RESUMO
Adolescent psychotic mood disorder (MDP) is a specific phenotype that characterized by more severe symptoms and prognosis compared to nonpsychotic mood disorder (MDNP). But the underlying neural mechanisms remain unknown, and graph theory analysis can help to understand possible mechanisms of psychotic symptoms from the perspective of functional networks. A total of 177 adolescent patients with mood disorders were recruited, including 61 MDP and 116 MDNP. Functional networks were constructed, and topological properties were compared between the two groups at baseline and after treatment, and the association between properties changes and symptom improvement was explored. Compared to the MDNP group, the MDP group exhibited higher small-world properties (FDR q = 0.003) and normalized clustering coefficients (FDR q = 0.008) but demonstrated decreased nodal properties in the superior temporal gyrus (STG), Heschl's gyrus, and medial cingulate gyrus (all FDR q < 0.05). These properties were found to be correlated with the severity of psychotic symptoms. Topological properties also changed with improvement of psychotic symptoms after treatment, and changes in degree centrality of STG in the MDP was significantly positive correlated with improvement of psychotic symptoms (r = 0.377, P = 0.031). This study indicated that functional networks are more severely impaired in patients with psychotic symptoms. Topological properties, particularly those associated with the STG, hold promise as emerging metrics for assessing symptoms and treatment efficacy in patients with psychotic symptoms.
RESUMO
BACKGROUND: Schools play a crucial role in providing mental health services to children and adolescents. However, the vastness of the student population and mental health workforce shortage in China severely limit the capacity for adequate care access and delivery. OBJECTIVE: We propose a large, mixed longitudinal cohort study, 'School-based Evaluation Advancing Response for Child Health (SEARCH)', aimed at addressing the increasing demand from individuals seeking access to mental healthcare services. METHODS: SEARCH uses a digital platform and school-based protocol for comprehensive assessment of the mental well-being of Chinese students in grades 4-12 incorporating individual, caregiver and teacher input, including capture of facial and acoustic features and response times, as well as mental well-being assessments. FINDINGS: We completed first wave data collection from nearly 20 000 participants (students, caregivers and teachers) at 11 schools, grades 4-12, in 3 cities in Jiangsu province in Southeast China from September 2022 to February 2023. We intend to conduct follow-up assessments for grades 4 through 12 at the 11 school sites every 6 months for 5 years. CONCLUSIONS: SEARCH will provide important insight into the developmental trajectory of mental well-being in Chinese children and adolescents. The study protocol does not simply focus on student self-report and incorporates caregiver and teacher viewpoints as well. It also collects objective indicators that may facilitate development of screening tools. CLINICAL IMPLICATIONS: We believe future study findings will guide the development and implementation of school-based mental healthcare initiatives to improve the well-being of children and adolescents.