected results should be considered exploratory, the dorsal cingulate was robustly associated with guilt. We speculate that this network integrates cognitive and emotional processes involved in the experience of guilt, including self-representation, theory of mind, conflict monitoring and moral values. Limitations of our meta-analyses comprise the small sample size and the heterogeneity of included studies, and concerns about naturalistic validity.
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Affiliation(s)
- Anthony J Gifuni
- Department of Psychiatry & Douglas Mental Health University Institute, McGill Group for Suicide Studies, McGill University, Frank B. Common building, 6875 LaSalle Boulevard, Montréal, Québec, H4H1R3, Canada
| | - Adam Kendal
- Department of Psychiatry & Douglas Mental Health University Institute, McGill Group for Suicide Studies, McGill University, Frank B. Common building, 6875 LaSalle Boulevard, Montréal, Québec, H4H1R3, Canada
| | - Fabrice Jollant
- Department of Psychiatry & Douglas Mental Health University Institute, McGill Group for Suicide Studies, McGill University, Frank B. Common building, 6875 LaSalle Boulevard, Montréal, Québec, H4H1R3, Canada. .,Department of Psychiatry, Academic Hospital (CHU) of Nîmes, Nîmes, France.
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19
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Ying X, Luo J, Chiu CY, Wu Y, Xu Y, Fan J. Functional Dissociation of the Posterior and Anterior Insula in Moral Disgust. Front Psychol 2018; 9:860. [PMID: 29910758 PMCID: PMC5992674 DOI: 10.3389/fpsyg.2018.00860] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 05/14/2018] [Indexed: 11/13/2022] Open
Abstract
The insula is thought to be involved in disgust. However, the roles of the posterior insula (PI) and anterior insula (AI) in moral disgust have not been clearly dissociated in previous studies. In this functional magnetic resonance imaging study, the participants evaluated the degree of disgust using sentences related to mild moral violations with different types of behavioral agents (mother and stranger). The activation of the PI in response to the stranger agent was significantly higher than that in response to the mother agent. In contrast, the activation of the AI in response to the mother agent was significantly higher than that in response to the stranger agent. These data suggest a clear functional dissociation between the PI and AI in which the PI is more involved in the primary level of moral disgust than is the AI, and the AI is more involved in the secondary level of moral disgust than is the PI. Our results provide key evidence for understanding the principle of embodied cognition and particularly demonstrate that high-level moral disgust is built on more basic disgust via a mental construction approach through a process of embodied schemata.
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Affiliation(s)
- Xiaoping Ying
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education, Faculty of Psychology, Beijing Normal University, Beijing, China.,Institute of Sociology, Chinese Academy of Social Sciences, Beijing, China
| | - Jing Luo
- School of Psychology, Capital Normal University, Beijing, China
| | - Chi-Yue Chiu
- Department of Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Yanhong Wu
- School of Psychological and Cognitive Sciences, Peking University, Beijing, China
| | - Yan Xu
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education, Faculty of Psychology, Beijing Normal University, Beijing, China
| | - Jin Fan
- Department of Psychology, Queens College, The City University of New York, Flushing, NY, United States.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States.,Fishberg Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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20
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Zuo Z, Ran S, Wang Y, Li C, Han Q, Tang Q, Qu W, Li H. Altered Structural Covariance Among the Dorsolateral Prefrontal Cortex and Amygdala in Treatment-Naïve Patients With Major Depressive Disorder. Front Psychiatry 2018; 9:323. [PMID: 30079037 PMCID: PMC6062642 DOI: 10.3389/fpsyt.2018.00323] [Citation(s) in RCA: 15] [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: 05/02/2018] [Accepted: 06/29/2018] [Indexed: 12/27/2022] Open
Abstract
Background: Impairments in cognitive and emotional processing are a characteristic of major depressive disorder (MDD), and the dorsolateral prefrontal cortex (DLPFC) and amygdala are involved in these processes. However, the structural covariance between these two areas in patients with MDD has not been examined. Whether anatomical patterns are further damaged or compensated in untreated multiple-episode MDD compared to those in first-episode MDD is unclear. Methods: Structural magnetic resonance imaging was performed in 35 treatment-naïve, currently depressed patients with MDD and 35 age-, sex-, and education-matched controls. The cortical thickness and subcortical volume were calculated using FreeSurfer software. Patients were divided into two subgroups based on the previous number of episodes. Results: Regional abnormalities in patients with MDD were primarily observed in the frontal-limbic circuits. The negative structural association between the left DLPFC and left amygdala and the positive structural association between the bilateral DLPFC observed in controls were absent in patients with MDD. The medial orbitofrontal cortex and posterior cingulate cortex were thicker in patients with multiple-episode MDD than in patients with first-episode MDD and were positively correlated with disorder duration. No structural alterations were correlated with symptom severity. Conclusions: These findings may provide structural evidence for deficits in functional networks in MDD and supports an underlying structural mechanism of dysfunction involving top-down or bottom-up processes. Morphological abnormalities in the medial orbitofrontal cortex and posterior cingulate cortex may be critical for the pathophysiological progression of multiple-episode MDD.
