Impaired implicit emotion regulation in patients with panic disorder: An event-related potential study on affect labeling.

BACKGROUND: Panic disorder (PD) involves emotion dysregulation, but its underlying mechanisms remain poorly understood. Previous research suggests that implicit emotion regulation may play a central role in PD-related emotion dysregulation and symptom maintenance. However, there is a lack of studies exploring the neural mechanisms of implicit emotion regulation in PD using neurophysiological indicators. AIM: To study the neural mechanisms of implicit emotion regulation in PD with event-related potentials (ERP). METHODS: A total of 25 PD patients and 20 healthy controls (HC) underwent clinical eva-luations. The study utilized a case-control design with random sampling, selecting participants for the case group from March to December 2018. Participants performed an affect labeling task, using affect labeling as the experimental condition and gender labeling as the control condition. ERP and behavioral data were recorded to compare the late positive potential (LPP) within and between the groups. RESULTS: Both PD and HC groups showed longer reaction times and decreased accuracy under the affect labeling. In the HC group, late LPP amplitudes exhibited a dynamic pattern of initial increase followed by decrease. Importantly, a significant group × condition interaction effect was observed. Simple effect analysis revealed a reduction in the differences of late LPP amplitudes between the affect labeling and gender labeling conditions in the PD group compared to the HC group. Furthermore, among PD patients under the affect labeling, the late LPP was negatively correlated with disease severity, symptom frequency, and intensity. CONCLUSION: PD patients demonstrate abnormalities in implicit emotion regulation, hampering their ability to mobilize cognitive resources for downregulating negative emotions. The late LPP amplitude in response to affect labeling may serve as a potentially valuable clinical indicator of PD severity.

Shared and distinct prefrontal cortex alterations of implicit emotion regulation in depression and anxiety: An fNIRS investigation.

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.

Resting-state cortico-limbic functional connectivity pattern in panic disorder: Relationships with emotion regulation strategy use and symptom severity.

Cognitive reappraisal is an effective emotion regulation strategy involving prefrontal cortex (PFC) control of the amygdala. Its aberrant functioning is closely associated with panic disorder (PD). However, the resting-state functional connectivity (rsFC) between the PFC, implicated in cognitive reappraisal, and the amygdala in PD has not been studied. Thus, this study aims to investigate the rsFC patterns and their association with cognitive reappraisal and PD. This study involved 51 participants, including 26 untreated patients with PD and 25 healthy controls (HC). We evaluated the habit of cognitive reappraisal assessment and the severity of PD using neuropsychological and clinical measures. Resting-state fMRI was utilized to evaluate the rsFC pattern between the PFC, engaged in cognitive reappraisal, and the amygdala. Mediation analysis was performed to explore the role of this rsFC in the relationship between cognitive reappraisal and PD severity. PD patients showed reduced rsFC between the PFC and the amygdala compared to HC. This weakened rsFC was associated with the severity of PD symptoms. Moreover, cognitive reappraisal was negatively correlated with PD severity, and mediation analysis indicated that the rsFC of the PFC-amygdala played a mediating role in this association. Abnormal PFC-amygdala rsFC may play a pivotal role in PD development and/or manifestation and mediate the association between cognitive reappraisal and PD severity, potentially serving as a clinical indicator for monitoring and intervention.

Neural basis of implicit cognitive reappraisal in panic disorder: an event-related fMRI study.

