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How EH, Chin SM, Teo CH, Parhar IS, Soga T. Accelerated biological brain aging in major depressive disorder. Rev Neurosci 2024; 0:revneuro-2024-0025. [PMID: 39002110 DOI: 10.1515/revneuro-2024-0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 06/26/2024] [Indexed: 07/15/2024]
Abstract
Major depressive disorder (MDD) patients commonly encounter multiple types of functional disabilities, such as social, physical, and role functioning. MDD is related to an accreted risk of brain atrophy, aging-associated brain diseases, and mortality. Based on recently available studies, there are correlations between notable biological brain aging and MDD in adulthood. Despite several clinical and epidemiological studies that associate MDD with aging phenotypes, the underlying mechanisms in the brain remain unknown. The key areas in the study of biological brain aging in MDD are structural brain aging, impairment in functional connectivity, and the impact on cognitive function and age-related disorders. Various measurements have been used to determine the severity of brain aging, such as the brain age gap estimate (BrainAGE) or brain-predicted age difference (BrainPAD). This review summarized the current results of brain imaging data on the similarities between the manifestation of brain structural changes and the age-associated processes in MDD. This review also provided recent evidence of BrainPAD or BrainAGE scores in MDD, brain structural abnormalities, and functional connectivity, which are commonly observed between MDD and age-associated processes. It serves as a basis of current reference for future research on the potential areas of investigation for diagnostic, preventive, and potentially therapeutic purposes for brain aging in MDD.
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Affiliation(s)
- Eng Han How
- 65210 Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia , Jalan Lagoon Selatan, Bandar Sunway, 47500, Selangor, Malaysia
| | - Shar-Maine Chin
- 65210 Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia , Jalan Lagoon Selatan, Bandar Sunway, 47500, Selangor, Malaysia
| | - Chuin Hau Teo
- 65210 Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia , Jalan Lagoon Selatan, Bandar Sunway, 47500, Selangor, Malaysia
| | - Ishwar S Parhar
- Center Initiatives for Training International Researchers (CiTIR), University of Toyama, Gofuku, 930-8555 Toyama, Japan
| | - Tomoko Soga
- 65210 Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia , Jalan Lagoon Selatan, Bandar Sunway, 47500, Selangor, Malaysia
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2
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Thibaut P, Mwamuka R, Nyamayaro P, Rubin LH, Nakasujja N, Langenecker S, Abas M. Cognitive performance in depression in low- and middle-income countries: A systematic review with meta-analytic components. J Affect Disord 2023; 342:16-32. [PMID: 37690541 DOI: 10.1016/j.jad.2023.09.007] [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: 04/30/2023] [Revised: 08/22/2023] [Accepted: 09/05/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Depression is highly prevalent in low- and middle- income countries (LMIC) and associated with significant cognitive dysfunction across multiple domains. However, little is known about neurocognitive tests used in people with depression in LMIC. We aimed to investigate cognitive performance and cognitive tests in depression research in LMIC. METHODS APA PsycInfo, Embase, Ovid MEDLINE, and Global Health were systematically searched for studies that implemented a cognitive performance test in a depressed, LMIC population. Tool quality was assessed using an adapted scale for quality of measures in cross-cultural settings. Data extracted included demographics, depression and cognitive performance measures, and cognitive performance comparisons between depression and control groups. RESULTS 29 studies met eligibility criteria, involving a total of 19,100 participants from 11 LMIC. 93.1 % of studies were conducted in upper middle-income countries. 67 cognitive performance tools were implemented. Reliability was reported for 5.6 % of cognitive performance tests and validity was reported for 8.3 %. 36.1 % of tests used were culturally adapted. 75.9 % of included studies implemented at least one memory test. Cognitive deficits were observed in all depressed groups, especially in memory (Cohen's d = -1.60, 95 % CI -2.02 to -1.18). LIMITATIONS Heterogeneity between studies; averaged results across memory subtypes; no assessment of depression severity and cognitive deficits associations; restrictive search terms. CONCLUSIONS Cognitive impairments in depression, especially in memory, are prevalent in LMIC. This research has drawn attention to the burden of cognitive dysfunction in depression in LMIC, and to the disparate research gap in LMIC. PROSPERO registration CRD42022315397.