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Affiliation(s)
- Zhiwei Zuo
- Department of Radiology, Affiliated Southwest Hospital, Army Medical University, Chongqing, China
| | - Shuhua Ran
- Department of Radiology, Affiliated Southwest Hospital, Army Medical University, Chongqing, China
| | - Yao Wang
- Department of Radiology, Affiliated Southwest Hospital, Army Medical University, Chongqing, China
| | - Chang Li
- Department of Radiology, Affiliated Southwest Hospital, Army Medical University, Chongqing, China
| | - Qi Han
- Department of Radiology, Affiliated Southwest Hospital, Army Medical University, Chongqing, China
| | - Qianying Tang
- Department of Psychology, Affiliated Southwest Hospital, Army Medical University, Chongqing, China
| | - Wei Qu
- Department of Psychology, Affiliated Southwest Hospital, Army Medical University, Chongqing, China
| | - Haitao Li
- Department of Radiology, Affiliated Southwest Hospital, Army Medical University, Chongqing, China
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21
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Wei S, Womer F, Geng H, Jiang X, Zhou Q, Chang M, Zhou Y, Tang Y, Wang F. Similarities and differences of functional connectivity in drug-naïve, first-episode adolescent and young adult with major depressive disorder and schizophrenia. Sci Rep 2017; 7:44316. [PMID: 28287187 PMCID: PMC5347082 DOI: 10.1038/srep44316] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 02/06/2017] [Indexed: 12/27/2022] Open
Abstract
Major depressive disorder (MDD) and schizophrenia (SZ) are considered two distinct psychiatric disorders. Yet, they have considerable overlap in symptomatology and clinical features, particularly in the initial phases of illness. The amygdala and prefrontal cortex (PFC) appear to have critical roles in these disorders; however, abnormalities appear to manifest differently. In our study forty-nine drug-naïve, first-episode MDD, 45 drug-naïve, first-episode SZ, and 50 healthy control (HC) participants from 13 to 30 years old underwent resting-state functional magnetic resonance imaging. Functional connectivity (FC) between the amygdala and PFC was compared among the three groups. Significant differences in FC were observed between the amygdala and ventral PFC (VPFC), dorsolateral PFC (DLPFC), and dorsal anterior cingulated cortex (dACC) among the three groups. Further analyses demonstrated that MDD showed decreased amygdala-VPFC FC and SZ had reductions in amygdala-dACC FC. Both the diagnostic groups had significantly decreased amygdala-DLPFC FC. These indicate abnormalities in amygdala-PFC FC and further support the importance of the interaction between the amygdala and PFC in adolescents and young adults with these disorders. Additionally, the alterations in amygdala-PFC FC may underlie the initial similarities observed between MDD and SZ and suggest potential markers of differentiation between the disorders at first onset.
