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Wang HY, You HL, Song CL, Zhou L, Wang SY, Li XL, Liang ZH, Zhang BW. Shared and distinct prefrontal cortex alterations of implicit emotion regulation in depression and anxiety: An fNIRS investigation. J Affect Disord 2024; 354:126-135. [PMID: 38479517 DOI: 10.1016/j.jad.2024.03.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 03/04/2024] [Accepted: 03/09/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND Emotion regulation deficits, particularly in cognitive reappraisal, are crucial in depression and anxiety. However, research on the neural mechanisms of implicit emotion regulation is lacking, and it remains unclear whether these mechanisms are shared or distinct between the two disorders. METHODS We investigated the neural mechanisms of implicit cognitive reappraisal in 28 individuals with major depressive disorder (MDD), 25 with generalized anxiety disorder (GAD), and 30 healthy controls (HC) using functional near-infrared spectroscopy (fNIRS). Participants completed an implicit cognitive reappraisal task and underwent neuropsychological and clinical assessments. RESULTS We found that MDD patients reported higher levels of rumination and lower utilization of cognitive reappraisal, while GAD patients reported reduced use of perspective-taking. Notably, both MDD and GAD patients exhibited decreased activation in the dorsolateral prefrontal cortex (DLPFC) and orbitofrontal cortex (OFC) compared to HC participants during implicit cognitive reappraisal. Specifically, inadequate OFC activation was observed in MDD patients, while GAD patients demonstrated OFC deactivation during the task. Furthermore, DLPFC activation showed a negative correlation with depression severity in MDD patients, while OFC activation was positively correlated with perspective-taking in GAD patients. LIMITATIONS fNIRS has limited depth and spatial resolution. CONCLUSION Our fNIRS study is the first to reveal shared and distinct neurobiological profiles of depression and anxiety in implicit emotion regulation. These findings underscore the significance of reduced DLPFC/OFC activation in emotion regulation impairment and highlight unique OFC activation patterns in these disorders. These insights have potential implications for developing cognitive-behavioral therapy and transcranial magnetic stimulation as treatment approaches.
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Affiliation(s)
- Hai-Yang Wang
- Department of Neurology and Psychiatry, The First Affiliated Hospital of Dalian Medical University, Dalian 116011, China; Department of Neurology, Jining No. 1 People's Hospital, Jining 272000, China
| | - Hui-Li You
- Department of Neurology and Psychiatry, The First Affiliated Hospital of Dalian Medical University, Dalian 116011, China
| | - Chun-Li Song
- Department of Neurology and Psychiatry, The First Affiliated Hospital of Dalian Medical University, Dalian 116011, China
| | - Lu Zhou
- Department of Neurology and Psychiatry, The First Affiliated Hospital of Dalian Medical University, Dalian 116011, China
| | - Shi-Yao Wang
- Department of Neurology and Psychiatry, The First Affiliated Hospital of Dalian Medical University, Dalian 116011, China
| | - Xue-Lin Li
- Department of Intensive Care Unit, Jining No. 1 People's Hospital, Jining 272000, China
| | - Zhan-Hua Liang
- Department of Neurology and Psychiatry, The First Affiliated Hospital of Dalian Medical University, Dalian 116011, China
| | - Bing-Wei Zhang
- Department of Neurology and Psychiatry, The First Affiliated Hospital of Dalian Medical University, Dalian 116011, China; Department of Psychology, Dalian Medical University, Dalian 116044, China.
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El Yacoubi M, Altersitz C, Latapie V, Rizkallah E, Arthaud S, Bougarel L, Pereira M, Wierinckx A, El-Hage W, Belzeaux R, Turecki G, Svenningsson P, Martin B, Lachuer J, Vaugeois JM, Jamain S. Two polygenic mouse models of major depressive disorders identify TMEM161B as a potential biomarker of disease in humans. Neuropsychopharmacology 2024; 49:1129-1139. [PMID: 38326457 PMCID: PMC11109134 DOI: 10.1038/s41386-024-01811-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 01/17/2024] [Accepted: 01/18/2024] [Indexed: 02/09/2024]
Abstract
Treatments are only partially effective in major depressive disorders (MDD) but no biomarker exists to predict symptom improvement in patients. Animal models are essential tools in the development of antidepressant medications, but while recent genetic studies have demonstrated the polygenic contribution to MDD, current models are limited to either mimic the effect of a single gene or environmental factor. We developed in the past a model of depressive-like behaviors in mice (H/Rouen), using selective breeding based on behavioral reaction after an acute mild stress in the tail suspension test. Here, we propose a new mouse model of depression (H-TST) generated from a more complex genetic background and based on the same selection process. We first demonstrated that H/Rouen and H-TST mice had similar phenotypes and were more sensitive to glutamate-related antidepressant medications than selective serotonin reuptake inhibitors. We then conducted an exome sequencing on the two mouse models and showed that they had damaging variants in 174 identical genes, which have also been associated with MDD in humans. Among these genes, we showed a higher expression level of Tmem161b in brain and blood of our two mouse models. Changes in TMEM161B expression level was also observed in blood of MDD patients when compared with controls, and after 8-week treatment with duloxetine, mainly in good responders to treatment. Altogether, our results introduce H/Rouen and H-TST as the two first polygenic animal models of MDD and demonstrate their ability to identify biomarkers of the disease and to develop rapid and effective antidepressant medications.
