Personality traits influence the effectiveness of hypomania checklist-32 in screening for bipolar disorder.

Background: It is clinically challenging to distinguish bipolar disorder (BD) from major depressive disorder (MDD) in the early stages. While the hypomania checklist-32 (HCL-32) is a proper auxiliary tool that is useful to differentiate between BD and MDD, there is currently no standard cut-off value. The variations in HCL-32 cut-off values could potentially be influenced by personality traits. Therefore, the aim of this study is to explore the effect of personality traits on the screening performance of HCL-32. Methods: In this retrospective cross-sectional study, 168 patients with BD or MDD were evaluated with the Eysenck Personality Questionnaire (EPQ) and HCL-32. The associations between demographic data, diagnosis and clinical rating scales were analyzed. Results: Diagnosis was not associated with extraversion but was related to neuroticism. HCL-32 scores in typical extraverted patients were higher in contrast to atypical extraverted patients. The best cut-off value for BD recognition of typical and atypical extraversion groups were 15 and 12.5, respectively. In patients with MDD, HCL-32 score of typical neuroticism was higher than the atypical type, but there was no difference in patients with BD. In typical neuroticism, there was no difference in HCL-32 scores between patients with MDD and BD. But among atypical neurotic patients, HCL-32 scores of BD were higher compared to MDD, with a cut-off value of 14.5. Limitations: This study had a small sample size. Conclusion: HCL-32 scores were affected by personality traits, with higher scores for typical extraversion and neuroticism. Clinicians should also consider the patients' personality traits when referring to HCL-32 scores, so as to increase the recognition rate of BD and eliminate false positives.

Association Between Antidepressant Efficacy and Interactions of Three Core Depression-Related Brain Networks in Major Depressive Disorder.

Background: The central executive network (CEN), salience network (SN), and default mode network (DMN) are the three most studied depression-related brain networks. Many studies have shown that they are related to depression symptoms and treatment effects. However, few studies have related these three networks and their activity frequency bands to depressive symptoms and treatment efficacy. Methods: Sixty-six medication-free patients with major depressive disorder (MDD) were enrolled. Magnetoencephalography (MEG) was administered at baseline to calculate imaging indicators such as the power and functional connectivity (FC) of each brain network. The Hamilton Rating Score for Depression (HRSD-17) was assessed at baseline and weekly for 4 weeks. Pearson correlation and receiver operating characteristic curves (ROC) analyses were used to explore the relationship between brain imaging indicators and antidepressant efficacy. Results: The difference between therapeutically effective and ineffective groups was mainly manifested in the beta power of the SN. The FC of beta waves between the three networks was related to antidepressant efficacy, with ROC analysis results of AUC = 0.794, P = 0.004, sensitivity = 76.7%, and specificity = 81.8%. Limitations: The sample size was small and a healthy control group was not available. Conclusions: The interaction between the three networks is related to antidepressant efficacy and the relief of depressive symptoms.

Neuroleptic malignant syndrome with abnormally elevated cardiac troponin I: a case report.

Neuroleptic malignant syndrome (NMS) is a life-threatening neurological emergency that is primarily characterized by altered consciousness, hyperpyrexia, muscular rigidity, and autonomic instability. Here, we describe a unique case of NMS. A 54-year-old woman with major depressive disorder (MDD) was admitted to our hospital to relieve painful emotions; her laboratory tests and physical examinations were unremarkable. Her medication regime was as follows: day 1, quetiapine (200 mg), clonazepam (2 mg), and zopiclone (7.5 mg); day 2, olanzapine (5 mg) and sertraline (100 mg); day 3, olanzapine (15 mg), sertraline (100 mg), zopiclone (7.5 mg), and clonazepam (2 mg); day 4, olanzapine (15 mg) and haloperidol (5 mg); and day 5, sertraline (50 mg) and olanzapine (5 mg). The patient then developed NMS, and a series of tests showed further abnormalities. Unusually, her cardiac troponin I (TNI) was abnormally elevated as her NMS symptoms worsened, but gradually decreased after she was transferred to the cardiology department for treatment. The increased TNI was suspected to be related to the NMS. Here, we provide several potential explanations for the relationship between TNI and NMS. Based on the present case, it may be important to measure and monitor TNI concentrations in NMS patients.

Fluoxetine regulates glucose and lipid metabolism via the PI3K­AKT signaling pathway in diabetic rats.

Diabetes mellitus poses a major threat towards global heath due to a lack of effective treatment. Fluoxetine hydrochloride, a selective 5­hydroxytryptamine reuptake inhibitor, is the most commonly used antidepressant in clinical therapy; however, the potential molecular mechanisms of fluoxetine in diabetes remain unknown. In the present study, reduced glucose, total cholesterol and triglyceride levels and lipid metabolism, as well as upregulated proliferator­activated receptor γ, fatty acid synthase and lipoprotein lipase, and downregulated sterol regulatory element­binding protein 1­c were detected in rats with streptozotocin (STZ)­induced diabetes following treatment with fluoxetine. Furthermore, fluoxetine significantly inhibited the expression levels of glucose metabolism­associated proteins in liver tissues, including glycogen synthase kinase 3ß (GSK­3ß), glucose­6 phosphatase catalytic subunit (G6PC), phosphoenolpyruvate carboxykinase (PEPCK) and forkhead box protein O1 (FOXO1). In addition, fluoxetine treatment notably attenuated morphological liver damage in rats with STZ­induced diabetes. Additionally, fluoxetine could inhibit the phosphatidylinositol 3­kinase­protein kinase B (PI3K­AKT) signaling pathway, whereas LY294002, a specific inhibitor of PI3K, suppressed the function of PI3K­AKT signaling and suppressed the expression levels of glucose metabolism­associated proteins, including GSK­3ß, G6PC, PEPCK and FOXO1 in BRL­3A cells. The results of the present study revealed that fluoxetine may regulate glucose and lipid metabolism via the PI3K­AKT signaling pathway in diabetic rats.