BACKGROUND: Panic disorder (PD) is thought to be related with deficits in emotion regulation, especially in cognitive reappraisal. According to the cognitive model, PD patients' intrinsic and unconscious misappraisal strategies are the cause of panic attacks. However, no studies have yet been performed to explore the underlying neuromechanism of cognitive reappraisal that occur on an unconscious level in PD patients. METHODS: Twenty-six patients with PD and 25 healthy controls (HC) performed a fully-verified event-block design emotional regulation task aimed at investigating responses of implicit cognitive reappraisal during an fMRI scan. Participants passively viewed negatively valanced pictures that were beforehand neutrally, positively, or adversely portrayed in the task. RESULTS: Whole-brain analysis of fMRI data showed that PD patients exhibited less activation in the right dorsolateral prefrontal cortex (dlPFC) and right dorsomedial prefrontal cortex (dmPFC) compared to HC, but presented greater activation in parietal cortex when negative pictures were preceded by positive/neutral vs negative descriptions. Simultaneously, interactive effects of Group × Condition were observed in the right amygdala across both groups. Furthermore, activation in dlPFC and dmPFC was is negatively correlated to severity of anxiety and panic in PD when negative images were preceded by non-negative vs negative descriptions. CONCLUSIONS: Emotional dysregulation in PD is likely the result of deficient activation in dlPFC and dmPFC during implicit cognitive reappraisal, in line with impaired automatic top-down regulation. Correlations between severity of anxiety and panic attack and activation of right dlPFC and dmPFC suggest that the failure to engage prefrontal region during implicit cognitive reappraisal might be associated wtih the severity of anxiety and panic; such functional patterns might be the target of possible treatments.

Mild encephalitis/encephalopathy with a reversible splenial lesion associated with respiratory syncytial virus infection in infants.

Mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) is a clinicoradiologic syndrome typically characterized by transient mild encephalitis or encephalopathy with reversible lesions being found in the splenium of corpus callosum (SCC) by magnetic resonance imaging (MRI). A variety of pathogens including influenza virus, rotavirus, and adenovirus associated with MERS have been reported. However, respiratory syncytial virus (RSV)-related MERS is relatively rare in infants. In this study, we report two Chinese infants who suffered from RSV-related MERS. Both infants manifested as fever, seizure, and altered states of consciousness with confirmed detections of RSV-RNA in the specimens from throat swab. Clinical symptoms/signs such as apnea and shallow breathing were also noted in these two infants. Furthermore, brain MRI images indicated reversible isolated lesions with transiently reduced diffusion in the SCC. Fortunately, both of these two infants recovered completely following treatment within a month. Our study suggests that RSV may serve as a novel causative agent for MERS in infants. Clinicians should focus more attention on RSV-related MERS in infants in order to improve early accurate diagnosis and therapeutic decision making.

Altered resting-state network connectivity in panic disorder: an independent ComponentAnalysis.

Panic disorder (PD) is a prevalent anxiety disorder but its neurobiology remains poorly understood. It has been proposed that the pathophysiology of PD is related to an abnormality in a particular neural network. However, most studies investigating resting-state functional connectivity (FC) have relied on a priori restrictions of seed regions, which may bias observations. This study investigated changes in intra and internetwork FC in the whole brain of patients with PD using resting-state functional magnetic resonance imaging. A voxel-wise data-driven independent component analysis was performed on 26 PD patients and 27 healthy controls (HCs).We compared the differences in the intra and internetwork FC between the two groups of subjects using statistical parametric mapping with two-sample t-tests. PD patients exhibited decreased intra-network FC in the right anterior cingulate cortex (ACC) of the anterior default mode network, the left precentral and postcentral gyrus of the sensorimotor network, the right lobule V/VI, the cerebellum vermis, and the left lobule VI of the cerebellum network compared with the HCs. The intra-network FC in the right ACC was negatively correlated with symptom severity. None of the pairs of resting state networks showed significant differences in functional network connectivity between the two groups. These results suggest that the brain networks associated with emotion regulation, interoceptive awareness, and fear and somatosensory processing may play an important role in the pathophysiology of PD.

Regional cortical thinning and cerebral hypoperfusion in patients with panic disorder.

BACKGROUND: Although recent neuroimaging studies have suggested that functional deficits in facial perception are associated with panic disorder (PD), the possibility of cortical thickness and perfusion abnormalities have not been studied in patients with PD. We aimed to investigate alterations in cortical thickness and regional cerebral blood flow (CBF) between PD patients and healthy controls (HCs) using three-dimensional (3D) T1-weighted magnetic resonance imagery (MRI) and 3D arterial spin labeling (ASL) perfusion MRI. METHOD: An automated surface-based method (Cat12) measured the cortical thickness of each subject. Z-score normalization for CBF maps was used to generate Z-score maps. Statistical comparisons were performed using statistical parametric mapping with two-sample t-tests. RESULTS: Subjects with PD, unlike HCs, displayed cortical thinning in the right fusiform gyrus (FG). Post hoc analysis also revealed a decreased Z-score in the right FG. There was significant positive correlation between the Z-score and the cortical thickness of the right FG. The cortical thickness and Z-score were negatively correlated with the Panic Disorder Severity Scale and Hamilton Rating Scale for Anxiety scores. LIMITATIONS: The small sample size may have restricted the identification of additional differences. Other caveats included the use of medication by nine participants. CONCLUSIONS: These results provide further evidence of the significant role structural and functional deficits in the right FG play in patients with PD. Due to the observed regional specificity, this finding bears important clinical implications for potential treatment strategies.