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Affiliation(s)
- Malika El Yacoubi
- Univ Paris Est Créteil, INSERM, IMRB, Translational Neuropsychiatry, F-94010, Créteil, France
| | - Claire Altersitz
- Univ Paris Est Créteil, INSERM, IMRB, Translational Neuropsychiatry, F-94010, Créteil, France
| | - Violaine Latapie
- Univ Paris Est Créteil, INSERM, IMRB, Translational Neuropsychiatry, F-94010, Créteil, France
| | - Elari Rizkallah
- Univ Paris Est Créteil, INSERM, IMRB, Translational Neuropsychiatry, F-94010, Créteil, France
| | - Sébastien Arthaud
- SLEEP Team, CNRS UMR5292; INSERM U1028; Lyon Neuroscience Research; Center, Lyon, F-69372, France
- University of Lyon 1, Lyon, France
| | - Laure Bougarel
- Univ Paris Est Créteil, INSERM, IMRB, Translational Neuropsychiatry, F-94010, Créteil, France
- NETRIS Pharma, Lyon, France
| | - Marcela Pereira
- Department of Clinical Neuroscience, Karolinska Institute, Solna, Sweden
| | - Anne Wierinckx
- ProfileXpert, SFR Santé Lyon-Est, UCBL UMS 3453 CNRS, US7 INSERM, Lyon, France
| | - Wissam El-Hage
- UMR 1253, iBrain, Université de Tours, CHRU de Tours, INSERM, Tours, France
- Centre Expert Dépression Résistante, Fondation FondaMental, Tours, France
| | - Raoul Belzeaux
- Pôle Universitaire de Psychiatrie, CHU de Montpellier, Montpellier, France
- Fondation FondaMental, Créteil, F-94000, France
| | - Gustavo Turecki
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Per Svenningsson
- Department of Clinical Neuroscience, Karolinska Institute, Solna, Sweden
| | - Benoît Martin
- Univ Rennes, Inserm, LTSI (Laboratoire de Traitement du Signal et de l'Image), UMR-1099, F-35000, Rennes, France
| | - Joël Lachuer
- ProfileXpert, SFR Santé Lyon-Est, UCBL UMS 3453 CNRS, US7 INSERM, Lyon, France
| | - Jean-Marie Vaugeois
- Univ Rouen Normandie, Université Caen Normandie, Normandie Univ, ABTE UR 4651, F-76000, Rouen, France
| | - Stéphane Jamain
- Univ Paris Est Créteil, INSERM, IMRB, Translational Neuropsychiatry, F-94010, Créteil, France.
- Fondation FondaMental, Créteil, F-94000, France.
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Zhang Y, Feng Y, Liu L, Jiang G, Wang M. Abnormal prefrontal cortical activation during the GO/NOGO and verbal fluency tasks in adult patients with comorbid generalized anxiety disorder and attention-deficit/hyperactivity disorder: An fNIRS study. J Psychiatr Res 2024; 172:281-290. [PMID: 38428164 DOI: 10.1016/j.jpsychires.2024.02.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 02/16/2024] [Accepted: 02/24/2024] [Indexed: 03/03/2024]
Abstract
Generalized anxiety disorder (GAD) and adult attention-deficit/hyperactivity disorder (ADHD) are commonly reported comorbidities. Adult GAD patients with comorbid ADHD are often underdiagnosed and undertreated. To explore the clinical value of functional near-infrared spectroscopy (fNIRS) data for assisting in the accurate diagnosis of ADHD in individuals with GAD, haemoglobin (HbO) concentration changes in the prefrontal cortex (PFC) were detected via fNIRS in 49 patients with both GAD and ADHD, 46 patients with GAD, and 34 healthy controls (HCs) during a verbal fluency task (VFT) and a GO/NOGO task. The correlations between PFC fNIRS data and the severity of inattention and hyperactivity symptoms assessed using the adult ADHD Self-Report Scale (ASRS) were analyzed. Our results showed that, during the GO/NOGO task, channels in the left dorsolateral PFC (channels 28 and 29) were hyperactivated, while channels in the medial PFC (channels 36, 37, and 47) were hypoactivated in participants with ADHD and GAD compared with those with GAD alone. During the VFT, compared with the HC group, both the ADHD + GAD group and the GAD group exhibited significantly decreased HbO activation in the medial PFC (channels 37, 38, and 48) and in the left ventrolateral PFC (channel 39); moreover, no difference was found between the ADHD + GAD group and the GAD group. Activation in the left dorsolateral PFC (channels 28 and 29) during the GO/NOGO task showed a significant positive correlation with ASRS-inattention scores. Our results indicated that fNIRS data collected during the GO/NOGO task may help to distinguish patients with comorbid GAD and ADHD from those with GAD alone.
