Vagally-mediated HRV as a marker of trait rumination in healthy individuals? A large cross-sectional analysis

The tendency to ruminate (i.e., repetitive, self-referential, negative thoughts) is a maladaptive form of emotional regulation and represents a transdiagnostic vulnerability factor for stress-related psychopathology. Vagally-mediated heart rate variability (vmHRV) provides a non-invasive, surrogate measure of vagal modulation of the heart, and higher HRV is considered an indicator of susceptibility, or ability to respond to stress. Past research has suggested a link between trait rumination and vmHRV; however, inconsistent results exist in healthy individuals. In this study, we investigated the association between the tendency to ruminate, brooding, and reflection (using the Ruminative Response Scale) with vmHRV measured at baseline in a healthy population using a large cross-sectional dataset (N = 1189, 88% female; mean age = 21.55, ranging from 17 to 48 years old), which was obtained by combining samples of healthy individuals from different studies from our laboratory. The results showed no cross-sectional correlation between vmHRV and trait rumination (confirmed by Bayesian analysis), even after controlling for important confounders such as gender, age, and depressive symptoms. Also, a non-linear relationship was rejected. In summary, based on our results in a large sample of healthy individuals, vmHRV is not a marker of trait rumination (as measured by the Ruminative Response Scale).

Correlation of systemic immune-inflammation index and moderate/major depression in patients with depressive disorders: a large sample cross-sectional study

Objective

To evaluate the clinical value of systemic immune-inflammation index (SII) based on peripheral blood neutrophil, lymphocyte, and platelet count in evaluating the subtype and severity of depression in patients with depressive disorder.

Methods

This retrospective cohort study was conducted in the Third People's Hospital of Fuyang City from January 1, 2020 to December 31, 2022. The data included sociodemographic information at admission, clinical data, discharge diagnosis and inflammatory markers. Patients were divided into low SII group and high SII group according to the optimal threshold of SII determined by receiver operating characteristic curve (ROC curve). Binary logistic regression was used to analyze the correlation between moderate/major depression and SII level.

Results

Compared to the low SII group, the high SII group had a higher age level (χ² = 7.663, p = 0.006), more smokers (χ² = 9.458, p = 0.002), more moderate/major depression patients (χ² = 45.645, p < 0.001), and a higher proportion of patients with accompanying somatic symptoms (χ² = 14.867, p < 0.001). In the final logistic regression model, after controlling for confounding factors, SII at admission was significantly associated with moderate/major depression [β =1.285, p < 0.001; odds ratio (95% confidence intervals) = 3.614 (2.693-4.850)]. Patients with high SII scores were 3.614 times more likely to have moderate/severe depression than those with low SII scores. We propose a cut-off value of SII =540.78 (sensitivity = 36.4% and specificity = 80.3%) according to the maximum Youden index.

Conclusion

Our research indicates that SII may be a useful, repeatable, convenient, and affordable index to identify moderate/major depression in depressive disorder.

Evaluation of Metabolic Profiles of Patients with Anorexia Nervosa at Inpatient Admission, Short- and Long-Term Weight Regain-Descriptive and Pattern Analysis

Acute anorexia nervosa (AN) constitutes an extreme physiological state. We aimed to detect state related metabolic alterations during inpatient admission and upon short- and long-term weight regain. In addition, we tested the hypothesis that metabolite concentrations adapt to those of healthy controls (HC) after long-term weight regain. Thirty-five female adolescents with AN and 25 female HC were recruited. Based on a targeted approach 187 metabolite concentrations were detected at inpatient admission (T₀), after short-term weight recovery (T₁; half of target-weight) and close to target weight (T₂). Pattern hunter and time course analysis were performed. The highest number of significant differences in metabolite concentrations (N = 32) were observed between HC and T₁. According to the detected main pattern, metabolite concentrations at T₂ became more similar to those of HC. The course of single metabolite concentrations (e.g., glutamic acid) revealed different metabolic subtypes within the study sample. Patients with AN after short-term weight regain are in a greater “metabolic imbalance” than at starvation. After long-term weight regain, patients reach a metabolite profile similar to HC. Our results might be confounded by different metabolic subtypes of patients with AN.

