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Gaus R, Pölsterl S, Greimel E, Schulte‐Körne G, Wachinger C. Can we diagnose mental disorders in children? A large-scale assessment of machine learning on structural neuroimaging of 6916 children in the adolescent brain cognitive development study. JCPP Adv 2023; 3:e12184. [PMID: 38054056 PMCID: PMC10694548 DOI: 10.1002/jcv2.12184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 05/09/2023] [Indexed: 12/07/2023] Open
Abstract
Background Prediction of mental disorders based on neuroimaging is an emerging area of research with promising first results in adults. However, research on the unique demographic of children is underrepresented and it is doubtful whether findings obtained on adults can be transferred to children. Methods Using data from 6916 children aged 9-10 in the multicenter Adolescent Brain Cognitive Development study, we extracted 136 regional volume and thickness measures from structural magnetic resonance images to rigorously evaluate the capabilities of machine learning to predict 10 different psychiatric disorders: major depressive disorder, bipolar disorder (BD), psychotic symptoms, attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder, conduct disorder, post-traumatic stress disorder, obsessive-compulsive disorder, generalized anxiety disorder, and social anxiety disorder. For each disorder, we performed cross-validation and assessed whether models discovered a true pattern in the data via permutation testing. Results Two of 10 disorders can be detected with statistical significance when using advanced models that (i) allow for non-linear relationships between neuroanatomy and disorder, (ii) model interdependencies between disorders, and (iii) avoid confounding due to sociodemographic factors: ADHD (AUROC = 0.567, p = 0.002) and BD (AUROC = 0.551, p = 0.002). In contrast, traditional models perform consistently worse and predict only ADHD with statistical significance (AUROC = 0.529, p = 0.002). Conclusion While the modest absolute classification performance does not warrant application in the clinic, our results provide empirical evidence that embracing and explicitly accounting for the complexities of mental disorders via advanced machine learning models can discover patterns that would remain hidden with traditional models.
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Affiliation(s)
- Richard Gaus
- The Lab for Artificial Intelligence in Medical Imaging (AI‐Med)Department of Child and Adolescent PsychiatryLudwig‐Maximilians‐UniversitätMunichGermany
| | - Sebastian Pölsterl
- The Lab for Artificial Intelligence in Medical Imaging (AI‐Med)Department of Child and Adolescent PsychiatryLudwig‐Maximilians‐UniversitätMunichGermany
| | - Ellen Greimel
- Department of Child and Adolescent Psychiatry, Psychosomatics and PsychotherapyUniversity HospitalLudwig‐Maximilians‐UniversitätMunichGermany
| | - Gerd Schulte‐Körne
- Department of Child and Adolescent Psychiatry, Psychosomatics and PsychotherapyUniversity HospitalLudwig‐Maximilians‐UniversitätMunichGermany
| | - Christian Wachinger
- The Lab for Artificial Intelligence in Medical Imaging (AI‐Med)Department of Child and Adolescent PsychiatryLudwig‐Maximilians‐UniversitätMunichGermany
- Department of RadiologyTechnical University of MunichSchool of MedicineMunichGermany
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Rohrsetzer F, Balardin JB, Picon F, Sato JR, Battel L, Viduani A, Manfro PH, Yoon L, Kohrt BA, Fisher HL, Mondelli V, Swartz JR, Kieling C. An MRI-based morphometric and structural covariance network study of Brazilian adolescents stratified by depression risk. Braz J Psychiatry 2023; 45. [PMID: 37243979 PMCID: PMC10668308 DOI: 10.47626/1516-4446-2023-3037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 03/29/2023] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To explore differences in regional cortical morphometric structure between adolescents at risk for depression or with current depression. METHODS We analyzed cross-sectional structural neuroimaging data from a sample of 150 Brazilian adolescents classified as low-risk (n=50) or high-risk for depression (n=50) or with current depression (n=50) through a vertex-based approach with measurements of cortical volume, surface area and thickness. Differences between groups in subcortical volumes and in the organization of networks of structural covariance were also explored. RESULTS No significant differences in brain structure between groups were observed in whole-brain vertex-wise cortical volume, surface area or thickness. Also, no significant differences in subcortical volume were observed between risk groups. In relation to the structural covariance network, there was an indication of an increase in the hippocampus betweenness centrality index in the high-risk group network compared to the low-risk and current depression group networks. However, this result was only statistically significant when applying false discovery rate correction for nodes within the affective network. CONCLUSION In an adolescent sample recruited using an empirically based composite risk score, no major differences in brain structure were detected according to the risk and presence of depression.
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Affiliation(s)
- Fernanda Rohrsetzer
- Departamento de Psiquiatria e Medicina Legal, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
- Serviço de Psiquiatria da Infância e Adolescência, Hospital de Clínicas de Porto Alegre, UFRGS, Porto Alegre, RS, Brazil
| | - Joana Bisol Balardin
- Departamento de Psiquiatria e Medicina Legal, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
- Serviço de Psiquiatria da Infância e Adolescência, Hospital de Clínicas de Porto Alegre, UFRGS, Porto Alegre, RS, Brazil
| | - Felipe Picon
- Departamento de Psiquiatria e Medicina Legal, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
- Serviço de Psiquiatria da Infância e Adolescência, Hospital de Clínicas de Porto Alegre, UFRGS, Porto Alegre, RS, Brazil
| | - João Ricardo Sato
- Centro de Matemática, Computação e Cognição, Universidade Federal do ABC, São Paulo, SP, Brazil
| | - Lucas Battel
- Departamento de Psiquiatria e Medicina Legal, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
- Serviço de Psiquiatria da Infância e Adolescência, Hospital de Clínicas de Porto Alegre, UFRGS, Porto Alegre, RS, Brazil
| | - Anna Viduani
- Departamento de Psiquiatria e Medicina Legal, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
- Serviço de Psiquiatria da Infância e Adolescência, Hospital de Clínicas de Porto Alegre, UFRGS, Porto Alegre, RS, Brazil
| | - Pedro Henrique Manfro
- Departamento de Psiquiatria e Medicina Legal, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
- Serviço de Psiquiatria da Infância e Adolescência, Hospital de Clínicas de Porto Alegre, UFRGS, Porto Alegre, RS, Brazil
| | - Leehyun Yoon
- Department of Human Ecology, University of California, Davis, CA, USA
| | - Brandon A. Kohrt
- Division of Global Mental Health, Department of Psychiatry, School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
| | - Helen L. Fisher
- Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
- Economic and Social Research Council, Centre for Society and Mental Health, King’s College London, London, United Kingdom
| | - Valeria Mondelli
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
- National Institute for Health Research Mental Health, Biomedical Research Centre, South London and Maudsley National Health Service Foundation Trust, King’s College London, London, United Kingdom
| | - Johnna R. Swartz
- Department of Human Ecology, University of California, Davis, CA, USA
| | - Christian Kieling
- Departamento de Psiquiatria e Medicina Legal, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
- Serviço de Psiquiatria da Infância e Adolescência, Hospital de Clínicas de Porto Alegre, UFRGS, Porto Alegre, RS, Brazil
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Lu Y, Andescavage N, Wu Y, Kapse K, Andersen NR, Quistorff J, Saeed H, Lopez C, Henderson D, Barnett SD, Vezina G, Wessel D, du Plessis A, Limperopoulos C. Maternal psychological distress during the COVID-19 pandemic and structural changes of the human fetal brain. Commun Med 2022; 2. [PMID: 35647608 PMCID: PMC9135751 DOI: 10.1038/s43856-022-00111-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 04/11/2022] [Indexed: 12/12/2022] Open
Abstract
Abstract
Background
Elevated maternal psychological distress during pregnancy is linked to adverse outcomes in offspring. The potential effects of intensified levels of maternal distress during the COVID-19 pandemic on the developing fetal brain are currently unknown.
Methods
We prospectively enrolled 202 pregnant women: 65 without known COVID-19 exposures during the pandemic who underwent 92 fetal MRI scans, and 137 pre-pandemic controls who had 182 MRI scans. Multi-plane, multi-phase single shot fast spin echo T2-weighted images were acquired on a GE 1.5 T MRI Scanner. Volumes of six brain tissue types were calculated. Cortical folding measures, including brain surface area, local gyrification index, and sulcal depth were determined. At each MRI scan, maternal distress was assessed using validated stress, anxiety, and depression scales. Generalized estimating equations were utilized to compare maternal distress measures, brain volume and cortical folding differences between pandemic and pre-pandemic cohorts.
