Individual Deviations from Normative Electroencephalographic Connectivity Predict Antidepressant Response

Antidepressant medications yield unsatisfactory treatment outcomes in patients with major depressive disorder (MDD) with modest advantages over the placebo. This modest efficacy is partly due to the elusive mechanisms of antidepressant responses and unexplained heterogeneity in patient's response to treatment - the approved antidepressants only benefit a portion of patients, calling for personalized psychiatry based on individual-level prediction of treatment responses. Normative modeling, a framework that quantifies individual deviations in psychopathological dimensions, offers a promising avenue for the personalized treatment for psychiatric disorders. In this study, we built a normative model with resting-state electroencephalography (EEG) connectivity data from healthy controls of three independent cohorts. We characterized the individual deviation of MDD patients from the healthy norms, based on which we trained sparse predictive models for treatment responses of MDD patients. We successfully predicted treatment outcomes for patients receiving sertraline (r = 0.43, p < 0.001) and placebo (r = 0.33, p < 0.001). We also showed that the normative modeling framework successfully distinguished subclinical and diagnostic variabilities among subjects. From the predictive models, we identified key connectivity signatures in resting-state EEG for antidepressant treatment, suggesting differences in neural circuit involvement between treatment responses. Our findings and highly generalizable framework advance the neurobiological understanding in the potential pathways of antidepressant responses, enabling more targeted and effective MDD treatment.

Pathways Between Psychological Trauma and the Development of Personality Disorders

This chapter explores the connection between trauma and personality disorders (PDs). The mindset of a survivor of trauma is examined to elucidate how patterns of behavior evolve after trauma that may lead to the development of character pathology. Psychological etiologic theories coupled with neuroanatomical changes from neuroimaging research are reviewed. Details on both structural and functional magnetic resonance imaging findings specific to PDs in the context of early-life adversity are reviewed. Borderline, schizotypal, paranoid, and antisocial PDs s are highlighted in detail to assess both the psychological and known biological dimensions of the impact of trauma in the formation of these disorders.

Effect of Intrinsic Patterns of Functional Brain Connectivity in Moderating Antidepressant Treatment Response in Major Depression

OBJECTIVE

Major depressive disorder is associated with aberrant resting-state functional connectivity across multiple brain networks supporting emotion processing, executive function, and reward processing. The purpose of this study was to determine whether patterns of resting-state connectivity between brain regions predict differential outcome to antidepressant medication (sertraline) compared with placebo.

METHODS

Participants in the Establishing Moderators and Biosignatures of Antidepressant Response in Clinical Care (EMBARC) study underwent structural and resting-state functional MRI at baseline. Participants were then randomly assigned to receive either sertraline or placebo treatment for 8 weeks (N=279). A region of interest-based approach was utilized to compute functional connectivity between brain regions. Linear mixed-model intent-to-treat analyses were used to identify brain regions that moderated (i.e., differentially predicted) outcomes between the sertraline and placebo arms.

RESULTS

Prediction of response to sertraline involved several within- and between-network connectivity patterns. In general, higher connectivity within the default mode network predicted better outcomes specifically for sertraline, as did greater between-network connectivity of the default mode and executive control networks. In contrast, both placebo and sertraline outcomes were predicted (in opposite directions) by between-network hippocampal connectivity.

CONCLUSIONS

This study identified specific functional network-based moderators of treatment outcome involving brain networks known to be affected by major depression. Specifically, functional connectivity patterns of brain regions between and within networks appear to play an important role in identifying a favorable response for a drug treatment for major depressive disorder.

Dientamoeba fragilis is more prevalent than Giardia duodenalis in children and adults attending a day care centre in Central Italy

Giardia duodenalis is a well recognised enteropathogen, while Dientamoeba fragilis is rarely detected and consequently it is not recognised as an important human pathogen. In 2002-2003, a survey has been carried out on enteroparasites in faecal samples of outpatients attending a day care centre in the town of Perugia (Central Italy). To improve the detection level, at least three samples from each patient were collected at different days and within two hours from defecation. The coproparasitological examination has been carried out by direct microscopic examination, faecal concentration, and Giemsa and modified Ziehl-Nielsen stainings of faecal smears. The genotypes of Giardia duodenalis isolates were determined by PCR of the beta-giardin gene. Of 1,989 enrolled people (966 children, 1,023 adults), 165 persons (8.3%; 153 adults, 15.0%; 12 children, 1.2%), were positive for parasites, but only 1 12 adults (73.2% of those infected) and eight children (66.7% of those infected) harboured D. fragilis and G. duodenalis. Both the Assemblages A and B were detected in 18 G. duodenalis isolates examined at the beta-giardin gene. The higher prevalence of D. fragilis infections than that of G. duodenalis is probably related to the method used, a procedure, which is rarely followed in laboratories for the diagnosis of enteric parasites. These epidemiological data suggest that when faecal samples are examined after a period of time and without Giemsa staining, most D. fragilis infections goes undetected.

[Urethral infections caused by Chlamydia trachomatis: indirect serological diagnosis]

The authors relate serological inquires (micro-immunofluorescent assay), for valuing the specifical antibody response anti-Chlamydia trachomatis, in acute urethritis. In 53% of cases a immunological response was present and in 18% of the cases was high and significant. Medium title was 1:28. In normal people the medium title was 1:10, and antibodies to Chlamydia were present in 8% of cases. The authors point out the importance and utility of a correct operative protocol for an efficacious diagnosis and for a correct therapy.