1
|
Schnyer DM, Clasen PC, Gonzalez C, Beevers CG. Evaluating the diagnostic utility of applying a machine learning algorithm to diffusion tensor MRI measures in individuals with major depressive disorder. Psychiatry Res Neuroimaging 2017; 264:1-9. [PMID: 28388468 PMCID: PMC5486995 DOI: 10.1016/j.pscychresns.2017.03.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 11/02/2016] [Accepted: 03/08/2017] [Indexed: 02/07/2023]
Abstract
Using MRI to diagnose mental disorders has been a long-term goal. Despite this, the vast majority of prior neuroimaging work has been descriptive rather than predictive. The current study applies support vector machine (SVM) learning to MRI measures of brain white matter to classify adults with Major Depressive Disorder (MDD) and healthy controls. In a precisely matched group of individuals with MDD (n =25) and healthy controls (n =25), SVM learning accurately (74%) classified patients and controls across a brain map of white matter fractional anisotropy values (FA). The study revealed three main findings: 1) SVM applied to DTI derived FA maps can accurately classify MDD vs. healthy controls; 2) prediction is strongest when only right hemisphere white matter is examined; and 3) removing FA values from a region identified by univariate contrast as significantly different between MDD and healthy controls does not change the SVM accuracy. These results indicate that SVM learning applied to neuroimaging data can classify the presence versus absence of MDD and that predictive information is distributed across brain networks rather than being highly localized. Finally, MDD group differences revealed through typical univariate contrasts do not necessarily reveal patterns that provide accurate predictive information.
Collapse
Affiliation(s)
- David M Schnyer
- Department of Psychology, University of Texas at Austin, Austin, TX, USA.
| | - Peter C Clasen
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Christopher Gonzalez
- Department of Psychology, University of California, San Diego, San Diego, CA, USA
| | | |
Collapse
|
2
|
Bruder GE, Stewart JW, McGrath PJ. Right brain, left brain in depressive disorders: Clinical and theoretical implications of behavioral, electrophysiological and neuroimaging findings. Neurosci Biobehav Rev 2017; 78:178-191. [PMID: 28445740 DOI: 10.1016/j.neubiorev.2017.04.021] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 04/19/2017] [Accepted: 04/20/2017] [Indexed: 12/15/2022]
Abstract
The right and left side of the brain are asymmetric in anatomy and function. We review electrophysiological (EEG and event-related potential), behavioral (dichotic and visual perceptual asymmetry), and neuroimaging (PET, MRI, NIRS) evidence of right-left asymmetry in depressive disorders. Recent electrophysiological and fMRI studies of emotional processing have provided new evidence of altered laterality in depressive disorders. EEG alpha asymmetry and neuroimaging findings at rest and during cognitive or emotional tasks are consistent with reduced left prefrontal activity in depressed patients, which may impair downregulation of amygdala response to negative emotional information. Dichotic listening and visual hemifield findings for non-verbal or emotional processing have revealed abnormal perceptual asymmetry in depressive disorders, and electrophysiological findings have shown reduced right-lateralized responsivity to emotional stimuli in occipitotemporal or parietotemporal cortex. We discuss models of neural networks underlying these alterations. Of clinical relevance, individual differences among depressed patients on measures of right-left brain function are related to diagnostic subtype of depression, comorbidity with anxiety disorders, and clinical response to antidepressants or cognitive behavioral therapy.
Collapse
Affiliation(s)
- Gerard E Bruder
- Department of Psychiatry, Columbia University College of Physicians & Surgeons, New York, USA; Cognitive Neuroscience Division, New York State Psychiatric Institute, New York, USA.
| | - Jonathan W Stewart
- Department of Psychiatry, Columbia University College of Physicians & Surgeons, New York, USA; Depression Evaluation Service, New York State Psychiatric Institute, New York, USA.
| | - Patrick J McGrath
- Department of Psychiatry, Columbia University College of Physicians & Surgeons, New York, USA; Depression Evaluation Service, New York State Psychiatric Institute, New York, USA.
| |
Collapse
|
3
|
Wang Y, Chai F, Zhang H, Liu X, Xie P, Zheng L, Yang L, Li L, Fang D. Cortical functional activity in patients with generalized anxiety disorder. BMC Psychiatry 2016; 16:217. [PMID: 27388467 PMCID: PMC4936202 DOI: 10.1186/s12888-016-0917-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 06/08/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The neurological correlates of Generalised Anxiety Disorder (GAD) are not well known, however there is evidence of cortical dysregulation in patients with GAD. The aim of the study was to examine cortical functional activity in different cerebral regions in patients with GAD using electroencephalogram (EEG) nonlinear analysis to evaluate its contribution of anxiety severity. METHODS The cohorts consisted of 64 patients diagnosed with GAD as classified by the Structured Clinical Interview for the Diagnostic and Statistical Manual of the American Psychiatric Association-IV-TR. Anxiety severity was assessed using the Hamilton Rating Scale for Anxiety (HAMA) severity score, with 7 ≤ scores ≤ 17 indicating mild anxiety as A group (n = 31) and 18 and above indicating moderate-severe anxiety as B group (n = 33). Participants with clinical levels of depression symptoms were excluded. A healthy control group comprising 30 participants was matched for age and gender. Closed eyes EEGs were conducted, and between-group differences on non-linear parameter Correlation Dimension (D2) were analyzed. The association of D2 value with HAMA scores was analyzed using multiple linear stepwise regression. RESULTS Compared with the control group, D2 values were increased in anxiety groups (P < .05). For those with mild anxiety, this difference occurred in the left prefrontal regions (P < .05). For those with moderate-severe anxiety, significantly greater D2 values were observed in all of the cerebral regions, especially in the left cerebral regions and right temporal lobe (P < .01). When compared with those with mild anxiety, D2 values were significantly greater for those with moderate-severe anxiety in the right temporal lobe and all left cerebral regions except for left occipital lobe (P < .05). A positive correlation was observed between D2 values and moderate-severe anxiety HAMA scores. CONCLUSIONS The increased D2 values were found in the majority of cerebral regions in GAD patients, especially in the left cerebral regions and the right temporal lobe. The increased GAD severity positively correlates to the D2 values in a larger number of cerebral regions. This analysis method can potentially be used as a complementary tool to examine dysfunctional cortical activity in GAD.
Collapse
Affiliation(s)
- Yiming Wang
- />Department of Psychiatry, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550004 China
| | - Fangxian Chai
- />Department of Psychiatry, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550004 China
| | - Hongming Zhang
- />Department of Cardiolog, The General Hospital of Jinan Military Region, Jinan, 250031 China
| | - Xingde Liu
- />Department of Cardiolog, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550004 China
| | - Pingxia Xie
- />Department of Psychiatry, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550004 China
| | - Lei Zheng
- />Department of Psychiatry, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550004 China
| | - Lixia Yang
- />Department of Psychiatry, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550004 China
| | - Lingjiang Li
- />The second Xiangya Hospital, Central South University, 139# Renmin road, Changsha, Hunan 410011 China
| | - Deyu Fang
- />Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, 60611 USA
| |
Collapse
|
4
|
Wang Y, Zhang H, Tang S, Liu X, O'Neil A, Turner A, Chai F, Chen F, Berk M. Assessing regional cerebral blood flow in depression using 320-slice computed tomography. PLoS One 2014; 9:e107735. [PMID: 25251476 PMCID: PMC4175469 DOI: 10.1371/journal.pone.0107735] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 08/15/2014] [Indexed: 12/17/2022] Open
Abstract
While there is evidence that the development and course of major depressive disorder (MDD) symptomatology is associated with vascular disease, and that there are changes in energy utilization in the disorder, the extent to which cerebral blood flow is changed in this condition is not clear. This study utilized a novel imaging technique previously used in coronary and stroke patients, 320-slice Computed-Tomography (CT), to assess regional cerebral blood flow (rCBF) in those with MDD and examine the pattern of regional cerebral perfusion. Thirty nine participants with depressive symptoms (Hamilton Depression Rating Scale 24 (HAMD24) score > 20, and Self-Rating Depression Scale (SDS) score > 53) and 41 healthy volunteers were studied. For all subjects, 3 ml of venous blood was collected to assess hematological parameters. Transcranial Doppler (TCD) ultrasound was utilized to measure parameters of cerebral artery rCBFV and analyse the Pulsatility Index (PI). 16 subjects (8 = MDD; 8 = healthy) also had rCBF measured in different cerebral artery regions using 320-slice CT. Differences among groups were analyzed using ANOVA and Pearson's tests were employed in our statistical analyses. Compared with the control group, whole blood viscosity (including high\middle\low shear rate)and hematocrit (HCT) were significantly increased in the MDD group. PI values in different cerebral artery regions and parameters of rCBFV in the cerebral arteries were decreased in depressive participants, and there was a positive relationship between rCBFV and the corresponding vascular rCBF in both gray and white matter. rCBF of the left gray matter was lower than that of the right in MDD. Major depression is characterized by a wide range of CBF impairments and prominent changes in gray matter blood flow. 320-slice CT appears to be a valid and promising tool for measuring rCBF, and could thus be employed in psychiatric settings for biomarker and treatment response purposes.