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Affiliation(s)
- Yuchen Zhang
- Department of Children and Adolescents, Chongqing Mental Health Center, Chongqing, China
| | - Yaju Feng
- Department of Children and Adolescents, Chongqing Mental Health Center, Chongqing, China
| | - Linfeng Liu
- Department of Children and Adolescents, Chongqing Mental Health Center, Chongqing, China
| | - Guoqing Jiang
- Department of Children and Adolescents, Chongqing Mental Health Center, Chongqing, China.
| | - Minjian Wang
- Department of Children and Adolescents, Chongqing Mental Health Center, Chongqing, China.
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Ren Y, Cui G, Feng K, Zhang X, Yu C, Liu P. A scoping review of utilization of the verbal fluency task in Chinese and Japanese clinical settings with near-infrared spectroscopy. Front Psychiatry 2024; 15:1282546. [PMID: 38525251 PMCID: PMC10957746 DOI: 10.3389/fpsyt.2024.1282546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 02/08/2024] [Indexed: 03/26/2024] Open
Abstract
This review targets the application of the Verbal Fluency Task (VFT) in conjunction with functional near-infrared spectroscopy (fNIRS) for diagnosing psychiatric disorders, specifically in the contexts of China and Japan. These two countries are at the forefront of integrating fNIRS with VFT in clinical psychiatry, often employing this combination as a complementary tool alongside traditional psychiatric examinations. Our study aims to synthesize research findings on the hemodynamic responses elicited by VFT task in clinical settings of the two countries, analyzing variations in task design (phonological versus semantic), stimulus modality (auditory versus visual), and the impact of language typology. The focus on China and Japan is crucial, as it provides insights into the unique applications and adaptations of VFT in these linguistically and culturally distinct environments. By exploring these specific cases, our review underscores the importance of tailoring VFT to fit the linguistic and cultural context, thereby enhancing its validity and utility in cross-cultural psychiatric assessments.
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Affiliation(s)
- Yufei Ren
- Department of Foreign Languages and Literatures, Tsinghua University, Beijing, China
| | - Gang Cui
- Department of Foreign Languages and Literatures, Tsinghua University, Beijing, China
| | - Kun Feng
- Department of Psychiatry, Yuquan Hospital, Tsinghua University, Beijing, China
| | - Xiaoqian Zhang
- Department of Psychiatry, Yuquan Hospital, Tsinghua University, Beijing, China
| | | | - Pozi Liu
- Department of Psychiatry, Yuquan Hospital, Tsinghua University, Beijing, China
- School of Clinical Medicine, Tsinghua University, Beijing, China
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5
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Han Y, Yan H, Shan X, Li H, Liu F, Li P, Zhao J, Guo W. Shared and distinctive neural substrates of generalized anxiety disorder with or without depressive symptoms and their roles in prognostic prediction. J Affect Disord 2024; 348:207-217. [PMID: 38160885 DOI: 10.1016/j.jad.2023.12.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 11/05/2023] [Accepted: 12/24/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND The neurophysiological mechanisms underlying generalized anxiety disorder (GAD) with or without depressive symptoms are obscure. This study aimed to uncover them and assess their predictive value for treatment response. METHODS We enrolled 98 GAD patients [58 (age: 33.22 ± 10.23 years old, males/females: 25/33) with and 40 (age: 33.65 ± 10.49 years old, males/females: 14/26) without depressive symptoms] and 54 healthy controls (HCs, age: 32.28 ± 10.56 years old, males/females: 21/33). Patients underwent clinical assessments and resting-state functional MRI (rs-fMRI) at baseline and after 4-week treatment with paroxetine, while HCs underwent rs-fMRI at baseline only. Regional homogeneity (ReHo) was employed to measure intrinsic brain activity. We compared ReHo in patients to HCs and examined changes in ReHo within the patient groups after treatment. Support vector regression (SVR) analyses were conducted separately for each patient group to predict the patients' treatment response. RESULTS Both patient groups exhibited higher ReHo in the middle/superior frontal gyrus decreased ReHo in different brain regions compared to HCs. Furthermore, differences in ReHo were detected between the two patient groups. After treatment, the patient groups displayed distinct ReHo change patterns. By utilizing SVR based on baseline abnormal ReHo, we effectively predicted treatment response of patients (p-value for correlation < 0.05). LIMITATIONS The dropout rate was relatively high. CONCLUSIONS This study identified shared and unique neural substrates in GAD patients with or without depressive symptoms, potentially serving as biomarkers for treatment response prediction. Comorbid depressive symptoms were associated with differences in disease manifestation and treatment response compared to pure GAD cases.
