Altered empathy-related resting-state functional connectivity in patients with bipolar disorder

Neuroimaging Changes in the Sensorimotor Network and Visual Network in Bipolar Disorder and Their Relationship with Genetic Characteristics

Objective: Patients with bipolar disorder (BD) may exhibit common and significant changes in brain activity across different networks. Our aim was to investigate the changes in functional connectivity (FC) within different brain networks in BD, as well as their neuroimaging homogeneity, heterogeneity, and genetic variation. Methods: In this study, we analyzed the seed points and whole-brain FC of the sensorimotor network (SMN) and visual network (VN) in 83 healthy controls (HCs) and 77 BD patients, along with their genetic neuroimaging associations. Results: The results showed that, compared to HCs, BD patients exhibited abnormal FC in the SMN and VN brain regions. However, after three months of treatment, there were no significant differences in SMN and VN FC in the brain regions of the patients compared to pre-treatment levels. Enrichment analysis indicated that genes associated with changes in FC were shared among different SMN seed points, but no shared genes were found among VN seed points. Conclusions: In conclusion, changes in SMN FC may serve as a potential neuroimaging marker in BD patients. Our genetic neuroimaging association analysis may help to comprehensively understand the molecular mechanisms underlying FC changes in BD patients.

Altered cerebellar subregion functional connectivity and structure in patients with pediatric bipolar depression

To explore the structural and functional changes of Cerebellar Subregion in patients with pediatric bipolar disorder (PBD) patients and its clinical significance by using multimodal magnetic resonance imaging, so as to further explore the specific role of the cerebellum in PBD. This study included 48 pediatric patients with bipolar disorder (PBD) in the depressive phase from the outpatient clinic of the Department of Psychosomatic Medicine of the First Affiliated Hospital of Nanchang University. 22 healthy controls (HCs) matched for gender, age, handedness and education level were chosen from the community as the control group. All subjects underwent 3.0T resting-state functional magnetic resonance imaging (rs-fMRI) scans and completed clinical scales, including the Hamilton Depression Scale (HAMD) and Young Mania Rating Scale (YMRS). The cerebellum was categorized into 34 distinct subregions (R17, L17) based on SUIT and designated as seed points to perform whole-brain functional connectivity (FC). Group differences in categorical variables were assessed using the chi-square test, while continuous variables were compared employing the two-sample t-test. Correlations between FC and clinical parameters were analyzed for differential brain intervals. Compared with HCs, PBD patients in the depressive phase showed reduced FC between the left cerebellar lobules I-IV and the occipital inferior lobe (Occipital_Inf_L), cerebellar vermis VIIIa, and VIIIb; decreased FC between cerebellar cerebellar vermis VI and the frontal inferior orbital gyrus (Frontal_Inf_Orb_L), as well as the right cerebellar Crus 1; reduced FC between the left cerebellar Crus I and the dentate nucleus; decreased FC between cerebellar vermis VIIIa and the left superior frontal gyrus; reduced FC between the right cerebellar lobule IX and the right lingual gyrus; lowered FC between the left dentate and the dorsolateral prefrontal cortex, and the left lingual gyrus; FC between the left fastigial nucleus and the right cerebellar X decreased. Depressive phase of PBD patients exhibit altered functional connectivity within various subregions of the cerebellum, suggesting that the cerebellum is involved in central neural reorganization in PBD, which may be instructive for the understanding of central mechanisms and its future diagnostic and therapeutic target development.

More empathy for others, more hurt for oneself? Empathy for pain is related to poor mental health and negative emotion regulation

BACKGROUND

Empathy for pain refers to a simulation of pain experiences evoked when seeing others in pain. Empathy for pain (vicarious pain) responders make up 27% of the healthy population, and are divided into two subsets: Sensory/Localized responders who feel localized physical pain and Affective/General responders who experience diffuse emotional pain. Empathy for pain is linked to pro-social behavior but can increase mental health symptoms.

METHODS

Multivariate analysis of variance and latent variable mediation model were used to investigate the relationship between empathy for pain, mental health, and emotion regulation based on a university student dataset (mainly Caucasian) from 2020 to 2021.

RESULTS

(1) Responders express significantly higher anxiety and somatization than non-responders, with Sensory/Localized responders reporting the greatest somatic concerns; (2) Sensory/localized responders show significantly higher depression than non-responders; (3) Two responder groups don't differ from non-responders on most positive emotional regulation strategies, but use more negative strategies (self-blame, rumination, and catastrophizing). (4) negative emotional regulation fully mediates the link between empathy and mental health.

CONCLUSIONS

These findings reveal a previously unrecognized link between empathy for pain and mental health, mediated by the increased use of negative emotion regulation strategies among responders. Our findings have particular implications for the mental health of empathic individuals or people who are often exposed to the pain of others (counselor or nurse, etc.).

Aberrant resting-state functional network centrality and cognitive impairment in unmedicated, euthymic bipolar patients

BACKGROUND

Cognitive impairment is prevalent in bipolar disorder (BD), and has negative impacts on functional impairments and quality of life, despite euthymic states in most individuals. The underlying neurobiological basis of cognitive impairment in BD is still unclear.

METHODS

To further explore potential connectivity abnormalities and their associations with cognitive impairment, we conducted a degree centrality (DC) analysis and DC (seed)-based functional connectivity (FC) approach in unmedicated, euthymic individuals with BD. Our study included 34 euthymic BD patients and 35 healthy controls (HC) matched for age, gender, and education years.