Collapse
Affiliation(s)
- Yiming Wang
- Department of Psychiatry, Hospital Affiliated to Guiyang Medical University, Guiyang, Guizhou, China
- * E-mail: (YW); (XL)
| | - Hongming Zhang
- Department of Cardiology, The General Hospital of Jinan Military Region, Jinan, China
| | - Songlin Tang
- Department of Psychiatry, Hospital Affiliated to Guiyang Medical University, Guiyang, Guizhou, China
- Department of Neurology, First People's Hospital of Shaoyang, Shaoyang, Hunan, China
| | - Xingde Liu
- Department of Cardiology, Hospital Affiliated to Guiyang Medical University, Guiyang City, Guizhou, China
- * E-mail: (YW); (XL)
| | - Adrienne O'Neil
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Alyna Turner
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Australia
- Department of Psychiatry, The University of Melbourne, Parkville, Victoria, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Fangxian Chai
- Department of Psychiatry, Hospital Affiliated to Guiyang Medical University, Guiyang, Guizhou, China
| | - Fanying Chen
- Mental Health Education And Counseling Center, Guiyang Medical University, Guiyang City, Guizhou, China
| | - Michael Berk
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Psychiatry, The University of Melbourne, Parkville, Victoria, Australia
- Department of Psychiatry, Orygen Youth Health Research Centre, The University of Melbourne, Parkville, Victoria, Australia
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia
| |
Collapse
|
5
|
Talati A, Weissman MM, Hamilton SP. Using the high-risk family design to identify biomarkers for major depression. Philos Trans R Soc Lond B Biol Sci 2013; 368:20120129. [PMID: 23440463 DOI: 10.1098/rstb.2012.0129] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
The familial nature of major depressive disorder (MDD) is now well recognized. We followed children and grandchildren of probands with and without MDD to examine transmission of depression over generations, and to identify early vulnerability markers prior to the onset of disease. The study now includes three generations and five completed assessment waves spanning 25 years, with a sixth wave underway. Beginning with the fourth wave, we collected measures of brain structure (magnetic resonance imaging, MRI) and physiology (electroencephalography, EEG) and DNA in order to examine at a biological level why the offspring of depressed parents were at higher risk. In this paper, we provide an overview of the study design, the main findings, including new data, and the role of the high-risk design in translational research. We demonstrate that offspring of depressed parents ('high-risk'), when compared with those of non-depressed parents ('low-risk'), were at increased risk for depressive and anxiety disorders, with anxiety appearing earlier and being a predisposing factor for MDD. Offspring with two generations previously affected were at greatest risk. Thinning of the cortical mantle (MRI) and reduced resting-state activity (EEG) within the right parieto-temporal hemisphere differentiated high- from low-risk offspring, regardless of whether the offspring had MDD, suggesting that these measures might serve as familial trait markers for depression and related syndromes. The high- and low-risk offspring also differed by serotonin transporter promoter length polymorphism genotypes, even though the same genotypes were not associated with the presence of MDD. The high-risk epidemiological design appears to be a particularly valuable asset in translational research as it allows targeting of biological processes that emerge prior to the onset of disease, and identifies individuals at high risk for the disorder who may carry the trait or marker but not yet be affected.
Collapse
Affiliation(s)
- Ardesheer Talati
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA.
| | | | | |
Collapse
|
6
|
Bruder GE, Stewart JW, Hellerstein D, Alvarenga JE, Alschuler D, McGrath PJ. Abnormal functional brain asymmetry in depression: evidence of biologic commonality between major depression and dysthymia. Psychiatry Res 2012; 196:250-4. [PMID: 22397909 PMCID: PMC3361602 DOI: 10.1016/j.psychres.2011.11.019] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Accepted: 11/21/2011] [Indexed: 11/16/2022]
Abstract
Prior studies have found abnormalities of functional brain asymmetry in patients having a major depressive disorder (MDD). This study aimed to replicate findings of reduced right hemisphere advantage for perceiving dichotic complex tones in depressed patients, and to determine whether patients having "pure" dysthymia show the same abnormality of perceptual asymmetry as MDD. It also examined gender differences in lateralization, and the extent to which abnormalities of perceptual asymmetry in depressed patients are dependent on gender. Unmedicated patients having either a MDD (n=96) or "pure" dysthymic disorder (n=42) and healthy controls (n=114) were tested on dichotic fused-words and complex-tone tests. Patient and control groups differed in right hemisphere advantage for complex tones, but not left hemisphere advantage for words. Reduced right hemisphere advantage for tones was equally present in MDD and dysthymia, but was more evident among depressed men than depressed women. Also, healthy men had greater hemispheric asymmetry than healthy women for both words and tones, whereas this gender difference was not seen for depressed patients. Dysthymia and MDD share a common abnormality of hemispheric asymmetry for dichotic listening.
Collapse
Affiliation(s)
- Gerard E. Bruder
- Columbia University College of Physicians & Surgeons,New York State Psychiatric Institute,Address Reprint requests to: Gerard Bruder, Cognitive Neuroscience, Unit 50, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032. Phone: 212-543-5468 FAX: 212-543-6540
| | - Jonathan W. Stewart
- Columbia University College of Physicians & Surgeons,New York State Psychiatric Institute
| | - David Hellerstein
- Columbia University College of Physicians & Surgeons,New York State Psychiatric Institute
| | | | | | - Patrick J. McGrath
- Columbia University College of Physicians & Surgeons,New York State Psychiatric Institute
| |
Collapse
|
7
|
Abstract
We have identified a brain-based endophenotype for major depressive disorder (MDD) that includes thinning of the cortex of the lateral aspect of the right hemisphere and the medial aspect of the left, as well as bilateral hypoplasia of frontal and parietal white matter. The endophenotype status of these abnormalities is supported by their presence in a multigenerational cohort of persons who themselves do not have MDD but who are at increased familial risk for developing the illness. Those who have the endophenotype but who are not ill nevertheless still suffer from inattention and poor visual memory for social stimuli in direct proportion to the magnitude of cortical thinning and white matter hypoplasia within the endophenotype. Identification of this endophenotype and its cognitive correlates provides targets for devising new preventive and therapeutic interventions for MDD.
Collapse
Affiliation(s)
- Bradley S Peterson
- Columbia College of Physicians & Surgeons and New York State Psychiatric Institute, New York, New York 10032, USA.
| | | |
Collapse
|
8
|
Cortical thinning in persons at increased familial risk for major depression. Proc Natl Acad Sci U S A 2009; 106:6273-8. [PMID: 19329490 DOI: 10.1073/pnas.0805311106] [Citation(s) in RCA: 223] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The brain disturbances that place a person at risk for developing depression are unknown. We imaged the brains of 131 individuals, ages 6 to 54 years, who were biological descendants (children or grandchildren) of individuals identified as having either moderate to severe, recurrent, and functionally debilitating depression or as having no lifetime history of depression. We compared cortical thickness across high- and low-risk groups, detecting large expanses of cortical thinning across the lateral surface of the right cerebral hemisphere in persons at high risk. Thinning correlated with measures of current symptom severity, inattention, and visual memory for social and emotional stimuli. Mediator analyses indicated that cortical thickness mediated the associations of familial risk with inattention, visual memory, and clinical symptoms. These findings suggest that cortical thinning in the right hemisphere produces disturbances in arousal, attention, and memory for social stimuli, which in turn may increase the risk of developing depressive illness.
Collapse
|
9
|
Brain glucose metabolism difference between bipolar and unipolar mood disorders in depressed and euthymic states. Prog Neuropsychopharmacol Biol Psychiatry 2009; 33:243-50. [PMID: 19100808 DOI: 10.1016/j.pnpbp.2008.11.014] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2008] [Revised: 11/17/2008] [Accepted: 11/20/2008] [Indexed: 11/24/2022]
Abstract
BACKGROUND Functional brain imaging studies have consistently demonstrated abnormalities in regional cerebral glucose metabolism in the prefrontal cortex in patients with mood disorders (MD). These studies, however, have not clarified the differential characteristics of glucose metabolism between depressed and euthymic states, or between bipolar mood disorder (BP) and unipolar mood disorder (UP). METHODS We used [(18)F]fluorodeoxyglucose (FDG) positron emission tomography (PET) to evaluate the differences in glucose metabolism at resting state. We compared 30 depressed and 17 euthymic female patients with mood disorders with age-, IQ-, and socioeconomically matched 20 healthy controls (HCs). Then, BP and UP patients were separately analyzed. The PET data were objectively analyzed by statistical parametric mapping (SPM). RESULTS Compared with HCs, the depressed MD patients showed significantly lower glucose metabolism in the bilateral frontal gyri, left cingulate gyrus, bilateral temporal gyri, right insula, bilateral inferior parietal lobules, and right occipital gyrus. In contrast, the euthymic MD patients demonstrated fewer areas with significant reduction. When the depressed BP patients were separately compared with HCs, the glucose metabolism was found to be significantly lower in the bilateral frontal gyri, right cingulate gyrus, and bilateral inferior parietal lobules. Meanwhile, the depressed UP patients showed a significantly lower metabolism in the bilateral frontal gyri, left cingulate gyrus, bilateral temporal gyri, bilateral insulae, bilateral inferior parietal lobules, and right occipital gyrus. CONCLUSIONS The results of this study provide evidence of persistent hypometabolism in depressed MD patients, particularly in the frontal gyrus. Although the conclusions are limited in the cross-sectional study, these findings suggest that abnormalities in the right frontal gyrus, left temporal gyrus, and left cingulate gyrus tend to normalize as the depression symptoms improve, although those in the left frontal gyrus, right cingulate gyrus, and right temporal gyrus persist. This study also elucidated the cerebral hypofunction specific to each BP and UP. BP patients showed a decrease in glucose metabolism in the right anterior cingulate and UP patients did in the right temporal gyrus, right insula, and left posterior cingulate. This study clarified the differences between subtypes.
Collapse
|
10
|
Developmental psychobiology of cyclic affective illness: Implications for early therapeutic intervention. Dev Psychopathol 2009. [DOI: 10.1017/s0954579400007082] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractThe recurrent affective disorders are discussed from the perspective of accumulating inherited and experiential effects on gene expression. Stress and episodes of affective illness are viewed as leaving biochemical and microstructural residues in the central nervous system (CNS) in relation to their patterning, severity, and recurrence. Comorbid factors such as substance abuse and developmental disturbances may also interact with these illness-related variables. In addition to the primary pathological processes, secondary adaptive changes can also be induced, which, in concert with pharmacological interventions, may be sufficient to counter episode occurrences and illness progression. We postulate that the balance of primary pathological and secondary adaptive changes at multiple levels of CNS regulation accounts for recurrence and cyclicity in the affective disorders. The importance of early, effective, long-term interventions in the recurrent affective disorders and the therapeutic potential of several new treatment modalities including repeated transcranial magnetic stimulation (rTMS) are discussed.