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Affiliation(s)
- Shengnan Wei
- Brain Function Research Section, First Affiliated Hospital, China Medical University, Shenyang, Liaoning, PR China.,Department of Radiology, First Affiliated Hospital, China Medical University, Shenyang, Liaoning, PR China
| | - Fay Womer
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Haiyang Geng
- Department of Radiology, First Affiliated Hospital, China Medical University, Shenyang, Liaoning, PR China
| | - Xiaowei Jiang
- Brain Function Research Section, First Affiliated Hospital, China Medical University, Shenyang, Liaoning, PR China.,Department of Radiology, First Affiliated Hospital, China Medical University, Shenyang, Liaoning, PR China
| | - Qian Zhou
- Department of Psychiatry, First Affiliated Hospital, China Medical University, Shenyang, Liaoning, PR China
| | - Miao Chang
- Department of Radiology, First Affiliated Hospital, China Medical University, Shenyang, Liaoning, PR China
| | - Yifang Zhou
- Department of Psychiatry, First Affiliated Hospital, China Medical University, Shenyang, Liaoning, PR China.,Department of Geriatric Medicine, First Affiliated Hospital, China Medical University, Shenyang, Liaoning, PR China
| | - Yanqing Tang
- Brain Function Research Section, First Affiliated Hospital, China Medical University, Shenyang, Liaoning, PR China.,Department of Psychiatry, First Affiliated Hospital, China Medical University, Shenyang, Liaoning, PR China.,Department of Geriatric Medicine, First Affiliated Hospital, China Medical University, Shenyang, Liaoning, PR China
| | - Fei Wang
- Brain Function Research Section, First Affiliated Hospital, China Medical University, Shenyang, Liaoning, PR China.,Department of Radiology, First Affiliated Hospital, China Medical University, Shenyang, Liaoning, PR China.,Department of Psychiatry, First Affiliated Hospital, China Medical University, Shenyang, Liaoning, PR China.,Department of Psychiatry, Yale University School of Medicine, New Haven, Conn., USA
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22
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Feelings of shame, embarrassment and guilt and their neural correlates: A systematic review. Neurosci Biobehav Rev 2016; 71:455-471. [DOI: 10.1016/j.neubiorev.2016.09.019] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Revised: 08/19/2016] [Accepted: 09/23/2016] [Indexed: 01/10/2023]
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23
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Social functioning in major depressive disorder. Neurosci Biobehav Rev 2016; 69:313-32. [PMID: 27395342 DOI: 10.1016/j.neubiorev.2016.07.002] [Citation(s) in RCA: 355] [Impact Index Per Article: 44.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 06/15/2016] [Accepted: 07/05/2016] [Indexed: 12/18/2022]
Abstract
Depression is associated with social risk factors, social impairments and poor social functioning. This paper gives an overview of these social aspects using the NIMH Research and Domain Criteria 'Systems for Social Processes' as a framework. In particular, it describes the bio-psycho-social interplay regarding impaired affiliation and attachment (social anhedonia, hyper-sensitivity to social rejection, competition avoidance, increased altruistic punishment), impaired social communication (impaired emotion recognition, diminished cooperativeness), impaired social perception (reduced empathy, theory-of-mind deficits) and their impact on social networks and the use of social media. It describes these dysfunctional social processes at the behavioural, neuroanatomical, neurochemical and genetic levels, and with respect to animal models of social stress. We discuss the diagnostic specificity of these social deficit constructs for depression and in relation to depression severity. Since social factors are importantly involved in the pathogenesis and the consequences of depression, such research will likely contribute to better diagnostic assessments and concepts, treatments and preventative strategies both at the diagnostic and transdiagnostic level.