Results
Stress and depression scores are significantly higher in the pandemic cohort, compared to the pre-pandemic cohort. Fetal white matter, hippocampal, and cerebellar volumes are decreased in the pandemic cohort. Cortical surface area and local gyrification index are also decreased in all four lobes, while sulcal depth is lower in the frontal, parietal, and occipital lobes in the pandemic cohort, indicating delayed brain gyrification.
Conclusions
We report impaired fetal brain growth and delayed cerebral cortical gyrification in COVID-19 pandemic era pregnancies, in the setting of heightened maternal psychological distress. The potential long-term neurodevelopmental consequences of altered fetal brain development in COVID-era pregnancies merit further study.
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Abstract
BACKGROUND In this modern era, depression is one of the most prevalent mental disorders from which millions of individuals are affected today. The symptoms of depression are heterogeneous and often coincide with other disorders such as bipolar disorder, Parkinson's, schizophrenia, etc. It is a serious mental illness that may lead to other health problems if left untreated. Currently, identifying individuals with depression is totally based on the expertise of the clinician's experience. In order to assist clinicians in identifying the characteristics and classifying depressed people, different types of data modalities and machine learning techniques have been incorporated by researchers in this field. This study aims to find the answers to some important questions related to the trend of publications, data modality, machine learning models, dataset usage, pre-processing techniques and feature extraction and selection techniques that are prevalent and guide the direction of future research on depression diagnosis. METHODS This systematic review was conducted using a broad range of articles from two major databases: IEEE Xplore and PubMed. Studies ranging from the years 2011 to April 2021 were retrieved from the databases resulting in a total of 590 articles (53 articles from the IEEE Xplore database and 537 articles from the PubMed database). Out of those, the articles which satisfied the defined inclusion criteria were investigated for further analysis. RESULTS A total of 135 articles were identified and analysed for this review. High growth in the number of publications has been observed in recent years. Furthermore, significant diversity in the use of data modalities and machine learning classifiers has also been noted in this study. fMRI data with an SVM classifier was found to be the most popular choice among researchers. In most of the studies, data scarcity and small sample size, particularly for neuroimaging data are major concerns. The use of identical data pre-processing tools for similar data modalities can be seen. This study also provides statistical analysis of the current framework with respect to the modality, machine learning classifier, sample size and accuracy by applying one-way ANOVA and the Tukey - Kramer test. CONCLUSION The results indicate that an effective fusion of machine learning techniques with a potential data modality has a promising future for assisting clinicians in automatic depression diagnosis.
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Affiliation(s)
- Sweta Bhadra
- Department of CS & IT, Cotton University, Guwahati, India
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Bas‐Hoogendam JM, Groenewold NA, Aghajani M, Freitag GF, Harrewijn A, Hilbert K, Jahanshad N, Thomopoulos SI, Thompson PM, Veltman DJ, Winkler AM, Lueken U, Pine DS, Wee NJA, Stein DJ, Agosta F, Åhs F, An I, Alberton BAV, Andreescu C, Asami T, Assaf M, Avery SN, Nicholas L, Balderston, Barber JP, Battaglia M, Bayram A, Beesdo‐Baum K, Benedetti F, Berta R, Björkstrand J, Blackford JU, Blair JR, Karina S, Blair, Boehme S, Brambilla P, Burkhouse K, Cano M, Canu E, Cardinale EM, Cardoner N, Clauss JA, Cividini C, Critchley HD, Udo, Dannlowski, Deckert J, Demiralp T, Diefenbach GJ, Domschke K, Doruyter A, Dresler T, Erhardt A, Fallgatter AJ, Fañanás L, Brandee, Feola, Filippi CA, Filippi M, Fonzo GA, Forbes EE, Fox NA, Fredrikson M, Furmark T, Ge T, Gerber AJ, Gosnell SN, Grabe HJ, Grotegerd D, Gur RE, Gur RC, Harmer CJ, Harper J, Heeren A, Hettema J, Hofmann D, Hofmann SG, Jackowski AP, Andreas, Jansen, Kaczkurkin AN, Kingsley E, Kircher T, Kosti c M, Kreifelts B, Krug A, Larsen B, Lee S, Leehr EJ, Leibenluft E, Lochner C, Maggioni E, Makovac E, Mancini M, Manfro GG, Månsson KNT, Meeten F, Michałowski J, Milrod BL, Mühlberger A, Lilianne R, Mujica‐Parodi, Munjiza A, Mwangi B, Myers M, Igor Nenadi C, Neufang S, Nielsen JA, Oh H, Ottaviani C, Pan PM, Pantazatos SP, Martin P, Paulus, Perez‐Edgar K, Peñate W, Perino MT, Peterburs J, Pfleiderer B, Phan KL, Poletti S, Porta‐Casteràs D, Price RB, Pujol J, Andrea, Reinecke, Rivero F, Roelofs K, Rosso I, Saemann P, Salas R, Salum GA, Satterthwaite TD, Schneier F, Schruers KRJ, Schulz SM, Schwarzmeier H, Seeger FR, Smoller JW, Soares JC, Stark R, Stein MB, Straube B, Straube T, Strawn JR, Suarez‐Jimenez B, Boris, Suchan, Sylvester CM, Talati A, Tamburo E, Tükel R, Heuvel OA, Van der Auwera S, Nieuwenhuizen H, Tol M, van Velzen LS, Bort CV, Vermeiren RRJM, Visser RM, Volman I, Wannemüller A, Wendt J, Werwath KE, Westenberg PM, Wiemer J, Katharina, Wittfeld, Wu M, Yang Y, Zilverstand A, Zugman A, Zwiebel HL. ENIGMA-anxiety working group: Rationale for and organization of large-scale neuroimaging studies of anxiety disorders. Hum Brain Mapp 2022; 43:83-112. [PMID: 32618421 PMCID: PMC8805695 DOI: 10.1002/hbm.25100] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/09/2020] [Accepted: 06/08/2020] [Indexed: 12/11/2022] Open
Abstract
Anxiety disorders are highly prevalent and disabling but seem particularly tractable to investigation with translational neuroscience methodologies. Neuroimaging has informed our understanding of the neurobiology of anxiety disorders, but research has been limited by small sample sizes and low statistical power, as well as heterogenous imaging methodology. The ENIGMA-Anxiety Working Group has brought together researchers from around the world, in a harmonized and coordinated effort to address these challenges and generate more robust and reproducible findings. This paper elaborates on the concepts and methods informing the work of the working group to date, and describes the initial approach of the four subgroups studying generalized anxiety disorder, panic disorder, social anxiety disorder, and specific phobia. At present, the ENIGMA-Anxiety database contains information about more than 100 unique samples, from 16 countries and 59 institutes. Future directions include examining additional imaging modalities, integrating imaging and genetic data, and collaborating with other ENIGMA working groups. The ENIGMA consortium creates synergy at the intersection of global mental health and clinical neuroscience, and the ENIGMA-Anxiety Working Group extends the promise of this approach to neuroimaging research on anxiety disorders.
