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Liu Q, Ely BA, Stern ER, Xu J, Kim JW, Pick DG, Alonso CM, Gabbay V. Neural function underlying reward expectancy and attainment in adolescents with diverse psychiatric symptoms. Neuroimage Clin 2022; 36:103258. [PMID: 36451362 PMCID: PMC9668660 DOI: 10.1016/j.nicl.2022.103258] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 10/31/2022] [Accepted: 11/02/2022] [Indexed: 11/08/2022]
Abstract
Reward dysfunction has been hypothesized to play a key role in the development of psychiatric conditions during adolescence. To help capture the complexity of reward function in youth, we used the Reward Flanker fMRI Task, which enabled us to examine neural activity during expectancy and attainment of both certain and uncertain rewards. Participants were 84 psychotropic-medication-free adolescents, including 67 with diverse psychiatric conditions and 17 healthy controls. Functional MRI used high-resolution acquisition and high-fidelity processing techniques modeled after the Human Connectome Project. Analyses examined neural activation during reward expectancy and attainment, and their associations with clinical measures of depression, anxiety, and anhedonia severity, with results controlled for family-wise errors using non-parametric permutation tests. As anticipated, reward expectancy activated regions within the fronto-striatal reward network, thalamus, occipital lobe, superior parietal lobule, temporoparietal junction, and cerebellum. Unexpectedly, however, reward attainment was marked by widespread deactivation in many of these same regions, which we further explored using cosine similarity analysis. Across all subjects, striatum and thalamus activation during reward expectancy negatively correlated with anxiety severity, while activation in numerous cortical and subcortical regions during reward attainment positively correlated with both anxiety and depression severity. These findings highlight the complexity and dynamic nature of neural reward processing in youth.
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Affiliation(s)
- Qi Liu
- Department of Psychiatry & Behavioral Science, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Benjamin A. Ely
- Department of Psychiatry & Behavioral Science, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Emily R. Stern
- Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, United States,Department of Psychiatry, New York University School of Medicine, New York, NY, United States
| | - Junqian Xu
- Departments of Radiology and Psychiatry, Baylor College of Medicine, Houston, TX, United States
| | - Joo-won Kim
- Departments of Radiology and Psychiatry, Baylor College of Medicine, Houston, TX, United States
| | - Danielle G. Pick
- Department of Psychiatry & Behavioral Science, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Carmen M. Alonso
- Department of Psychiatry & Behavioral Science, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Vilma Gabbay
- Department of Psychiatry & Behavioral Science, Albert Einstein College of Medicine, Bronx, NY, United States,Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, United States,Corresponding author at: Department of Psychiatry & Behavioral Science, Albert Einstein College of Medicine, Van Etten Building, 4A-44, 1300 Morris Park Avenue, The Bronx, NY 10461, United States.
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Liu Q, Ely BA, Simkovic S, Alonso CM, Gabbay V. Lack of Associations Between C-Reactive Protein and Mood and Anxiety Symptoms in Adolescents. J Child Adolesc Psychopharmacol 2021; 31:404-410. [PMID: 34166062 PMCID: PMC8403190 DOI: 10.1089/cap.2020.0201] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Indexed: 12/22/2022]
Abstract
Introduction: Increased peripheral inflammation has been consistently documented in both adult and pediatric depression. However, elevated levels of C-reactive protein (CRP), a nonspecific biomarker for inflammation, have been primarily reported in adults; whether CRP plays a similar role in adolescent depression has not been conclusively established. In our prior work, we identified relationships between CRP and reward neurocircuitry in adolescents with psychiatric symptoms (N = 64) but not with depressive symptoms. Extending this work, we sought to examine CRP across the full range of mood and anxiety symptom severity in a larger, clinically diverse cohort of psychotropic medication-free adolescents and healthy controls (HCs). Methods: Subjects were adolescents (N = 127, age: 15.17 ± 2.19 years, 78 female) with psychiatric symptoms (n = 96, including previous cohort of 64) and HC (n = 31). All completed a semi-structured psychiatric evaluation and dimensional assessments for depression, anxiety, anhedonia, and suicidality. Group-comparison and correlation analyses utilized nonparametric statistics controlled for body mass index, sex, and age at pFWE < 0.05. Results: No group differences were identified in CRP levels between the clinical cohort and HCs. In addition, correlations between CRP and clinical symptomatology were not significant in either the whole sample or the psychiatric group. Conclusions: We found that, unlike in adults, CRP was not associated with depressive symptoms. This suggests that inflammation in pediatric depression is more narrowly delimited at the onset of psychiatric symptoms and may only become systemic with chronicity.
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Affiliation(s)
- Qi Liu
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Benjamin A. Ely
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Sherry Simkovic
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Carmen M. Alonso
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Vilma Gabbay
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, New York, USA.,Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York, USA.,Address correspondence to: Vilma Gabbay, MD, MS, Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461, USA
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Ely BA, Liu Q, DeWitt SJ, Mehra LM, Alonso CM, Gabbay V. Data-driven parcellation and graph theory analyses to study adolescent mood and anxiety symptoms. Transl Psychiatry 2021; 11:266. [PMID: 33941762 PMCID: PMC8093238 DOI: 10.1038/s41398-021-01321-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 12/31/2020] [Accepted: 02/01/2021] [Indexed: 02/03/2023] Open
Abstract
Adolescence is a period of rapid brain development when psychiatric symptoms often first emerge. Studying adolescents may therefore facilitate the identification of neural alterations early in the course of psychiatric conditions. Here, we sought to utilize new, high-quality brain parcellations and data-driven graph theory approaches to characterize associations between resting-state networks and the severity of depression, anxiety, and anhedonia symptoms-salient features across psychiatric conditions. As reward circuitry matures considerably during adolescence, we examined both Whole Brain and three task-derived reward networks. Subjects were 87 psychotropic-medication-free adolescents (age = 12-20) with diverse psychiatric conditions (n = 68) and healthy controls (n = 19). All completed diagnostic interviews, dimensional clinical assessments, and 3T resting-state fMRI (10 min/2.3 mm/TR = 1 s). Following high-quality Human Connectome Project-style preprocessing, multimodal surface matching (MSMAll) alignment, and parcellation via the Cole-Anticevic Brain-wide Network Partition, weighted graph theoretical metrics (Strength Centrality = CStr; Eigenvector Centrality = CEig; Local Efficiency = ELoc) were estimated within each network. Associations with symptom severity and clinical status were assessed non-parametrically (two-tailed pFWE < 0.05). Across subjects, depression scores correlated with ventral striatum CStr within the Reward Attainment network, while anticipatory anhedonia correlated with CStr and ELoc in the subgenual anterior cingulate, dorsal anterior cingulate, orbitofrontal cortex, caudate, and ventral striatum across multiple networks. Group differences and associations with anxiety were not detected. Using detailed functional and clinical measures, we found that adolescent depression and anhedonia involve increased influence and communication efficiency in prefrontal and limbic reward areas. Resting-state network properties thus reflect positive valence system anomalies related to discrete reward sub-systems and processing phases early in the course of illness.