Collapse
|
11
|
Metabolic changes in the brain of patients with late-onset major depression. Psychiatry Res 2008; 164:48-57. [PMID: 18804352 DOI: 10.1016/j.pscychresns.2007.03.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2006] [Revised: 12/16/2006] [Accepted: 03/27/2007] [Indexed: 11/21/2022]
Abstract
Positron emission tomography (PET) with fluorodeoxyglucose-F18 was used to examine glucose metabolism in patients with late-onset major depression, all hospitalized non-responders to antidepressant medication. The three-dimensional stereotactic surface projection (3D-SSP) method provided 3D-SSP images and relative metabolic values with minimal partial volume effects. The 3D-SSP score map showed decreased relative metabolism in the prefontal, cingulate and parietal regions in both hemispheres, and in the temporal region on the right, and increased relative metabolism in the occipital pole, vermis, cerebellum, dorsal-frontal, central convexity areas and basal ganglia in both hemispheres in patients compared with controls. The ratio of the parietal to occipital values in right plus left hemispheres was significantly decreased. Correlation coefficients of the anterior cingulate-primary sensorimotor, posterior cingulate-primary sensorimotor and occipital-media frontal in both hemispheres, of the frontal-primary sensorimotor, occipital-parahippocampal, primary visual-medial frontal and parahippocampal-amygdala in the right, and the frontal-vermis, parietal-thalamus, temporal-vermis, occipital-putamen, primary visual-putamen, thalamus-vermis and thalamus-cerebellum in the left were significantly different in patients compared with controls. Patients with late-onset depression who were treatment non-responders showed alterations not only in limbic-cortical circuits, but also in a wider network of thalamo-cortical circuits.
Collapse
|
12
|
Tenke CE, Kayser J, Shankman SA, Griggs CB, Leite P, Stewart JW, Bruder GE. Hemispatial PCA dissociates temporal from parietal ERP generator patterns: CSD components in healthy adults and depressed patients during a dichotic oddball task. Int J Psychophysiol 2008; 67:1-16. [PMID: 17963912 PMCID: PMC2271144 DOI: 10.1016/j.ijpsycho.2007.09.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2006] [Revised: 08/15/2007] [Accepted: 09/10/2007] [Indexed: 11/20/2022]
Abstract
Event-related potentials (31-channel ERPs) were recorded from 38 depressed, unmedicated outpatients and 26 healthy adults (all right-handed) in tonal and phonetic oddball tasks developed to exploit the perceptual challenge of a dichotic stimulation. Tonal nontargets were pairs of complex tones (corresponding to musical notes G and B above middle C) presented simultaneously to each ear (L/R) in an alternating series (G/B or B/G; 2-s fixed SOA). A target tone (note A) replaced one of the pair on 20% of the trials (A/B, G/A, B/A, A/G). Phonetic nontargets were L/R pairs of syllables (/ba/, /da/) with a short voice onset time (VOT), and targets contained a syllable (/ta/) with a long VOT. Subjects responded with a left or right button press to targets (counterbalanced across blocks). Target detection was poorer in patients than controls and for tones than syllables. Reference-free current source densities (CSDs; spherical spline Laplacian) derived from ERP waveforms were simplified and measured using temporal, covariance-based PCA followed by unrestricted Varimax rotation. Target-related N2 sinks and mid-parietal P3 sources were represented by CSD factors peaking at 245 and 440 ms. The P3 source topography included a secondary, left-lateralized temporal lobe maximum for both targets and nontargets. However, a subsequent hemispheric spatiotemporal PCA disentangled temporal lobe N1 and P3 sources as distinct factors. P3 sources were reduced in patients compared with controls, even after using performance as a covariate. Results are consistent with prior reports of P3 reduction in depression and implicate distinct parietal and temporal generators of P3 when using a dichotic oddball paradigm.
Collapse
Affiliation(s)
- Craig E Tenke
- Division of Cognitive Neuroscience, New York State Psychiatric Institute, New York, NY 10032, USA.
| | | | | | | | | | | | | |
Collapse
|
13
|
Kaya M, Cermik TF, Bedel D, Kutucu Y, Tuglu C, Yigitbasi ON. Assessment of alterations in regional cerebral blood flow in patients with hypothyroidism due to Hashimoto's thyroiditis. J Endocrinol Invest 2007; 30:491-6. [PMID: 17646724 DOI: 10.1007/bf03346333] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
AIM The aim of this study was to assess regional cerebral blood flow (rCBF) using detailed semiquantitative analysis of Technetium-99m hexamethylpropyleneamine (HMPAO) brain single-photon emission computerized tomography (SPECT) in patients with hypothyroidism due to autoimmune thyroiditis. PATIENTS, MATERIAL AND METHODS Twenty patients (mean age: 42+/-9 yr) and 12 control subjects (mean age: 35.4+/-8.5 yr) were included in this study. The corticocerebellar rCBF ratios were obtained from 52 cerebral areas on 6 transaxial slices. By using control group rCBF ratios, lower reference values (RLV) (average ratio -2 SD) were calculated and the regions below RLV having an rCBF ratio were considered as abnormal decrease (hypoperfused) areas. RESULTS Significant reduced rCBF rates were measured for 15 (29%) cortical regions for the patient group. The areas in which significant reduced rCBF were demonstrated in the patient group were as follows: a) in the right hemisphere: superior frontal (slice 1 and 2), inferior frontal (slice 1), anterior temporal (slice 1 and 2), precentral gyrus (slice 1 and 2), postcentral gyrus (slice 1 and 2), and parietal cortex; b) in the left hemisphere: superior frontal (slice 1 and 2), inferior frontal (slice 1), caudate nucleus, and parietal cortex. The hypoperfusion was calculated in 154 (14%, 94 right and 60 left) cortical regions out of 1040 regions in the patient group. CONCLUSION These findings indicate that the alteration of rCBF in patients with hypothyroidism due to Hashimoto's thyroiditis before T4 therapy can be demonstrated with brain SPECT. Additionally, the degree of rCBF abnormalities could be determined with brain SPECT in patients with hypothyroidism due to Hashimoto's thyroiditis with or without neurologic or psychiatric symptoms.
Collapse
Affiliation(s)
- M Kaya
- Department of Nuclear Medicine, Hospital of the University of Trakya, 22030 Edirne, Turkey.
| | | | | | | | | | | |
Collapse
|
14
|
Rachid F, Bertschy G. Safety and efficacy of repetitive transcranial magnetic stimulation in the treatment of depression: a critical appraisal of the last 10 years. Neurophysiol Clin 2006; 36:157-83. [PMID: 17046610 DOI: 10.1016/j.neucli.2006.08.006] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2006] [Indexed: 01/18/2023] Open
Abstract
Depression is a common and debilitating illness, for which alternative treatments are urgently needed. Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive and relatively painless experimental technique of altering brain physiology. The authors critically review the evidence for the efficacy, safety and tolerability of rTMS in the treatment of depression based on published data over the last decade. They also discuss studies which have examined relevant clinical, demographic, methodological, and technical parameters that might be implicated in optimizing the antidepressant efficacy of this technique. rTMS depression trials conducted through early 2006 are included in this review, which focuses mainly on the results of published sham-controlled studies, literature reviews and meta-analyses. Trials published so far have been characterized by the use of a great variety of stimulation parameters, study designs, questionable sham controls, small sample sizes and heterogeneously depressed populations, all of which have made comparisons between studies difficult. Meta-analyses of 2-week rTMS sham-controlled studies support, for the most part, the antidepressant effects of rTMS which are statistically superior to sham. However, the degree of clinical improvement remains small, although greater efficacy has been shown with longer treatment courses and predictors of response to rTMS are progressively being identified. rTMS is a promising antidepressant treatment with overall minor adverse effects. Because the clinical efficacy of rTMS as an antidepressant remains questionable, further systematic, large-scale multicenter studies comparing rTMS to a sham and/or to an antidepressant medication along with more stringent stimulation parameters are warranted in order to identify patient populations most likely to benefit and treatment parameters most likely to optimize its antidepressant efficacy.
Collapse
Affiliation(s)
- F Rachid
- Département de psychiatrie, service de psychiatrie adulte, hôpitaux universitaires de Genève, consultation de la jonction, 16-18, boulevard Saint-Georges, 1205 Genève, Switzerland.
| | | |
Collapse
|
15
|
Oquendo MA, Krunic A, Parsey RV, Milak M, Malone KM, Anderson A, van Heertum RL, John Mann J. Positron emission tomography of regional brain metabolic responses to a serotonergic challenge in major depressive disorder with and without borderline personality disorder. Neuropsychopharmacology 2005; 30:1163-72. [PMID: 15770239 DOI: 10.1038/sj.npp.1300689] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Previous neuroimaging studies of major depression have not controlled for the presence of personality disorders characterized by impulsive aggressive behavior, such as borderline personality disorder (BPD). Using positron emission tomography (PET), we studied regional glucose uptake in response to fenfluramine (FEN) in depressed subjects with BPD (n=11) and depressed patients without Cluster B Axis II disorders (n=8). Subjects were scanned while medication-free after a single blind placebo administration and after FEN on a second day. Brain responses were measured by PET imaging of [18F]fluorodeoxyglucose (FDG) and serial prolactin levels. Scans were compared at a voxel level using statistical parametric mapping. Correlations of changes in relative regional cerebral uptake (rCMRglu) with clinical measures were assessed. Depressed borderline patients had greater relative activity in parietotemporal cortical regions (BA 40, BA 22, and BA 42) before and after FEN activation compared to those without BPD. They also had less relative uptake in the anterior cingulate cortex (BA 32) at baseline compared to depressed patients without BPD and FEN abolished this difference. Impulsivity was positively correlated with rCMRglu in superior and middle frontal cortex (BA 6 and 44). Hostility was positively correlated with rCMRglu in temporal cortical regions (BA 21 and 22). In conclusions, borderline pathology in the context of a Major Depressive Disorder is associated with altered activity in parietotemporal and anterior cingulate cortical regions. Controlling for the presence of BPD in future imaging studies of mood disorders may elucidate similarities and differences in regional serotonergic function in these two often comorbid disorders.