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Affiliation(s)
- Pauline Thibaut
- Department of Health Service & Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Rukudzo Mwamuka
- Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Primrose Nyamayaro
- Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Leah H Rubin
- Department of Psychiatry and Behavioural Sciences, John Hopkins University, MD, USA
| | - Noeline Nakasujja
- Department of Psychiatry, College of Health Sciences, Makerere University, Uganda
| | | | - Melanie Abas
- Department of Health Service & Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Mackin RS, Jin C, Burns E, Kassel M, Rhodes E, Nosheny R, Ashford M, Banh T, Eichenbaum J, Knight K, Tank R, Camacho MR, Fockler J, Truran D, Neuhaus J, Weiner M. Association of Major Depressive Disorder with remotely administered measures of cognition and subjective report of cognitive difficulties across the adult age spectrum. J Affect Disord 2023; 326:198-205. [PMID: 36528135 DOI: 10.1016/j.jad.2022.12.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 11/04/2022] [Accepted: 12/11/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Major depressive disorder (MDD) has increasing prevalence with age. Both objective measures of cognitive dysfunction and subjective report of cognitive difficulties related to MDD are often thought to worsen with increasing age. However, few studies have directly evaluated these characteristics across the adult lifespan. METHODS Participants included 23,594 adults completing objective and subjective measures of cognition on an online research registry. Linear regression including interactions of age group with depression was used to evaluate the association of self-reported MDD with measures of cognition in three age groups: 21-40 years; 41-60 years; 61+ years. RESULTS MDD (n = 2127) demonstrated poorer objective cognitive performance and greater subjective ratings of cognitive difficulties across all domains assessed compared to non-depressed individuals (ND; n = 21,467). Significant interactions of age group and MDD status with objective and subjective measures of cognition were observed for both middle age and older adults when compared to young adults but few significant differences between middle-aged and older adults were evident. LIMITATIONS This study relied on self-report of MDD diagnosis, utilized remotely administered and unsupervised measures of cognition, and the sample was not diverse. CONCLUSIONS The magnitude of association between MDD and cognitive correlates appears to plateau in middle age. Our results suggest that increased rates of dementia are not due to greater cognitive consequence of MDD in older adults and that age effects, and not greater effects of depression, may lead to increased diagnosis of MDD based on subjective report of cognitive symptoms.
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Affiliation(s)
- R Scott Mackin
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, USA; VA Advanced Imaging Research Center, San Francisco Veteran's Administration Medical Center, San Francisco, CA, USA; Mental Illness Research Education and Clinical Centers, Veterans Affairs Medical Center, San Francisco, CA, USA.
| | - Chengshi Jin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Emily Burns
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, USA
| | - Michelle Kassel
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, USA; Mental Illness Research Education and Clinical Centers, Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Emma Rhodes
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, USA; Mental Illness Research Education and Clinical Centers, Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Rachel Nosheny
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, USA; VA Advanced Imaging Research Center, San Francisco Veteran's Administration Medical Center, San Francisco, CA, USA
| | - Miriam Ashford
- VA Advanced Imaging Research Center, San Francisco Veteran's Administration Medical Center, San Francisco, CA, USA
| | - Tim Banh
- VA Advanced Imaging Research Center, San Francisco Veteran's Administration Medical Center, San Francisco, CA, USA
| | - Joseph Eichenbaum
- VA Advanced Imaging Research Center, San Francisco Veteran's Administration Medical Center, San Francisco, CA, USA
| | - Kristen Knight
- VA Advanced Imaging Research Center, San Francisco Veteran's Administration Medical Center, San Francisco, CA, USA
| | - Rachana Tank
- VA Advanced Imaging Research Center, San Francisco Veteran's Administration Medical Center, San Francisco, CA, USA
| | - Monica R Camacho
- VA Advanced Imaging Research Center, San Francisco Veteran's Administration Medical Center, San Francisco, CA, USA
| | - Juliet Fockler
- VA Advanced Imaging Research Center, San Francisco Veteran's Administration Medical Center, San Francisco, CA, USA
| | - Diana Truran
- VA Advanced Imaging Research Center, San Francisco Veteran's Administration Medical Center, San Francisco, CA, USA
| | - John Neuhaus
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Michael Weiner
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, USA; VA Advanced Imaging Research Center, San Francisco Veteran's Administration Medical Center, San Francisco, CA, USA; Department of Radiology, University of California, San Francisco, USA
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Inflammatory cytokines in and cognitive function of adolescents with first-episode schizophrenia, bipolar disorder, or major depressive disorder. CNS Spectr 2023; 28:70-77. [PMID: 34664544 DOI: 10.1017/s1092852921000857] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Few studies have explored the complex relationship of pro- and anti-inflammatory cytokines with cognitive function in adolescents with first-episode schizophrenia, bipolar disorder, or major depressive disorder. METHODS In total, 26, 35, and 29 adolescents with first-episode schizophrenia, bipolar disorder, and major depressive disorder, respectively, and 22 age- and sex-matched controls were included in the current study. Cytokines, namely interleukin (IL)-2, IL-6, tumor necrosis factor (TNF)-α, and C-reactive protein (CRP), were assessed. The Wisconsin Card Sorting Test (WCST) and the working memory task were administered to assess cognitive function. RESULTS Using generalized linear models with adjustment for demographic data and clinical symptoms, patients with bipolar disorder were found to exhibit the highest levels of CRP (P = .023), IL-6 (P = .022), and TNF-α (P = .011), and had the lowest IL-2 levels (P = .034) among the four groups. According to the results of the WCST and working memory task, adolescents with schizophrenia exhibited the lowest performance in cognitive function. In addition, among the assessed cytokines, only CRP levels (P = .027) were negatively associated with WCST scores. DISCUSSION Dysregulated pro- and anti-inflammatory cytokines and impaired cognitive functioning were observed in first-episode adolescent-onset schizophrenia, bipolar disorder, and major depressive disorder. The altered cytokine profiles may play important roles in the pathophysiology of schizophrenia, bipolar disorder, and major depressive disorder.