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Affiliation(s)
- Yiding Han
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Haohao Yan
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Xiaoxiao Shan
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Huabing Li
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, China
| | - Feng Liu
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Ping Li
- Department of Psychiatry, Qiqihar Medical University, Qiqihar, Heilongjiang 161006, China
| | - Jingping Zhao
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Wenbin Guo
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China.
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Gao C, Li T. Gender specificity of frontal activity based on fNIRS in distinguishing bipolar depression population from health control. JOURNAL OF BIOPHOTONICS 2024; 17:e202300346. [PMID: 37934196 DOI: 10.1002/jbio.202300346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 10/19/2023] [Accepted: 10/24/2023] [Indexed: 11/08/2023]
Abstract
Bipolar depression (BD) is a chronic psychiatric disorder characterized by recurring bouts of bipolar mania or hypomania followed by depression. In this essay, we used the functional near-infrared spectroscopy to investigate the frontal function of BD in males and females, which included a total of 43 BD patients and 28 healthy subjects. The hemodynamic response associated with the task was estimated using the generalized linear model (GLM) approach. Wavelet transforms coherence and Granger causality (GC) methods were employed to calculate brain connectivity. GLM and GC results revealed that female patients were more distinguishable from healthy controls than males. Additionally, the correlation between BD scores and GLM results showed that the brain activation of male subjects was affected by their anxiety levels. This study suggests that traditional diagnostic methods for BD may not be as sensitive in men as in women.
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Affiliation(s)
- Chenyang Gao
- Institute of Biomedical Engineering, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Ting Li
- Institute of Biomedical Engineering, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
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Wang H, Song P, Hou Y, Liu J, Hao W, Hu S, Dai X, Zhan S, Li N, Peng M, Wang H, Lin H, Wang Y. 820-nm Transcranial Near-infrared Stimulation on the Left DLPFC Relieved Anxiety: A Randomized, Double-blind, Sham-controlled Study. Brain Res Bull 2023:110682. [PMID: 37301483 DOI: 10.1016/j.brainresbull.2023.110682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/13/2023] [Accepted: 06/05/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Generalized anxiety disorder (GAD) is a chronic mood disease associated with abnormal brain network connections, including decreased activity in the left dorsolateral prefrontal cortex (DLPFC). Cortical excitability can be increased with 820-nm transcranial near-infrared stimulation (tNIRS), while transcranial magnetic stimulation with electroencephalography (TMS-EEG) can help evaluate time-varying brain network connectivity. A randomized, double-blind, sham-controlled trial was conducted to assess the efficacy of tNIRS on the left DLPFC and the impact on time-varying brain network connections in GAD patients. METHODS A total of 36 GAD patients were randomized to receive active or sham tNIRS for 2 weeks. Clinical psychological scales were assessed before, after, and at the 2-, 4-, and 8-week follow-ups. TMS-EEG was performed for 20minutes before and immediately after tNIRS treatment. The healthy controls did not receive tNIRS and only had TMS-EEG data collected once in the resting state. RESULTS The Hamilton Anxiety Scale (HAMA) scores of the active stimulation group decreased post-treatment compared with the sham group (P=0.021). The HAMA scores of the active stimulation group at the 2-, 4-, and 8-week follow-up assessments were lower than those before treatment (P<0.05). The time-varying EEG network pattern showed an information outflow from the left DLPFC and the left posterior temporal region after active treatment. CONCLUSION Herein, 820-nm tNIRS targeting the left DLPFC had significant positive effects on therapy for GAD that lasted at least 2 months. tNIRS may reverse the abnormality of time-varying brain network connections in GAD.
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Affiliation(s)
- Huicong Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; Beijing Key Laboratory of Neuromodulation, Beijing 100053, China; Center of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Beijing 100053, China; Center for sleep and consciousness disorders, Beijing Institute for Brain Disorders, Beijing 100053, China; Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing 100053, China
| | - Penghui Song
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; Beijing Key Laboratory of Neuromodulation, Beijing 100053, China; Center of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Beijing 100053, China; Center for sleep and consciousness disorders, Beijing Institute for Brain Disorders, Beijing 100053, China; Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing 100053, China.