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Subgenual Cingulate-Amygdala Functional Disconnection and Vulnerability to Melancholic Depression. Neuropsychopharmacology 2016; 41:2082-90. [PMID: 26781519 PMCID: PMC4820084 DOI: 10.1038/npp.2016.8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 01/06/2016] [Accepted: 01/12/2016] [Indexed: 11/08/2022]
Abstract
The syndromic heterogeneity of major depressive disorder (MDD) hinders understanding of the etiology of predisposing vulnerability traits and underscores the importance of identifying neurobiologically valid phenotypes. Distinctive fMRI biomarkers of vulnerability to MDD subtypes are currently lacking. This study investigated whether remitted melancholic MDD patients, who are at an elevated lifetime risk for depressive episodes, demonstrate distinctive patterns of resting-state connectivity with the subgenual cingulate cortex (SCC), known to be of core pathophysiological importance for severe and familial forms of MDD. We hypothesized that patterns of disrupted SCC connectivity would be a distinguishing feature of melancholia. A total of 63 medication-free remitted MDD (rMDD) patients (33 melancholic and 30 nonmelancholic) and 39 never-depressed healthy controls (HC) underwent resting-state fMRI scanning. SCC connectivity was investigated with closely connected bilateral a priori regions of interest (ROIs) relevant to MDD (anterior temporal, ventromedial prefrontal, dorsomedial prefrontal cortices, amygdala, hippocampus, septal region, and hypothalamus). Decreased (less positive) SCC connectivity with the right parahippocampal gyrus and left amygdala distinguished melancholic rMDD patients from the nonmelancholic rMDD and HC groups (cluster-based familywise error-corrected p⩽0.007 over individual a priori ROIs corresponding to approximate Bonferroni-corrected p⩽0.05 across all seven a priori ROIs). No areas demonstrating increased (more positive) connectivity were observed. Abnormally decreased connectivity of the SCC with the amygdala and parahippocampal gyrus distinguished melancholic from nonmelancholic rMDD. These results provide the first resting-state neural signature distinctive of melancholic rMDD and may reflect a subtype-specific primary vulnerability factor given a lack of association with the number of previous episodes.
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25
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Abstract
Although it is generally accepted that cognitive factors contribute to the pathogenesis of major depressive disorder (MDD), there are missing links between behavioral and biological models of depression. Nevertheless, research employing neuroimaging technologies has elucidated some of the neurobiological mechanisms related to cognitive-vulnerability factors, especially from a whole-brain, dynamic perspective. In this review, we integrate well-established cognitive-vulnerability factors for MDD and corresponding neural mechanisms in intrinsic networks using a dual-process framework. We propose that the dynamic alteration and imbalance among the intrinsic networks, both in the resting-state and the rest-task transition stages, contribute to the development of cognitive vulnerability and MDD. Specifically, we propose that abnormally increased resting-state default mode network (DMN) activity and connectivity (mainly in anterior DMN regions) contribute to the development of cognitive vulnerability. Furthermore, when subjects confront negative stimuli in the period of rest-to-task transition, the following three kinds of aberrant network interactions have been identified as facilitators of vulnerability and dysphoric mood, each through a different cognitive mechanism: DMN dominance over the central executive network (CEN), an impaired salience network-mediated switching between the DMN and CEN, and ineffective CEN modulation of the DMN. This focus on interrelated networks and brain-activity changes between rest and task states provides a neural-system perspective for future research on cognitive vulnerability and resilience, and may potentially guide the development of new intervention strategies for MDD.
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26
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The role of self-blame and worthlessness in the psychopathology of major depressive disorder. J Affect Disord 2015; 186:337-41. [PMID: 26277271 PMCID: PMC4573463 DOI: 10.1016/j.jad.2015.08.001] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 07/08/2015] [Accepted: 08/01/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Cognitive models predict that vulnerability to major depressive disorder (MDD) is due to a bias to blame oneself for failure in a global way resulting in excessive self-blaming emotions, decreased self-worth, hopelessness and depressed mood. Clinical studies comparing the consistency and coherence of these symptoms in order to probe the predictions of the model are lacking. METHODS 132 patients with remitted MDD and no relevant lifetime co-morbid axis-I disorders were assessed using a phenomenological psychopathology-based interview (AMDP) including novel items to assess moral emotions (n=94 patients) and the structured clinical interview-I for DSM-IV-TR. Cluster analysis was employed to identify symptom coherence for the most severe episode. RESULTS Feelings of inadequacy, depressed mood, and hopelessness emerged as the most closely co-occurring and consistent symptoms (≥90% of patients). Self-blaming emotions occurred in most patients (>80%) with self-disgust/contempt being more frequent than guilt, followed by shame. Anger or disgust towards others was experienced by only 26% of patients. 85% of patients reported feelings of inadequacy and self-blaming emotions as the most bothering symptoms compared with 10% being more distressed by negative emotions towards others. LIMITATIONS Symptom assessment was retrospective, but this is unlikely to have biased patients towards particular emotions relative to others. CONCLUSIONS As predicted, feelings of inadequacy and hopelessness were part of the core depressive syndrome, closely co-occurring with depressed mood. Self-blaming emotions were highly frequent and bothering but not restricted to guilt. This calls for a refined assessment of self-blaming emotions to improve the diagnosis and stratification of MDD.