Collapse
Affiliation(s)
- Maria A Oquendo
- Department of Psychiatry, Columbia University, College of Physicians & Surgeons, New York, NY, USA.
| | | | | | | | | | | | | | | |
Collapse
|
16
|
Holthoff VA, Beuthien-Baumann B, Zündorf G, Triemer A, Lüdecke S, Winiecki P, Koch R, Füchtner F, Herholz K. Changes in brain metabolism associated with remission in unipolar major depression. Acta Psychiatr Scand 2004; 110:184-94. [PMID: 15283738 DOI: 10.1111/j.1600-0447.2004.00351.x] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Functional brain correlates of remission in patients with major depressive disorder (MDD) are measured with positron emission tomography (PET) and 18F-fluorodeoxyglucose. METHOD Glucose metabolism was measured in patients (n = 41) with moderate to severe MDD during acute depression and in the remitted state defined as a period of asymptomatic condition over 12 weeks. Data analyses used a region-of-interest (ROI) approach and statistical parametric mapping (SPM). RESULTS There were significant decreases in metabolism upon remission with respect to the baseline scan in left prefrontal, anterior temporal and anterior cingulate cortex and bilateral thalamus (SPM analysis) and bilateral putamen and cerebellum (SPM and ROI analyses). There was a significant asymmetry in prefrontal and anterior cingulate cortex metabolism with lower metabolism in the left hemisphere that persisted despite clinical remission. CONCLUSION These findings support the hypothesis that selective monoamine reuptake inhibition leads to an attenuation of a brain circuit that mediates depressive symptomatology.
Collapse
Affiliation(s)
- V A Holthoff
- Department of Psychiatry and Psychotherapy, Dresden University of Technology, Dresden, Germany.
| | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Lyoo IK, Kim MJ, Stoll AL, Demopulos CM, Parow AM, Dager SR, Friedman SD, Dunner DL, Renshaw PF. Frontal lobe gray matter density decreases in bipolar I disorder. Biol Psychiatry 2004; 55:648-51. [PMID: 15013835 DOI: 10.1016/j.biopsych.2003.10.017] [Citation(s) in RCA: 206] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2003] [Revised: 10/21/2003] [Accepted: 10/23/2003] [Indexed: 10/26/2022]
Abstract
BACKGROUND This study was conducted to explore differences in gray and white matter density between bipolar and healthy comparison groups using voxel-based morphometry (VBM). METHODS Brain magnetic resonance imaging was performed for 39 subjects with bipolar I disorder and 43 comparison subjects. Images were registered into a proportional stereotaxic space and segmented into gray matter, white mater, and cerebrospinal fluid. Statistical parametric mapping was used to calculate differences in gray and white matter density between groups. RESULTS Bipolar subjects had decreased gray matter density in left anterior cingulate gyrus (Brodmann's area [BA] 32, 7.3% decrease), an adjacent left medial frontal gyrus (BA 10, 6.9% decrease), right inferior frontal gyrus (BA 47, 9.2% decrease), and right precentral gyrus (BA 44, 6.2% decrease), relative to comparison subjects. CONCLUSIONS The observation of a gray matter density decrease in the left anterior cingulate, which processes emotions, in bipolar subjects is consistent with prior reports that used region-of-interest analytic methods. Decreased gray matter density in the right inferior frontal gyrus, which processes nonverbal and intrinsic functions, supports nondominant hemisphere dysfunction as a component of bipolar disorder.
Collapse
Affiliation(s)
- In Kyoon Lyoo
- Brain Imaging Center, McLean Hospital, Belmont, Massachusetts 02478, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Kawasaki T, Tanaka S, Wang J, Hokama H, Hiramatsu K. Abnormalities of P300 cortical current density in unmedicated depressed patients revealed by LORETA analysis of event-related potentials. Psychiatry Clin Neurosci 2004; 58:68-75. [PMID: 14678460 DOI: 10.1111/j.1440-1819.2004.01195.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The purpose of the present study was to investigate the neural substrates underlying event-related potential (ERP) abnormalities, with respect to the generators of the ERP components in depressed patients. Using an oddball paradigm, ERP from auditory stimuli were recorded from 22 unmedicated patients with current depressive episodes and compared with those from 22 age- and gender-matched normal controls. Cortical current densities of the N100 and P300 components were analyzed using low-resolution electromagnetic tomography (LORETA). Group differences in cortical current density were mapped on a 3-D cortex model. The results revealed that N100 cortical current densities did not differ between the two groups, while P300 cortical current densities were significantly lower in depressed patients over the bilateral temporal lobes, the left frontal region, and the right temporal-parietal area. Furthermore, the cortical area in which the group difference in P300 current density had been identified was remarkably larger over the right than the left hemisphere, thus supporting the hypothesis of right hemisphere dysfunction in depression.
Collapse
Affiliation(s)
- Toshihiko Kawasaki
- Department of Neuropsychiatry, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan.
| | | | | | | | | |
Collapse
|
19
|
Mayberg HS. Positron emission tomography imaging in depression: a neural systems perspective. Neuroimaging Clin N Am 2003; 13:805-15. [PMID: 15024963 DOI: 10.1016/s1052-5149(03)00104-7] [Citation(s) in RCA: 189] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PET measures of regional glucose metabolism, although chemically nonspecific, are sensitive indices of brain function in the untreated state and following disparate treatments. The continued development of imaging and multivariate statistical strategies is expected to provide an important perspective toward the full characterization of the depression phenotype at the neural systems level. An additional goal is the development of routine, brain-based clinical algorithms that optimize diagnosis and treatment of individual depressed patients.
Collapse
Affiliation(s)
- Helen S Mayberg
- Department of Psychiatry and Medicine (Neurology), Rotman Research Institute, Baycrest Centre, University of Toronto, 3560 Bathurst Street, Toronto, Ontario M6A 2E1, Canada.
| |
Collapse
|
20
|
Abstract
Blood flow, metabolism, and structural imaging studies suggest altered neural circuits in major psychiatric disorders including mood disorders, schizophrenia, and obsessive compulsive disorder. Neuroreceptor mapping studies have identified serotonergic abnormalities in mood disorders and dopaminergic abnormalities in schizophrenia. Further imaging applications have involved development of new positron emission tomography (PET) tracers that may identify abnormalities in peptide neurotransmitter systems such as corticotrophin releasing factor or substance P. Finally, PET can play an important role in quantifying the relationship between receptor occupancy, drug blood levels, oral dose and therapeutic outcome. In that way PET scanning can contribute to both therapeutics and to drug development by more rapid identification of the likely therapeutic dose range compared with conventional parallel group dose comparisons or dose ranging studies.
Collapse
Affiliation(s)
- Ramin V Parsey
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | | |
Collapse
|
21
|
Davidson LL, Heinrichs RW. Quantification of frontal and temporal lobe brain-imaging findings in schizophrenia: a meta-analysis. Psychiatry Res 2003; 122:69-87. [PMID: 12714172 DOI: 10.1016/s0925-4927(02)00118-x] [Citation(s) in RCA: 171] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Magnetic resonance imaging (MRI) and positron emission tomography (PET) studies of the frontal and temporal lobes in schizophrenia patients and healthy controls have proliferated over the past 2 decades, but there have been relatively few attempts to quantify the evidence. In this meta-analytic review, 155 studies on frontal and temporal lobe neurobiology were synthesized, reflecting results from 4043 schizophrenia patients and 3977 normal controls. Cohen's d was used to quantify case-control differences, and moderator variable analysis indexed the relation of sample and imaging characteristics to the magnitude of these differences. Frontal metabolic and blood flow deficiencies in conjunction with cognitive activation tasks ("hypofrontality") emerged as the strongest body of evidence, demonstrating abnormalities that distinguish approximately half of schizophrenia patients from healthy people. Most case-control comparisons with structural and functional imaging yield small and in many cases unstable findings. Technical scanning parameters like slice thickness and magnet strength did not vary with case-control differences consistently across the meta-analyses. However, patient sample characteristics including sample size, handedness and gender composition emerged frequently as moderators of brain-imaging effect sizes.
Collapse
Affiliation(s)
- Lara L Davidson
- Department of Psychology, York University, 4700 Keele Street, Toronto, Ontario, Canada M3J 1P3.
| | | |
Collapse
|
22
|
Ketter TA, Drevets WC. Neuroimaging studies of bipolar depression: functional neuropathology, treatment effects, and predictors of clinical response. ACTA ACUST UNITED AC 2002. [DOI: 10.1016/s1566-2772(02)00043-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
23
|
Abstract
Given that the nature of hemispheric dysfunction is different in heterogeneous disorders, in the present investigation EEG power mapping was applied to establish neurophysiological profiles that might potentially discriminate patients with seasonal affective disorder (SAD) among other affective disorders. The baseline resting EEG activity was recorded from 31 depressed SAD patients and 30 controls. Power in the delta, theta-1, theta-2, alpha, beta-1 and beta-2 frequency bands was extracted by Fourier transformation. Patients were found to have a lower delta (in central, parietal, occipital, temporal, posterior-temporal areas), theta-1 (in central and parietal), theta-2 (in anterior-frontal, parietal, occipital) and alpha activity (in anterior-frontal, midfrontal, central, parietal and occipital areas) than controls. SAD subjects showed, compared to controls, an asymmetrical distribution of delta, theta-1, theta-2 and alpha activity in parietal and temporal regions due to an increase of EEG power over the right electrode sites, and beta activity in the lateral frontal region due to an increase of beta power over the right electrode site. It is assumed that differential hemispheric contributions of EEG spectra may discriminate between the varieties of depression or different depressive states.