RESULTS

We found extensive DC changes in brain activity, with lower DC values in the left medial frontal gyrus, inferior frontal gyrus, and middle frontal gyrus, and increased DC values in the left insula, bilateral precentral gyrus, and right medial frontal gyrus in BD patients compared to HC. Furthermore, we observed positive or negative correlations between DC values of the inferior frontal gyrus, insula_L, precentral gyrus (L), precentral gyrus (R), and medial frontal gyrus and multiple-domain cognitive assessment scores. Additionally, we identified intranetwork and internetwork functional connectivity alterations in the default mode network (DMN), fronto-parietal network (FPN), and central executive network (CEN) in euthymic BD patients compared to HC.

CONCLUSION

Our findings highlight abnormal neuronal networks involving multiple frontal brain regions and thalamus, which may contribute to cognitive deficits in individuals with euthymic BD. These findings may serve as potential hallmarks of BD, contributing to a better understanding of the neural mechanism of cognitive impairment during euthymia.

[Psychometric evaluation of the German version of the Questionnaire of Cognitive and Affective Empathy (QCAE)]

Empathy as a central element of social cognition plays a decisive role in various psychosocial areas and interpersonal dynamics, especially within the context of psychotherapy. Despite the controversy surrounding a standardized definition, empathy is generally regarded as a multidimensional concept that encompasses both cognitive and affective dimensions. This differentiation between cognitive and affective facets is addressed by a widely used and internationally well-established self-report measure of empathy, the Questionnaire of Cognitive and Affective Empathy (QCAE). This study focuses on evaluating the psychometric properties of the German version of the QCAE. In a convenience sample (N=1300), the postulated confirmatory five-factor model showed an adequate fit to the underlying structure. The subscales of the QCAE exhibited satisfactory internal consistency and convergent validity with other instruments measuring empathy. Despite certain methodological limitations, our findings suggest that the German version of the QCAE is suitable as a reliable and valid instrument for measuring empathy. Further studies in population-representative samples and clinical populations are required before a clear recommendation regarding its utilization can be provided.

A Virtual Reality Cognitive Stimulation Program as an Effective Tool Against Residual/Prodromal Depressive Symptoms in Bipolar Disorders

Background: Bipolar disorder (BD) is a severe psychiatric illness characterized by a chronic course and recurrent episodes, including residual depressive symptoms even during euthymic phases. These symptoms, although not meeting criteria for a depressive episode, are linked to relapse risk and impaired social functioning. This study aims to assess whether Virtual Reality Cognitive Remediation Training reduces depressive symptoms below the clinical threshold in individuals with BD. Methods: This post hoc analysis focuses on the secondary outcome (PHQ9) of a randomized-controlled trial. Participants were recruited from the Center of Liaison Psychiatry and Psychosomatics in Italy. The experimental group received Virtual Reality Cognitive Remediation, while the control group received standard treatment Results: Data from 39 individuals in the experimental group and 25 in the control group were analyzed. A greater reduction in PHQ-9 scores (>9) was observed in the experimental group (71.8% to 48.7%) compared to the control group. Significant improvements in total PHQ-9 scores and specific symptoms were noted in the experimental group compared to the control group. Conclusions: The study highlights the significant impact of virtual reality intervention on reducing depressive symptoms in bipolar disorder. This promising outcome underscores the potential preventive role of cognitive stimulation in relapse prevention. The intervention could offer valuable benefits for both treatment and prevention strategies in bipolar disorder.

Role of the Cerebellum in Bipolar Disorder: A Systematic Literature Review

The aim of this systematic literature review was to investigate the role of the cerebellum in the affective symptoms observed in patients with bipolar disorder. The present systematic literature review included clinical studies conducted from 2013-2023 among adult populations with bipolar I and II disorders, along with their specifiers. With regard to cerebellar pathology, it was found that those with bipolar disorder performed worse than their healthy counterparts in their ability to comprehend the mental states of others and in identifying negative mental states. Additionally, individuals with bipolar disorder had reduced gray matter loss in regions such as lobules I-IX, crus I, and crus II, different functional activation patterns of the thalamus, striatum, and hippocampus on functional magnetic resonance imaging (fMRI), and increased cortical thickness. Cerebro-cerebellar functional connectivities were altered in patients with bipolar disorder. The effects of lamotrigine and lithium on cerebellar volume and abnormalities are also discussed in this paper. The present systematic literature review illustrates the emerging involvement of the cerebellum in bipolar disorder and its affective symptoms and paves the way for future research and a better understanding of bipolar disorder.

Abnormal degree centrality can be a potential imaging biomarker in first-episode, drug-naive bipolar mania

Brain network abnormalities in emotional response exist in bipolar mania. However, few studies have been published on network degree centrality of first-episode, drug-naive bipolar mania, and healthy controls. This study aimed to assess the utility of neural activity values analyzed via degree centrality methods. Sixty-six first-episode, drug-naive patients with bipolar mania and 60 healthy controls participated in resting-state functional magnetic resonance rescanning and scale estimating. The degree centrality and receiver operating characteristic (ROC) curve methods were used for an analysis of the imaging data. Relative to healthy controls, first-episode bipolar mania patients displayed increased degree centrality values in the left middle occipital gyrus, precentral gyrus, supplementary motor area, Precuneus, and decreased degree centrality values in the left parahippocampal gyrus, right insula and superior frontal gyrus, medial. ROC results exhibited degree centrality values in the left parahippocampal gyrus that could distinguish first-episode bipolar mania patients from healthy controls with 0.8404 for AUC. Support vector machine results showed that reductions in degree centrality values in the left parahippocampal gyrus can be used to effectively differentiate between bipolar disorder patients and healthy controls with respective accuracy, sensitivity, and specificity values of 83.33%, 85.51%, and 88.41%. Increased activity in the left parahippocampal gyrus may be a distinctive neurobiological feature of first-episode, drug-naive bipolar mania. Degree centrality values in the left parahippocampal gyrus might be served as a potential neuroimaging biomarker to discriminate first-episode, drug-naive bipolar mania patients from healthy controls.