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Affiliation(s)
- Janna Marie Bas‐Hoogendam
- Department of Developmental and Educational PsychologyLeiden University, Institute of Psychology Leiden The Netherlands
- Department of PsychiatryLeiden University Medical Center Leiden The Netherlands
- Leiden Institute for Brain and Cognition Leiden The Netherlands
| | - Nynke A. Groenewold
- Department of Psychiatry & Mental HealthUniversity of Cape Town Cape Town South Africa
| | - Moji Aghajani
- Department of PsychiatryAmsterdam UMC / VUMC Amsterdam The Netherlands
- Department of Research & InnovationGGZ inGeest Amsterdam The Netherlands
| | - Gabrielle F. Freitag
- National Institute of Mental Health, Emotion and Development Branch Bethesda Maryland USA
| | - Anita Harrewijn
- National Institute of Mental Health, Emotion and Development Branch Bethesda Maryland USA
| | - Kevin Hilbert
- Department of PsychologyHumboldt‐Universität zu Berlin Berlin Germany
| | - Neda Jahanshad
- University of Southern California Keck School of MedicineImaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute Los Angeles California USA
| | - Sophia I. Thomopoulos
- University of Southern California Keck School of MedicineImaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute Los Angeles California USA
| | - Paul M. Thompson
- University of Southern California Keck School of MedicineImaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute Los Angeles California USA
| | - Dick J. Veltman
- Department of PsychiatryAmsterdam UMC / VUMC Amsterdam The Netherlands
| | - Anderson M. Winkler
- National Institute of Mental Health, Emotion and Development Branch Bethesda Maryland USA
| | - Ulrike Lueken
- Department of PsychologyHumboldt‐Universität zu Berlin Berlin Germany
| | - Daniel S. Pine
- National Institute of Mental Health, Emotion and Development Branch Bethesda Maryland USA
| | - Nic J. A. Wee
- Department of PsychiatryLeiden University Medical Center Leiden The Netherlands
- Leiden Institute for Brain and Cognition Leiden The Netherlands
| | - Dan J. Stein
- Department of Psychiatry & Mental HealthUniversity of Cape Town Cape Town South Africa
- University of Cape TownSouth African MRC Unit on Risk & Resilience in Mental Disorders Cape Town South Africa
- University of Cape TownNeuroscience Institute Cape Town South Africa
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LI MI, ZHANG JINYU, ZHAI QIAN, KANG JIAMING, LU SHENGFU, YANG JIAN. AUTOMATED RECOGNITION OF DEPRESSION FROM FEWER-SHOT LEANING IN RESTING-STATE fMRI WITH ReHo USING DEEP CONVOLUTIONAL NEURAL NETWORK. J MECH MED BIOL 2021. [DOI: 10.1142/s0219519421400686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Up to now, there is still the absence of research about depression recognition using resting-state functional magnetic resonance imaging (rest_fMRI) and deep learning. Previous studies have shown that regional homogeneity (ReHo) of rest_fMRI (rest_ReHo_fMRI) is a characterization of the functional synchronization of adjacent voxels in brain regions, and the mental and behavioral abnormalities in depression are due to an imbalance of ReHo synchronization in some brain functional areas. Accordingly, this paper presents a method for depression recognition using rest_ReHo_fMRI. First, the rest_ReHo_fMRI is extracted from the preprocessed rest-fMRI by calculation. Then, deep convolutional networks (such as VGG16) pretrained on ImageNet are used to automatically complete extracting the classification features from rest_ReHo_fMRI. Finally, the Kernel Extreme Learning Machine (KELM) was used to classify the depression. The results of the test set show that the proposed method achieves 89.07% in sensitivity and 89.74% in specificity. This study suggests that features of rest_ReHo_fMRI can be used as biomarkers to distinguish depression from normal people.
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Affiliation(s)
- MI LI
- Department of Artificial Intelligence and Automation, Faculty of Information Technology, Beijing University of Technology, Beijing International Collaboration Base on Brain Informatics and Wisdom Services, Engineering Research Center of Intelligent Perception and Autonomous Control, Ministry of Education, Engineering Research Center of Digital Community, Ministry of Education, Beijing 100124, P. R. China
| | - JINYU ZHANG
- Department of Artificial Intelligence and Automation, Faculty of Information Technology, Beijing University of Technology, Beijing 100124, P. R. China
| | - QIAN ZHAI
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, The Advanced Innovation Center for Human Brain Protection, Capital Medical University Beijing 100124, P. R. China
| | - JIAMING KANG
- Department of Artificial Intelligence and Automation, Faculty of Information Technology, Beijing University of Technology, Beijing 100124, P. R. China
| | - SHENGFU LU
- Department of Artificial Intelligence and Automation, Faculty of Information Technology, Beijing University of Technology, Beijing International Collaboration Base on Brain Informatics and Wisdom Services, Engineering Research Center of Intelligent Perception and Autonomous Control, Ministry of Education, Engineering Research Center of Digital Community, Ministry of Education, Beijing 100124, P. R. China
| | - JIAN YANG
- Department of Artificial Intelligence and Automation, Faculty of Information Technology, Beijing University of Technology, Beijing International Collaboration Base on Brain Informatics and Wisdom Services, Beijing 100124, P. R. China
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7
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Harrewijn A, Cardinale EM, Groenewold NA, Bas-Hoogendam JM, Aghajani M, Hilbert K, Cardoner N, Porta-Casteràs D, Gosnell S, Salas R, Jackowski AP, Pan PM, Salum GA, Blair KS, Blair JR, Hammoud MZ, Milad MR, Burkhouse KL, Phan KL, Schroeder HK, Strawn JR, Beesdo-Baum K, Jahanshad N, Thomopoulos SI, Buckner R, Nielsen JA, Smoller JW, Soares JC, Mwangi B, Wu MJ, Zunta-Soares GB, Assaf M, Diefenbach GJ, Brambilla P, Maggioni E, Hofmann D, Straube T, Andreescu C, Berta R, Tamburo E, Price RB, Manfro GG, Agosta F, Canu E, Cividini C, Filippi M, Kostić M, Munjiza Jovanovic A, Alberton BAV, Benson B, Freitag GF, Filippi CA, Gold AL, Leibenluft E, Ringlein GV, Werwath KE, Zwiebel H, Zugman A, Grabe HJ, Van der Auwera S, Wittfeld K, Völzke H, Bülow R, Balderston NL, Ernst M, Grillon C, Mujica-Parodi LR, van Nieuwenhuizen H, Critchley HD, Makovac E, Mancini M, Meeten F, Ottaviani C, Ball TM, Fonzo GA, Paulus MP, Stein MB, Gur RE, Gur RC, Kaczkurkin AN, Larsen B, Satterthwaite TD, Harper J, Myers M, Perino MT, Sylvester CM, Yu Q, Lueken U, Veltman DJ, Thompson PM, Stein DJ, Van der Wee NJA, Winkler AM, Pine DS. Cortical and subcortical brain structure in generalized anxiety disorder: findings from 28 research sites in the ENIGMA-Anxiety Working Group. Transl Psychiatry 2021; 11:502. [PMID: 34599145 PMCID: PMC8486763 DOI: 10.1038/s41398-021-01622-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 09/02/2021] [Accepted: 09/14/2021] [Indexed: 12/22/2022] Open
Abstract
The goal of this study was to compare brain structure between individuals with generalized anxiety disorder (GAD) and healthy controls. Previous studies have generated inconsistent findings, possibly due to small sample sizes, or clinical/analytic heterogeneity. To address these concerns, we combined data from 28 research sites worldwide through the ENIGMA-Anxiety Working Group, using a single, pre-registered mega-analysis. Structural magnetic resonance imaging data from children and adults (5-90 years) were processed using FreeSurfer. The main analysis included the regional and vertex-wise cortical thickness, cortical surface area, and subcortical volume as dependent variables, and GAD, age, age-squared, sex, and their interactions as independent variables. Nuisance variables included IQ, years of education, medication use, comorbidities, and global brain measures. The main analysis (1020 individuals with GAD and 2999 healthy controls) included random slopes per site and random intercepts per scanner. A secondary analysis (1112 individuals with GAD and 3282 healthy controls) included fixed slopes and random intercepts per scanner with the same variables. The main analysis showed no effect of GAD on brain structure, nor interactions involving GAD, age, or sex. The secondary analysis showed increased volume in the right ventral diencephalon in male individuals with GAD compared to male healthy controls, whereas female individuals with GAD did not differ from female healthy controls. This mega-analysis combining worldwide data showed that differences in brain structure related to GAD are small, possibly reflecting heterogeneity or those structural alterations are not a major component of its pathophysiology.
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Affiliation(s)
- Anita Harrewijn
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA.