Collapse
Affiliation(s)
- Nina V Volf
- State Research Institute of Physiology, Siberian Branch of Russian Academy of Medical Sciences, Timakova Str 4, 630117, Novosibirsk, Russia.
| | | |
Collapse
|
24
|
Passynkova NR, Volf NV. Seasonal affective disorder: spatial organization of EEG power and coherence in the depressive state and in light-induced and summer remission. Psychiatry Res 2001; 108:169-85. [PMID: 11756015 DOI: 10.1016/s0925-4927(01)00122-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The present study analyzed EEG power and coherence in subjects with seasonal affective disorder (SAD) during depressive episodes and during light-induced and summer remission. Baseline EEG activity was recorded during the winter period before light treatment (31 SAD patients, 30 control subjects); after 10 days of 2-h morning light treatment (10 SAD subjects); and during the summer period (14 SAD subjects, 27 control subjects). EEG power and coherence were calculated for the delta, theta-1, theta-2, alpha, beta-1 and beta-2 frequency bands. Compared with control subjects, SAD subjects had lower than normal EEG power in most frequency bands; asymmetrical distribution of delta, theta-1, theta-2 and alpha activity in parietal and temporal regions due to increased EEG power over the left electrode sites; and beta activity in the lateral frontal region due to increased beta power over the right electrode site. The foci of decreased EEG coherence were mainly in the right and left frontal and the right posterior regions. Remitted SAD subjects showed normalization of inter-hemispheric asymmetry in lateral frontal areas; increases of delta, theta-2, and alpha activity compared with control values; theta-1 activity in excess of control values; and disappearance of the foci of decreased coherence in anterior areas of the left hemisphere.
Collapse
Affiliation(s)
- N R Passynkova
- Laboratory of Cognitive Physiology, State Research Institute of Physiology, Siberian Branch of Russian Academy of Medical Sciences, Timakova Str. 4, 630117, Novosibirsk, Russia.
| | | |
Collapse
|
25
|
Bearden CE, Hoffman KM, Cannon TD. The neuropsychology and neuroanatomy of bipolar affective disorder: a critical review. Bipolar Disord 2001; 3:106-50; discussion 151-3. [PMID: 11465675 DOI: 10.1034/j.1399-5618.2001.030302.x] [Citation(s) in RCA: 383] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
UNLABELLED Bearden CE, Hoffman KM, Cannon TD. The neuropsychology and neuroanatomy of bipolar affective disorder: a critical review. Bipolar Disord 2001: 3: 106 150. C Munksgaard, 2001 OBJECTIVES To present a comprehensive review of the existing neuropsychological and neuroimaging literature on bipolar affective disorder. This review critically evaluates two common conceptions regarding the neuropsychology of bipolar disorder: 1) that, in contrast to schizophrenia, bipolar affective disorder is not associated with general cognitive impairment independent of illness episodes, and 2) relative right hemisphere (RH) dysfunction is implicated in bipolar illness patients, supported by reports of relatively greater impairment in visuospatial functioning, lateralization abnormalities, and mania secondary to RH lesions. METHODS The major computerized databases (Medline and PSYCInfo) were consulted in order to conduct a comprehensive, integrated review of the literature on the neuropsychology and neuroanatomy of bipolar disorder. Articles meeting specified criteria were included in this review. RESULTS In a critical evaluation of the above notions, this paper determines that: 1) while there is little evidence for selective RH dysfunction, significant cognitive impairment may be present in bipolar illness, particularly in a subgroup of chronic, elderly or multiple-episode patients, suggesting a possible toxic disease process, and 2) the underlying functional correlate of these cognitive deficits may be white matter lesions ('signal hyperintensities') in the frontal lobes and basal ganglia, regions critical for executive function, attention, speeded information processing, learning and memory, and affect regulation. While this hypothesized neural correlate of cognitive impairment in bipolar disorder is speculative, preliminary functional neuroimaging evidence supports the notion of frontal and subcortical hypometabolism in bipolar illness. CONCLUSIONS The etiology of the structural brain abnormalities commonly seen in bipolar illness, and their corresponding functional deficits, remains unknown. It is possible that neurodevelopmental anomalies may play a role, and it remains to be determined whether there is also some pathophysiological progression that occurs with repeated illness episodes. More research is needed on first-episode patients, relatives of bipolar probands, and within prospective longitudinal paradigms in order to isolate disease-specific impairments and genetic markers of neurocognitive function in bipolar disorder.
Collapse
Affiliation(s)
- C E Bearden
- Department of Psychiatry, University of Pennsylvania, Philadelphia, USA.
| | | | | |
Collapse
|
26
|
Ketter TA, Kimbrell TA, George MS, Dunn RT, Speer AM, Benson BE, Willis MW, Danielson A, Frye MA, Herscovitch P, Post RM. Effects of mood and subtype on cerebral glucose metabolism in treatment-resistant bipolar disorder. Biol Psychiatry 2001; 49:97-109. [PMID: 11164756 DOI: 10.1016/s0006-3223(00)00975-6] [Citation(s) in RCA: 211] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Functional brain imaging studies in unipolar and secondary depression have generally found decreased prefrontal cortical activity, but in bipolar disorders findings have been more variable. METHODS Forty-three medication-free, treatment-resistant, predominantly rapid-cycling bipolar disorder patients and 43 age- and gender-matched healthy control subjects had cerebral glucose metabolism assessed using positron emission tomography and fluorine-18-deoxyglucose. RESULTS Depressed bipolar disorder patients compared to control subjects had decreased global, absolute prefrontal and anterior paralimbic cortical, and increased normalized subcortical (ventral striatum, thalamus, right amygdala) metabolism. Degree of depression correlated negatively with absolute prefrontal and paralimbic cortical, and positively with normalized anterior paralimbic subcortical metabolism. Increased normalized cerebello-posterior cortical metabolism was seen in all patient subgroups compared to control subjects, independent of mood state, disorder subtype, or cycle frequency. CONCLUSIONS In bipolar depression, we observed a pattern of prefrontal hypometabolism, consistent with observations in primary unipolar and secondary depression, suggesting this is part of a common neural substrate for depression independent of etiology. In contrast, the cerebello-posterior cortical normalized hypermetabolism seen in all bipolar subgroups (including euthymic) suggests a possible congenital or acquired trait abnormality. The degree to which these findings in treatment-resistant, predominantly rapid-cycling patients pertain to community samples remains to be established.
Collapse
Affiliation(s)
- T A Ketter
- Department of Psychiatry and Behavioral Science, Stanford University School of Medicine, Stanford, California, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Berg D, Supprian T, Thomae J, Warmuth-Metz M, Horowski A, Zeiler B, Magnus T, Rieckmann P, Becker G. Lesion pattern in patients with multiple sclerosis and depression. Mult Scler 2000; 6:156-62. [PMID: 10871826 DOI: 10.1177/135245850000600304] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
To assess if a specific lesion pattern or changes of the basal limbic system as seen in primary depression and depression associated with neurodegenerative disorders might be identified in depressive multiple sclerosis (MS) patients, we submitted 78 MS patients to a MRI examination consisting of a quantitative measurement of lesions and of hyperintense signals from the pontomesencephalic midline (raphe). Furthermore relaxometry of the pontomesencephalic midline, a transcranial ultrasound examination rating its echogenicity semiquantitatively and a standardized neurological, neuropsychiatric and neuropsychological assessment were obtained. Thirty-one patients fulfilled the DSM-IV criteria for depression. Depressed MS patients had a significantly larger temporal lesion load than non-depressed MS patients, especially on the right side. A trend of difference was detected for lesions of the right parietal lobe, the right frontal lobe, the cerebellum and the total lesion load. Neither hyperintense signals or relaxometry nor echogenicity of the region at the level of the pontomesencephalic midline were significantly different between the groups. We conclude that depression in MS patients is not associated with an alteration of the basal limbic system at the brainstem as seen in Parkinson's disease or unipolar depression but with an increased lesion load of the projection areas of the basal limbic system.
Collapse
Affiliation(s)
- D Berg
- Department of Neurology, Bayerische Julius-Maximilians-Universität Würzburg, Germany
| | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Conca A, Fritzsche H, Peschina W, König P, Swoboda E, Wiederin H, Haas C. Preliminary findings of simultaneous 18F-FDG and 99mTc-HMPAO SPECT in patients with depressive disorders at rest: differential correlates with ratings of anxiety. Psychiatry Res 2000; 98:43-54. [PMID: 10708925 DOI: 10.1016/s0925-4927(99)00051-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The assumption of a dynamic coupling between regional cerebral blood flow (rCBF) and cerebral glucose metabolic rates (rCMRGlu) has been challenged by simultaneous measurements of both. Through the use of a dual-headed gamma camera with a 511-keV collimator applying the double isotope 18F-FDG and 99mTc-HMPAO SPECT technique, the uptake rates of these isotopes can be semi-quantitatively evaluated. Sixteen depressed patients, diagnosed by ICD-10 criteria and assessed with the 17-item Hamilton Rating Scale for Depression (HRSD), were studied. Based on the severity of HRSD-rated anxiety (item 10: low=1-21; high=3-4), two eight-patient subgroups were formed and compared with 12 age- and handedness-matched healthy control subjects. As regions of interest, we selected areas implicated in the neuroanatomy of anxiety and depression: hippocampus (hippo), basal ganglia (BG) and gyri temporales superiores (G.t.s.). In the control subjects, a significant statistical coupling between rCBF and rCMRGlu was revealed by the Spearman correlation coefficient only in left hippo and left BG. Patients in the low-anxiety subgroup demonstrated a marked dynamic coupling bilaterally for the G.t.s., while patients in the high-anxiety subgroup showed a significant statistical correlation of rCBF and rCMRGlu only in the left G.t.s. These findings indicate that a dynamic coupling between blood flow and glucose metabolism exists only in distinct brain regions, and that the depressive illness has an uncoupling effect on this correlation in the left BG. Furthermore, our results suggest that the HRSD anxiety score might interact with the underlying depressive illness to influence the relationship of rCBF and rCMRGlu.