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Wang M, Qi X, Yang X, Fan H, Dou Y, Guo W, Wang Q, Chen E, Li T, Ma X. The pattern glare and visual memory are disrupted in patients with major depressive disorder. BMC Psychiatry 2022; 22:518. [PMID: 35918667 PMCID: PMC9344705 DOI: 10.1186/s12888-022-04167-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 07/25/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Visual memory impairment is one of the most commonly complained symptoms in patients with major depressive disorder (MDD). Pattern glare is also a distorted visual phenomenon that puzzles patients with MDD. Nevertheless, how these two phenomena interact in MDD remains unknown. This study investigated the association between pattern glare and visual memory in MDD patients. METHODS Sixty-two patients with MDD and forty-nine age-, sex- and education level-matched healthy controls (HCs) were included in this study. The Pattern Recognition Memory (PRM) test and the Brief Visual Memory Test-Revised (BVMT-R) were applied to measure visual memory. The pattern glare test including three patterns with different spatial frequencies (SFs) was used to explore pattern glare levels. RESULTS Patients with MDD scored lower on the PRM-PCi, BVMT-R1, BVMT-R2, BVMT-R3, and BVMT-Rt and higher on the PRM-MCLd than HCs (all p < 0.05). Pattern glare scores for MDD patients were higher with mid-SF (p < 0.001), high-SF (p = 0.006) and mid-high SF differences (p = 0.01) than for HCs. A positive correlation between mid-SF and PRM-MCLd scores in all participants was observed (p = 0.01, r = 0.246). A negative correlation between mid-high difference scores and BVMT-R2 scores (p = 0.032, r = -0.317) was observed in HCs, but no significant correlation was observed in MDD patients. CONCLUSIONS The present study showed that visual memory and pattern glare are disrupted in MDD. Visual memory may be associated with pattern glare and needs to be studied in future work.
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Affiliation(s)
- Min Wang
- grid.412901.f0000 0004 1770 1022Psychiatric Laboratory and Mental Health Center, West China Hospital of Sichuan University, Chengdu, China ,grid.412901.f0000 0004 1770 1022Huaxi Brain Research Center, West China Hospital of Sichuan University, Chengdu, China
| | | | - Xiao Yang
- grid.412901.f0000 0004 1770 1022Psychiatric Laboratory and Mental Health Center, West China Hospital of Sichuan University, Chengdu, China ,grid.412901.f0000 0004 1770 1022Huaxi Brain Research Center, West China Hospital of Sichuan University, Chengdu, China
| | - Huanhuan Fan
- grid.412901.f0000 0004 1770 1022Psychiatric Laboratory and Mental Health Center, West China Hospital of Sichuan University, Chengdu, China ,grid.412901.f0000 0004 1770 1022Huaxi Brain Research Center, West China Hospital of Sichuan University, Chengdu, China
| | - Yikai Dou
- grid.412901.f0000 0004 1770 1022Psychiatric Laboratory and Mental Health Center, West China Hospital of Sichuan University, Chengdu, China ,grid.412901.f0000 0004 1770 1022Huaxi Brain Research Center, West China Hospital of Sichuan University, Chengdu, China
| | - Wanjun Guo
- grid.412901.f0000 0004 1770 1022Psychiatric Laboratory and Mental Health Center, West China Hospital of Sichuan University, Chengdu, China ,grid.412901.f0000 0004 1770 1022Huaxi Brain Research Center, West China Hospital of Sichuan University, Chengdu, China
| | - Qiang Wang
- grid.412901.f0000 0004 1770 1022Psychiatric Laboratory and Mental Health Center, West China Hospital of Sichuan University, Chengdu, China ,grid.412901.f0000 0004 1770 1022Huaxi Brain Research Center, West China Hospital of Sichuan University, Chengdu, China
| | - Eric Chen
- grid.415550.00000 0004 1764 4144Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - Tao Li
- grid.412901.f0000 0004 1770 1022Psychiatric Laboratory and Mental Health Center, West China Hospital of Sichuan University, Chengdu, China ,grid.412901.f0000 0004 1770 1022Huaxi Brain Research Center, West China Hospital of Sichuan University, Chengdu, China
| | - Xiaohong Ma
- Psychiatric Laboratory and Mental Health Center, West China Hospital of Sichuan University, Chengdu, China. .,Huaxi Brain Research Center, West China Hospital of Sichuan University, Chengdu, China.