| | - Elise M Cardinale
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Nynke A Groenewold
- Department of Psychiatry & Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Janna Marie Bas-Hoogendam
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
- Department of Developmental and Educational Psychology, Institute of Psychology, Leiden University, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden, The Netherlands
| | - Moji Aghajani
- Department of Psychiatry, Amsterdam UMC, location VUMC, Amsterdam, The Netherlands
- Department of Research & Innovation, GGZ InGeest, Amsterdam, The Netherlands
| | - Kevin Hilbert
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Narcis Cardoner
- Department of Mental Health, University Hospital Parc Taulí-I3PT, Barcelona, Spain
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Carlos III Health Institute, Madrid, Spain
| | - Daniel Porta-Casteràs
- Department of Mental Health, University Hospital Parc Taulí-I3PT, Barcelona, Spain
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Carlos III Health Institute, Madrid, Spain
| | - Savannah Gosnell
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Ramiro Salas
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Andrea P Jackowski
- LiNC, Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Pedro M Pan
- LiNC, Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Giovanni A Salum
- Section on Negative Affect and Social Processes, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Karina S Blair
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USA
| | - James R Blair
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Mira Z Hammoud
- Department of Psychiatry, NYU School of Medicine, New York University, New York, NY, USA
| | - Mohammed R Milad
- Department of Psychiatry, NYU School of Medicine, New York University, New York, NY, USA
| | - Katie L Burkhouse
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - K Luan Phan
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
| | - Heidi K Schroeder
- Department of Psychiatry & Behavioral Neuroscience, University of Cincinnati, Cincinnati, OH, USA
| | - Jeffrey R Strawn
- Department of Psychiatry & Behavioral Neuroscience, University of Cincinnati, Cincinnati, OH, USA
| | - Katja Beesdo-Baum
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Neda Jahanshad
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - Sophia I Thomopoulos
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - Randy Buckner
- Center for Brain Science & Department of Psychology, Harvard University, Cambridge, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Jared A Nielsen
- Center for Brain Science & Department of Psychology, Harvard University, Cambridge, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Psychology Department & Neuroscience Center, Brigham Young University, Provo, USA
| | - Jordan W Smoller
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Jair C Soares
- Center Of Excellence On Mood Disorders, Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Benson Mwangi
- Center Of Excellence On Mood Disorders, Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Mon-Ju Wu
- Center Of Excellence On Mood Disorders, Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Giovana B Zunta-Soares
- Center Of Excellence On Mood Disorders, Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Michal Assaf
- Olin Neuropsychiatry Research Center, Institute of Living, Hartford Hospital, Hartford, CT, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Gretchen J Diefenbach
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Anxiety Disorders Center, Institute of Living, Hartford Hospital, Hartford, CT, USA
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Eleonora Maggioni
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - David Hofmann
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Muenster, Germany
| | - Thomas Straube
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Muenster, Germany
| | - Carmen Andreescu
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rachel Berta
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Erica Tamburo
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rebecca B Price
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
- Department Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Gisele G Manfro
- Anxiety Disorder Program, Hospital de Clínicas de Porto Alegre, Department of Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Federica Agosta
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Elisa Canu
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Camilla Cividini
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurophysiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Milutin Kostić
- Institute of Mental Health, University of Belgrade, Belgrade, Serbia
- Department of Psychiatry, School of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Bianca A V Alberton
- Graduate Program in Electrical and Computer Engineering, Universidade Tecnológica Federal do Paraná, Curitiba, Puerto Rico, Brazil
| | - Brenda Benson
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Gabrielle F Freitag
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Courtney A Filippi
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Andrea L Gold
- Department of Psychiatry and Human Behavior, Brown University Warren Alpert Medical School, Providence, RI, USA
| | - Ellen Leibenluft
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Grace V Ringlein
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Kathryn E Werwath
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Hannah Zwiebel
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - André Zugman
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Hans J Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Greifswald, Germany
| | - Sandra Van der Auwera
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Greifswald, Germany
| | - Katharina Wittfeld
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Greifswald, Germany
| | - Henry Völzke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Robin Bülow
- Institute for Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Nicholas L Balderston
- Center for Neuromodulation in Depression and Stress, University of Pennsylvania, Philadelphia, PA, USA
| | - Monique Ernst
- Section on Neurobiology of Fear and Anxiety, National Institute of Mental Health, Bethesda, MD, USA
| | - Christian Grillon
- Section on Neurobiology of Fear and Anxiety, National Institute of Mental Health, Bethesda, MD, USA
| | | | | | - Hugo D Critchley
- Department of Neuroscience, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Elena Makovac
- Centre for Neuroimaging Science, Kings College London, London, UK
| | - Matteo Mancini
- Department of Neuroscience, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Frances Meeten
- School of Psychology, University of Sussex, Brighton, UK
| | - Cristina Ottaviani
- Department of Psychology, Sapienza University of Rome, Rome, Italy
- IRCCS Santa Lucia Foundation, Rome, Italy
| | - Tali M Ball
- Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Gregory A Fonzo
- Department of Psychiatry and Behavioral Sciences, The University of Texas at Austin Dell Medical School, Austin, TX, USA
| | | | - Murray B Stein
- Department of Psychiatry, School of Medicine and Herbert Wertheim School of Public Health, University of California, San Diego, La Jolla, CA, USA
| | - Raquel E Gur
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Ruben C Gur
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Bart Larsen
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Jennifer Harper
- Department of Psychiatry, Washington University, St. Louis, MO, USA
| | - Michael Myers
- Department of Psychiatry, Washington University, St. Louis, MO, USA
| | - Michael T Perino
- Department of Psychiatry, Washington University, St. Louis, MO, USA
| | - Chad M Sylvester
- Department of Psychiatry, Washington University, St. Louis, MO, USA
| | - Qiongru Yu
- Department of Psychiatry, Washington University, St. Louis, MO, USA
| | - Ulrike Lueken
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Dick J Veltman
- Department of Psychiatry, Amsterdam UMC, location VUMC, Amsterdam, The Netherlands
| | - Paul M Thompson
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - Dan J Stein
- South African Medical Research Council Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry & Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Nic J A Van der Wee
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden, The Netherlands
| | - Anderson M Winkler
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Daniel S Pine
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
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Maallo AMS, Moulton EA, Sieberg CB, Giddon DB, Borsook D, Holmes SA. A lateralized model of the pain-depression dyad. Neurosci Biobehav Rev 2021; 127:876-883. [PMID: 34090918 DOI: 10.1016/j.neubiorev.2021.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/01/2021] [Indexed: 11/25/2022]
Abstract
Chronic pain and depression are two frequently co-occurring and debilitating conditions. Even though the former is treated as a physical affliction, and the latter as a mental illness, both disorders closely share neural substrates. Here, we review the association of pain with depression, especially when symptoms are lateralized on either side of the body. We also explore the overlapping regions in the forebrain implicated in these conditions. Finally, we synthesize these findings into a model, which addresses gaps in our understanding of comorbid pain and depression. Our lateralized pain-depression dyad model suggests that individuals diagnosed with depression should be closely monitored for pain symptoms in the left hemibody. Conversely, for patients in pain, with the exception of acute pain with a known source, referrals in today's pain centers for psychological evaluation should be part of standard practice, within the framework of an interdisciplinary approach to pain treatment.
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Affiliation(s)
- Anne Margarette S Maallo
- Center for Pain and the Brain, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Eric A Moulton
- Center for Pain and the Brain, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Christine B Sieberg
- Center for Pain and the Brain, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Biobehavioral Pediatric Pain Lab, Department of Psychiatry & Behavioral Sciences, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Donald B Giddon
- Harvard School of Dental Medicine, Harvard University, Boston, MA, USA; Pain Management Center, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - David Borsook
- Harvard Medical School, Boston, MA, USA; Departments of Psychiatry and Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Scott A Holmes
- Center for Pain and the Brain, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
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Yan M, Cui X, Liu F, Li H, Huang R, Tang Y, Chen J, Zhao J, Xie G, Guo W. Abnormal Default-Mode Network Homogeneity in Melancholic and Nonmelancholic Major Depressive Disorder at Rest. Neural Plast 2021; 2021:6653309. [PMID: 33995525 DOI: 10.1155/2021/6653309] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 03/27/2021] [Accepted: 03/31/2021] [Indexed: 12/27/2022] Open
Abstract
Background Melancholic depression has been assumed as a severe type of major depressive disorder (MDD). We aimed to explore if there were some distinctive alterations in melancholic MDD and whether the alterations could be used to discriminate the melancholic MDD and nonmelancholic MDD. Methods Thirty-one outpatients with melancholic MDD, thirty-three outpatients with nonmelancholic MDD, and thirty-two age- and gender-matched healthy controls were recruited. All participants were scanned by resting-state functional magnetic resonance imaging (fMRI). Imaging data were analyzed with the network homogeneity (NH) and support vector machine (SVM) methods. Results Both patient groups exhibited increased NH in the right PCC/precuneus and right angular gyrus and decreased NH in the right middle temporal gyrus compared with healthy controls. Compared with nonmelancholic patients and healthy controls, melancholic patients exhibited significantly increased NH in the bilateral superior medial frontal gyrus and decreased NH in the left inferior temporal gyrus. But merely for melancholic patients, the NH of the right middle temporal gyrus was negatively correlated with TEPS total and contextual anticipatory scores. SVM analysis showed that a combination of NH values in the left superior medial frontal gyrus and left inferior temporal gyrus could distinguish melancholic patients from nonmelancholic patients with accuracy, sensitivity, and specificity of 79.66% (47/59), 70.97% (22/31), and 89.29%(25/28), respectively. Conclusion Our findings showed distinctive network homogeneity alterations in melancholic MDD which may be potential imaging markers to distinguish melancholic MDD and nonmelancholic MDD.