| | - Yue Hou
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; Beijing Key Laboratory of Neuromodulation, Beijing 100053, China; Center of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Beijing 100053, China; Center for sleep and consciousness disorders, Beijing Institute for Brain Disorders, Beijing 100053, China; Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing 100053, China; Hebei Hospital of Xuanwu Hospital, Capital Medical University, Shijiazhuang, 050000 China; Neuromedical Technology Innovation Center of Hebei Province, 050000 China
| | - Jianghong Liu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; Beijing Key Laboratory of Neuromodulation, Beijing 100053, China; Center of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Beijing 100053, China; Center for sleep and consciousness disorders, Beijing Institute for Brain Disorders, Beijing 100053, China; Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing 100053, China
| | - Wensi Hao
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; Beijing Key Laboratory of Neuromodulation, Beijing 100053, China; Center of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Beijing 100053, China
| | - Shimin Hu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; Beijing Key Laboratory of Neuromodulation, Beijing 100053, China; Center of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Beijing 100053, China
| | - Xiaona Dai
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; Beijing Key Laboratory of Neuromodulation, Beijing 100053, China; Center of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Beijing 100053, China
| | - Shuqin Zhan
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; Beijing Key Laboratory of Neuromodulation, Beijing 100053, China; Center of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Beijing 100053, China; Center for sleep and consciousness disorders, Beijing Institute for Brain Disorders, Beijing 100053, China; Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing 100053, China
| | - Ning Li
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; Beijing Key Laboratory of Neuromodulation, Beijing 100053, China; Center of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Beijing 100053, China; Center for sleep and consciousness disorders, Beijing Institute for Brain Disorders, Beijing 100053, China; Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing 100053, China
| | - Mao Peng
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; Beijing Key Laboratory of Neuromodulation, Beijing 100053, China; Center of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Beijing 100053, China; Center for sleep and consciousness disorders, Beijing Institute for Brain Disorders, Beijing 100053, China; Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing 100053, China
| | - Hongxing Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; Beijing Key Laboratory of Neuromodulation, Beijing 100053, China; Center of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Beijing 100053, China; Center for sleep and consciousness disorders, Beijing Institute for Brain Disorders, Beijing 100053, China; Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing 100053, China
| | - Hua Lin
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; Beijing Key Laboratory of Neuromodulation, Beijing 100053, China; Center of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Beijing 100053, China; Center for sleep and consciousness disorders, Beijing Institute for Brain Disorders, Beijing 100053, China; Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing 100053, China
| | - Yuping Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; Beijing Key Laboratory of Neuromodulation, Beijing 100053, China; Center of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Beijing 100053, China; Center for sleep and consciousness disorders, Beijing Institute for Brain Disorders, Beijing 100053, China; Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing 100053, China; Hebei Hospital of Xuanwu Hospital, Capital Medical University, Shijiazhuang, 050000 China; Neuromedical Technology Innovation Center of Hebei Province, 050000 China.
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Yan H, Han Y, Shan X, Li H, Liu F, Xie G, Li P, Guo W. Common and exclusive spontaneous neural activity patterns underlying pure generalized anxiety disorder and comorbid generalized anxiety disorder and depression. J Affect Disord 2023; 331:82-91. [PMID: 36958484 DOI: 10.1016/j.jad.2023.03.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/05/2023] [Accepted: 03/16/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND This study aimed to identify common and exclusive neural substrates underlying pure generalized anxiety disorder (GAD, G0) and comorbid GAD and depression (G1), assess whether they could assist in diagnosis and prediction of treatment response, and determine whether comorbid depression in GAD patients would change their neural plasticity. METHODS A longitudinal study was conducted, involving 98 patients (40 in the G0 group and 58 in the G1 group) and 54 healthy controls (HCs). The fractional amplitude of low-frequency fluctuations (fALFF), support vector machine, and support vector regression were employed. RESULTS The shared neural underpinnings across the two subtypes of GAD were hyperactivity in the right cerebellar Crus II and inferior temporal gyrus and hypoactivity in the right postcentral gyrus. The G1 group showed hypoactivity in the frontal gyrus, compared with HCs, and hyperactivity in the middle temporal gyrus, compared with the G0 group or HCs. These alterations could aid in diagnosis and the prediction of treatment response with high accuracy. After treatment, both the G1 and G0 groups showed higher fALFF than those before treatment but were located in different brain regions. LIMITATIONS The study was performed in a single center and subjects showed a fairly homogeneous ethnicity. CONCLUSIONS Common and exclusive neural substrates underlying the two subtypes of GAD were identified, which could assist in diagnosis and the prediction of treatment response. Pharmacotherapy for the two subtypes of GAD recruited different pathways, suggesting that comorbid depression in GAD patients would change their neural plasticity.
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Affiliation(s)
- Haohao Yan
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Yiding Han
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Xiaoxiao Shan
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Huabing Li
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, China
| | - Feng Liu
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Guojun Xie
- Department of Psychiatry, The Third People's Hospital of Foshan, Foshan 528000, Guangdong, China
| | - Ping Li
- Department of Psychiatry, Qiqihar Medical University, Qiqihar, Heilongjiang 161006, China
| | - Wenbin Guo
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China.