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6
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Cao B, Xiao M, Chen X, Zhao Y, Pan Z, McIntyre RS, Chen H. Application of computerized cognitive test battery in major depressive disorder: a narrative literature review. Nord J Psychiatry 2022; 76:263-271. [PMID: 34423722 DOI: 10.1080/08039488.2021.1965654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Major depressive disorder (MDD) is a chronic and debilitating relapsing-remitting mood disorder, characterized by psychological, cognitive, and behavioral disturbances. The assessment of cognitive dysfunction in individuals with MDD has increasingly become a topic of concern in recent years. AIMS To pool and compare the characteristics of various cognition evaluation tools. METHOD Overview of recent research in application of computerized cognitive test battery in MDD. RESULTS With recent technological advances in mobile health technologies and the ubiquity of smartphones, the use of traditional tools is no longer sufficient to monitor the dynamic changes of an individual's cognitive performance, which may be influenced by many factors, including, but not limited to, disease course and medications. Computerized tests have many advantages over traditional neuropsychological testing, chiefly in terms of time and cost savings, accurate recording of multiple response components, and the ability to automatically store and compare performance between testing sessions. In the following review, we summarized cognitive impairment characteristics of MDD, introduced traditional assessment tools of cognitive function in MDD, and reviewed the development of the current computerized cognitive test batteries for MDD. The comparisons among cognitive function evaluation tools were also performed. CONCLUSIONS It is our belief that the improvement of existing novel computerized cognitive test batteries, the development of more comprehensive and easy-to-operate scales, verification techniques and multiple follow-up surveys among large sample populations may provide valuable clues for the evaluation and tracking of cognitive function in individuals with MDD.
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Affiliation(s)
- Bing Cao
- Key Laboratory of Cognition and Personality, Faculty of Psychology, Ministry of Education, Southwest University, Chongqing, P. R. China.,National Demonstration Center for Experimental Psychology Education, Southwest University, Chongqing, P. R. China
| | - Mingyue Xiao
- Key Laboratory of Cognition and Personality, Faculty of Psychology, Ministry of Education, Southwest University, Chongqing, P. R. China
| | - Ximei Chen
- Key Laboratory of Cognition and Personality, Faculty of Psychology, Ministry of Education, Southwest University, Chongqing, P. R. China
| | - Yuxiao Zhao
- Key Laboratory of Cognition and Personality, Faculty of Psychology, Ministry of Education, Southwest University, Chongqing, P. R. China
| | - Zihang Pan
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Canada.,Duke-NUS Medical School, Singapore, Singapore
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Canada.,Brain and Cognition Discovery Foundation, Toronto, Canada
| | - Hong Chen
- Key Laboratory of Cognition and Personality, Faculty of Psychology, Ministry of Education, Southwest University, Chongqing, P. R. China.,National Demonstration Center for Experimental Psychology Education, Southwest University, Chongqing, P. R. China
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7
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Yang Y, Wei K, Zhang H, Hu H, Yan L, Gui W, Liu Y, Chen X. Identifying functional brain abnormalities in migraine and depression comorbidity. Quant Imaging Med Surg 2022; 12:2288-2302. [PMID: 35371950 PMCID: PMC8923836 DOI: 10.21037/qims-21-667] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 12/12/2021] [Indexed: 10/10/2023]
Abstract
BACKGROUND Migraine and major depressive disorder (MDD) are both highly prevalent brain disorders and are often comorbid. However, the common and distinctive neural mechanisms underlying these disorders and the brain function alterations associated with their comorbidity are largely unknown. We aimed to explore the functional abnormalities of the brain associated with the co-occurrence of migraine and depression. METHODS High-resolution T1-weighted and resting-state functional magnetic resonance images (MRI) were acquired from 93 well-matched patients with comorbid migraine and depression, patients with migraine, patients with MDD, and healthy controls. Voxel-wise analysis of variance (ANOVA) and a two-sample t-test of multiple functional variables were performed among the groups. Furthermore, correlation analysis was conducted to detect the clinical significance of the altered functional regions in the brain. RESULTS Migraine patients with and without depression revealed widely shared regional networks of functional changes. Brain function changes in the right paracentral lobule and fusiform were specific to patients with comorbid migraine and depression [P<0.05, cluster-level familywise error (FWE)-corrected], while changes in the left thalamus, medial orbital of superior frontal gyrus and triangular part of the inferior frontal gyrus were specific to patients with migraine (P<0.05, cluster-level FWE-corrected). Importantly, the brain activity of the right paracentral lobule, left calcarine, and left dorsolateral superior frontal gyrus was associated with emotional symptoms in the pooled migraine data (P<0.05). CONCLUSIONS These findings help to identify the neural correlates underlying patients with migraine and those with comorbid migraine and depression. These shared and distinct brain changes could be used as potential image markers to decipher the comorbidity of the 2 disorders.