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Nielsen JD, Mennies RJ, Olino TM. Application of a diathesis-stress model to the interplay of cortical structural development and emerging depression in youth. Clin Psychol Rev 2020; 82:101922. [PMID: 33038741 PMCID: PMC8594424 DOI: 10.1016/j.cpr.2020.101922] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 08/28/2020] [Accepted: 09/17/2020] [Indexed: 12/21/2022]
Abstract
Cross-sectional studies in adults have long identified differences in cortical structure in adults with depression compared to healthy adults, with most studies identifying reductions in grey matter volume, cortical thickness, and surface area in primarily frontal cortical regions including the OFC, ACC, and variable sub-regions of the PFC. However, when, why, and for whom these neural correlates of depression emerge remains poorly understood, necessitating developmental study of associations between depression and cortical structure. We systematically reviewed studies examining these associations in child/adolescent samples, and applied a developmentally-focused diathesis-stress model to understand the impacts of depressogenic risk-factors and stressors on the development of structural neural correlates of depression. Cross-sectional findings in youth are generally similar to those found in adults, but vary in magnitude and direction of effects. Preliminary evidence suggests that age, sex, severity, and comorbidity moderate these associations. Longitudinal studies show depression prospectively predicting cortical structure and structure predicting emerging depression. Consistent with a diathesis-stress model, associations have been noted between risk-factors for depression (e.g., genetic risk, family risk) and environmental stressors (e.g., early life stress) and structural neural correlates. Further investigation of these associations across development with attention to vulnerability factors and stressors is indicated.
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Affiliation(s)
- Johanna D Nielsen
- Department of Psychology, Temple University, Philadelphia, PA 19122, USA..
| | - Rebekah J Mennies
- Department of Psychology, Temple University, Philadelphia, PA 19122, USA..
| | - Thomas M Olino
- Department of Psychology, Temple University, Philadelphia, PA 19122, USA..
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Sankar T, Chakravarty MM, Jawa N, Li SX, Giacobbe P, Kennedy SH, Rizvi SJ, Mayberg HS, Hamani C, Lozano AM. Neuroanatomical predictors of response to subcallosal cingulate deep brain stimulation for treatment-resistant depression. J Psychiatry Neurosci 2020; 45:45-54. [PMID: 31525860 PMCID: PMC6919920 DOI: 10.1503/jpn.180207] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Deep brain stimulation targeting the subcallosal cingulate gyrus (SCG DBS) improves the symptoms of treatment-resistant depression in some patients, but not in others. We hypothesized that there are pre-existing structural brain differences between responders and nonresponders to SCG DBS, detectable using structural MRI. METHODS We studied preoperative, T1-weighted MRI scans of 27 patients treated with SCG DBS from 2003 to 2011. Responders (n = 15) were patients with a >50% improvement in Hamilton Rating Scale for Depression score following 12 months of SCG DBS. Preoperative subcallosal cingulate gyrus grey matter volume was obtained using manual segmentation by a trained observer blinded to patient identity. Volumes of hippocampus, thalamus, amygdala, whole-brain cortical grey matter and white matter volume were obtained using automated techniques. RESULTS Preoperative subcallosal cingulate gyrus, thalamic and amygdalar volumes were significantly larger in patients who went on to respond to SCG-DBS. Hippocampal volume did not differ between groups. Cortical grey matter volume was significantly smaller in responders, and cortical grey matter:white matter ratio distinguished between responders and nonresponders with high sensitivity and specificity. LIMITATIONS Normalization by intracranial volume nullified some between-group differences in volumetric measures. CONCLUSION There are structural brain differences between patients with treatment-resistant depression who respond to SCG DBS and those who do not. Specifically, the structural integrity of the subcallosal cingulate gyrus target region and its connected subcortical areas, and variations in cortical volume across the entire brain, appear to be important determinants of response. Structural MRI shows promise as a biomarker in deep brain stimulation for depression, and may play a role in refining patient selection for future trials.
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Affiliation(s)
- Tejas Sankar
- From the Division of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada (Sankar); the Department of Psychiatry, McGill University, Montreal, Quebec, Canada (Chakravarty); the Department of Biological and Biomedical Engineering, McGill University, Montreal, Quebec, Canada (Chakravarty); the Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada (Jawa, Li, Hamani, Lozano); the Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada (Giacobbe, Kennedy, Rizvi); and the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States (Mayberg)
| | - M. Mallar Chakravarty
- From the Division of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada (Sankar); the Department of Psychiatry, McGill University, Montreal, Quebec, Canada (Chakravarty); the Department of Biological and Biomedical Engineering, McGill University, Montreal, Quebec, Canada (Chakravarty); the Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada (Jawa, Li, Hamani, Lozano); the Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada (Giacobbe, Kennedy, Rizvi); and the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States (Mayberg)
| | - Natasha Jawa
- From the Division of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada (Sankar); the Department of Psychiatry, McGill University, Montreal, Quebec, Canada (Chakravarty); the Department of Biological and Biomedical Engineering, McGill University, Montreal, Quebec, Canada (Chakravarty); the Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada (Jawa, Li, Hamani, Lozano); the Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada (Giacobbe, Kennedy, Rizvi); and the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States (Mayberg)
| | - Stanley X. Li
- From the Division of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada (Sankar); the Department of Psychiatry, McGill University, Montreal, Quebec, Canada (Chakravarty); the Department of Biological and Biomedical Engineering, McGill University, Montreal, Quebec, Canada (Chakravarty); the Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada (Jawa, Li, Hamani, Lozano); the Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada (Giacobbe, Kennedy, Rizvi); and the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States (Mayberg)
| | - Peter Giacobbe
- From the Division of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada (Sankar); the Department of Psychiatry, McGill University, Montreal, Quebec, Canada (Chakravarty); the Department of Biological and Biomedical Engineering, McGill University, Montreal, Quebec, Canada (Chakravarty); the Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada (Jawa, Li, Hamani, Lozano); the Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada (Giacobbe, Kennedy, Rizvi); and the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States (Mayberg)
| | - Sidney H. Kennedy
- From the Division of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada (Sankar); the Department of Psychiatry, McGill University, Montreal, Quebec, Canada (Chakravarty); the Department of Biological and Biomedical Engineering, McGill University, Montreal, Quebec, Canada (Chakravarty); the Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada (Jawa, Li, Hamani, Lozano); the Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada (Giacobbe, Kennedy, Rizvi); and the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States (Mayberg)
| | - Sakina J. Rizvi
- From the Division of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada (Sankar); the Department of Psychiatry, McGill University, Montreal, Quebec, Canada (Chakravarty); the Department of Biological and Biomedical Engineering, McGill University, Montreal, Quebec, Canada (Chakravarty); the Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada (Jawa, Li, Hamani, Lozano); the Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada (Giacobbe, Kennedy, Rizvi); and the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States (Mayberg)
| | - Helen S. Mayberg
- From the Division of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada (Sankar); the Department of Psychiatry, McGill University, Montreal, Quebec, Canada (Chakravarty); the Department of Biological and Biomedical Engineering, McGill University, Montreal, Quebec, Canada (Chakravarty); the Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada (Jawa, Li, Hamani, Lozano); the Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada (Giacobbe, Kennedy, Rizvi); and the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States (Mayberg)
| | - Clement Hamani
- From the Division of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada (Sankar); the Department of Psychiatry, McGill University, Montreal, Quebec, Canada (Chakravarty); the Department of Biological and Biomedical Engineering, McGill University, Montreal, Quebec, Canada (Chakravarty); the Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada (Jawa, Li, Hamani, Lozano); the Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada (Giacobbe, Kennedy, Rizvi); and the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States (Mayberg)
| | - Andres M. Lozano
- From the Division of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada (Sankar); the Department of Psychiatry, McGill University, Montreal, Quebec, Canada (Chakravarty); the Department of Biological and Biomedical Engineering, McGill University, Montreal, Quebec, Canada (Chakravarty); the Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada (Jawa, Li, Hamani, Lozano); the Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada (Giacobbe, Kennedy, Rizvi); and the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States (Mayberg)
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11th International Congress on Psychopharmacology & 7th International Symposium on Child and Adolescent Psychopharmacology. PSYCHIAT CLIN PSYCH 2019; 29:311-446. [DOI: 10.1080/24750573.2019.1606883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Abstract
Mood disorders include all types of depression and bipolar disorder, and mood disorders are sometimes called affective disorders. We will discuss newly developing two issues in affective disorders in children and adolescents. Those are the new diagnostic challenges using neuroimaging techniques in affective disorders and the introduction of disruptive mood dysregulation disorder (DMDD). During the 1980s, mental health professionals began to recognize symptoms of mood disorders in children and adolescents, as well as adults. However, children and adolescents do not necessarily have or exhibit the same symptoms as adults. It is more difficult to diagnose mood disorders in children, especially because children are not always able to express how they feel. Child mental health professionals believe that mood disorders in children and adolescents remain one of the most underdiagnosed mental health problems. We are currently trying to introduce the new diagnostic technique-machine learning in children and adolescents with MDD. We will discuss the current progress in the clinical application of machine learning for MDD. After that, we would also discuss a new challenging diagnosis-DMDD. We are still suffering from a lack of evidence when trying to treat the patients with DMDD. In addition, there are some debates about the diagnostic validity of DMDD. We will explain the current situation of DMDD studies and the future directions in the study of DMDD.