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Affiliation(s)
- Benjamin A. Ely
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY USA
| | - Qi Liu
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY USA
| | - Samuel J. DeWitt
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Lushna M. Mehra
- Department of Psychology, Florida State University, Tallahassee, FL USA
| | - Carmen M. Alonso
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY USA
| | - Vilma Gabbay
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, USA. .,Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, USA.
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Liu Q, Ely BA, Schwartz JJ, Alonso CM, Stern ER, Gabbay V. Reward function as an outcome predictor in youth with mood and anxiety symptoms. J Affect Disord 2021; 278:433-442. [PMID: 33010568 PMCID: PMC7704618 DOI: 10.1016/j.jad.2020.09.074] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 03/12/2020] [Revised: 06/14/2020] [Accepted: 09/15/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Adolescent depression varies considerably in its course. However, there remain no biobehavioral predictors of illness trajectory, and follow-up studies in depressed youth are sparse. Here, we sought to examine whether reward function would predict future clinical outcomes in adolescents with depressive symptoms. We utilized the reward flanker fMRI task to assess brain function during distinct reward processes of anticipation, attainment, and positive prediction error (PPE, i.e. receiving uncertain rewards). METHODS Subjects were 29 psychotropic-medication-free adolescents with mood and anxiety symptoms and 14 healthy controls (HC). All had psychiatric evaluations at baseline and approximately 24-month follow-up. Thirty-two participants (10 HC) had usable fMRI data. Correlation and hierarchical regression models examined baseline symptom severity measures as predictors of follow-up clinical outcomes. Whole-brain analyses examined relationships between neural reward processes and follow-up outcomes. RESULTS Clinically, anhedonia, but not irritability, predicted future depression and suicidal ideation. Among reward processes, only baseline neural activation during PPE correlated with follow-up depression and anhedonia severity. Specifically, activation in the left angular gyrus-a component of the default mode network-was associated with future depression, while activation in the dorsal anterior cingulate, operculum, and left insula-key salience and pain network regions-was associated with future anhedonia, even when controlling for baseline anhedonia. LIMITATIONS The small sample size and variable follow-up intervals limit the generalizability of conclusions. CONCLUSIONS This research suggests that reward dysfunction, indexed by anhedonia, may predict worse clinical trajectories in depressed youth. Adolescents presenting with significant anhedonia should be carefully monitored for illness progression.
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Affiliation(s)
- Qi Liu
- Department of Psychiatry and Behavioral Science, Albert Einstein College of Medicine, Bronx, NY
| | - Benjamin A. Ely
- Department of Psychiatry and Behavioral Science, Albert Einstein College of Medicine, Bronx, NY
| | - Joshua J. Schwartz
- Department of Psychiatry and Behavioral Science, Albert Einstein College of Medicine, Bronx, NY
| | - Carmen M. Alonso
- Department of Psychiatry and Behavioral Science, Albert Einstein College of Medicine, Bronx, NY
| | - Emily R. Stern
- Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY,New York University School of Medicine, New York, NY
| | - Vilma Gabbay
- Department of Psychiatry and Behavioral Science, Albert Einstein College of Medicine, Bronx, NY, United States; Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, United States.
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Liu Q, Ely BA, Simkovic SJ, Tao A, Wolchok R, Alonso CM, Gabbay V. Correlates of C-reactive protein with neural reward circuitry in adolescents with psychiatric symptoms. Brain Behav Immun Health 2020; 9:100153. [PMID: 33381770 PMCID: PMC7771888 DOI: 10.1016/j.bbih.2020.100153] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 09/27/2020] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Increased inflammation has been implicated in many psychiatric conditions across ages. We previously reported relationships between blood cytokine levels and anhedonia, the decreased capacity to experience pleasure, as well as with reward brain activation in adolescents with psychiatric symptoms. Here, we sought to extend this work in a larger cohort of adolescents with psychiatric symptoms and assess the relationships of C-Reactive Protein (CRP, inflammation biomarker) with clinical symptoms and reward-related brain activation. METHODS Subjects were 64 psychotropic-medication-free adolescents with psychiatric symptoms (ages: 15.17 ± 2.10, 44 female). All had psychiatric evaluations and dimensional assessments for anxiety, depression, anhedonia, and suicidality. Neuroimaging included the Reward Flanker fMRI Task examining brain activation during reward anticipation, attainment and positive prediction error. Both whole-brain and ROI analyses focusing on reward circuitry were performed. All analyses were controlled for BMI, age, and sex at pFWE < 0.05. RESULTS No relationships were identified between CRP and clinical symptom severity. CRP was positively associated with brain activation during reward attainment in regions of the visual and dorsal attention networks, as well as during positive prediction error in the cerebellum. In ROI analyses, CRP was negatively correlated with brain activation during reward anticipation in dorsal anterior cingulate cortex. When subject with high CRP was excluded, CRP was also positively correlated with positive predication error activation in nucleus accumbens. CONCLUSION Despite lack of associations of CRP with clinical symptomatology, our fMRI findings suggest a relationship between inflammation and brain function early course of psychiatric conditions.
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Affiliation(s)
- Qi Liu
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Benjamin A. Ely
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Sherry J. Simkovic
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Annie Tao
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rachel Wolchok
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Carmen M. Alonso
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Vilma Gabbay
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, USA
- Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, USA
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Alonso CM, Llop M, Sargas C, Pedrola L, Panadero J, Hervás D, Cervera J, Such E, Ibáñez M, Ayala R, Martínez-López J, Onecha E, de Juan I, Palanca S, Martínez-Cuadrón D, Rodríguez-Veiga R, Boluda B, Montesinos P, Sanz G, Sanz MA, Barragán E. Clinical Utility of a Next-Generation Sequencing Panel for Acute Myeloid Leukemia Diagnostics. J Mol Diagn 2019; 21:228-240. [DOI: 10.1016/j.jmoldx.2018.09.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 09/06/2018] [Accepted: 09/20/2018] [Indexed: 10/27/2022] Open
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Freed RD, Mehra LM, Laor D, Patel M, Alonso CM, Kim-Schulze S, Gabbay V. Anhedonia as a clinical correlate of inflammation in adolescents across psychiatric conditions. World J Biol Psychiatry 2018; 20:712-722. [PMID: 29843560 PMCID: PMC6377856 DOI: 10.1080/15622975.2018.1482000] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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] [Indexed: 01/18/2023]
Abstract
Objectives: Peripheral inflammation has been associated with multiple psychiatric disorders, particularly with depression. However, findings remain inconsistent and unreproducible, most likely due to the disorder's heterogeneity in phenotypic presentation. Therefore, in the present study, in an effort to account for inter-individual differences in symptom severity, we utilised a dimensional approach to assess the relationships between a broad panel of inflammatory cytokines and key psychiatric symptoms (i.e. depression, anhedonia, anxiety, fatigue and suicidality) in adolescents across psychiatric disorders. We hypothesised that only anhedonia (reflecting deficits of reward function) will be associated with inflammation.Methods: Participants were 54 psychotropic medication-free adolescents with diverse psychiatric conditions and 22 healthy control (HC) adolescents, aged 12-20. We measured 41 cytokines after in vitro lipopolysaccharide stimulation. Mann-Whitney U and Spearman correlation tests examined group comparison and associations, respectively, while accounting for multiple comparisons and confounds, including depression severity adolescent.Results: There were no group differences in cytokine levels. However, as hypothesised, within the psychiatric group, only anhedonia was associated with 19 cytokines, including haematopoietic growth factors, chemokines, pro-inflammatory cytokines, and anti-inflammatory cytokines.Conclusions: Our findings suggest that general inflammation may induce reward dysfunction, which plays a salient role across psychiatric conditions, rather than be specific to one categorical psychiatric disorder.