Autoimmune glial fibrillary acidic protein astrocytopathy with lesions distributed predominantly in the entire spinal cord.

Autoimmune glial fibrillary acidic protein (GFAP) astrocytopathy has been considered a novel central nervous system autoimmune disease characterized by relapse and responsiveness to corticosteroid with a specific GFAP-Immunoglobulin G (IgG) being noted in cerebrospinal fluid. We report the case of a 21-year-old girl presenting with dysuria and weariness, who subsequently developed blurry vision, slight dysphagia, slurred speech, and sensory abnormality. GFAP-IgG was detected in her cerebrospinal fluid. Magnetic resonance imaging using both T2-weighted and contrast-enhanced T1-weighted images revealed a rare finding of lesions distributed mainly in the entire spinal cord rather than typical brain lesions. After treating with corticosteroids, her clinical symptoms were alleviated, and the spinal cord lesion enhancement was reduced. Our observations extend the clinical spectrum of autoimmune GFAP astrocytopathy. We suggest that rare distributed lesions in the entire spinal cord in patients with autoimmune GFAP astrocytopathy cannot be ignored by neurologists. The identification of potential atypical lesions broadens the understanding of autoimmune GFAP astrocytopathy.

Prefrontoparietal dysfunction during emotion regulation in anxiety disorder: a meta-analysis of functional magnetic resonance imaging studies.

OBJECTIVE: Impairments in emotion regulation, and more specifically in cognitive reappraisal, are thought to play a key role in the pathogenesis of anxiety disorders. However, the available evidence on such deficits is inconsistent. To further illustrate the neurobiological underpinnings of anxiety disorder, the present meta-analysis summarizes functional magnetic resonance imaging (fMRI) findings for cognitive reappraisal tasks and investigates related brain areas. METHODS: We performed a comprehensive series of meta-analyses of cognitive reappraisal fMRI studies contrasting patients with anxiety disorder with healthy control (HC) subjects, employing an anisotropic effect-size signed differential mapping approach. We also conducted a subgroup analysis of medication status, anxiety disorder subtype, data-processing software, and MRI field strengths. Meta-regression was used to explore the effects of demographics and clinical characteristics. Eight studies, with 11 datasets including 219 patients with anxiety disorder and 227 HC, were identified. RESULTS: Compared with HC, patients with anxiety disorder showed relatively decreased activation of the bilateral dorsomedial prefrontal cortex (dmPFC), bilateral dorsal anterior cingulate cortex (dACC), bilateral supplementary motor area (SMA), left ventromedial prefrontal cortex (vmPFC), bilateral parietal cortex, and left fusiform gyrus during cognitive reappraisal. The subgroup analysis, jackknife sensitivity analysis, heterogeneity analysis, and Egger's tests further confirmed these findings. CONCLUSIONS: Impaired cognitive reappraisal in anxiety disorder may be the consequence of hypo-activation of the prefrontoparietal network, consistent with insufficient top-down control. Our findings provide robust evidence that functional impairment in prefrontoparietal neuronal circuits may have a significant role in the pathogenesis of anxiety disorder.

Multiple Neural Networks Malfunction in Primary Blepharospasm: An Independent Components Analysis.