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27
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Pulcu E, Elliott R. Neural origins of psychosocial functioning impairments in major depression. Lancet Psychiatry 2015; 2:835-43. [PMID: 26360902 DOI: 10.1016/s2215-0366(15)00237-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 04/30/2015] [Accepted: 05/07/2015] [Indexed: 11/23/2022]
Abstract
Major depressive disorder, a complex neuropsychiatric condition, is associated with psychosocial functioning impairments that could become chronic even after symptoms remit. Social functioning impairments in patients could also pose coping difficulties to individuals around them. In this Personal View, we trace the potential neurobiological origins of these impairments down to three candidate domains-namely, social perception and emotion processing, motivation and reward value processing, and social decision making. We argue that the neural basis of abnormalities in these domains could be detectable at different temporal stages during social interactions (eg, before and after decision stages), particularly within frontomesolimbic networks (ie, frontostriatal and amygdala-striatal circuitries). We review some of the experimental designs used to probe these circuits and suggest novel, integrative approaches. We propose that an understanding of the interactions between these domains could provide valuable insights for the clinical stratification of major depressive disorder subtypes and might inform future developments of novel treatment options in return.
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Affiliation(s)
- Erdem Pulcu
- Neuroscience and Psychiatry Unit, School of Medicine, The University of Manchester and Manchester Academic Health Sciences Centre, Manchester, UK.
| | - Rebecca Elliott
- Neuroscience and Psychiatry Unit, School of Medicine, The University of Manchester and Manchester Academic Health Sciences Centre, Manchester, UK
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Admon R, Holsen LM, Aizley H, Remington A, Whitfield-Gabrieli S, Goldstein JM, Pizzagalli DA. Striatal Hypersensitivity During Stress in Remitted Individuals with Recurrent Depression. Biol Psychiatry 2015; 78:67-76. [PMID: 25483401 PMCID: PMC4383718 DOI: 10.1016/j.biopsych.2014.09.019] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 08/29/2014] [Accepted: 09/19/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND Increased sensitivity to stress and dysfunctional reward processing are two primary characteristics of major depressive disorder (MDD) that may persist after remission. Preclinical work has established the pivotal role of the striatum in mediating both stress and reward responses. Human neuroimaging studies have corroborated these preclinical findings and highlighted striatal dysfunction in MDD in response to reward but have yet to investigate striatal function during stress, in particular in individuals with recurrent depression. METHODS A validated mild psychological stress task involving viewing of negative stimuli during functional magnetic resonance imaging was conducted in 33 remitted individuals with a history of recurrent major depressive disorder (rMDD) and 35 matched healthy control subjects. Cortisol and anxiety levels were assessed throughout scanning. Stress-related activation was investigated in three striatal regions: caudate, nucleus accumbens, and putamen. Psychophysiologic interaction analyses probed connectivity of regions with central structures of the neural stress circuitry, such as the amygdala and hippocampus. RESULTS The task increased cortisol and anxiety levels, although to a greater extent in rMDD individuals than healthy control subjects. In response to the negative stimuli, rMDD individuals, but not controls, also exhibited significantly potentiated caudate, nucleus accumbens, and putamen activations and increased caudate-amygdala and caudate-hippocampus connectivity. CONCLUSIONS The findings highlight striatal hypersensitivity in response to a mild psychological stress in rMDD, as manifested by hyperactivation and hyperconnectivity with the amygdala and hippocampus. Striatal hypersensitivity during stress might thus constitute a trait mark of depression, providing a potential neural substrate for the interaction between stress and reward dysfunction in MDD.