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Affiliation(s)
- Ying Yang
- Department of Radiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Kai Wei
- Department of Neurology, Fourth Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Hongchun Zhang
- Department of Radiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Hongyun Hu
- Department of Radiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Li Yan
- Department of Radiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Wei Gui
- Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Ying Liu
- Department of Radiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Xin Chen
- Department of Neurology, Fourth Affiliated Hospital of Anhui Medical University, Hefei, China
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Varghese S, Frey BN, Schneider MA, Kapczinski F, de Azevedo Cardoso T. Functional and cognitive impairment in the first episode of depression: A systematic review. Acta Psychiatr Scand 2022; 145:156-185. [PMID: 34758106 DOI: 10.1111/acps.13385] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 10/27/2021] [Accepted: 11/07/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To describe the cognitive and functional impairment in individuals with the first episode of major depressive disorder (MDD) as compared to controls and individuals with recurrent MDD. Also to describe the functional and cognitive trajectory after the first episode of MDD. METHODS A total of 52 studies were included in our systematic review. 32 studies compared the cognitive performance between first episode of depression (FED) and controls, 11 studies compared the cognitive performance between recurrent depression (RD) and FED, 10 compared global functioning between RD and FED, four studies assessed cognition in FED over time, and two studies assessed global functioning in FED over time. RESULTS The majority of studies (n = 22/32, 68.8%) found that FED subjects performed significantly worse than controls on cognitive tests, with processing speed (n = 12) and executive/working memory (n = 11) being the most commonly impaired domains. Seven out of 11 studies (63.6%) found that RD performed significantly worse than FED, with verbal learning and memory being the most commonly impaired domain (n = 4). Most studies (n = 7/10, 70%) did not find a significant difference in global functioning between RD and FED. In three of four longitudinal studies assessing cognition, subgroup analyses were used instead of directly assessing cognition in FED over time while the remaining study found significant cognitive declines over time in FED when compared to controls. The two longitudinal studies assessing functional trajectory found that functioning significantly improved over time, possibly due to the improvement of depressive symptoms. CONCLUSION There is strong evidence that cognitive impairment is present during the first episode of depression, and individuals with multiple episodes display greater cognitive impairment than individuals with a single episode. Future studies aimed at identifying predictors of cognitive and functional impairment after the first episode of depression are needed to describe the functional and cognitive trajectory of individuals with the first episode of MDD over time.
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Affiliation(s)
- Shawn Varghese
- Undergraduate Medical Education (UGME), McMaster University, Hamilton, Ontario, Canada
| | - Benicio N Frey
- Mood Disorders Program, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.,Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Maiko A Schneider
- Mood Disorders Program, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.,Youth Wellness Centre, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Flavio Kapczinski
- Mood Disorders Program, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.,Instituto Nacional de Ciência e Tecnologia Translacional em Medicina (INCT-TM), Porto Alegre, Rio Grande do Sul, Brazil.,Bipolar Disorder Program, Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.,Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Taiane de Azevedo Cardoso
- Mood Disorders Program, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
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Liu X, Wang X, Liu Y, Gao F, Xia J, Fan J, Zhu X. The abnormal implicit memory to positive and negative stimuli in patients with current and remitted major depressive disorder: A systematic review and meta-analysis. Front Psychiatry 2022; 13:1043987. [PMID: 36704726 PMCID: PMC9871490 DOI: 10.3389/fpsyt.2022.1043987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 12/12/2022] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION In patients with current major depressive disorder (cMDD) a general abnormal implicit memory has been reported. However, the elaborate function of implicit memory when processing stimuli with different emotions (i.e., positive, neutral, and negative) in current and remitted (rMDD) patients is unclear. The present review examines implicit memory's general and elaborate in cMDD and rMDD patients. METHODS We conducted meta-analyses based on published studies meeting criteria in Web of Science, PubMed, and EMBASE databases between 1990 and July 2022. The full sample patients included cMDD = 601 and rMDD = 143. RESULTS Initial analysis of cMDD patients revealed a general implicit memory deficit. Subsequent subgroup analyses showed that the implicit memory performance to neutral stimuli is poorer in cMDD patients than controls, but recovered in rMDD patients; the deficient implicit memory to positive stimuli existed in cMDD and rMDD patients; the implicit memory performance to negative stimuli in cMDD patients is similar to controls but poorer in rMDD patients. CONCLUSION These findings indicate that the negative bias in cMDD patients might compensate for the general implicit memory deficit. Together, the implicit memory to neutral stimuli could recover with remission, whereas still abnormal in processing positive and negative stimuli. These results suggested that the abnormal implicit memory to positive and negative information might be relevant to depression pathogenesis. SYSTEMATIC REVIEW REGISTRATION https://www.crd.york.ac.uk/prospero, identifier CRD42020205003.