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9
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Tran BX, Nguyen TT, Boyer L, Fond G, Auquier P, Nguyen HSA, Tran HTN, Nguyen HM, Choi J, Le HT, Latkin CA, Nathan KI, Husain SF, McIntyre RS, Ho CSH, Zhang MWB, Ho RCM. Differentiating people with schizophrenia from healthy controls in a developing Country: An evaluation of portable functional near infrared spectroscopy (fNIRS) as an adjunct diagnostic tool. Front Psychiatry 2023; 14:1061284. [PMID: 36778640 PMCID: PMC9910791 DOI: 10.3389/fpsyt.2023.1061284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 01/05/2023] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION This study aimed to evaluate portable functional near-infrared spectroscopy (fNIRS) device as an adjunct diagnostic tool in Vietnam to assess hemodynamics when people with schizophrenia and healthy controls performed cognitive tasks. METHODS One hundred fifty-seven participants were divided into schizophrenia (n = 110) and healthy controls group (n = 47), which were recruited by match of age, and gender. Hemodynamic responses in the frontal cortex were monitored with a 48-channel portable device during the Stroop Color-Word Test (SCWT) and Verbal Fluency Test (VFT). General linear model compared the differences in oxyhemoglobin (HbO2) levels between the two groups. The Receiver Operating Characteristic (ROC) graph was generated for each neuroanatomical area. RESULTS People with schizophrenia did not show significant activation in the frontal lobe during the SCWT and VFT as compared to pre-task. During the VFT, the area under the ROC curve of the bilateral dorsolateral prefrontal cortex, bilateral orbitofrontal cortex, bilateral frontopolar prefrontal cortex, and bilateral ventrolateral prefrontal cortex were greater than 0.7 (p < 0.001). The area under the ROC curve (AUC) for the right orbitofrontal cortex was maximal during the VFT (AUC = 0.802, 95%CI = 0.731-0.872). The Youden's index reached a peak (0.57) at the optimal cut-point value (HbO2 cutoff <0.209 μmol/ml for schizophrenia) in which the sensitivity was 85%; specificity was 72%; positive predictive value (PPV) was 0.88; negative predictive value (NPV) was 0.68 and correct classification rate was 76%. DISCUSSION Assessing hemodynamics during VFT by portable fNIRS offers the potential as an adjunct diagnostic tool for schizophrenia in developing countries.
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Affiliation(s)
- Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Tham Thi Nguyen
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Laurent Boyer
- EA 3279, CEReSS, Research Centre on Health Services and Quality of Life, Aix Marseille University, Marseille, France
| | - Guillaume Fond
- EA 3279, CEReSS, Research Centre on Health Services and Quality of Life, Aix Marseille University, Marseille, France
| | - Pascal Auquier
- EA 3279, CEReSS, Research Centre on Health Services and Quality of Life, Aix Marseille University, Marseille, France
| | | | | | | | | | - Huong Thi Le
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Carl A Latkin
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Kalpana Isabel Nathan
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States
| | - Syeda F Husain
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Roger S McIntyre
- Mood Disorder Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Department of Pharmacology, University of Toronto, Toronto, ON, Canada
| | - Cyrus S H Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Melvyn W B Zhang
- Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - Roger C M Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Institute for Health Innovation and Technology, National University of Singapore, Singapore, Singapore
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10
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Yang T, Wang H, Dai H, Hui J, Zhang J, Li J, Cui G, Wang J, Mu J, Zhang Z. The fNIRS evaluation of frontal and temporal lobe cortical activation in Chinese first-episode medication-naïve and recurrent depression during a verbal fluency task. Front Psychiatry 2023; 14:1132666. [PMID: 37113544 PMCID: PMC10126326 DOI: 10.3389/fpsyt.2023.1132666] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 03/27/2023] [Indexed: 04/29/2023] Open
Abstract
Background Functional near-infrared spectroscopy (fNIRS) identifies neurophysiological differences between psychiatric disorders by assessing cortical hemodynamic function. Few trials have studied differences in brain functional activity between first-episode medication-naïve depression patients (FMD) and recurrent major depression (RMD). We aimed to determine the differences between FMD and RMD in oxygenated hemoglobin concentration ([oxy-Hb]), and to investigate the correlation between frontotemporal cortex activation and clinical symptoms. Methods We recruited 40 patients with FMD, 53 with RMD, and 38 healthy controls (HCs) from May 2021 to April 2022. Symptom severity was assessed with the 24-item Hamilton Depression Rating Scale (HAM-D) and the Hamilton Anxiety Rating Scale (HAM-A). A 52-channel fNIRS measured changes in [oxy-Hb] during VFT performance. Results Both patient groups performed poorly during the VFT task compared with HC (FDR p < 0.05), but there was no significant difference between the two patient groups. Analysis of variance showed that mean [oxy-Hb] activation was lower in both the frontal and temporal lobes in the MDD group compared with HCs (FDR p < 0.05). Additionally, patients with RMD had a significantly lower hemodynamic response in the right dorsolateral prefrontal cortex (DLPFC) and dorsal frontal pole cortex (DFPC) than patients with FMD (FDR p < 0.05). No significant correlation was found between changes in mean [oxy-Hb] and either medical history or clinical symptoms (FDR p < 0.05). Conclusion The presence of different neurofunctional activity in some of the same brain regions in FMD and RMD patients implied a link between the level of complexity activation in frontal regions and the stage of MDD. Cognitive impairment may already be present at the beginning of an MDD episode. Clinical trial registration www.chictr.org.cn, identifier ChiCTR2100043432.