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Affiliation(s)
- Roee Admon
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Laura M. Holsen
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA,Connors Center for Women's Health and Gender Biology, Division of Women's Health, Department of Medicine, Brigham & Women's Hospital, Boston, MA, USA,Department of Psychiatry, Brigham & Women's Hospital, Boston, MA, USA
| | - Harlyn Aizley
- Connors Center for Women's Health and Gender Biology, Division of Women's Health, Department of Medicine, Brigham & Women's Hospital, Boston, MA, USA,Department of Psychiatry, Brigham & Women's Hospital, Boston, MA, USA
| | - Anne Remington
- Connors Center for Women's Health and Gender Biology, Division of Women's Health, Department of Medicine, Brigham & Women's Hospital, Boston, MA, USA
| | - Susan Whitfield-Gabrieli
- Athinoula A. Martinos Center, Massachusetts General Hospital and Massachusetts Institute of Technology, Charlestown, MA, USA,Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Jill M. Goldstein
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA,Connors Center for Women's Health and Gender Biology, Division of Women's Health, Department of Medicine, Brigham & Women's Hospital, Boston, MA, USA,Department of Psychiatry, Brigham & Women's Hospital, Boston, MA, USA,Athinoula A. Martinos Center, Massachusetts General Hospital and Massachusetts Institute of Technology, Charlestown, MA, USA
| | - Diego A. Pizzagalli
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA,Department of Psychiatry, Harvard Medical School, Boston, MA, USA,McLean Imaging Center, McLean Hospital, Belmont, MA, USA
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Moses-Kolko EL, Horner MS, Phillips ML, Hipwell AE, Swain JE. In search of neural endophenotypes of postpartum psychopathology and disrupted maternal caregiving. J Neuroendocrinol 2014; 26:665-84. [PMID: 25059408 PMCID: PMC4353923 DOI: 10.1111/jne.12183] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 07/18/2014] [Accepted: 07/21/2014] [Indexed: 12/11/2022]
Abstract
This is a selective review that provides the context for the study of perinatal affective disorder mechanisms and outlines directions for future research. We integrate existing literature along neural networks of interest for affective disorders and maternal caregiving: (i) the salience/fear network; (ii) the executive network; (iii) the reward/social attachment network; and (iv) the default mode network. Extant salience/fear network research reveals disparate responses and corticolimbic coupling to various stimuli based upon a predominantly depressive versus anxious (post-traumatic stress disorder) clinical phenotype. Executive network and default mode connectivity abnormalities have been described in postpartum depression (PPD), although studies are very limited in these domains. Reward/social attachment studies confirm a robust ventral striatal response to infant stimuli, including cry and happy infant faces, which is diminished in depressed, insecurely attached and substance-using mothers. The adverse parenting experiences received and the attachment insecurity of current mothers are factors that are associated with a diminution in infant stimulus-related neural activity similar to that in PPD, and raise the need for additional studies that integrate mood and attachment concepts in larger study samples. Several studies examining functional connectivity in resting state and emotional activation functional magnetic resonance imaging paradigms have revealed attenuated corticolimbic connectivity, which remains an important outcome that requires dissection with increasing precision to better define neural treatment targets. Methodological progress is expected in the coming years in terms of refining clinical phenotypes of interest and experimental paradigms, as well as enlarging samples to facilitate the examination of multiple constructs. Functional imaging promises to determine neural mechanisms underlying maternal psychopathology and impaired caregiving, such that earlier and more precise detection of abnormalities will be possible. Ultimately, the discovery of such mechanisms will promote the refinement of treatment approaches toward maternal affective disturbance, parenting behaviours and the augmentation of parenting resiliency.