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Affiliation(s)
- Xingze Liu
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Medical Psychological Institute of Central South University, Changsha, Hunan, China.,National Clinical Research Center for Mental Disorders, Changsha, Hunan, China
| | - Xiang Wang
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Medical Psychological Institute of Central South University, Changsha, Hunan, China.,National Clinical Research Center for Mental Disorders, Changsha, Hunan, China
| | - Yao Liu
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Medical Psychological Institute of Central South University, Changsha, Hunan, China.,National Clinical Research Center for Mental Disorders, Changsha, Hunan, China
| | - Feng Gao
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Medical Psychological Institute of Central South University, Changsha, Hunan, China.,National Clinical Research Center for Mental Disorders, Changsha, Hunan, China
| | - Jie Xia
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Medical Psychological Institute of Central South University, Changsha, Hunan, China.,National Clinical Research Center for Mental Disorders, Changsha, Hunan, China
| | - Jie Fan
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Medical Psychological Institute of Central South University, Changsha, Hunan, China.,National Clinical Research Center for Mental Disorders, Changsha, Hunan, China
| | - Xiongzhao Zhu
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Medical Psychological Institute of Central South University, Changsha, Hunan, China.,National Clinical Research Center for Mental Disorders, Changsha, Hunan, China
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Wang X, Cheng B, Roberts N, Wang S, Luo Y, Tian F, Yue S. Shared and distinct brain fMRI response during performance of working memory tasks in adult patients with schizophrenia and major depressive disorder. Hum Brain Mapp 2021; 42:5458-5476. [PMID: 34431584 PMCID: PMC8519858 DOI: 10.1002/hbm.25618] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 07/02/2021] [Accepted: 07/13/2021] [Indexed: 02/05/2023] Open
Abstract
Working memory (WM) impairments are common features of psychiatric disorders. A systematic meta-analysis was performed to determine common and disorder-specific brain fMRI response during performance of WM tasks in patients with SZ and patients with MDD relative to healthy controls (HC). Thirty-four published fMRI studies of WM in patients with SZ and 18 published fMRI studies of WM in patients with MDD, including relevant HC, were included in the meta-analysis. In both SZ and MDD there was common stronger fMRI response in right medial prefrontal cortex (MPFC) and bilateral anterior cingulate cortex (ACC), which are part of the default mode network (DMN). The effects were of greater magnitude in SZ than MDD, especially in prefrontal-temporal-cingulate-striatal-cerebellar regions. In addition, a disorder-specific weaker fMRI response was observed in right middle frontal gyrus (MFG) in MDD, relative to HC. For both SZ and MDD a significant correlation was observed between the severity of clinical symptoms and lateralized fMRI response relative to HC. These findings indicate that there may be common and distinct anomalies in brain function underlying deficits in WM in SZ and MDD, which may serve as a potential functional neuroimaging-based diagnostic biomarker with value in supporting clinical diagnosis, measuring illness severity and assessing the efficacy of treatments for SZ and MDD at the brain level.
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Affiliation(s)
- Xiuli Wang
- Department of Psychiatry, the Fourth People's Hospital of Chengdu, Chengdu, China
| | - Bochao Cheng
- Department of Radiology, West China Second University Hospital of Sichuan University, Chengdu, China
| | - Neil Roberts
- Edinburgh Imaging Facility, Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Song Wang
- Department of Radiology, Huaxi MR Research Center, West China Hospital of Sichuan University, Chengdu, China
| | - Ya Luo
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
| | - Fangfang Tian
- Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Suping Yue
- Department of Psychiatry, the Fourth People's Hospital of Chengdu, Chengdu, China
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Li X, Chen XL, Zhang YT, Li RT, Bai HP, Lui SSY, Chan RCK. Deficits in maintenance and interference control of working memory in major depression: evidence from the visuospatial change detection task. Cogn Neuropsychiatry 2021; 26:122-135. [PMID: 33412994 DOI: 10.1080/13546805.2021.1871890] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Recent theories in cognitive psychology suggest that working memory (WM) processing involves a set of specific functions, in particular the WM functions of maintenance and interference control. Previous findings on WM impairments in patients with major depressive disorder (MDD) had been inconsistent, partly because earlier studies did not take into account these two different functions of WM. METHOD Forty-two participants with MDD and 39 controls completed the visuospatial change detection task. We estimated the WM function of maintenance, based on performance in trials using the targets only, and the WM function of interference control, based on performance in trials with distractor rectangles. RESULTS Our results showed that participants with MDD had poorer WM function of maintenance and interference control than controls. However, the results of filtering efficiency did not show significant group difference, thus patients with MDD showed comparable impairments in WM function of maintanance as well as in WM function of interference control. CONCLUSION Our findings suggested that patients with MDD appear to show generalised impairments on visuospatial WM function of maintenance and interference control. Future studies should use refined paradigms to assess the different functions of WM and their distinctive contributions to symptomatology of depression.