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Sakai K, Yamada K. Machine learning studies on major brain diseases: 5-year trends of 2014–2018. Jpn J Radiol 2018; 37:34-72. [DOI: 10.1007/s11604-018-0794-4] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 11/14/2018] [Indexed: 12/17/2022]
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Sartori JM, Reckziegel R, Passos IC, Czepielewski LS, Fijtman A, Sodré LA, Massuda R, Goi PD, Vianna-Sulzbach M, Cardoso TDA, Kapczinski F, Mwangi B, Gama CS. Volumetric brain magnetic resonance imaging predicts functioning in bipolar disorder: A machine learning approach. J Psychiatr Res 2018; 103:237-243. [PMID: 29894922 DOI: 10.1016/j.jpsychires.2018.05.023] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 04/30/2018] [Accepted: 05/24/2018] [Indexed: 12/14/2022]
Abstract
Neuroimaging studies have been steadily explored in Bipolar Disorder (BD) in the last decades. Neuroanatomical changes tend to be more pronounced in patients with repeated episodes. Although the role of such changes in cognition and memory is well established, daily-life functioning impairments bulge among the consequences of the proposed progression. The objective of this study was to analyze MRI volumetric modifications in BD and healthy controls (HC) as possible predictors of daily-life functioning through a machine learning approach. Ninety-four participants (35 DSM-IV BD type I and 59 HC) underwent clinical and functioning assessments, and structural MRI. Functioning was assessed using the Functioning Assessment Short Test (FAST). The machine learning analysis was used to identify possible candidates of regional brain volumes that could predict functioning status, through a support vector regression algorithm. Patients with BD and HC did not differ in age, education and marital status. There were significant differences between groups in gender, BMI, FAST score, and employment status. There was significant correlation between observed and predicted FAST score for patients with BD, but not for controls. According to the model, the brain structures volumes that could predict FAST scores were: left superior frontal cortex, left rostral medial frontal cortex, right white matter total volume and right lateral ventricle volume. The machine learning approach demonstrated that brain volume changes in MRI were predictors of FAST score in patients with BD and could identify specific brain areas related to functioning impairment.
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Affiliation(s)
- Juliana M Sartori
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Avenida Ramiro Barcelos, 2350, 90035-903, Porto Alegre, Brazil; Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400 - 2° andar, 90035-003, Porto Alegre, Brazil
| | - Ramiro Reckziegel
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Avenida Ramiro Barcelos, 2350, 90035-903, Porto Alegre, Brazil; Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400 - 2° andar, 90035-003, Porto Alegre, Brazil
| | - Ives Cavalcante Passos
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Avenida Ramiro Barcelos, 2350, 90035-903, Porto Alegre, Brazil; Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400 - 2° andar, 90035-003, Porto Alegre, Brazil
| | - Leticia S Czepielewski
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Avenida Ramiro Barcelos, 2350, 90035-903, Porto Alegre, Brazil; Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400 - 2° andar, 90035-003, Porto Alegre, Brazil
| | - Adam Fijtman
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Avenida Ramiro Barcelos, 2350, 90035-903, Porto Alegre, Brazil; Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400 - 2° andar, 90035-003, Porto Alegre, Brazil
| | - Leonardo A Sodré
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Avenida Ramiro Barcelos, 2350, 90035-903, Porto Alegre, Brazil; Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400 - 2° andar, 90035-003, Porto Alegre, Brazil
| | - Raffael Massuda
- Departamento de Psiquiatria, Universidade Federal do Paraná, Rua Padre Camargo, 280 - 6º andar, 80060-240, Curitiba, Brazil
| | - Pedro D Goi
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Avenida Ramiro Barcelos, 2350, 90035-903, Porto Alegre, Brazil; Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400 - 2° andar, 90035-003, Porto Alegre, Brazil
| | - Miréia Vianna-Sulzbach
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Avenida Ramiro Barcelos, 2350, 90035-903, Porto Alegre, Brazil; Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400 - 2° andar, 90035-003, Porto Alegre, Brazil
| | - Taiane de Azevedo Cardoso
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Avenida Ramiro Barcelos, 2350, 90035-903, Porto Alegre, Brazil; Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400 - 2° andar, 90035-003, Porto Alegre, Brazil
| | - Flávio Kapczinski
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Avenida Ramiro Barcelos, 2350, 90035-903, Porto Alegre, Brazil; Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400 - 2° andar, 90035-003, Porto Alegre, Brazil; Department of Psychiatry and Behavioural Neurosciences, McMaster University, West 5th Campus, Administration - B3, 100 West 5th, Hamilton, ON L8N 3K7, Canada
| | - Benson Mwangi
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center, Houston, 1941 East Road, Houston, TX 77054, USA
| | - Clarissa S Gama
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Avenida Ramiro Barcelos, 2350, 90035-903, Porto Alegre, Brazil; Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400 - 2° andar, 90035-003, Porto Alegre, Brazil.
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17
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Kuang D, Yang R, Chen X, Lao G, Wu F, Huang X, Lv R, Zhang L, Song C, Ou S. Depression recognition according to heart rate variability using Bayesian Networks. J Psychiatr Res 2017; 95:282-287. [PMID: 28926794 DOI: 10.1016/j.jpsychires.2017.09.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Revised: 08/20/2017] [Accepted: 09/08/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Doctors mainly use scale tests and subjective judgment in the clinical diagnosis of depression. Researches have demonstrated that depression is associated with the dysfunction of the autonomic nervous system (ANS), where its modulation can be evaluated by heart rate variability (HRV). Depression patients have lower HRV than healthy subjects. Therefore, HRV may be used to distinguish depression patients from healthy people. METHODS HRV signals were collected from 76 female subjects composed of 38 depression patients and 38 healthy people. Time domain, frequency domain, and non-linear features were extracted from the HRV signals of these subjects, who were subjected to the Ewing test as an ANS stimulus. Then, these multiple features were input into Bayesian networks, served as a classifier, to distinguish depression patients from healthy people. Hence, accuracy, sensitivity, and specificity were calculated to evaluate the performance of the classifier. RESULTS Recognition results indicate 86.4% accuracy, 89.5% sensitivity, and 84.2% specificity. The individuals subjected to the Ewing test showed better recognition results than those at individual test states (resting state, deep breathing state, Valsalva state, and standing state) of the Ewing test. The root mean square of successive differences (RMSSD) of the HRV exhibits a significant relevance with recognition. CONCLUSION Bayesian networks can be applied to the recognition of depression patients from healthy people and the recognition results demonstrate the significant association between depression and HRV. The Ewing test is a good ANS stimulus for acquiring the difference of HRV between depression patients and healthy people to recognize depression. The RMSSD of the HRV is important in recognition and may be a significant index in distinguishing depression patients from healthy people.
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Affiliation(s)
- Danni Kuang
- Department of Biomedical Engineering, South China University of Technology, Guangzhou, China
| | - Rongqian Yang
- Department of Biomedical Engineering, South China University of Technology, Guangzhou, China.
| | - Xiuwen Chen
- Department of Biomedical Engineering, South China University of Technology, Guangzhou, China
| | - Guohui Lao
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Fengchun Wu
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Xiong Huang
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Ruixue Lv
- Shenzhen Sayes Medical Technology Co., Ltd., Shenzhen, China
| | - Lei Zhang
- Shenzhen Sayes Medical Technology Co., Ltd., Shenzhen, China
| | - Chuanxu Song
- Shenzhen Sayes Medical Technology Co., Ltd., Shenzhen, China
| | - Shanxing Ou
- General Hospital of Guangzhou Military Command of PLA, Guangzhou, China
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18
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Kambeitz J, Cabral C, Sacchet MD, Gotlib IH, Zahn R, Serpa MH, Walter M, Falkai P, Koutsouleris N. Detecting Neuroimaging Biomarkers for Depression: A Meta-analysis of Multivariate Pattern Recognition Studies. Biol Psychiatry 2017; 82:330-338. [PMID: 28110823 DOI: 10.1016/j.biopsych.2016.10.028] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 09/27/2016] [Accepted: 10/20/2016] [Indexed: 12/24/2022]
Abstract
BACKGROUND Multiple studies have examined functional and structural brain alteration in patients diagnosed with major depressive disorder (MDD). The introduction of multivariate statistical methods allows investigators to utilize data concerning these brain alterations to generate diagnostic models that accurately differentiate patients with MDD from healthy control subjects (HCs). However, there is substantial heterogeneity in the reported results, the methodological approaches, and the clinical characteristics of participants in these studies. METHODS We conducted a meta-analysis of all studies using neuroimaging (volumetric measures derived from T1-weighted images, task-based functional magnetic resonance imaging [MRI], resting-state MRI, or diffusion tensor imaging) in combination with multivariate statistical methods to differentiate patients diagnosed with MDD from HCs. RESULTS Thirty-three (k = 33) samples including 912 patients with MDD and 894 HCs were included in the meta-analysis. Across all studies, patients with MDD were separated from HCs with 77% sensitivity and 78% specificity. Classification based on resting-state MRI (85% sensitivity, 83% specificity) and on diffusion tensor imaging data (88% sensitivity, 92% specificity) outperformed classifications based on structural MRI (70% sensitivity, 71% specificity) and task-based functional MRI (74% sensitivity, 77% specificity). CONCLUSIONS Our results demonstrate the high representational capacity of multivariate statistical methods to identify neuroimaging-based biomarkers of depression. Future studies are needed to elucidate whether multivariate neuroimaging analysis has the potential to generate clinically useful tools for the differential diagnosis of affective disorders and the prediction of both treatment response and functional outcome.