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Affiliation(s)
- Rachel D. Freed
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY
| | - Lushna M. Mehra
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY
| | - Daniel Laor
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY
| | - Manishkumar Patel
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY
| | - Carmen M. Alonso
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY
| | | | - Vilma Gabbay
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY,Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Rd, Orangeburg, NY
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Gabbay V, Freed RD, Alonso CM, Senger S, Stadterman J, Davison BA, Klein RG. A Double-Blind Placebo-Controlled Trial of Omega-3 Fatty Acids as a Monotherapy for Adolescent Depression. J Clin Psychiatry 2018; 79:17m11596. [PMID: 29985566 PMCID: PMC6625364 DOI: 10.4088/jcp.17m11596] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 11/13/2017] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Reports are mixed on the efficacy of omega-3 fatty acids (O3FA) for the treatment of major depressive disorder (MDD), with only limited data in adolescents. The present trial aimed to investigate systematically the efficacy of O3FA as a monotherapy, compared to a placebo, in adolescents with MDD. Secondarily, we explored O3FA effects on anhedonia, irritability, and suicidality-all key features of adolescent MDD. METHODS Fifty-one psychotropic medication-free adolescents with DSM-IV-TR diagnoses of MDD (aged 12-19 years; 57% female) were randomized to receive O3FA or a placebo for 10 weeks. Data were collected between January 2006 and June 2013. O3FA and a placebo were administered on a fixed-flexible dose titration schedule based on clinical response and side effects. The initial dose of 1.2 g/d was increased 0.6 g/d every 2 weeks, up to a maximum of 3.6 g/d. Clinician-rated and self-rated depression severity, along with treatment response, served as primary outcome measures. Additionally, we examined O3FA effects on depression-related symptoms, including anhedonia, irritability, and suicidality. Treatment differences were analyzed via intent-to-treat analyses. RESULTS O3FA were not superior to a placebo on any clinical feature, including depression severity and levels of anhedonia, irritability, or suicidality. Additionally, response rates were comparable between treatment groups. Within-treatment analyses indicated that both treatments were associated with significant improvement in depression severity on self- (O3FA: t = -4.38, P < .001; placebo: t = -3.52, P = .002) and clinician (O3FA: t = -6.47, P < .001; placebo: t = -8.10, P < .001) ratings. CONCLUSIONS In adolescents with MDD, O3FA do not appear to be superior to placebo. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT00962598.
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Affiliation(s)
- Vilma Gabbay
- Pediatric Mood and Anxiety Disorders Program, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029. .,Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York, USA
| | | | | | | | | | | | - Rachel G. Klein
- New York University Langone Medical Center, New York, New York
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Bradley KAL, Colcombe S, Henderson SE, Alonso CM, Milham MP, Gabbay V. Neural correlates of self-perceptions in adolescents with major depressive disorder. Dev Cogn Neurosci 2016; 19:87-97. [PMID: 26943454 PMCID: PMC4912932 DOI: 10.1016/j.dcn.2016.02.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [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: 07/08/2015] [Revised: 01/08/2016] [Accepted: 02/17/2016] [Indexed: 12/11/2022] Open
Abstract
Alteration in self-perception is a salient feature in major depression. Hyperactivity of anterior cortical midline regions has been implicated in this phenomenon in depressed adults. Here, we extend this work to depressed adolescents during a developmental time when neuronal circuitry underlying the sense of self matures by using task-based functional magnetic resonance imaging (fMRI) and connectivity analyses. Twenty-three depressed adolescents and 18 healthy controls (HC) viewed positive and negative trait words in a scanner and judged whether each word described them ('self' condition) or was a good trait to have ('general' condition). Self-perception scores were based on participants' endorsements of positive and negative traits during the fMRI task. Depressed adolescents exhibited more negative self-perceptions than HC. Both groups activated cortical midline regions in response to self-judgments compared to general-judgments. However, depressed adolescents recruited the posterior cingulate cortex/precuneus more for positive self-judgments. Additionally, local connectivity of the dorsal medial prefrontal cortex was reduced during self-reflection in depressed adolescents. Our findings highlight differences in self-referential processing network function between depressed and healthy adolescents and support the need for further investigation of brain mechanisms associated with the self, as they may be paramount to understanding the etiology and development of major depressive disorder.
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Affiliation(s)
- Kailyn A L Bradley
- Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029-6574, United States
| | - Stan Colcombe
- Nathan Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY 10962, United States
| | - Sarah E Henderson
- Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029-6574, United States
| | - Carmen M Alonso
- Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029-6574, United States
| | - Michael P Milham
- Nathan Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY 10962, United States; Center for the Developing Brain, Child Mind Institute, 445 Park Avenue, New York, NY 10022, United States
| | - Vilma Gabbay
- Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029-6574, United States; Nathan Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY 10962, United States.