Neutrophil-to-lymphocyte ratio: A potential new peripheral biomarker of suicidal behavior

BACKGROUND

Neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and platelet-to-lymphocyte ratio (PLR) have emerged as important peripheral inflammatory biomarkers. Recent data suggest a possible role of the immune system in the pathophysiology of suicidal behavior (SB). The aim of this study is to evaluate the association among NLR, MLR, and PLR and SB in patients with major depressive disorder (MDD), and to test its validity as a biomarker for suicidality.

METHODS

We evaluated 538 patients with MDD (mean age [standard deviation] = 43.87 [14.36] years; females: 68.8%). A logistic regression model was estimated to determine the independent factors associated with suicide risk in patients with and without a history of suicide attempt (SA).

RESULTS

Three hundred ninety-three patients (74.7%) had a personal history of SA. Patients with a previous SA were more frequently female (71.9% vs. 59.6%; p = 0.007), significantly younger (41.20 vs. 51.77 years; p < 0.001), had lower depression severity at enrolment (15.58 vs. 18.42; p < 0.000), and significantly higher mean NLR and PLR ratios (2.27 vs. 1.68, p = 0.001; 127.90 vs. 109.97, p = 0.007, respectively). In the final logistic regression model, after controlling for age, sex, and depression severity, NLR was significantly associated with SB (β = 0.489, p = 0.000; odds ratio [95% confidence intervals] = 1.631 [1.266-2.102]). We propose a cut-off value of NLR = 1.30 (sensitivity = 75% and specificity = 35%).

CONCLUSIONS

Our data suggest that NLR may be a valuable, reproducible, easily accessible, and cost-effective strategy to determine suicide risk in MDD.

Altered global brain network topology as a trait marker in patients with anorexia nervosa

BACKGROUND

Resting state functional magnetic resonance imaging studies have identified functional connectivity patterns associated with acute undernutrition in anorexia nervosa (AN), but few have investigated recovered patients. Thus, a trait connectivity profile characteristic of the disorder remains elusive. Using state-of-the-art graph-theoretic methods in acute AN, the authors previously found abnormal global brain network architecture, possibly driven by local network alterations. To disentangle trait from starvation effects, the present study examines network organization in recovered patients.

METHODS

Graph-theoretic metrics were used to assess resting-state network properties in a large sample of female patients recovered from AN (recAN, n = 55) compared with pairwise age-matched healthy controls (HC, n = 55).

RESULTS

Indicative of an altered global network structure, recAN showed increased assortativity and reduced global clustering as well as small-worldness compared with HC, while no group differences at an intermediate or local network level were evident. However, using support-vector classifier on local metrics, recAN and HC could be separated with an accuracy of 70.4%.

CONCLUSIONS

This pattern of results suggests that long-term recovered patients have an aberrant global brain network configuration, similar to acutely underweight patients. While the finding of increased assortativity may represent a trait marker of AN, the remaining findings could be seen as a scar following prolonged undernutrition.

Prospective memory in individuals with first-episode schizophrenia: A two-year longitudinal study

AIM

The present study aimed to explore the two-year naturalistic trajectory of time- and event-based prospective memory (PM) in patients with first-episode schizophrenia.

METHODS

We administered a computer-based dual-task PM paradigm to 57 individuals with first-episode schizophrenia at baseline and after 6 months, 12 months and 24 months. Forty-eight healthy controls were also recruited and completed all the measures at baseline. We compared the trajectories between time-based and event-based PM in first-episode schizophrenia patients using repeated measures ANOVAs, and examined the relationship between PM and clinical symptoms using Spearman's correlation.

RESULTS

PM impairments improved significantly after 24 months of follow-up. However, time-based and event-based PM appeared to run different trajectories. After 24 months, first-episode schizophrenia patient performed poorer than healthy controls in time-based but not event-based PM. PM did not appear to be correlated with clinical symptoms, both cross-sectionally and longitudinally.

CONCLUSIONS

This is one of the longest follow-up studies investigating PM in first-episode schizophrenia. Our results provide evidence to support that time-based PM is more temporally stable than event-based PM.