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Affiliation(s)
- Joseph Kambeitz
- Department of Psychiatry, Ludwig-Maximilians University Munich, Munich.
| | - Carlos Cabral
- Department of Psychiatry, Ludwig-Maximilians University Munich, Munich
| | - Matthew D Sacchet
- Neurosciences Program and Department of Psychology, Stanford University, Stanford, California
| | - Ian H Gotlib
- Neurosciences Program and Department of Psychology, Stanford University, Stanford, California
| | - Roland Zahn
- Institute of Psychiatry, King's College London, London, United Kingdom
| | - Mauricio H Serpa
- Laboratory of Psychiatric Neuroimaging, Institute and Department of Psychiatry, Sao Paulo, Brazil; Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), University of Sao Paulo, Sao Paulo, Brazil
| | - Martin Walter
- Clinical Affective Neuroimaging Laboratory, Department of Behavioural Neurology, Leibniz Institute for Neurobiology, Magdeburg; Department of Psychiatry and Psychotherapy, Eberhard Karls University, Tubingen, Germany
| | - Peter Falkai
- Department of Psychiatry, Ludwig-Maximilians University Munich, Munich
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19
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Fleck DE, Ernest N, Adler CM, Cohen K, Eliassen JC, Norris M, Komoroski RA, Chu WJ, Welge JA, Blom TJ, DelBello MP, Strakowski SM. Prediction of lithium response in first-episode mania using the LITHium Intelligent Agent (LITHIA): Pilot data and proof-of-concept. Bipolar Disord 2017; 19:259-272. [PMID: 28574156 PMCID: PMC5517343 DOI: 10.1111/bdi.12507] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 04/06/2017] [Accepted: 04/16/2017] [Indexed: 01/27/2023]
Abstract
OBJECTIVES Individualized treatment for bipolar disorder based on neuroimaging treatment targets remains elusive. To address this shortcoming, we developed a linguistic machine learning system based on a cascading genetic fuzzy tree (GFT) design called the LITHium Intelligent Agent (LITHIA). Using multiple objectively defined functional magnetic resonance imaging (fMRI) and proton magnetic resonance spectroscopy (1 H-MRS) inputs, we tested whether LITHIA could accurately predict the lithium response in participants with first-episode bipolar mania. METHODS We identified 20 subjects with first-episode bipolar mania who received an adequate trial of lithium over 8 weeks and both fMRI and 1 H-MRS scans at baseline pre-treatment. We trained LITHIA using 18 1 H-MRS and 90 fMRI inputs over four training runs to classify treatment response and predict symptom reductions. Each training run contained a randomly selected 80% of the total sample and was followed by a 20% validation run. Over a different randomly selected distribution of the sample, we then compared LITHIA to eight common classification methods. RESULTS LITHIA demonstrated nearly perfect classification accuracy and was able to predict post-treatment symptom reductions at 8 weeks with at least 88% accuracy in training and 80% accuracy in validation. Moreover, LITHIA exceeded the predictive capacity of the eight comparator methods and showed little tendency towards overfitting. CONCLUSIONS The results provided proof-of-concept that a novel GFT is capable of providing control to a multidimensional bioinformatics problem-namely, prediction of the lithium response-in a pilot data set. Future work on this, and similar machine learning systems, could help assign psychiatric treatments more efficiently, thereby optimizing outcomes and limiting unnecessary treatment.
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Affiliation(s)
- David E. Fleck
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA,Center for Imaging Research, University of Cincinnati College of Medicine, Cincinnati, OH, USA,Address correspondence to Dr. Fleck, University of Cincinnati Department of Psychiatry and Behavioral Neuroscience, Cincinnati OH 45229-3019. ; Telephone: (513) 558-4940; Fax: (513) 558-3399
| | | | - Caleb M. Adler
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA,Center for Imaging Research, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Kelly Cohen
- Department of Aerospace Engineering and Engineering Mechanics, University of Cincinnati College of Engineering and Applied Science, Cincinnati, OH, USA
| | - James C. Eliassen
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA,Center for Imaging Research, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Matthew Norris
- Center for Imaging Research, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Richard A. Komoroski
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA,Center for Imaging Research, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Wen-Jang Chu
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA,Center for Imaging Research, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jeffrey A. Welge
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Thomas J. Blom
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Melissa P. DelBello
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Stephen M. Strakowski
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA,Center for Imaging Research, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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20
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Wu MJ, Passos IC, Bauer IE, Lavagnino L, Cao B, Zunta-Soares GB, Kapczinski F, Mwangi B, Soares JC. Individualized identification of euthymic bipolar disorder using the Cambridge Neuropsychological Test Automated Battery (CANTAB) and machine learning. J Affect Disord 2016; 192:219-25. [PMID: 26748737 PMCID: PMC4727980 DOI: 10.1016/j.jad.2015.12.053] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 12/17/2015] [Accepted: 12/26/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Previous studies have reported that patients with bipolar disorder (BD) present with cognitive impairments during mood episodes as well as euthymic phase. However, it is still unknown whether reported neurocognitive abnormalities can objectively identify individual BD patients from healthy controls (HC). METHODS A total of 21 euthymic BD patients and 21 demographically matched HC were included in the current study. Participants performed the computerized Cambridge Neurocognitive Test Automated Battery (CANTAB) to assess cognitive performance. The least absolute shrinkage selection operator (LASSO) machine learning algorithm was implemented to identify neurocognitive signatures to distinguish individual BD patients from HC. RESULTS The LASSO machine learning algorithm identified individual BD patients from HC with an accuracy of 71%, area under receiver operating characteristic curve of 0.7143 and significant at p=0.0053. The LASSO algorithm assigned individual subjects with a probability score (0-healthy, 1-patient). Patients with rapid cycling (RC) were assigned increased probability scores as compared to patients without RC. A multivariate pattern of neurocognitive abnormalities comprising of affective Go/No-go and the Cambridge gambling task was relevant in distinguishing individual patients from HC. LIMITATIONS Our study sample was small as we only considered euthymic BD patients and demographically matched HC. CONCLUSION Neurocognitive abnormalities can distinguish individual euthymic BD patients from HC with relatively high accuracy. In addition, patients with RC had more cognitive impairments compared to patients without RC. The predictive neurocognitive signature identified in the current study can potentially be used to provide individualized clinical inferences on BD patients.