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Affiliation(s)
- Ting Yang
- Department of Neurology, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Hongyu Wang
- The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Haiyue Dai
- The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Juan Hui
- The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Jintong Zhang
- Department of Neurology, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Juan Li
- The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
- Henan Key Laboratory of Neurorestoratology, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Guimei Cui
- The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Juan Wang
- The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Junlin Mu
- The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Zhaohui Zhang
- Department of Neurology, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
- Henan Key Laboratory of Neurorestoratology, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
- *Correspondence: Zhaohui Zhang,
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11
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Xu Y, Wang Y, Hu N, Yang L, Yu Z, Han L, Xu Q, Zhou J, Chen J, Mao H, Pan Y. Intrinsic Organization of Occipital Hubs Predicts Depression: A Resting-State fNIRS Study. Brain Sci 2022; 12:brainsci12111562. [PMID: 36421888 PMCID: PMC9688420 DOI: 10.3390/brainsci12111562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/11/2022] [Accepted: 11/15/2022] [Indexed: 11/19/2022] Open
Abstract
Dysfunctional brain networks have been found in patients with major depressive disorder (MDD). In this study, to verify this in a more straightforward way, we investigated the intrinsic organization of brain networks in MDD by leveraging the resting-state functional near-infrared spectroscopy (rs-fNIRS). Thirty-four MDD patients (24 females, 38.41 ± 13.14 years old) and thirty healthy controls (22 females, 34.43 ± 5.03 years old) underwent a 10 min rest while their brain activity was recorded via fNIRS. The results showed that MDD patients and healthy controls exhibited similar resting-state functional connectivity. Moreover, the depression group showed lower small-world Lambda (1.12 ± 0.04 vs. 1.16 ± 0.10, p = 0.04) but higher global efficiency (0.51 ± 0.03 vs. 0.48 ± 0.05, p = 0.03) than the control group. Importantly, MDD patients, as opposed to healthy controls, showed a significantly lower nodal local efficiency at the left middle occipital gyrus (0.56 ± 0.36 vs. 0.81 ± 0.20, pFDR < 0.05), which predicted the level of depression in MDD (r = 0.45, p = 0.01, R2 = 0.15). In sum, we found a more integrated brain network in MDD patients with a lower nodal local efficiency at the occipital hub, which could predict depressive symptoms.
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Affiliation(s)
- You Xu
- Department of Sleep Medicine, Affiliated Mental Health Center & Hangzhou Seventh People’s Hospital, Zhejiang University School of Medicine, Tianmushan Road 305, Hangzhou 310013, China
| | - Yajie Wang
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou 310058, China
| | - Nannan Hu
- Department of Psychiatry, Affiliated Mental Health Center & Hangzhou Seventh People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310013, China
| | - Lili Yang
- Department of Sleep Medicine, Affiliated Mental Health Center & Hangzhou Seventh People’s Hospital, Zhejiang University School of Medicine, Tianmushan Road 305, Hangzhou 310013, China
| | - Zhenghe Yu
- Department of Sleep Medicine, Affiliated Mental Health Center & Hangzhou Seventh People’s Hospital, Zhejiang University School of Medicine, Tianmushan Road 305, Hangzhou 310013, China
| | - Li Han
- Department of Sleep Medicine, Affiliated Mental Health Center & Hangzhou Seventh People’s Hospital, Zhejiang University School of Medicine, Tianmushan Road 305, Hangzhou 310013, China
| | - Qianqian Xu
- Department of Sleep Medicine, Affiliated Mental Health Center & Hangzhou Seventh People’s Hospital, Zhejiang University School of Medicine, Tianmushan Road 305, Hangzhou 310013, China
| | - Jingjing Zhou
- Department of Sleep Medicine, Affiliated Mental Health Center & Hangzhou Seventh People’s Hospital, Zhejiang University School of Medicine, Tianmushan Road 305, Hangzhou 310013, China
| | - Ji Chen
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou 310058, China
| | - Hongjing Mao
- Department of Sleep Medicine, Affiliated Mental Health Center & Hangzhou Seventh People’s Hospital, Zhejiang University School of Medicine, Tianmushan Road 305, Hangzhou 310013, China
- Correspondence: (H.M.); (Y.P.)
| | - Yafeng Pan
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou 310058, China
- Correspondence: (H.M.); (Y.P.)