Decreased need for sleep as an endophenotype of bipolar disorder: an actigraphy study

Reports of subjective sleep impairments have been replicated in adults with bipolar disorder (BD), young BD patients, and even children of parents with BD. Furthermore, circadian rhythm alterations are a core feature of BD. Despite the impairment in circadian rhythms and altered sleep included in various heuristic developmental models of BD, thus far, biomarkers have not been sufficiently objectively validated. Thus, here, we assessed the rest-activity circadian rhythmicity and sleep macrostructure using actigraphy in a sample of unaffected child and adolescent offspring of bipolar parents (BO; n = 43; 21 females; 11.0 ± 3.2 years) and controls (n = 42; 17 females; 11.1 ± 3.4 years) comparable in sex (p = .4) and age (p = .7). All participants wore a MotionWatch 8 (Camntech, Cambridge, UK) actigraph on their nondominant wrist for ≥ 14 days and completed sleep diaries. Psychopathology was assessed by the Kiddie Schedule for Affective Disorders and Schizophrenia and by subjective scales. The main areas of interest were rest-activity circadian rhythmicity, chronotype and sleep macrostructure. Subgroup analyses (child and adolescent subgroups) were conducted to identify physiological differences in sleep between these age groups. The BO and controls did not differ in the presence of current mood (p = .5) and anxiety (p = .6) disorders. The BO had shorter sleep time on free days (p = .007; effect size, Cohen´s d = 0.56), lower sleep efficiency on free days (p = .01; d = 0.47), lower prolongation of time in bed on free days (p = .046; d = 0.41), and lower social jet lag (p = .04; d = 0.5) than the controls. A longer sleep time on school days (p < .001; d = 0.21), lower prolongation of sleep time between school and free days (p = .008; d = 0.74), and larger difference in sleep onset latency between school days and free days (p = .009; d = 0.52) were observed in the adolescent BO than in the controls. The child BO had poorer sleep quality on free days than the controls (p = .02; d = 0.96). In all cases, the results remained significant after controlling for subthreshold mood and anxiety symptoms. The BO had less variable rest-activity rhythm than controls (p = .04; d = 0.32). No other significant differences between the BO and controls were observed in the rest-activity circadian rhythmicity and chronotype. The results showed decreased physiological catch-up sleep on free days in the BO, which may indicate a decreased need for sleep in this population. Thus, the decreased need for sleep observed in the unaffected BO may represent an endophenotype of BD.

Biological rhythm impairment in bipolar disorder: A state or trait marker?

CONTEXT

There is limited research on biological rhythms in bipolar disorder (BD) from the Indian setting despite its intricate relationship with metabolic syndrome (MS) and functioning.

AIMS

The study aimed to assess "trait marker" status of biological rhythms as well as correlates of biological rhythm impairment in euthymic BD.

SETTING AND DESIGN

Cross-sectional observational study over 6 months was carried out in hospital setting.

MATERIALS AND METHODS

Biological Rhythms Interview of Assessment in Neuropsychiatry Questionnaire (BRIAN) and Functioning Assessment Short Test (FAST) were used to assess biological rhythms and functioning, respectively. MS was diagnosed as per modified National Cholesterol Education Program- Adult Treatment Panel III. Depressive symptoms were assessed by the Hamilton Depression Rating Scale (HDRS). Euthymia was defined as symptomatic remission for at least 8 weeks. Ethical approval was taken.

RESULTS

Fifty cases of euthymic BD and fifty apparently healthy controls were recruited. Total as well as certain domain-specific BRIAN and FAST scores were significantly higher in cases compared to controls. A significant positive correlation was found between the total BRIAN score with HDRS as well as FAST score. No correlation was obtained between biological rhythms and metabolic parameters.

CONCLUSIONS

Our results support the hypothesis that biological rhythm impairment is a trait marker in patients with BD. The study supports the need for management of subsyndromal depressive symptoms even in inter-episodic period.