Collapse
Affiliation(s)
- A Conca
- Department of Psychiatry I, LKH Rankweil, Valunastr. 16, A-6830, Rankweil, Austria
| | | | | | | | | | | | | |
Collapse
|
29
|
Neuropsychological differentiation of depression and anxiety. JOURNAL OF ABNORMAL PSYCHOLOGY 2000. [DOI: 10.1037/0021-843x.109.1.3] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
30
|
Kimbrell TA, Little JT, Dunn RT, Frye MA, Greenberg BD, Wassermann EM, Repella JD, Danielson AL, Willis MW, Benson BE, Speer AM, Osuch E, George MS, Post RM. Frequency dependence of antidepressant response to left prefrontal repetitive transcranial magnetic stimulation (rTMS) as a function of baseline cerebral glucose metabolism. Biol Psychiatry 1999; 46:1603-13. [PMID: 10624541 DOI: 10.1016/s0006-3223(99)00195-x] [Citation(s) in RCA: 210] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Recent studies suggest that both high frequency (10-20 Hz) and low frequency (1 Hz) repetitive transcranial magnetic stimulation (rTMS) have an antidepressant effect in some individuals. Electrophysiologic data indicate that high frequency rTMS enhances neuronal firing efficacy and that low frequency rTMS has the opposite effect. METHODS We investigated the antidepressant effects of 10 daily left prefrontal 1 Hz versus 20 Hz rTMS with the hypothesis that within a given subject, antidepressant response would differ by frequency and vary as a function of baseline cerebral glucose metabolism. After baseline PET scans utilizing [18F]-Fluorodeoxyglucose, thirteen subjects participated in a randomized crossover trial of 2 weeks of 20 Hz paired with 2 weeks 1 Hz or placebo rTMS. RESULTS We found a negative correlation between degree of antidepressant response after 1 Hz compared to 20 Hz rTMS (r = -0.797, p < .004). Additionally, better response to 20 Hz was associated with the degree of baseline hypometabolism, whereas response to 1 Hz rTMS tended to be associated with baseline hypermetabolism. CONCLUSIONS These preliminary results suggest that antidepressant response to rTMS might vary as a function of stimulation frequency and may depend on pretreatment cerebral metabolism. Further studies combining rTMS and functional neuroimaging are needed.
Collapse
Affiliation(s)
- T A Kimbrell
- Biological Psychiatry Branch, National Institutes of Health, Bethesda, Maryland, Psychiatry Department, University of Arkansas, Little Rock, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Brody AL, Saxena S, Silverman DH, Alborzian S, Fairbanks LA, Phelps ME, Huang SC, Wu HM, Maidment K, Baxter LR. Brain metabolic changes in major depressive disorder from pre- to post-treatment with paroxetine. Psychiatry Res 1999; 91:127-39. [PMID: 10641577 DOI: 10.1016/s0925-4927(99)00034-7] [Citation(s) in RCA: 177] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Functional brain imaging studies of subjects with Major Depressive Disorder (MDD) have suggested that decreased dorsolateral (DLPFC) and increased ventrolateral (VLPFC) prefrontal cortical activity mediate the depressed state. Pre- to post-treatment studies indicate that these abnormalities normalize with successful treatment. We performed [18F]fluorodeoxyglucose positron emission tomography (FDG-PET) scans on 16 outpatients with MDD before and after treatment with paroxetine (target dose = 40 mg/day). Regions of interest (ROIs) for this analysis were drawn by a rater blind to subject identity on the magnetic resonance image of each subject and transferred onto their coregistered PET scans. We hypothesized that DLPFC metabolism would increase, while ventral frontal metabolism [in the VLPFC, the orbitofrontal cortex (OFC), and the inferior frontal gyrus (IFG)] would decrease with successful treatment. Treatment response was defined as a decrease in the Hamilton Depression Rating Scale of > 50% and a Clinical Global Improvement Scale rating of 'much' or 'very much' improved. By these criteria, nine of the subjects were classified as treatment responders. These responders had significantly greater decreases in normalized VLPFC and OFC metabolism than did non-responders. There were no significant effects of treatment response on change in the DLPFC or IFG in this sample. However, there was a positive correlation between change in HAM-D scores and change in normalized IFG and VLPFC metabolism. There were no significant interactions with laterality. On pre-treatment scans, lower metabolism in the left ventral anterior cingulate gyrus was associated with better treatment response. These findings implicate ventral prefrontal-subcortical brain circuitry in the mediation of response to serotonin reuptake inhibitors in MDD.
Collapse
Affiliation(s)
- A L Brody
- UCLA Department of Psychiatry and Biobehavioral Sciences, Neuropsychiatric Institute and Hospital, Los Angeles, CA 90024, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Abou-Saleh MT, Al Suhaili AR, Karim L, Prais V, Hamdi E. Single photon emission tomography with 99m Tc-HMPAO in Arab patients with depression. J Affect Disord 1999; 55:115-23. [PMID: 10628880 DOI: 10.1016/s0165-0327(98)00209-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND This study investigates the rate of cerebral blood flow (rCBF) in Arab patients wth depression. METHODS Forty-four patients with DSM-III-R major depressive disorders were studied at rest using single photon emission computerized tomography (SPECT) with 99m Tc-HMPAO in comparison with 20 normal controls. All patients were assessed using the Hamilton Rating Scale for Depression (HRSD). RESULTS The depressed group showed greater rCBF in left and right posterior frontal and parietal cortical regions than normal controls. Within the depressed group, patients with the least severe illness (HRSD < 20) had significantly lower rCBF than normal controls, whilst those with moderately severe (HRSD 20-29) and severe (HRSD > 30) had significantly greater rCBF in most cortical regions than normal controls. Symptom scores, derived from the HRSD were predicted by rCBF principally increased rCBF in the left frontal cortex. CONCLUSIONS These results suggest a generalized cerebral activation principally in the frontal cortex which is in contrast to the results of most previous studies but more in line with the results of studies of induced affect and some studies of depression subsyndromes.
Collapse
Affiliation(s)
- M T Abou-Saleh
- Department of Psychiatry and Behavioural Sciences, Faculty of Medicine and Health Sciences, United Arab Emirates University, Al Ain
| | | | | | | | | |
Collapse
|
33
|
Positron emissie tomografie (PET) bij stemmingsstoornissen: een overzicht. Acta Neuropsychiatr 1999; 11:97-102. [PMID: 26976369 DOI: 10.1017/s0924270800036048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Positron emission tomography is one of the most important techniques of functional imaging in psychiatry. This paper gives a synopsis of the findings in mood disorders: determination of brain glucose metabolism, cerebral blood flow and receptor studies. Investigation in a resting state as well as after activation are discussed. Although findings are somewhat discrepant hypometabolism, and/or hypoperfusion, most often in frontal and limbic areas are frequently described. Further research is needed, and standardization of the methodology would be most wellcome.
Collapse
|
34
|
Lior R, Nachson I. Impairments in judgment of chimeric faces by schizophrenic and affective patients. Int J Neurosci 1999; 97:185-209. [PMID: 10372647 DOI: 10.3109/00207459909000660] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The hypothesis that schizophrenic and affective patients have differential impairments in judgment of facial emotional expressions was tested on 55 right-handed patients: 15 in each of two groups of schizophrenic patients, with positive and negative symptoms; and 10 in each of two groups of bipolar affective patients, in manic and depressive states. In addition, 37 normal control subjects were also tested. The subjects were presented with eight schematic drawings of chimeric faces (each depicting a positive emotion in a given hemiface, and a negative emotion in the other hemiface), as well as with two drawings of composite faces (each depicting either a positive or a negative emotion). Subjects judged the emotions depicted by the facial expressions, as well as their intensity. The data, analyzed by analyses of variance, showed that normals judged the chimeric expressions on the basis of the emotions depicted by the left hemifaces. This tendency was weaker among the psychiatric patients. Schizophrenics with negative symptoms judged positive expressions in the left hemifaces as depicting negative emotions, and negative expressions as depicting positive emotions. Schizophrenics with positive symptoms and manic patients judged all expressions as depicting positive emotions. Depressive patients showed a stronger tendency to judge negative expressions as depicting negative emotions than positive expressions as depicting positive emotions. No significant group differences appeared in judgment of composite faces (except for schizophrenic with negative symptoms who were more accurate in judging positive than negative expressions). Patients performances were interpreted in terms of differential dysfunctions in posterior areas of the right cerebral hemisphere which might be associated with bilateral effects of dysfunctions in anterior cerebral areas.