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Bradley KAL, Case JAC, Khan O, Ricart T, Hanna A, Alonso CM, Gabbay V. The role of the kynurenine pathway in suicidality in adolescent major depressive disorder. Psychiatry Res 2015; 227:206-12. [PMID: 25865484 PMCID: PMC4430385 DOI: 10.1016/j.psychres.2015.03.031] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [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: 11/17/2014] [Revised: 03/06/2015] [Accepted: 03/08/2015] [Indexed: 11/25/2022]
Abstract
The neuroimmunological kynurenine pathway (KP) has been implicated in major depressive disorder (MDD) in adults and adolescents, most recently in suicidality in adults. The KP is initiated by the enzyme indoleamine 2,3-dioxygenase (IDO), which degrades tryptophan (TRP) into kynurenine (KYN) en route to neurotoxins. Here, we examined the KP in 20 suicidal depressed adolescents-composed of past attempters and those who expressed active suicidal intent-30 non-suicidal depressed youth, and 22 healthy controls (HC). Plasma levels of TRP, KYN, 3-hydroxyanthranilic acid (3-HAA), and KYN/TRP (index of IDO) were assessed. Suicidal adolescents showed decreased TRP and elevated KYN/TRP compared to both non-suicidal depressed adolescents and HC. Findings became more significantly pronounced when excluding medicated participants, wherein there was also a significant positive correlation between KYN/TRP and suicidality. Finally, although depressed adolescents with a history of suicide attempt differed from acutely suicidal adolescents with respect to disease severity, anhedonia, and suicidality, the groups did not differ in KP measures. Our findings suggest a possible specific role of the KP in suicidality in depressed adolescents, while illustrating the clinical phenomenon that depressed adolescents with a history of suicide attempt are similar to acutely suicidal youth and are at increased risk for completion of suicide.
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Affiliation(s)
- Kailyn A. L. Bradley
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY, 10029, USA
| | - Julia A. C. Case
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY, 10029, USA
| | - Omar Khan
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, USA.
| | - Thomas Ricart
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, USA.
| | - Amira Hanna
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, USA.
| | - Carmen M. Alonso
- NYU Child Study Center, Child and Adolescent Psychiatry, New York University School of Medicine, One Park Ave. 10th Floor, New York, NY, 10016, USA
| | - Vilma Gabbay
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, USA; Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Rd, Orangeburg, NY 10962, USA; Department of Neuroscience, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, USA.
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Gabbay V, Johnson AR, Alonso CM, Evans LK, Babb JS, Klein RG. Anhedonia, but not irritability, is associated with illness severity outcomes in adolescent major depression. J Child Adolesc Psychopharmacol 2015; 25:194-200. [PMID: 25802984 PMCID: PMC4403015 DOI: 10.1089/cap.2014.0105] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Unlike adult major depressive disorder (MDD) which requires anhedonia or depressed mood for diagnosis, adolescent MDD can be sufficiently diagnosed with irritability in the absence of the former symptoms. In addition, the current Diagnostic and Statistical Manual of Mental Disorders (DSM) schema does not account for the interindividual variability of symptom severity among depressed adolescents. This practice has contributed to the high heterogeneity and diagnostic complexity of adolescent MDD. Here, we sought to examine relationships between two core symptoms of adolescent MDD - irritability and anhedonia, assessed both quantitatively and categorically - and other clinical correlates among depressed adolescents. METHODS Ninety adolescents with MDD (51 females), ages 12-20, were enrolled. Anhedonia and irritability scores were quantified by summing related items on the Children's Depression Rating Scale-Revised and the Beck Depression Inventory. Extremes of score distribution were defined as high or low irritability/anhedonia subgroups. A significance level of p=0.01 was set to adjust for the five comparisons. RESULTS Despite all subjects exhibiting moderate to severe MDD, both irritability and anhedonia scores manifested a full and normally distributed severity range including the lowest values possible. However, only anhedonia severity was associated with more severe clinical outcomes, including greater overall illness severity (p<0.001), suicidality scores (p<0.001), episode duration (p=0.006), and number of MDD episodes (p=0.01). Similarly, only the high-anhedonia subgroup manifested more severe outcomes; specifically, greater illness severity (p<0.0001), number of MDD episodes (p=0.01), episode duration (p=0.01), and suicidality scores (p=0.0001). CONCLUSIONS Our findings suggest the significance of anhedonia as a hallmark of adolescent MDD and the need to incorporate dimensional analyses. These data are preliminary, and future prospective studies are needed to better characterize the syndrome of adolescent MDD.
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Affiliation(s)
- Vilma Gabbay
- Icahn School of Medicine at Mount Sinai, New York, New York.,Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York
| | - Amy R. Johnson
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Lori K. Evans
- New York University Langone Medical Center, New York, New York
| | - James S. Babb
- New York University Langone Medical Center, New York, New York
| | - Rachel G. Klein
- New York University Langone Medical Center, New York, New York
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Montesinos P, Rodríguez-Veiga R, Martínez-Cuadrón D, Boluda B, Navarro I, Vera B, Alonso CM, Sanz J, López-Chulia F, Martín G, Jannone R, Sanz G, Lancharro A, Cano I, Palau J, Lorenzo I, Jarque I, Salavert M, Ramírez P, Sanz MÁ. Treatment of invasive fungal disease using anidulafungin alone or in combination for hematologic patients with concomitant hepatic or renal impairment. Rev Iberoam Micol 2015; 32:185-9. [PMID: 25858598 DOI: 10.1016/j.riam.2014.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 07/16/2014] [Accepted: 10/21/2014] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Invasive fungal disease (IFD) treatment is challenging in hematologic patients due to drug interactions and toxicities that limit the use of the antifungal agents. AIMS To analyze retrospectively in terms of safety and potential efficacy anidulafungin therapy, alone or in combination. METHODS Our institutional guidelines recommended anidulafungin treatment in hematologic patients with suspected IFD and concomitant renal or liver impairment (to avoid drug interactions and preserve organ function). RESULTS From 2008 to 2013, 24 episodes of IFD occurring in 21 patients were classified as proven (4 cases), probable (15 cases) and possible (5 cases). Anidulafungin was administered alone (13%) or in combination (88%). Eight (33%) episodes were resolved, using monotherapy (1 out of 3, 33%) or a combined therapy (7 out of 21, 33%). Twelve cases (50%) were registered as failure (death due to IFD progression in 4 patients, and treatment change due to lack of efficacy in 8), and 4 cases (17%) were not evaluable (death unrelated to the IFD). Anidulafungin was not withdrawn in any case due to toxicity. CONCLUSIONS Anidulafungin therapy, alone or in combination, could be considered in hematologic patients with IFD and concomitant liver or renal impairment. Due to the low number of patients, we cannot draw any conclusion about efficacy.