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Affiliation(s)
- E L Moses-Kolko
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Pulcu E, Zahn R, Moll J, Trotter PD, Thomas EJ, Juhasz G, Deakin JFW, Anderson IM, Sahakian BJ, Elliott R. Enhanced subgenual cingulate response to altruistic decisions in remitted major depressive disorder. NEUROIMAGE-CLINICAL 2014; 4:701-10. [PMID: 24936421 PMCID: PMC4053655 DOI: 10.1016/j.nicl.2014.04.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 04/16/2014] [Accepted: 04/17/2014] [Indexed: 01/09/2023]
Abstract
BACKGROUND Major depressive disorder (MDD) is associated with functional abnormalities in fronto-meso-limbic networks contributing to decision-making, affective and reward processing impairments. Such functional disturbances may underlie a tendency for enhanced altruism driven by empathy-based guilt observed in some patients. However, despite the relevance of altruistic decisions to understanding vulnerability, as well as everyday psychosocial functioning, in MDD, their functional neuroanatomy is unknown. METHODS Using a charitable donations experiment with fMRI, we compared 14 medication-free participants with fully remitted MDD and 15 demographically-matched control participants without MDD. RESULTS Compared with the control group, the remitted MDD group exhibited enhanced BOLD response in a septal/subgenual cingulate cortex (sgACC) region for charitable donation relative to receiving simple rewards and higher striatum activation for both charitable donation and simple reward relative to a low level baseline. The groups did not differ in demographics, frequency of donations or response times, demonstrating only a difference in neural architecture. CONCLUSIONS We showed that altruistic decisions probe residual sgACC hypersensitivity in MDD even after symptoms are fully remitted. The sgACC has previously been shown to be associated with guilt which promotes altruistic decisions. In contrast, the striatum showed common activation to both simple and altruistic rewards and could be involved in the so-called "warm glow" of donation. Enhanced neural response in the depression group, in areas previously linked to altruistic decisions, supports the hypothesis of a possible association between hyper-altruism and depression vulnerability, as shown by recent epidemiological studies.
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Affiliation(s)
- Erdem Pulcu
- Neuroscience & Psychiatry Unit, Manchester Academic Health Sciences Centre, School of Medicine, University of Manchester, Manchester M13 9PL, UK
| | - Roland Zahn
- Neuroscience & Psychiatry Unit, Manchester Academic Health Sciences Centre, School of Medicine, University of Manchester, Manchester M13 9PL, UK ; Department of Psychological Medicine, Institute of Psychiatry, King's College London, London SE5 8AF, UK
| | - Jorge Moll
- Cognitive and Behavioural Neuroscience Unit, D'or Institute, Rio de Janeiro, Brazil
| | - Paula D Trotter
- Neuroscience & Psychiatry Unit, Manchester Academic Health Sciences Centre, School of Medicine, University of Manchester, Manchester M13 9PL, UK
| | - Emma J Thomas
- Neuroscience & Psychiatry Unit, Manchester Academic Health Sciences Centre, School of Medicine, University of Manchester, Manchester M13 9PL, UK
| | - Gabriella Juhasz
- Neuroscience & Psychiatry Unit, Manchester Academic Health Sciences Centre, School of Medicine, University of Manchester, Manchester M13 9PL, UK ; Department of Pharmacodynamics, Faculty of Pharmacy, Semmelweis University, Budapest, Hungary
| | - J F William Deakin
- Neuroscience & Psychiatry Unit, Manchester Academic Health Sciences Centre, School of Medicine, University of Manchester, Manchester M13 9PL, UK
| | - Ian M Anderson
- Neuroscience & Psychiatry Unit, Manchester Academic Health Sciences Centre, School of Medicine, University of Manchester, Manchester M13 9PL, UK
| | - Barbara J Sahakian
- Department of Psychiatry, MRC Wellcome Trust Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Rebecca Elliott
- Neuroscience & Psychiatry Unit, Manchester Academic Health Sciences Centre, School of Medicine, University of Manchester, Manchester M13 9PL, UK
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