Collapse
Affiliation(s)
- R Lior
- Department of Criminology, Bar-Ilan University, Ramat-Gan, Israel
| | | |
Collapse
|
35
|
Staley JK, Malison RT, Innis RB. Imaging of the serotonergic system: interactions of neuroanatomical and functional abnormalities of depression. Biol Psychiatry 1998; 44:534-49. [PMID: 9787877 DOI: 10.1016/s0006-3223(98)00185-1] [Citation(s) in RCA: 97] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
For nearly three decades, evidence supporting a role for aberrant serotonergic function in the pathogenesis of depression has accumulated; however, only recently have methodologies and radiotracers suitable for in vivo clinical assessment of depression become available. To date, only a few neurochemical imaging studies have been performed in actively depressed subjects. A preliminary study using single photon emission computed tomography (SPECT) has demonstrated decreased levels of serotonin (5-HT) transporters in the midbrain regions of subjects with major depression. Analysis of the 5-HT2 receptor using positron emission tomography (PET) has suggested that this receptor may not be altered significantly in the depressed brain but may increase in response to antidepressant treatment. These findings are supported by studies in secondary "poststroke" depression that have shown that elevations in 5-HT2 receptor density correlated with the alleviation of symptoms of depressed mood. With the rapid development of novel PET and SPECT radiotracers, future studies of the serotonergic system that evaluate presynaptic (5-HT transporter) and postsynaptic (5-HT1A and 5-HT2A receptors) markers and the interaction of synaptic levels of 5-HT with these sites will make profound contributions to the understanding of the role of the serotonergic synapse in the pathophysiology of depression.
Collapse
Affiliation(s)
- J K Staley
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut 06516, USA
| | | | | |
Collapse
|
36
|
Kegeles LS, Humaran TJ, Mann JJ. In vivo neurochemistry of the brain in schizophrenia as revealed by magnetic resonance spectroscopy. Biol Psychiatry 1998; 44:382-98. [PMID: 9777167 DOI: 10.1016/s0006-3223(97)00425-3] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Magnetic resonance spectroscopy (MRS), an application of the methods of nuclear magnetic resonance (NMR), is a functional imaging modality that provides a view of localized biochemistry in vivo. A number of studies applying MRS to the neurochemistry of schizophrenia have been reported, which encompass a range of patient populations, states of medication, anatomic regions, nuclear species, and MRS techniques. A brief review of the history and methodology of NMR and MRS is presented. Comparison is made of MRS capabilities with other functional imaging modalities. Aspects of the neurochemistry of schizophrenia relevant to MRS studies are reviewed, as are the reported MRS studies involving patients with schizophrenia. Areas of consistent findings include decreased phosphomonoesters and increased phosphodiesters in frontal lobes, and decreases in the putative neuronal cell marker, N-acetylaspartate, in temporal lobes. Studies of neurotransmitters such as glutamate, gamma-aminobutyric acid, and glutamine have generated inconsistent results. New insights into alterations in neurochemistry in schizophrenia have been provided by MRS. Studies of neurotransmitters have future potential with improvements in field strength and in spectral editing techniques. MRS has the potential to measure brain medication levels and simultaneous effects on neurochemistry. MRS may assist in characterizing high-risk populations, and ultimately guide medication use.
Collapse
Affiliation(s)
- L S Kegeles
- Department of Psychiatry, Columbia University, New York, New York, USA
| | | | | |
Collapse
|
37
|
Cook IA, Leuchter AF, Uijtdehaage SH, Osato S, Holschneider DH, Abrams M, Rosenberg-Thompson S. Altered cerebral energy utilization in late life depression. J Affect Disord 1998; 49:89-99. [PMID: 9609672 DOI: 10.1016/s0165-0327(97)00192-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Global and regional changes in cerebral energy utilization are reported to characterize late life depression. METHODS Twenty seven subjects with late life depression (9 prior to starting medication, 18 after starting) and 27 matched controls were evaluated with cordance, a quantitative EEG measure that reflects cerebral energy utilization. RESULTS Global and focal (anterior and centrotemporal) differences were present in theta-band cordance between unmedicated depressed and control subjects. Depressed subjects receiving treatment had cordance patterns similar to controls. CONCLUSIONS The presence of both diffuse and focal disturbances in energy utilization prior to initiating treatment indicates that cordance detects altered cerebral physiology in depressed patients, and that this measure may also be sensitive to treatment interventions.
Collapse
Affiliation(s)
- I A Cook
- Quantitative EEG Laboratory, Neuropsychiatric Institute and Hospital, UCLA School of Medicine, University of California, Los Angeles, USA.
| | | | | | | | | | | | | |
Collapse
|
38
|
Nitschke WHJB. The Puzzle of Regional Brain Activity in and Anxiety: The Importance of Subtypes and Comorbidity. Cogn Emot 1998. [DOI: 10.1080/026999398379664] [Citation(s) in RCA: 108] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
|
39
|
Lingford-Hughes A. Psychiatric disorders. Clin Nucl Med 1998. [DOI: 10.1007/978-1-4899-3356-0_26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
40
|
Henriques JB, Davidson RJ. Brain electrical asymmetries during cognitive task performance in depressed and nondepressed subjects. Biol Psychiatry 1997; 42:1039-50. [PMID: 9386856 DOI: 10.1016/s0006-3223(97)00156-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Studies using electroencephalogram (EEG) measures of activation asymmetry have reported differences in anterior asymmetry between depressed and nondepressed subjects. Several studies have suggested reciprocal relations between measures of anterior and posterior activation asymmetries. We hypothesized that depressed subjects would fail to show the normal activation of posterior right hemisphere regions in response to an appropriate cognitive challenge. METHODS EEG activity was recorded from 11 depressed and 19 nondepressed subjects during the performance of psychometrically matched verbal (word finding) and spatial (dot localization) tasks. Band power was extracted from all epochs of artifact-free data and averaged within each condition. Task performance was also assessed. RESULTS Depressed subjects showed a specific deficit in the performance of the spatial task, whereas no group differences were evident on verbal performance. In posterior scalp regions, nondepressed controls had a pattern of relative left-sided activation during the verbal task and relative right-sided activation during the spatial task. In contrast, depressed subjects failed to show activation in posterior right hemisphere regions during spatial task performance. CONCLUSIONS These findings suggest that deficits in right posterior functioning underlie the observed impairments in spatial functioning among depressed subjects.
Collapse
Affiliation(s)
- J B Henriques
- Department of Psychology, University of Wisconsin-Madison 53706, USA
| | | |
Collapse
|
41
|
Abstract
Mood disorders may be associated with global and regional changes in cerebral blood flow and metabolism. The accumulated functional neuroimaging findings in mood disorders were reviewed in order to examine a proposed neuroanatomic model of pathophysiology. Global cerebral blood flow and glucose metabolism appear normal, but may be decreased in late-life depression. Regional cerebral blood flow and glucose metabolism deficits are present, and may be indicators of brain regions participating in neuroanatomic circuits involved in mood disorders. Decreased pre-frontal cortex blood flow and metabolism in depressed unipolar and bipolar patients are the most consistently replicated findings, and correlate with severity of illness. Basal ganglia abnormalities have been found in depressed unipolar and bipolar patients, involving decreased blood flow and metabolism. Temporal lobe abnormalities are present in bipolar disorder patients, and perhaps unipolar depression. There is conflicting evidence of abnormalities in other limbic regions. Cognitive impairment may correlate with decreased metabolism in frontal and cerebellar areas. The relationship between functional neuroimaging findings and clinical course, and therefore state and trait characteristics, has not been systematically investigated. Antidepressant medications, but not ECT, seem to reverse some of the identified functional brain changes in the depressed state. The structural, neurotransmitter and neuropathological correlates of these functional abnormalities are yet to be determined. Functional abnormalities in frontal, subcortical and limbic structures appear to be part of the pathophysiology of mood disorders.
Collapse
Affiliation(s)
- J C Soares
- Department of Psychiatry, University of Pittsburgh School of Medicine, PA, USA
| | | |
Collapse
|
42
|
Kennedy SH, Javanmard M, Vaccarino FJ. A review of functional neuroimaging in mood disorders: positron emission tomography and depression. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 1997; 42:467-75. [PMID: 9220109 DOI: 10.1177/070674379704200502] [Citation(s) in RCA: 103] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To examine the progress of positron emission tomography (PET) as a tool for understanding the psychobiology of mood disorders, particularly major depression and bipolar disorder. METHOD Review of the literature on functional imaging of mood disorders. RESULTS Functional imaging techniques have been used in psychiatric research as a noninvasive method to study the behaviour and function of the brain. Techniques used so far have involved the manipulation of emotion in healthy volunteers, the evaluation of depressed (unipolar and bipolar as well as secondary depression), manic, and normal subjects under resting and various activation conditions, such as cognitive activation, acute pharmacological challenge, and chronic thymoleptic treatments. As a result, functional imaging studies tend to support abnormalities in specific frontal and limbic regions. CONCLUSION Different PET methods demonstrate consistent abnormalities in the prefrontal, cingulate, and amygdala regions. These findings are in agreement with past animal and clinical anatomical correlates of mood and emotions.
Collapse
Affiliation(s)
- S H Kennedy
- Department of Psychiatry, University of Toronto, Ontario
| | | | | |
Collapse
|
43
|
Abstract
Postmortem neuropathological investigations in the last half decade provide increasing evidence compatible with a neurodevelopmental defect in schizophrenia. Basic and clinical data support hypotheses suggesting that disturbances in neurodevelopment in schizophrenia may involve the cortical subplate and a theorized second trimester "window of vulnerability". The focus of this paper is on (1) selected methodological issues involved in the collection, analyses and preservation of human postmortem brain tissue; (2) a review of evidence showing morphological defects particularly in prefrontal cortical regions of the schizophrenic brain; and (3) potential future research directions.