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Affiliation(s)
- Pau Montesinos
- Hematology Department of the Hospital Universitario La Fe, Valencia, Spain.
| | | | | | - Blanca Boluda
- Hematology Department of the Hospital Universitario La Fe, Valencia, Spain
| | - Inés Navarro
- Hematology Department of the Hospital Universitario La Fe, Valencia, Spain
| | - Belen Vera
- Hematology Department of the Hospital Universitario La Fe, Valencia, Spain
| | - Carmen M Alonso
- Hematology Department of the Hospital Universitario La Fe, Valencia, Spain
| | - Jaime Sanz
- Hematology Department of the Hospital Universitario La Fe, Valencia, Spain
| | | | - Guillermo Martín
- Hematology Department of the Hospital Universitario La Fe, Valencia, Spain
| | - Rosa Jannone
- Intensive Care Unit Department of the Hospital Universitario La Fe, Valencia, Spain
| | - Guillermo Sanz
- Hematology Department of the Hospital Universitario La Fe, Valencia, Spain
| | - Aima Lancharro
- Hematology Department of the Hospital Universitario La Fe, Valencia, Spain
| | - Isabel Cano
- Hematology Department of the Hospital Universitario La Fe, Valencia, Spain
| | - Javier Palau
- Hematology Department of the Hospital Universitario La Fe, Valencia, Spain
| | - Ignacio Lorenzo
- Hematology Department of the Hospital Universitario La Fe, Valencia, Spain
| | - Isidro Jarque
- Hematology Department of the Hospital Universitario La Fe, Valencia, Spain
| | - Miguel Salavert
- Infectious Diseases Unit of the Hospital Universitario La Fe, Valencia, Spain
| | - Paula Ramírez
- Intensive Care Unit Department of the Hospital Universitario La Fe, Valencia, Spain
| | - Miguel Ángel Sanz
- Hematology Department of the Hospital Universitario La Fe, Valencia, Spain
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13
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Gabbay V, Ely BA, Li Q, Bangaru SD, Panzer AM, Alonso CM, Castellanos FX, Milham MP. Striatum-based circuitry of adolescent depression and anhedonia. J Am Acad Child Adolesc Psychiatry 2013; 52:628-41.e13. [PMID: 23702452 PMCID: PMC3762469 DOI: 10.1016/j.jaac.2013.04.003] [Citation(s) in RCA: 153] [Impact Index Per Article: 13.9] [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: 12/07/2012] [Revised: 02/19/2013] [Accepted: 04/01/2013] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Striatum-based circuits have been implicated in both major depressive disorder (MDD) and anhedonia, a symptom that reflects deficits of reward processing. Yet adolescents with MDD often exhibit a wide range of anhedonia severity. Addressing this clinical phenomenon, we aimed to use intrinsic functional connectivity (iFC) to study striatum-based circuitry in relation to categorical diagnosis of MDD and anhedonia severity. METHOD A total of 21 psychotropic medication-free adolescents with MDD and 21 healthy controls (HC), group-matched for age and sex, underwent resting-state functional magnetic resonance imagining (fMRI) scans. Voxelwise maps indicating correlation strengths of spontaneous blood-oxygenation-level-dependent (BOLD) signals among 6 bilateral striatal seeds (dorsal caudate, ventral caudate, nucleus accumbens, dorsal-rostral putamen, dorsal-caudal putamen, ventral-rostral putamen) and the remaining brain regions were compared between groups. Relationships between striatal iFC and severity of MDD and anhedonia were examined in the MDD group. Analyses were corrected for multiple comparisons. RESULTS Adolescents with MDD manifested increased iFC between all striatal regions bilaterally and the dorsomedial prefrontal cortex (dmPFC), as well as between the right ventral caudate and the anterior cingulate cortex (ACC). MDD severity was associated with iFC between the striatum and midline structures including the precuneus, posterior cingulate cortex, and dmPFC. However, distinct striatal iFC patterns involving the pregenual ACC, subgenual ACC, supplementary motor area, and supramarginal gyrus were associated with anhedonia severity. CONCLUSIONS Although MDD diagnosis and severity were related to striatal networks involving midline cortical structures, distinct circuits within the reward system were associated with anhedonia. Findings support the incorporation of both categorical and dimensional approaches in neuropsychiatric research.
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Affiliation(s)
- Vilma Gabbay
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY 10029-6574, USA.
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14
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Alonso CM, Such E, Gómez-Seguí I, Cervera J, Martínez-Cuadrón D, Luna I, Ibáñez M, López-Pavía M, Vera B, Navarro I, Senent L, Sanz Alonso MA. BRAFV600E mutation in adult acute lymphoblastic leukemia. Leuk Lymphoma 2012; 54:1105-6. [DOI: 10.3109/10428194.2012.733878] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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15
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Gabbay V, Babb JS, Klein RG, Panzer AM, Katz Y, Alonso CM, Petkova E, Wang J, Coffey BJ. A double-blind, placebo-controlled trial of ω-3 fatty acids in Tourette's disorder. Pediatrics 2012; 129:e1493-500. [PMID: 22585765 PMCID: PMC3362909 DOI: 10.1542/peds.2011-3384] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [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] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Clinical observations have suggested therapeutic effects for ω-3 fatty acids (O3FA) in Tourette's disorder (TD), but no randomized, controlled trials have been reported. In a placebo-controlled trial, we examined the efficacy of O3FA in children and adolescents with TD. METHODS Thirty-three children and adolescents (ages 6-18) with TD were randomly assigned, double-blind, to O3FA or placebo for 20 weeks. O3FA consisted of combined eicosapentaenoic acid and docosahexaenoic acid. Placebo was olive oil. Groups were compared by using (1) intent-to-treat design, with the last-observation-carried-forward controlling for baseline measures and attention-deficit/hyperactivity disorder via (a) logistic regression, comparing percentage of responders on the primary Yale Global Tic Severity Scale (YGTSS)-Tic and secondary (YGTSS-Global and YGTSS-Impairment) outcome measures and (b) analysis of covariance; and (2) longitudinal mixed-effects models. RESULTS At end point, subjects treated with O3FA did not have significantly higher response rates or lower mean scores on the YGTSS-Tic (53% vs 38%; 15.6 ± 1.6 vs 17.1 ± 1.6, P > .1). However, significantly more subjects on O3FA were considered responders on the YGTSS-Global measure (53% vs 31%, P = .05) and YGTSS-Impairment measure (59% vs 25%, P < .05), and mean YGTSS-Global scores were significantly lower in the O3FA-treated group than in the placebo group (31.7 ± 2.9 vs 40.9 ± 3.0, P = .04). Obsessive-compulsive, anxiety, and depressive symptoms were not significantly affected by O3FA. Longitudinal analysis did not yield group differences on any of the measures. CONCLUSIONS O3FA did not reduce tic scores, but it may be beneficial in reduction of tic-related impairment for some children and adolescents with TD. Limitations include the small sample and the possible therapeutic effects of olive oil.