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Affiliation(s)
- Xu Li
- Key Laboratory of Adolescent Cyberpsychology and Behaviour, Ministry of Education, Central China Normal University, Wuhan, People's Republic of China.,Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan, People's Republic of China
| | - Xue-Lei Chen
- Key Laboratory of Adolescent Cyberpsychology and Behaviour, Ministry of Education, Central China Normal University, Wuhan, People's Republic of China.,Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan, People's Republic of China
| | - Yu-Ting Zhang
- Key Laboratory of Adolescent Cyberpsychology and Behaviour, Ministry of Education, Central China Normal University, Wuhan, People's Republic of China.,Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan, People's Republic of China
| | - Rui-Ting Li
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, People's Republic of China
| | - Han-Ping Bai
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, People's Republic of China
| | - Simon S Y Lui
- Castle Peak Hospital, Hong Kong Special Administrative Region, People's Republic of China.,Department of Psychiatry, University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Raymond C K Chan
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, People's Republic of China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, People's Republic of China
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12
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Wei XY, Chen H, Guo C, Tan WL, Zhan SH. The Instant and Sustained Effect of Electroacupuncture in Postgraduate Students with Depression: An fMRI Study. Neuropsychiatr Dis Treat 2021; 17:873-883. [PMID: 33776442 PMCID: PMC7989050 DOI: 10.2147/ndt.s307083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 03/08/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTION This study was a primary study to evaluate the instant and sustained effect of electroacupuncture (EA) at GV20 (Baihui) in postgraduate students with mild depression by using a special flexible head coil. METHODS A total of 20 postgraduate students with mild depression underwent EA stimulation at GV20 and 3 phases of resting-state functional magnetic resonance imaging (rs-fMRI) scanning. Phase I: Preparation (before needle insertion); Phase II: during EA; Phase III: 15 minutes after needle removal. The Rs-fMRI data were processed using DPABI and SPSS 25. RESULTS 1) ReHo values showed significantly differences in the right posterior cingulate cortex, right calcarine gyrus, right angular gyrus, right precuneus, right cuneus, and bilateral postcentral gyri among Phase I, Phase II and Phase III; 2) Relative to the Phase I, increased brain activity in the Phase II was observed in the bilateral postcentral gyri, right calcarine gyrus, right cuneus. Compared with the Phase II, decreased brain activity in the Phase III was observed in the right precuneus, right posterior cingulate cortex, right angular gyrus. Relative to the Phase I, Significantly increased brain activity in the Phase III was observed in the right calcarine gyrus, right cuneus, and bilateral postcentral gyri. While decreased ReHo values were found in the right posterior cingulate cortex, right angular gyrus, right precuneus; and 3) Correlation analysis showed that the ReHo values of multiple brain regions in Phase I and Phase III were significantly correlated with the VAS and HRSD-17 scores. CONCLUSION This study focuses on the instant and sustained effect in postgraduate students with depression. Our study showed that instant effect produced by EA stimulation at GV20 firstly induced changes in somatosensory and visual area, and then, sustained effect (Phase III) have a higher intensity and more extensive than instant effects. Meanwhile, we provide a visualization way to study the instant effects of head acupoints by using a flexible head coil.
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Affiliation(s)
- Xiang-Yu Wei
- Department of Radiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, People's Republic of China
| | - Hui Chen
- Department of Radiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, People's Republic of China
| | - Cui Guo
- Department of Radiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, People's Republic of China
| | - Wen-Li Tan
- Department of Radiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, People's Republic of China
| | - Song-Hua Zhan
- Department of Radiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, People's Republic of China
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Acute Effects of Aerobic Exercise on Cognitive Attention and Memory Performance: An Investigation on Duration-Based Dose-Response Relations and the Impact of Increased Arousal Levels. J Clin Med 2020; 9:jcm9051380. [PMID: 32397081 PMCID: PMC7291087 DOI: 10.3390/jcm9051380] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/22/2020] [Accepted: 05/01/2020] [Indexed: 11/17/2022] Open
Abstract
Current evidence indicates that acute aerobic exercise might increase domain-specific cognitive performance. However, only a small number of studies deduced the impact on lower and higher cognitive functions systematically or analyzed dose-response relationships and the underlying mechanisms. This study aimed to expose the dose-response relationships by investigating the influence of exercise duration on subjective and objective arousal, cognitive attention and visual recognition memory tasks. Nineteen participants (eight female; 25.69 ± 3.11 years) were included in a randomized, three-armed intervention study in a cross-over design. The participants completed three different interventions consisting of either 15, 30 or 45 min of cycling at 60-70% VO2max. Arousal and cognitive measurements were taken before and immediately after (<2 min) exercise. All three interventions led to significant but comparable effects on self-perceived arousal, heart rate (HR) and rating of perceived exertion (RPE) (p < 0.05). Analysis of variance (ANOVA) indicated significant effects of exercise duration on visual recognition memory accuracy. Reaction times for higher and lower cognitive tasks did not change after exercise. Fifteen minutes of aerobic exercise was feasible to induce beneficial changes in self-perceived arousal. Processing speed of visual recognition memory and attention remained unaltered. Exercise exceeding fifteen minutes seemed to negatively impact visual recognition memory accuracy.
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Qi X, Fan H, Yang X, Chen Y, Deng W, Guo W, Wang Q, Chen E, Li T, Ma X. High level of pattern glare in major depressive disorder. BMC Psychiatry 2019; 19:415. [PMID: 31864335 PMCID: PMC6925875 DOI: 10.1186/s12888-019-2399-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 12/09/2019] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Visual deficits have been reported in abundance by recent studies on major depressive disorder. Pattern glare manifests as visual distortions, such as the symptoms of headache, glare, eyestrain, illusions of shapes, colors, and motion when viewing repetitive striped patterns, of which some can be observed in major depressive disorder. Inspired by what mentioned, the present study aims to explore whether there exists association between pattern glare and major depressive disorder and further attempts to explore possible clinical diagnostic value of pattern glare in major depressive disorder. METHODS Twenty-four patients diagnosed with major depressive disorder (MDDs group) were compared with 30 age-, gender- and education level-matched healthy control subjects (HCs group) on their visual stress with black-and-white gratings of different spatial frequencies-0.3 (low-SF), 2.3 (mid-SF), and 9.4 (high-SF) cycles per degree (c/deg)-which was named pattern glare test. The MDDs group divided into first episode medication-free group (fMDD) and recurrent medicated group (rMDD), comparisons of pattern glare scores (PGS) were performed within the MDDs group. We used Pearson and Spearman analysis to explore the relationship between some clinical indexes and pattern glare scores. ROC (receiver operating characteristic) curve was used to evaluate whether pattern glare test was able to discriminate patients and healthy controls. RESULTS The mid-SF pattern glare score significantly elevated in patients with major depressive disorder compared to control subjects. No differences of pattern glare scores were found between fMDD and rMDD. A significant negative correlation between mid-high difference and age in HCs group was found. There were no correlations between other variables and pattern glare scores. The mid-SF score has limited value in the diagnosis of major depressive disorder. CONCLUSIONS We observed an increased level of pattern glare in patients with major depressive disorder, reflecting the existence of cortical hyper-excitability in major depressive disorder. The mid-SF score may have a value in understanding cortical excitability in major depressive disorder.