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Affiliation(s)
- Mon-Ju Wu
- UT Center of Excellence on Mood Disorder, Department of Psychiatry and Behavioral Sciences, The University of Texas Science Center at Houston, Houston, Texas, USA
| | - Ives Cavalcante Passos
- UT Center of Excellence on Mood Disorder, Department of Psychiatry and Behavioral Sciences, The University of Texas Science Center at Houston, Houston, Texas, USA,Bipolar Disorder Program and Laboratory of Molecular Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Isabelle E. Bauer
- UT Center of Excellence on Mood Disorder, Department of Psychiatry and Behavioral Sciences, The University of Texas Science Center at Houston, Houston, Texas, USA
| | - Luca Lavagnino
- UT Center of Excellence on Mood Disorder, Department of Psychiatry and Behavioral Sciences, The University of Texas Science Center at Houston, Houston, Texas, USA
| | - Bo Cao
- UT Center of Excellence on Mood Disorder, Department of Psychiatry and Behavioral Sciences, The University of Texas Science Center at Houston, Houston, Texas, USA
| | - Giovana B. Zunta-Soares
- UT Center of Excellence on Mood Disorder, Department of Psychiatry and Behavioral Sciences, The University of Texas Science Center at Houston, Houston, Texas, USA
| | - Flávio Kapczinski
- UT Center of Excellence on Mood Disorder, Department of Psychiatry and Behavioral Sciences, The University of Texas Science Center at Houston, Houston, Texas, USA,Bipolar Disorder Program and Laboratory of Molecular Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Benson Mwangi
- UT Center of Excellence on Mood Disorder, Department of Psychiatry and Behavioral Sciences, The University of Texas Science Center at Houston, Houston, TX, USA.
| | - Jair C. Soares
- UT Center of Excellence on Mood Disorder, Department of Psychiatry and Behavioral Sciences, The University of Texas Science Center at Houston, Houston, Texas, USA
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21
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Mwangi B, Wu MJ, Cao B, Passos IC, Lavagnino L, Keser Z, Zunta-Soares GB, Hasan KM, Kapczinski F, Soares JC. Individualized Prediction and Clinical Staging of Bipolar Disorders using Neuroanatomical Biomarkers. Biol Psychiatry Cogn Neurosci Neuroimaging 2016; 1:186-194. [PMID: 27047994 DOI: 10.1016/j.bpsc.2016.01.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Neuroanatomical abnormalities in Bipolar disorder (BD) have previously been reported. However, the utility of these abnormalities in distinguishing individual BD patients from Healthy controls and stratify patients based on overall illness burden has not been investigated in a large cohort. METHODS In this study, we examined whether structural neuroimaging scans coupled with a machine learning algorithm are able to distinguish individual BD patients from Healthy controls in a large cohort of 256 subjects. Additionally, we investigated the relationship between machine learning predicted probability scores and subjects' clinical characteristics such as illness duration and clinical stages. Neuroimaging scans were acquired from 128 BD patients and 128 Healthy controls. Gray and white matter density maps were obtained and used to 'train' a relevance vector machine (RVM) learning algorithm which was used to distinguish individual patients from Healthy controls. RESULTS The RVM algorithm distinguished patients from Healthy controls with 70.3 % accuracy (74.2 % specificity, 66.4 % sensitivity, chi-square p<0.005) using white matter density data and 64.9 % accuracy (71.1 % specificity, 58.6 % sensitivity, chi-square p<0.005) with gray matter density. Multiple brain regions - largely covering the fronto - limbic system were identified as 'most relevant' in distinguishing both groups. Patients identified by the algorithm with high certainty (a high probability score) - belonged to a subgroup with more than ten total lifetime manic episodes including hospitalizations (late stage). CONCLUSIONS These results indicate the presence of widespread structural brain abnormalities in BD which are associated with higher illness burden - which points to neuroprogression.
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Affiliation(s)
- Benson Mwangi
- UT Center of Excellence on Mood Disorders, The University of Texas Health Science Center Houston, Houston, TX, USA
| | - Mon-Ju Wu
- UT Center of Excellence on Mood Disorders, The University of Texas Health Science Center Houston, Houston, TX, USA
| | - Bo Cao
- UT Center of Excellence on Mood Disorders, The University of Texas Health Science Center Houston, Houston, TX, USA
| | - Ives C Passos
- UT Center of Excellence on Mood Disorders, The University of Texas Health Science Center Houston, Houston, TX, USA
| | - Luca Lavagnino
- UT Center of Excellence on Mood Disorders, The University of Texas Health Science Center Houston, Houston, TX, USA
| | - Zafer Keser
- Department of Physical Medicine and Rehabilitation and TIRR Memorial Hermann Neuro-Recovery Research Center, The University of Texas Health Science Center Houston, Houston, TX, USA
| | - Giovana B Zunta-Soares
- UT Center of Excellence on Mood Disorders, The University of Texas Health Science Center Houston, Houston, TX, USA
| | - Khader M Hasan
- Department of Diagnostic and Interventional Radiology, The University of Texas Health Science Center Houston, Houston, TX, USA
| | - Flavio Kapczinski
- Bipolar Disorder Program, Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Graduation Program in Psychiatry and Department of Psychiatry, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Jair C Soares
- UT Center of Excellence on Mood Disorders, The University of Texas Health Science Center Houston, Houston, TX, USA
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22
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Mwangi B, Wu MJ, Bauer IE, Modi H, Zeni CP, Zunta-Soares GB, Hasan KM, Soares JC. Predictive classification of pediatric bipolar disorder using atlas-based diffusion weighted imaging and support vector machines. Psychiatry Res 2015; 234:265-71. [PMID: 26459075 DOI: 10.1016/j.pscychresns.2015.10.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 08/15/2015] [Accepted: 10/01/2015] [Indexed: 12/30/2022]
Abstract
Previous studies have reported abnormalities of white-matter diffusivity in pediatric bipolar disorder. However, it has not been established whether these abnormalities are able to distinguish individual subjects with pediatric bipolar disorder from healthy controls with a high specificity and sensitivity. Diffusion-weighted imaging scans were acquired from 16 youths diagnosed with DSM-IV bipolar disorder and 16 demographically matched healthy controls. Regional white matter tissue microstructural measurements such as fractional anisotropy, axial diffusivity and radial diffusivity were computed using an atlas-based approach. These measurements were used to 'train' a support vector machine (SVM) algorithm to predict new or 'unseen' subjects' diagnostic labels. The SVM algorithm predicted individual subjects with specificity=87.5%, sensitivity=68.75%, accuracy=78.12%, positive predictive value=84.62%, negative predictive value=73.68%, area under receiver operating characteristic curve (AUROC)=0.7812 and chi-square p-value=0.0012. A pattern of reduced regional white matter fractional anisotropy was observed in pediatric bipolar disorder patients. These results suggest that atlas-based diffusion weighted imaging measurements can distinguish individual pediatric bipolar disorder patients from healthy controls. Notably, from a clinical perspective these findings will contribute to the pathophysiological understanding of pediatric bipolar disorder.
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23
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Levman J, Takahashi E. Multivariate analyses applied to fetal, neonatal and pediatric MRI of neurodevelopmental disorders. Neuroimage Clin 2015; 9:532-44. [PMID: 26640765 PMCID: PMC4625213 DOI: 10.1016/j.nicl.2015.09.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 09/23/2015] [Accepted: 09/25/2015] [Indexed: 01/15/2023]
Abstract
Multivariate analysis (MVA) is a class of statistical and pattern recognition methods that involve the processing of data that contains multiple measurements per sample. MVA can be used to address a wide variety of medical neuroimaging-related challenges including identifying variables associated with a measure of clinical importance (i.e. patient outcome), creating diagnostic tests, assisting in characterizing developmental disorders, understanding disease etiology, development and progression, assisting in treatment monitoring and much more. Compared to adults, imaging of developing immature brains has attracted less attention from MVA researchers. However, remarkable MVA research growth has occurred in recent years. This paper presents the results of a systematic review of the literature focusing on MVA technologies applied to neurodevelopmental disorders in fetal, neonatal and pediatric magnetic resonance imaging (MRI) of the brain. The goal of this manuscript is to provide a concise review of the state of the scientific literature on studies employing brain MRI and MVA in a pre-adult population. Neurological developmental disorders addressed in the MVA research contained in this review include autism spectrum disorder, attention deficit hyperactivity disorder, epilepsy, schizophrenia and more. While the results of this review demonstrate considerable interest from the scientific community in applications of MVA technologies in pediatric/neonatal/fetal brain MRI, the field is still young and considerable research growth remains ahead of us.
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Affiliation(s)
- Jacob Levman
- Division of Newborn Medicine, Department of Medicine, Boston Children's Hospital, Harvard Medical School, 1 Autumn Street #456, Boston, MA 02115, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, 149 13th Street, Charlestown, MA 02129, USA
| | - Emi Takahashi
- Division of Newborn Medicine, Department of Medicine, Boston Children's Hospital, Harvard Medical School, 1 Autumn Street #456, Boston, MA 02115, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, 149 13th Street, Charlestown, MA 02129, USA
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24
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Abstract
Smartphones are now ubiquitous and can be harnessed to offer psychiatry a wealth of real-time data regarding patient behavior, self-reported symptoms, and even physiology. The data collected from smartphones meet the three criteria of big data: velocity, volume, and variety. Although these data have tremendous potential, transforming them into clinically valid and useful information requires using new tools and methods as a part of assessment in psychiatry. In this paper, we introduce and explore numerous analytical methods and tools from the computational and statistical sciences that appear readily applicable to psychiatric data collected using smartphones. By matching smartphone data with appropriate statistical methods, psychiatry can better realize the potential of mobile mental health and empower both patients and providers with novel clinical tools.
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Affiliation(s)
- John Torous
- Harvard Longwood Psychiatry Residency Training Program, 330 Brookline Ave, Boston, MA, 02215, USA,
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