Collapse
Affiliation(s)
- B G Bunney
- California College of Medicine, University of California, Irvine 92717, USA
| | | | | |
Collapse
|
44
|
Gyulai L, Alavi A, Broich K, Reilley J, Ball WB, Whybrow PC. I-123 iofetamine single-photon computed emission tomography in rapid cycling bipolar disorder: a clinical study. Biol Psychiatry 1997; 41:152-61. [PMID: 9018385 DOI: 10.1016/s0006-3223(96)00002-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The regional distribution of I-123 iofetamine (IMP) in the brain of 12 patients with rapid cycling bipolar disorder was studied by single-photon computed emission tomography imaging. Patients who were either medication free (n = 4) or on lithium monotherapy (n = 8) were assessed serially in depressed/dysphoric, manic/hypomanic, or euthymic states. In 23 imaging studies, IMP images of the brain were taken on a GE Starcam system 20 min after injection of 3-4 mCi of I-123 labeled IMP. The I-123 IMP distribution in the anterior part of the temporal lobes was asymmetric in both depression/dysphoria and mania/hypomania but not in euthymia. Images taken sequentially on the same patient showed temporal lobe asymmetry in the pathological mood states that diminished or disappeared in the euthymic state. The observed changes most likely reflect an altered cerebral blood flow and changes in high-affinity IMP binding to amine receptors in the temporal lobes. This pilot study suggests the presence of a state-dependent temporal dysfunction in bipolar disorder.
Collapse
Affiliation(s)
- L Gyulai
- Department of Psychiatry, University of Pennsylvania Medical Center, Philadelphia 19104, USA
| | | | | | | | | | | |
Collapse
|
45
|
Bonne O, Krausz Y, Gorfine M, Karger H, Gelfin Y, Shapira B, Chisin R, Lerer B. Cerebral hypoperfusion in medication resistant, depressed patients assessed by Tc99m HMPAO SPECT. J Affect Disord 1996; 41:163-71. [PMID: 8988448 DOI: 10.1016/s0165-0327(96)00058-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Functional imaging studies generally show decreased cerebral metabolism and perfusion in depressed patients relative to normal controls, although the location of the deficits varies. We used Tc99m HMPAO SPECT to compare cerebral blood flow in medication resistant, depressed patients and a normal control group. HMPAO uptake ratios (adjusted for age) were significantly lower in the depressed patients in the transaxial slices 4 cm and 6 cm above the orbitomeatal line (OML) on the left side. Examining individual regions of interest (corrected for age and multiple testing), we found significantly lower perfusion in the left superior temporal, right parietal and bilateral occipital regions in the patient group. These findings are in limited agreement with previous HMPAO SPECT studies. Methodological differences between studies, particularly variability in adjusting data for age, lead to a divergence in findings. Future research should seek to standardize protocols and data analysis in order to generate comparable results.
Collapse
Affiliation(s)
- O Bonne
- Biological Psychiatry Laboratory, Hadassah-Hebrew University Medical Center, Jerusolem 91120, Israel
| | | | | | | | | | | | | | | |
Collapse
|
46
|
Gullion CM, Devous MD, Rush AJ. Effects of four normalizing methods on data analytic results in functional brain imaging. Biol Psychiatry 1996; 40:1106-21. [PMID: 8931913 DOI: 10.1016/s0006-3223(95)00636-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Functional brain imaging data may contain large individual differences in information about whole brain and regional levels of activity, and it is common to remove these differences using arithmetic transformation (normalization) prior to statistical analysis. As no single transformation is widely accepted, we examine the effects of four normalizing methods (ratioing, residuals from regressions on global cerebral blood flow, Z scores, and subject residual profiles) on 1) profile shape, 2) correlations between regions, 3) correlations between subjects, and 4) analysis of variance results. These effects are evaluated using an empirical data set consisting of regional cerebral blood flow values from 22 regions of interest in 46 depressed adults and 48 age-matched normal controls obtained by 133Xe single photon emission computed tomography. Results show that normalization method has substantial but different effects on characteristics of the data and statistical results. The rationing method appears to be an optimal choice for most analyses.
Collapse
Affiliation(s)
- C M Gullion
- Department of Psychiatry, University of Texas Southwestern Medical Center at Dallas, TX, USA
| | | | | |
Collapse
|
47
|
Klemm E, Danos P, Grünwald F, Kasper S, Möller HJ, Biersack HJ. Temporal lobe dysfunction and correlation of regional cerebral blood flow abnormalities with psychopathology in schizophrenia and major depression--a study with single photon emission computed tomography. Psychiatry Res 1996; 68:1-10. [PMID: 9027928 DOI: 10.1016/s0925-4927(96)02837-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Studies of regional cerebral blood flow in both schizophrenic and depressed patients have yielded contradictory findings. Single photon emission computed tomography (SPECT) was used to compare brain-perfusion patterns in 17 patients with schizophrenia and 12 patients with major depression and to evaluate the relationship of the findings to psychopathology. The images were analyzed both visually and quantitatively. Twelve of the 17 schizophrenic patients and 8 of the 12 depressed patients showed a pathological blood flow pattern. Hypoperfusion of the left temporal lobe was observed in seven of the schizophrenic and five of the depressed patients. Five of the schizophrenic patients also had a hypoperfusion of the left frontal lobe. Separation of both diagnostic cohorts in two subgroups with pathological and normal cerebral blood flow patterns revealed significantly higher levels of symptomatology in the group with hypoperfusion in the SPECT image. The analysis of different cerebral regions revealed statistically significant temporal hypoperfusion was significantly related to positive symptoms in schizophrenia. Our data suggest that left-sided temporal lobe dysfunction is related both to schizophrenia and major depression. The localization of hypoperfusion seems to be associated with the type of psychopathology (positive vs. negative symptoms in schizophrenia). Thus, the results support the model of paralimbic and prefrontal dysfunction in both diseases.
Collapse
Affiliation(s)
- E Klemm
- Department of Nuclear Medicine, University of Bonn, Germany
| | | | | | | | | | | |
Collapse
|
48
|
Kwon JS, Youn T, Jung HY. Right hemisphere abnormalities in major depression: quantitative electroencephalographic findings before and after treatment. J Affect Disord 1996; 40:169-73. [PMID: 8897116 DOI: 10.1016/0165-0327(96)00057-2] [Citation(s) in RCA: 92] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The quantitative EEGs of drug-free depressed patients were analyzed and compared to age and sex-matched controls, using spectral analysis. In addition, QEEGs of depressed patients after clinical improvement resulting from 6 weeks of antidepressant treatment were also analyzed. The subjects were 20 patients suffering from major depression (DSM-III-R). Scores on the Hamilton Rating Scale for Depression (HRSD) of all patients showed a reduction of more than 50% at the end of the 6th week. The results show: (1) delta and theta bipolar absolute powers of the right hemisphere increased in drug-free depressed patients, compared to controls. (2) No changes in all bands of QEEG were found after clinical improvement resulting from 6 weeks of treatment. These results suggest that the right hemisphere plays an important role in major depression, and that a reduction in symptoms is not necessarily indicative of an improvement in underlying major depression.
Collapse
Affiliation(s)
- J S Kwon
- Department of Psychiatry, Seoul National University Hospital, Seoul National University, College of Medicine, South Korea
| | | | | |
Collapse
|
49
|
Weingartner HJ, Andreason PJ, Hommer DW, Sirocco KY, Rio DE, Ruttimann UE, Rawlings RR, Eckardt MJ. Monitoring the source of memory in detoxified alcoholics. Biol Psychiatry 1996; 40:43-53. [PMID: 8780854 DOI: 10.1016/0006-3223(95)00290-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The ability to monitor the source of remembered information and related reflective cognitive processes was examined in normal volunteers and detoxified alcoholics. Normal volunteers were very accurate judges of whether remembered events were presented as stimuli or were self-generated, even when memory was tested 2 days later. In contrast, a subgroup of otherwise cognitively unimpaired alcoholics demonstrated impairments in the ability to track the source of remembered knowledge and were also less able to inhibit intrusion errors in recalling information from memory. These findings provide preliminary evidence of an impairment in cognitive control functions in certain alcoholics. This conclusion is supported by associated findings indicating that, among alcoholics, performance on explicit memory tasks that required reflective cognitive operations were positively correlated with glucose utilization rates in left prefrontal, temporal, and posterior orbital frontal cortical regions.
Collapse
Affiliation(s)
- H J Weingartner
- Section of Brain Electrophysiology and Imaging, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD 20892-1250, USA
| | | | | | | | | | | | | | | |
Collapse
|
50
|
Mozley PD, Hornig-Rohan M, Woda AM, Kim HJ, Alavi A, Payer F, Amsterdam JD. Cerebral HMPAO SPECT in patients with major depression and healthy volunteers. Prog Neuropsychopharmacol Biol Psychiatry 1996; 20:443-58. [PMID: 8771600 DOI: 10.1016/0278-5846(96)00008-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
1. The authors examined the regional cerebral distribution of [Tc-99m] HMPAO using single photon emission computed tomography (SPECT) in patients with major depression and in healthy controls. 2. 19 patients and 16 healthy controls had SPECT images of the brain acquired with 740 MBq (20 mCl) of [Tc-99m] HMPAO on a triple-headed camera equipped with fan beam collimators. 3. Mean counts per pixel were measured in 13 regions of each hemisphere and compared to the mean activity in the whole brain, the ipsilateral hemisphere, and cerebellum. A "laterality score" was calculated for each structure by subtracting the mean counts per pixel in a region of the right hemisphere from the mean counts in the homotopic region of the left hemisphere and normalizing the difference by the average in both regions. The degree of hemispheric asymmetry was calculated from the absolute values of the laterality scores. 4. The distribution of HMPAO was more variable in patients than in controls; while the mean activity ratios were not significantly different in any region. Asymmetries between homotopic regions of the limbic system were more pronounced in patients than in controls. However, there were no consistent left-to-right asymmetries in either group. 5. The present data indicate that regional cerebral distribution of HMPAO may not be discretely abnormal in depression, but demonstrates heightened variability in depressives (vs. control subjects).
Collapse
Affiliation(s)
- P D Mozley
- Division of Nuclear Medicine, University of Pennsylvania Medical Center, Philadelphia, USA
| | | | | | | | | | | | | |
Collapse
|