Primary blepharospasm (BPS) is a focal dystonia characterized by involuntary blinking and eyelid spasms. The pathophysiology of BPS remains unclear. Several neuroimaging studies have suggested dysfunction of sensory processing and sensorimotor integration, but the results have been inconsistent. This study aimed to determine whether patients with BPS exhibit altered functional brain connectivity and to explore possible correlations between these networks and clinical variables. Twenty-five patients with BPS and 25 healthy controls were enrolled. We found that the patient group exhibited decreased connectivity within the sensory-motor network (SMN), which involved regions of the bilateral primary sensorimotor cortex, supplementary motor area (SMA), right premotor cortex, bilateral precuneus and left superior parietal cortex. Within the right fronto-parietal network, decreased connections were observed in the middle frontal gyrus, dorsal lateral prefrontal cortex and inferior frontal gyrus. Regarding the salience network (SN), increased connectivity was observed in the left superior frontal gyrus and middle frontal gyrus. These findings suggest the involvement of multiple neural networks in primary BPS.

Neural mechanisms of implicit cognitive reappraisal: Preceding descriptions alter emotional response to unpleasant images.

The importance of reappraising negative events to reduce negative emotional responses has been widely acknowledged. However, most neuroimaging studies have explored the neural mechanisms of deliberate and intentional reappraisal, while little is known about the neural correlates of reappraisal that occurs outside of one's awareness. Electrophysiological studies suggest that precedent neutral descriptions could implicitly reduce neural responses to unpleasant images. To investigate the neural mechanism underlying implicit reappraisal, functional magnetic resonance imaging was conducted on 25 participants while they passively viewed unpleasant images that were previously neutrally/positively or negatively described. Increased activity in prefrontal areas including the dorsolateral and dorsomedial prefrontal cortices, lateral orbitofrontal cortex, and temporal cortex, and decreased activation in the amygdala was observed-similar to the pattern reported in deliberate emotion regulation-when unpleasant images were preceded by neutral/positive versus negative descriptions. Functional connectivity analysis revealed significant negative couplings between prefrontal regions and the amygdala. These findings suggest that implicit reappraisal recruits prefrontal regions to change semantic representations in the temporal cortex, in turn modulating the emotional response of the amygdala.

The Effect of Aging in Inhibitory Control of Major Depressive Disorder Revealed by Event-Related Potentials.

Elderly depressed patients manifest pronounced executive dysfunction compared with younger subjects with depressive disorder. Aging-related brain changes may result in executive dysfunction in geriatric depression. We investigated the neural correlates of inhibitory control processing in depressed subjects at different ages using event-related potentials (ERPs). A equiprobable visual Go/Nogo task was used in 19 young (27.4 ± 5.0 years) and 18 elderly (70.8 ± 6.9 years) depressed subjects and their age-matched healthy controls (20 young subjects, 26.2 ± 3.7 years, and 18 elderly subjects, 68.1 ± 4.8 years). The responses were based on two types of equilateral triangular figures of upright (Go) and inverted triangle (Nogo). The elderly subjects exhibited later N2 and P3 latencies, and larger Go-N2 and P3 amplitudes, compared with the younger subjects. Further, the elderly controls displayed smaller P3 in the central and parietal regions, and yielded larger Nogo-P3 amplitude in the frontal region compared with younger controls. While the young depressed patients yielded smaller P3 amplitude than the controls across frontal, central and parietal regions, elderly depressed patients yielded smaller P3 than the elderly controls only in the frontal region. Our results suggest that the inhibitory control subprocesses are differentially affected by depression and aging. The stimulus response speed and the effort intensity of inhibition control are specifically impaired in the elderly depressed patients. And the diminished amplitudes of frontal P3 in the elderly depression imply a frontal dysfunction mechanism.

Impaired cognitive reappraisal in panic disorder revealed by the late positive potential.