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12
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Zhang Y, Lei L, Liu Z, Gao M, Liu Z, Sun N, Yang C, Zhang A, Wang Y, Zhang K. Theta oscillations: A rhythm difference comparison between major depressive disorder and anxiety disorder. Front Psychiatry 2022; 13:827536. [PMID: 35990051 PMCID: PMC9381950 DOI: 10.3389/fpsyt.2022.827536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 06/10/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Due to substantial comorbidities of major depressive disorder (MDD) and anxiety disorder (AN), these two disorders must be distinguished. Accurate identification and diagnosis facilitate effective and prompt treatment. EEG biomarkers are a potential research hotspot for neuropsychiatric diseases. The purpose of this study was to investigate the differences in EEG power spectrum at theta oscillations between patients with MDD and patients with AN. METHODS Spectral analysis was used to study 66 patients with MDD and 43 patients with AN. Participants wore 16-lead EEG caps to measure resting EEG signals. The EEG power spectrum was measured using the fast Fourier transform. Independent samples t-test was used to analyze the EEG power values of the two groups, and p < 0.05 was statistically significant. RESULTS EEG power spectrum of the MDD group significantly differed from the AN group in the theta oscillation on 4-7 Hz at eight electrode points at F3, O2, T3, P3, P4, FP1, FP2, and F8. CONCLUSION Participants with anxiety demonstrated reduced power in the prefrontal cortex, left temporal lobe, and right occipital regions. Confirmed by further studies, theta oscillations could be another biomarker that distinguishes MDD from AN.
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Affiliation(s)
- Yu Zhang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China.,Laboratory of Artificial Intelligence Assisted Diagnosis and Treatment for Mental Disorder, First Hospital of Shanxi Medical University, Taiyuan, China.,Department of Mental Health, Shanxi Medical University, Taiyuan, China
| | - Lei Lei
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Ziwei Liu
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China.,Laboratory of Artificial Intelligence Assisted Diagnosis and Treatment for Mental Disorder, First Hospital of Shanxi Medical University, Taiyuan, China.,Department of Mental Health, Shanxi Medical University, Taiyuan, China
| | - Mingxue Gao
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China.,Laboratory of Artificial Intelligence Assisted Diagnosis and Treatment for Mental Disorder, First Hospital of Shanxi Medical University, Taiyuan, China.,Department of Mental Health, Shanxi Medical University, Taiyuan, China
| | - Zhifen Liu
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China.,Laboratory of Artificial Intelligence Assisted Diagnosis and Treatment for Mental Disorder, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Ning Sun
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China.,Laboratory of Artificial Intelligence Assisted Diagnosis and Treatment for Mental Disorder, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Chunxia Yang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China.,Laboratory of Artificial Intelligence Assisted Diagnosis and Treatment for Mental Disorder, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Aixia Zhang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China.,Laboratory of Artificial Intelligence Assisted Diagnosis and Treatment for Mental Disorder, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Yikun Wang
- Laboratory of Artificial Intelligence Assisted Diagnosis and Treatment for Mental Disorder, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Kerang Zhang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China.,Laboratory of Artificial Intelligence Assisted Diagnosis and Treatment for Mental Disorder, First Hospital of Shanxi Medical University, Taiyuan, China
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13
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Ren Y, Cui G, Zhang X, Feng K, Yu C, Liu P. The promising fNIRS: Uncovering the function of prefrontal working memory networks based on multi-cognitive tasks. Front Psychiatry 2022; 13:985076. [PMID: 36386968 PMCID: PMC9640951 DOI: 10.3389/fpsyt.2022.985076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 10/04/2022] [Indexed: 11/13/2022] Open
Abstract
The diversity of cognitive task paradigms using functional near-infrared spectroscopy (fNIRS) and the lack of theoretical explanations for these functional imaging atlases have greatly hindered the application of fNIRS in psychiatry. The fNIRS brain imaging based on multiple cognitive tasks could generally reflect the working patterns and neurovascular coupling changes in the prefrontal working memory network. By alternating the stimulation patterns of resting and task states, six typical symptom-related functional brain imaging waveforms related to psychiatric disorders are identified and three joint networks of the prefrontal working memory, namely, the attentional working memory primary coordination network, the perceptual content working memory secondary network, and the emotional-behavioral working memory executive network, are initially represented. This is the first attempt to characterize the cognitive, emotional, and behavioral regulation of the prefrontal working memory network using fNIRS, which may promote the application of fNIRS in clinical settings.
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Affiliation(s)
- Yufei Ren
- Department of Foreign Languages and Literatures, Tsinghua University, Beijing, China
| | - Gang Cui
- Department of Foreign Languages and Literatures, Tsinghua University, Beijing, China
| | - Xiaoqian Zhang
- Department of Psychiatry, Yuquan Hospital, Tsinghua University, Beijing, China
| | - Kun Feng
- Department of Psychiatry, Yuquan Hospital, Tsinghua University, Beijing, China
| | | | - Pozi Liu
- Department of Psychiatry, Yuquan Hospital, Tsinghua University, Beijing, China.,School of Clinical Medicine, Tsinghua University, Beijing, China
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