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Affiliation(s)
- Vilma Gabbay
- NYU Child Study Center, NYU School of Medicine, New York, New York, USA.
| | - James S. Babb
- Department of Radiology, NYU School of Medicine, New York, New York
| | - Rachel G. Klein
- NYU Child Study Center, NYU School of Medicine, New York, New York
| | - Aviva M. Panzer
- NYU Child Study Center, NYU School of Medicine, New York, New York
| | - Yisrael Katz
- NYU Child Study Center, NYU School of Medicine, New York, New York
| | - Carmen M. Alonso
- NYU Child Study Center, NYU School of Medicine, New York, New York
| | - Eva Petkova
- NYU Child Study Center, NYU School of Medicine, New York, New York
| | - Jing Wang
- NYU Child Study Center, NYU School of Medicine, New York, New York
| | - Barbara J. Coffey
- NYU Child Study Center, NYU School of Medicine, New York, New York;,Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York; and
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16
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Gabbay V, Mao X, Klein RG, Ely BA, Babb JS, Panzer AM, Alonso CM, Shungu DC. Anterior cingulate cortex γ-aminobutyric acid in depressed adolescents: relationship to anhedonia. ACTA ACUST UNITED AC 2011; 69:139-49. [PMID: 21969419 DOI: 10.1001/archgenpsychiatry.2011.131] [Citation(s) in RCA: 142] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
CONTEXT Anhedonia, a core symptom of major depressive disorder (MDD) and highly variable among adolescents with MDD, may involve alterations in the major inhibitory amino acid neurotransmitter system of γ-aminobutyric acid (GABA). OBJECTIVE To test whether anterior cingulate cortex (ACC) GABA levels, measured by proton magnetic resonance spectroscopy, are decreased in adolescents with MDD. The associations of GABA alterations with the presence and severity of anhedonia were explored. DESIGN Case-control, cross-sectional study using single-voxel proton magnetic resonance spectroscopy at 3 T. SETTING Two clinical research divisions at 2 teaching hospitals. PARTICIPANTS Twenty psychotropic medication-free adolescents with MDD (10 anhedonic, 12 female, aged 12-19 years) with episode duration of 8 weeks or more and 21 control subjects group matched for sex and age. MAIN OUTCOME MEASURES Anterior cingulate cortex GABA levels expressed as ratios relative to unsuppressed voxel tissue water (w) and anhedonia scores expressed as a continuous variable. RESULTS Compared with control subjects, adolescents with MDD had significantly decreased ACC GABA/w (t = 3.2; P < .003). When subjects with MDD were categorized based on the presence of anhedonia, only anhedonic patients had decreased GABA/w levels compared with control subjects (t = 4.08; P < .001; P(Tukey) < .001). Anterior cingulate cortex GABA/w levels were negatively correlated with anhedonia scores for the whole MDD group (r = -0.50; P = .02), as well as for the entire participant sample including the control subjects (r = -0.54; P < .001). Anterior cingulate cortex white matter was also significantly decreased in adolescents with MDD compared with controls (P = .04). CONCLUSIONS These findings suggest that GABA, the major inhibitory neurotransmitter in the brain, may be implicated in adolescent MDD and, more specifically, in those with anhedonia. In addition, use of a continuous rather than categorical scale of anhedonia, as in the present study, may permit greater specificity in evaluating this important clinical feature.
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Affiliation(s)
- Vilma Gabbay
- Department of Child and Adolescent Psychiatry, New York University Child Study Center, New York University Langone Medical Center, New York, NY 10016, USA.
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Gabbay V, Klein RG, Katz Y, Mendoza S, Guttman LE, Alonso CM, Babb JS, Hirsch GS, Liebes L. The possible role of the kynurenine pathway in adolescent depression with melancholic features. J Child Psychol Psychiatry 2010; 51:935-43. [PMID: 20406333 PMCID: PMC3711227 DOI: 10.1111/j.1469-7610.2010.02245.x] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [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] [Indexed: 01/01/2023]
Abstract
BACKGROUND Although adolescent major depressive disorder (MDD) is acknowledged to be a heterogeneous disorder, no studies have reported on biological correlates of its clinical subgroups. This study addresses this issue by examining whether adolescent MDD with and without melancholic features (M-MDD and NonM-MDD) have distinct biological features in the kynurenine pathway (KP). The KP is initiated by pro-inflammatory cytokines via induction of the enzyme indoleamine 2,3-dioxygenase (IDO), which degrades tryptophan (TRP) into kynurenine (KYN). KYN is further metabolized into neurotoxins linked to neuronal dysfunction in MDD. Hypotheses were that, compared to healthy controls and to NonM-MDD adolescents, adolescents with M-MDD would exhibit: (i) increased activation of the KP [i.e., increased KYN and KYN/TRP (reflecting IDO activity)]; (ii) greater neurotoxic loads [i.e., increased 3-hydroxyanthranilic acid (3-HAA, neurotoxin) and 3-HAA/KYN (reflecting production of neurotoxins)]; and (iii) decreased TRP. We also examined relationships between severity of MDD and KP metabolites. METHODS Subjects were 20 adolescents with M-MDD, 30 adolescents with NonM-MDD, and 22 healthy adolescents. MDD episode duration had to be >or= 6 weeks and Children's Depression Rating Scale-Revised (CDRS-R) scores were >or= 36. Blood samples were collected at AM after an overnight fast and analyzed using high-performance liquid chromatography. Group contrasts relied on analysis of covariance based on ranks, adjusted for age, gender, and CDRS-R scores. Analyses were repeated excluding medicated patients. Fisher's protected least significant difference was used for multiple comparisons. RESULTS As hypothesized, KYN/TRP ratios were elevated and TRP concentrations were reduced in adolescents with M-MDD compared to NonM-MDD adolescents (p = .001 and .006, respectively) and to healthy controls (p = .008 and .022, respectively). These findings remained significant when medicated patients were excluded from the analyses. Significant correlations were obtained exclusively in the M-MDD group between KYN and 3-HAA/KYN and CDRS-R. CONCLUSIONS Findings support the notion that adolescent M-MDD may represent a biologically distinct clinical syndrome.
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Affiliation(s)
- Vilma Gabbay
- NYU Child Study Center, Child and Adolescent Psychiatry, New York University School of Medicine, NY 10016, USA.