According to the cognitive model of panic disorder (PD), panic attacks are triggered and maintained by catastrophic misappraisals of bodily sensations. Clinically, PD is associated with impaired cognitive emotion regulation strategies involving cognitive reappraisal. To investigate the neural correlates and time course of cognitive reappraisal in patients with PD, event-related potentials were recorded from patients with PD and demographically matched control group during passive viewing of affective images under three conditions: (a) neutral pictures preceded by neutral descriptions, (b) unpleasant pictures preceded by negative descriptions, and (c) unpleasant pictures preceded by neutral descriptions. The late positive potential (LPP), an event-related potential component sensitive to cognitive change strategies, was examined as an index of cognitive reappraisal. Consistent with previous results, the unpleasant pictures preceded by negative descriptions had decreased valence ratings, increased arousal ratings, and increased LPP amplitudes compared with the unpleasant pictures preceded by neutral descriptions in the control group. In contrast, no reliable effect of description condition was observed for valence ratings in the PD group. The patients demonstrated differing response patterns from the control participants, with higher arousal ratings and larger LPPs during the 1000-2000 ms window when unpleasant pictures were preceded by a neutral description than when unpleasant pictures were preceded by a negative description. The present study suggests that emotion regulation is impaired in patients with PD. These findings describe the first electrophysiological correlates of abnormal cognitive reappraisal in patients with PD.

[Inhibitory control deficit in patients with panic disorder: an event-related potentials study].

OBJECTIVE: To investigate the electrophysiological evidence of inhibitory control deficit in panic disorder patients using a visual simple Go/Nogo task. METHOD: Sixteen patients with panic disorder and 13 healthy volunteers received a visual simple Go/Nogo task. The stimuli were single or double English letters and appeared with equal probability. The subjects were instructed to press a button as quickly as possible when the double letter was presented (i.e., Go), but make no response to the single letter (i.e., Nogo). 32 channel EEG data were recorded. RESULT: All subjects displayed a distinct Go/Nogo effect in the N2 component (PD group:F(1,30) = 8.00, P = 0.008; NC group: F(1,24) = 4.60, P = 0.042) and P3 component (PD group: F(1,30) = 7.85, P = 0.009; NC group: F(1,24) = 13.57, P = 0.000) at frontocentral sites, but the amplitudes of Nogo-N2 and Nogo-P3 were significantly reduced in panic disorder patients as compared to the healthy subjects (Fz: F = 9.135, P = 0.005; F = 8.511, P = 0.006, respectively). There was no significant differences between the latencies of Nogo-N2 and Nogo-P3. CONCLUSION: Panic disorder may consist inhibitory control deficit which may assist in offering new objective evidence to understand the etiology of panic disorder.

[Automatic auditory information management in panic disorder patients: an event-related potentials study].

OBJECTIVE: To investigate the characteristics of automatic auditory information management in sufferers of panic disorder (PD). METHOD: Mismatch negativity (MMN), as a component of event-related potentials, was recorded from 15 PD patients, 8 males and 7 females, aged 40 +/- 12, and 15 sex, and aged-matched controls. Repeated measures ANOVA was used on 4 representative electrodes: T3, T4, F3, and F4. RESULTS: Compared with the normal controls, the PD patients showed significant enlargement of MMN amplitude in 60 - 210 ms latency windows (60 - 110 ms: F(1, 28) = 11.413, P = 0.02; 110 - 160 ms: F(1, 28) = 6.639, P = 0.016; 160 - 210 ms: F(1, 28) = 5.758, P = 0.023), and exhibited early (60 - 160 ms) left encephalic region predominant effect. CONCLUSION: PD patients may deal excessive automatic processing of the auditory information changes which may assist in offering new objective evidence to understand the etiology of PD.

Electrophysiological activity underlying inhibitory control processes in late-life depression: a Go/Nogo study.

Late-life depression is characterized by the coexistence of affective disorder and executive impairment. We investigated the neural correlates of inhibitory control processing in people with late-life depression using event-related potentials (ERPs). A visual Go/Nogo task was employed. A larger Nogo-N2 and Nogo-P3 was found in the depressed group compared to the control group. This reflects the non-physiological process of conflict monitoring and inhibitory control in depressed patients. The results also showed that the difference wave between Go and Nogo conditions (Pd3) over the frontal electrode sites was more robust and earlier in the control group compared to the depressed group, which reflects frontal dysfunction in the depressed group. Also in the depressed subject a significant correlation between the 17-item Hamilton rating scale for depression (HRSD-17) and the amplitudes of Nogo-N2 and Pd3 was found. Our results imply that the Nogo-N2, Nogo-P3 and Pd3 features can be considered as endophenotypic markers of the late-life depression.