A study of physical anhedonia as a trait marker in schizophrenia

BACKGROUND

Inability to define the heritable phenotype might be a reason for failure to replicate results in psychiatric genetics. Hence, the use of a candidate symptom approach to identify more homogeneous forms of diseases among affected individuals and subclinical traits among first-degree relatives (FDRs) may increase genetic validity. The objective of the present study was to determine whether physical anhedonia can be used as a marker for individuals at risk of schizophrenia.

MATERIALS AND METHODS

Physical anhedonia scores (measured using Revised Physical Anhedonia Scale [rPAS]) were compared across thirty remitted schizophrenic patients, thirty of their unaffected FDRs, and thirty healthy controls. We compared anhedonia scores among the three main groups using one-way ANOVA.

RESULTS

Physical anhedonia (rPAS) scores of the schizophrenic patient group were significantly higher than that of their FDRs and controls both, and physical anhedonia (rPAS) scores of FDRs were significantly higher than that of healthy controls (F = 115.33, P < 0.001). The subgroups did not differ on various other clinical characteristics.

CONCLUSION

Our data suggest that physical anhedonia is a candidate symptom for schizophrenia.

Heart Rate Variability as Indicator of Clinical State in Depression

Background: Depression is a severe disease with great burdens for the affected individuals and public health care systems. Autonomic nervous system (ANS) dysfunction indexed by measures of heart rate variability (HRV) has repeatedly been associated with depression. However, HRV parameters are subject to a wide range of multi-factorial influences and underlying mechanisms in depression are still unclear. HRV parameters have been proposed to be promising candidates for diagnostic or predictive bio-markers for depression but necessary longitudinal design studies investigating the relationship between HRV and depression are scarce. Methods: The sample in this study consisted of 62 depressive individuals without antidepressant medication prior to assessment and 65 healthy controls. Fifteen minute blocks of resting ECGs were recorded 1-2 days before onset of antidepressant treatment and 2 weeks thereafter. The ECGs were pre-processed to extract inter-beat-intervals. Linear and non-linear methods were used to extract HRV parameters. ANOVAS were performed to investigate group differences between depressive patients and healthy controls. Associations between the change in severity of depression and HRV parameters were assessed in a repeated measurements design. Results: Analyses revealed HRV parameter differences between the groups of depressive patients and healthy controls at baseline. Further results show differences in HRV parameters within subjects after 2 weeks of antidepressant treatment. Change in HRV parameter values correlated with changes in symptom severity of depression. Discussion: The current results provide further insight into the relationship between HRV parameters and depression. This may help to underpin utilization of HRV parameters are bio-maker for disease state in depression. Results are discussed within a theoretical framework to link arousal and ANS regulation in depression.

Altered integrity of the right arcuate fasciculus as a trait marker of schizophrenia: a sibling study using tractography-based analysis of the whole brain

Trait markers of schizophrenia aid the dissection of the heterogeneous phenotypes into distinct subtypes and facilitate the genetic underpinning of the disease. The microstructural integrity of the white matter tracts could serve as a trait marker of schizophrenia, and tractography-based analysis (TBA) is the current method of choice. Manual tractography is time-consuming and limits the analysis to preselected fiber tracts. Here, we sought to identify a trait marker of schizophrenia from among 74 fiber tracts across the whole brain using a novel automatic TBA method. Thirty-one patients with schizophrenia, 31 unaffected siblings and 31 healthy controls were recruited to undergo diffusion spectrum magnetic resonance imaging at 3T. Generalized fractional anisotropy (GFA), an index reflecting tract integrity, was computed for each tract and compared among the three groups. Ten tracts were found to exhibit significant differences between the groups with a linear, stepwise order from controls to siblings to patients; they included the right arcuate fasciculus, bilateral fornices, bilateral auditory tracts, left optic radiation, the genu of the corpus callosum, and the corpus callosum to the bilateral dorsolateral prefrontal cortices, bilateral temporal poles, and bilateral hippocampi. Posthoc between-group analyses revealed that the GFA of the right arcuate fasciculus was significantly decreased in both the patients and unaffected siblings compared to the controls. Furthermore, the GFA of the right arcuate fasciculus exhibited a trend toward positive symptom scores. In conclusion, the right arcuate fasciculus may be a candidate trait marker and deserves further study to verify any genetic association.