| | - Rachel G. Klein
- NYU Child Study Center, Child and Adolescent Psychiatry, New York University School of Medicine, NY, USA
| | - Yisrael Katz
- NYU Child Study Center, Child and Adolescent Psychiatry, New York University School of Medicine, NY, USA
| | - Sandra Mendoza
- Cancer Institute, New York University School of Medicine, NY, USA
| | - Leah E. Guttman
- NYU Child Study Center, Child and Adolescent Psychiatry, New York University School of Medicine, NY, USA
| | - Carmen M. Alonso
- NYU Child Study Center, Child and Adolescent Psychiatry, New York University School of Medicine, NY, USA
| | - James S. Babb
- Radiology, Research, New York University School of Medicine, NY, USA
| | - Glenn S. Hirsch
- NYU Child Study Center, Child and Adolescent Psychiatry, New York University School of Medicine, NY, USA
| | - Leonard Liebes
- Cancer Institute, New York University School of Medicine, NY, USA
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Gabbay V, Klein RG, Guttman LE, Babb JS, Alonso CM, Nishawala M, Katz Y, Gaite MR, Gonzalez CJ. A preliminary study of cytokines in suicidal and nonsuicidal adolescents with major depression. J Child Adolesc Psychopharmacol 2009; 19:423-30. [PMID: 19702494 PMCID: PMC2778037 DOI: 10.1089/cap.2008.0140] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Increased systemic cytokine levels, modulators of the immune system, have been repeatedly documented in adult and adolescent major depressive disorder (MDD). This preliminary study extends this work to test the role of cytokines in suicidal symptomatology in adolescent MDD. Hypotheses were that acutely suicidal depressed adolescents would have: (1) increased plasma levels of interferon-gamma (IFN-gamma), tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6), and IL-1beta, and (2) a proinflammatory/antiinflammatory cytokine imbalance (indexed by plasma IFN-gamma/IL-4), compared to nonsuicidal depressed adolescents and healthy controls. METHODS Twelve suicidal adolescents with MDD (7 females [58%]; 5 medication-free/naïve), 18 nonsuicidal adolescents with MDD (12 females [67%]; 8 medication-free/naïve), and 15 controls (8 females [53%]) were enrolled. MDD had to be of at least 6 weeks duration, with a minimum severity score of 40 on the Children's Depression Rating Scale-Revised. Plasma cytokines were examined using enzyme-linked immunosorbent assays. Nonparametric tests were used to compare subject groups. RESULTS Unexpectedly, suicidal adolescents with MDD had significantly decreased plasma TNF-alpha concentrations compared to nonsuicidal adolescents with MDD (1.33 +/- 2.95 pg/mL versus 30.9 +/- 110.9 pg/mL; p = 0.03). IFN-gamma was increased in both suicidal and nonsuicidal adolescents with MDD compared to controls (2.14 +/- 6.22 and 4.20 +/- 14.48 versus 0.37 +/- 0.64; p < 0.02, p = 0.005). Findings remained evident when controlled for age and gender. CONCLUSIONS Our preliminary findings suggest that immune system dysregulation may be associated with suicidal symptomatology in adolescent MDD. These findings should be replicated in larger samples with medication-free adolescents.
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Affiliation(s)
- Vilma Gabbay
- New York University School of Medicine , NYU Child Study Center, New York, New York 10016, USA.
| | - Rachel G. Klein
- New York University School of Medicine, NYU Child Study Center, New York, New York
| | - Leah E. Guttman
- New York University School of Medicine, NYU Child Study Center, New York, New York
| | - James S. Babb
- New York University School of Medicine, NYU Child Study Center, New York, New York
| | - Carmen M. Alonso
- New York University School of Medicine, NYU Child Study Center, New York, New York
| | - Melissa Nishawala
- New York University School of Medicine, NYU Child Study Center, New York, New York
| | - Yisrael Katz
- New York University School of Medicine, NYU Child Study Center, New York, New York
| | - Marta R. Gaite
- New York University School of Medicine, NYU Child Study Center, New York, New York.,Harvard School of Public Health, Boston, Massachusetts
| | - Charles J. Gonzalez
- New York University School of Medicine, NYU Child Study Center, New York, New York.,New York State Department of Health, AIDS Institute, New York, New York
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Gabbay V, Klein RG, Alonso CM, Babb JS, Nishawala M, De Jesus G, Hirsch GS, Hottinger-Blanc PM, Gonzalez CJ. Immune system dysregulation in adolescent major depressive disorder. J Affect Disord 2009; 115:177-82. [PMID: 18790541 PMCID: PMC2770721 DOI: 10.1016/j.jad.2008.07.022] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.1] [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: 05/23/2008] [Revised: 07/31/2008] [Accepted: 07/31/2008] [Indexed: 01/08/2023]
Abstract
BACKGROUND A large body of evidence suggests that immune system dysregulation is associated with Major Depressive Disorder (MDD) in adults. This study extends this work to adolescent MDD to examine the hypotheses of immune system dysregulation in adolescents with MDD, as manifested by significantly: (i) elevated plasma levels of cytokines (interferon [IFN]-gamma, tumor necrosis factor-alpha, interleukin [IL]-6, IL-1beta, and IL-4); and (ii) Th1/Th2 cytokine imbalance shifted toward Th1 as indexed by increased IFN-gamma/IL-4. METHOD Thirty adolescents with MDD (19 females; 13 medication-free/naïve; ages 12-19) of at least 6 weeks duration and a minimum severity score of 40 on the Children's Depression Rating Scale-Revised, and 15 healthy comparisons (8 females), group-matched for age, were enrolled. Plasma cytokines were examined using enzyme-linked immunosorbent assay. Mann-Whitney test was used to compare subjects with MDD and controls. RESULTS Adolescents with MDD had significantly elevated plasma IFN-gamma levels (3.38+/-11.8 pg/ml versus 0.37+/-0.64 pg/ml; p<0.003), and IFN-gamma/IL-4 ratio (16.6+/-56.5 versus 1.76+/-2.28; p=0.007). A trend for IL-6 to be elevated in the MDD group was also observed (1.52+/-2.88 pg/ml versus 0.49+/-0.90 pg/ml; p=0.09). Importantly, findings remained evident when medicated subjects were excluded. CONCLUSIONS Findings suggest that immune system dysregulation may be associated with adolescent MDD, with an imbalance of Th1/Th2 shifted toward Th1, as documented in adult MDD. Larger studies with medication-free adolescents should follow.
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Affiliation(s)
- Vilma Gabbay
- New York University School of Medicine, NYU Child Study Center, NY 10016, United States.
| | - Rachel G. Klein
- New York University School of Medicine, NYU Child Study Center, United States
| | - Carmen M. Alonso
- New York University School of Medicine, NYU Child Study Center, United States
| | - James S. Babb
- New York University School of Medicine, Department of Radiology, Research, United States
| | - Melissa Nishawala
- New York University School of Medicine, NYU Child Study Center, United States
| | - Georgette De Jesus
- New York University School of Medicine, NYU Child Study Center, United States
| | - Glenn S. Hirsch
- New York University School of Medicine, NYU Child Study Center, United States
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Abstract
The etiology and pathophysiology of body dysmorphic disorder (BDD) have not been delineated. The authors report a 24-year-old man who developed BDD at age 21 after an inflammatory brain process. Neuroimaging studies showed new atrophy in the frontotemporal region. The authors review cases from the literature with similar clinical features and neuroimaging findings as well as discuss the possible correlation between the neuroanatomic lesion and the clinical presentation of BDD in the patient.
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Affiliation(s)
- V Gabbay
- Division of Child and Adolescent Psychiatry of the New York University School of Medicine, New York, NY 10016-9196, USA.