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Affiliation(s)
- Xiongwei Qi
- 0000 0004 1770 1022grid.412901.fPsychiatric Laboratory and Mental Health Center, West China Hospital of Sichuan University, Chengdu, Sichuan 610064 People’s Republic of China
| | - Huanhuan Fan
- 0000 0004 1770 1022grid.412901.fPsychiatric Laboratory and Mental Health Center, West China Hospital of Sichuan University, Chengdu, Sichuan 610064 People’s Republic of China
| | - Xiao Yang
- 0000 0004 1770 1022grid.412901.fPsychiatric Laboratory and Mental Health Center, West China Hospital of Sichuan University, Chengdu, Sichuan 610064 People’s Republic of China
| | - Yayun Chen
- 0000 0004 1770 1022grid.412901.fPsychiatric Laboratory and Mental Health Center, West China Hospital of Sichuan University, Chengdu, Sichuan 610064 People’s Republic of China
| | - Wei Deng
- 0000 0004 1770 1022grid.412901.fPsychiatric Laboratory and Mental Health Center, West China Hospital of Sichuan University, Chengdu, Sichuan 610064 People’s Republic of China ,0000 0004 1770 1022grid.412901.fWest China Brain Research Center, West China Hospital of Sichuan University, Chengdu, China
| | - Wanjun Guo
- 0000 0004 1770 1022grid.412901.fPsychiatric Laboratory and Mental Health Center, West China Hospital of Sichuan University, Chengdu, Sichuan 610064 People’s Republic of China ,0000 0004 1770 1022grid.412901.fWest China Brain Research Center, West China Hospital of Sichuan University, Chengdu, China
| | - Qiang Wang
- 0000 0004 1770 1022grid.412901.fPsychiatric Laboratory and Mental Health Center, West China Hospital of Sichuan University, Chengdu, Sichuan 610064 People’s Republic of China ,0000 0004 1770 1022grid.412901.fWest China Brain Research Center, West China Hospital of Sichuan University, Chengdu, China
| | - Eric Chen
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - Tao Li
- 0000 0004 1770 1022grid.412901.fPsychiatric Laboratory and Mental Health Center, West China Hospital of Sichuan University, Chengdu, Sichuan 610064 People’s Republic of China ,0000 0004 1770 1022grid.412901.fWest China Brain Research Center, West China Hospital of Sichuan University, Chengdu, China
| | - Xiaohong Ma
- Psychiatric Laboratory and Mental Health Center, West China Hospital of Sichuan University, Chengdu, Sichuan, 610064, People's Republic of China. .,West China Brain Research Center, West China Hospital of Sichuan University, Chengdu, China.
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Ambaw A, Desalegn GT. Magnitude and correlates of cognitive impairment among major depressive disorder patients in Addis Ababa: institution based cross-sectional study. BMC Res Notes 2019; 12:135. [PMID: 30871643 PMCID: PMC6416877 DOI: 10.1186/s13104-019-4184-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 03/11/2019] [Indexed: 01/10/2023] Open
Abstract
Objective Cognitive impairments are now widely recognized and emerging as an important therapeutic target in a patient with a major depressive disorder (MDD). It associated with a more deteriorating course of illness among MDD patients. Therefore, understanding the level of cognitive impairment and associated factors is crucial to provide optimal care for MDD patients. Result The proportion of cognitive impairment among MDD patients was found to be 54.4% (95%, CI (49.6, 59.3). Factors significantly associated with having cognitive impairment were age adjusted odds ratio (AOR) = 3.00, 95%, confidence interval (CI): (1.49, 6.03), educational status, (AOR = 5.36, 95% CI 2.16, 13.26), employment status (AOR = 3.63, 95 CI 1.99, 6.62), duration of the illness (AOR = 3.16, 95% CI 1.31, 7.64), having co-morbid psychiatric illnesses (AOR = 2.16, 95% CI 1.26, 3.71), and illness relapse (AOR = 2.97, 95% CI 1.54, 5.73). Electronic supplementary material The online version of this article (10.1186/s13104-019-4184-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Getachew Tesfaw Desalegn
- Department of Psychiatry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
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