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21
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Koplewicz HS, Vogel JM, Solanto MV, Morrissey RF, Alonso CM, Abikoff H, Gallagher R, Novick RM. Child and parent response to the 1993 World Trade Center bombing. J Trauma Stress 2002; 15:77-85. [PMID: 11936725 DOI: 10.1023/a:1014339513128] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This study evaluated children's symptoms 3 and 9 months after the 1993 bombing of the World Trade Center, and the relationship between parent and child reactions when only the children had been in the building. Nine children who had been trapped in an elevator, 13 who had been on the observation deck, and 27 controls completed the Posttraumatic Stress Reaction Index and a Fear Inventory. Parents completed these measures about the children and comparable measures about themselves. Exposed children reported posttraumatic stress disorder (PTSD) symptoms and disaster-related fears; their parents reported experiencing PTSD symptoms. Only parents rated children's symptoms as decreasing significantly over time. Association between child symptoms and parent symptoms increased over time. Children's initial distress predicted parents' distress 9 months postdisaster.
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Affiliation(s)
- Harold S Koplewicz
- Division of Child and Adolescent Psychiatry, Schneider Children's Hospital, Long Island Jewish Medical Center, New Hyde Park, New York, USA
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Pujol RM, Perez–Losada E, Matias–Guiu X, Fuentes J, Alonso CM, Alomar A, Craven–Bartle J. Postirradiation Multiple Minute Digitate Porokeratosis. J Cutan Med Surg 2001. [DOI: 10.1177/120347540100500205] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Development of multiple minute digitate hyperkeratoses (MMDH) after irradiation has been reported previously. The keratotic lesions in these cases were confined within the irradiation field, and histopathological examination disclosed a focal column of parakeratosis (cornoid lamella) arising from an epidermis devoid of granular layer. Objective: We describe a 78-year-old woman who developed multiple, discrete, tiny, filiform, keratotic papules on the anterior aspect of the right chest wall, 13 months after postmastectomy cobalt irradiation therapy for mammary infiltrating ductal carcinoma. Conclusion: Postirradiation MMDH represents a peculiar radiation-induced disorder that we believe should be distinguished from other cases of MMDH and included within the spectrum of porokeratosis.
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Affiliation(s)
- Ramon M. Pujol
- Department of Dermatology, Hospital del Mar, IMAS, Barcelona, Spain
| | - Eugenia Perez–Losada
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Xavier Matias–Guiu
- Department of Pathology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Josefina Fuentes
- Department of Radiotherapy, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Carmen M. Alonso
- Department of Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Agustin Alomar
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Jordi Craven–Bartle
- Department of Radiotherapy, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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Alonso CM, Lozada CJ. Effects of IV cyclophosphamide on HIV viral replication in a patient with systemic lupus erythematosus. Clin Exp Rheumatol 2000; 18:510-2. [PMID: 10949730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Several cases of patients with concomitant SLE and HIV infection have been reported in the literature; however, the effect of immunosuppressive therapy on HIV replication has not been described. We present the case of a 46 y/o woman with a ten-year history of HIV infection who was treated with IV cyclophosphamide for SLE nephritis. She had a positive HIV Western Blot just a few months before the diagnosis of SLE. Serum levels of HIV RNA had been persistently non-detectable since the assay became available. The patient was not receiving any antiretroviral therapy, raising doubts about the diagnosis of HIV infection. After 3 pulses of IV cyclophosphamide, HIV RNA levels went up to 135,720 copies/ml. Shortly after discontinuation of therapy viral levels were again undetectable. This case shows one of the possible clinical scenarios in patients with coexistent HIV infection and SLE. In our patient SLE appears to provide some immunologic defense against viral replication. Cross-reactivity of autoantibodies with HIV proteins may play a role in this mechanism. Effective immunosuppressive therapy suppresses this protection and leaves the immune system vulnerable to HIV reproduction. Treatment in these cases can be difficult and should be individualized in an attempt to achieve a balance between control of viral infection and SLE activity.
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Affiliation(s)
- C M Alonso
- Division of Rheumatology and Immunology, University of Miami School of Medicine, Florida, USA
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Abstract
OBJECTIVE This report reviews the obstetric outcomes of women with multifetal pregnancy reductions who subsequently underwent elective amniocentesis. STUDY DESIGN Five hundred eight patients underwent multifetal pregnancy reduction at our institution. Among these, 91 patients underwent subsequent elective amniocentesis. The obstetric outcomes of all 508 patients were followed up. By means of logistic regression we evaluated several variables to determine any association with loss rate: (1) the finishing number of fetuses, (2) the number of fetuses undergoing reduction (starting number of fetuses minus the finishing number of fetuses), (3) the gestational age at reduction, (4) the maternal age at reduction, and (5) the procedure protocol. We observed that the finishing number of fetuses, the number of fetuses removed, and the procedure protocol were significantly associated with pregnancy loss rate. Women who underwent subsequent amniocentesis were compared with those who did not undergo amniocentesis. By means of multivariate conditional likelihood analysis we stratified the two groups according to the previously mentioned significant variables to compare the pregnancy loss rates. RESULTS Among patients who subsequently underwent elective amniocentesis the total uncorrected pregnancy loss rate was 9.0% and the early premature delivery rate was 4.5%. The number of fetuses removed, the finishing number of fetuses, and the procedure protocol were statistically significantly associated with the loss rate. The adjusted odds ratio relating amniocentesis to the pregnancy loss rate was 0.7 (95% confidence interval, 0.31.5; P =.3.) CONCLUSIONS The uncorrected rates of pregnancy loss and of early premature delivery among patients with multifetal pregnancy reduction who underwent subsequent amniocentesis were comparable to those of patients with multifetal pregnancy reduction who did not undergo amniocentesis.
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Affiliation(s)
- J A Stephen
- Department of Obstetrics and Gynecology, Columbia Presbyterian Medical Center, New York, New York, USA
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Alonso CM, Bernabé RR, Moreno E, Diaz de Espada F. Depletion of monocytes from human peripheral blood leucocytes by passage through sephadex G-10 columns. J Immunol Methods 1978; 22:361-8. [PMID: 150450 DOI: 10.1016/0022-1759(78)90043-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Passage of human peripheral blood leucocytes through Sephadex G-10 columns results in a complete depletion of monocytes. Microscopic examination and ingestion of latex particles failed to reveal any monocytes in the column-passed cells. The study of surface markers shows a slight enrichment of T-cells and a decrease of B-cells that is more pronounced in the IgG- and IgA-bearing lymphocytes. No changes were seen in the Fc receptor-positive cells. Con A-induced activation was significantly affected. Pokeweed mitogen activation was reduced 50% at optimal doses of mitogen whereas the response was unaffected at suboptimal doses. Mixed leucocyte reactions (MLR) were greatly depressed when monocytes were removed from either the responder or the stimulator cells, indicating an important role of monocytes both in the elicitation of the response and as auxiliary cells in the mixed leucocyte culture.
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