Efficacy and tolerability of escitalopram in treatment of major depressive disorder with anxiety symptoms: a 24-week, open-label, prospective study in Chinese population.

BACKGROUND: Significant anxiety symptoms are associated with poor clinical course and outcome in major depressive disorder (MDD). This single-arm, open-label study aimed to evaluate the efficacy and tolerability of escitalopram treatment in patients with MDD and anxiety symptoms. METHODS: Adult patients with MDD and anxiety symptoms (Montgomery-Asberg Depression Rating Scale [MADRS] ≥22 and Hamilton Anxiety Rating Scale [HAM-A] ≥14) were enrolled and received escitalopram (10-20 mg/day) treatment for 24 weeks. Symptom status was assessed by MADRS, 17-item-Hamilton Depression Rating Scale, HAM-A, and Clinical Global Impression Scale at baseline and the following visits. Quality of life was assessed by Short Form-12, and safety was evaluated by adverse events, laboratory investigations, vital signs, and physical findings. RESULTS: Overall, 200 of 318 (66.2%) enrolled patients completed the 24-week treatment. The remission (MADRS ≤10 and HAM-A ≤7) rate in the full analysis set (N=285) was 73.3% (95% confidence interval: 67.80, 78.38) at week 24. Mean (± standard deviation) MADRS total score was 33.4 (±7.13) and HAM-A score was 27.6 (±7.26) at baseline, which reduced to 6.6 (±10.18) and 6.0 (±8.39), respectively, at week 24. Patients with higher baseline depression and anxiety level took longer to achieve similar remission rates. Overall, 80 of the 302 (26.5%) patients included in the safety set reported at least 1 treatment-emergent adverse event (TEAE). Most frequently reported TEAEs (>2%) were headache (4.0%), nasopharyngitis (3.6%), nausea (3.0%), and dizziness (2.6%). Serious TEAEs were reported by 1.3% patients; no deaths were reported. CONCLUSION: Escitalopram 10-20 mg/day was effective and well-tolerated in the long-term treatment of MDD with anxiety symptoms in adult Chinese population.

Evaluation of apparent diffusion coefficient mappings in amnestic mild cognitive impairment using an image analysis software brain search.

BACKGROUND: The apparent diffusion coefficient (ADC) from diffusion-weighted imaging (DWI) can quantify alterations in water diffusivity resulting from microscopic structural changes from amnestic mild cognitive impairment (aMCI) and Alzheimer's disease (AD). PURPOSE: To investigate the ADC value for aMCI and AD using Brain Search (BS) software based on anatomical volumes of interest (AVOI). MATERIAL AND METHODS: In total, 174 aged people were screened, and 25 patients with AD, 26 patients with aMCI, and 18 normal controls (NCs) were recruited. DWI was performed at 1.5 T with a fluid-attenuated inversion recovery (FLAIR), and the independent ADC mapping was generated after imaging acquisition. Ninety regional parcellations were adopted in a Brain Search (BS) based on the automated anatomic labeling atlas. The gray scale intensities (water diffusivity) from the collected ADC mappings were analyzed with BS. The mean value of each anatomical brain region was compared among aMCI, AD, and NC. The statistically significant (P < 0.05) group differences are displayed in color. RESULTS: During the pathological process of AD, the changes of water diffusivity appeared first in the left hippocampus, then gradually progressed to the bilateral sides and eventually displayed right lateralization. The ADC values from aMCI were obviously elevated compared to the values from the NC group in the left limbic cortex. Between the AD and NC groups, the significantly different brain areas included the bilateral hippocampus, the Cingulum_Mid, the ParaHippocampal_R, and the Temporal and Frontal lobes. There was a negative correlation between the ADC values and the scores from MMSE, MoCA, the Digit test, Raven's IQ, and WAIS IQ. Additionally, the ADC values were positively correlated with the scores from CDR, ADL, and ADAS-Cog. CONCLUSION: The water diffusivity for aMCI and AD displays asymmetric anatomical lateralization. The water diffusivity alterations can be analyzed and visualized with our newly designed analytic imaging software, BS, which can be used as a good reference for examining and diagnosing aMCI and AD patients.

Multi-center study on Alzheimer's disease using FDG PET: group and individual analyses.

Using statistical parametric mapping (SPM), we evaluate the feasibility and accuracy of (18) F -2-deoxy-2-fluoro-D-glucose (FDG) positron emission tomography (PET) for clinical diagnosis with characteristic hypo-metabolic regions, and examine the consistency of cerebral hypo-metabolism in Alzheimer's disease (AD) cross multicenters at both the group and the individual levels. Four groups of scan data including 39 AD patients and 52 healthy control subjects derived from three centers were analyzed and comparisons between patient subgroups or individual patient and relevant control population were performed using Two Sample T-test. In the group analysis, the hypo-metabolic regions of AD patients obtained from different PET centers were similar and consistent. The common hypo-metabolic cerebral areas were located bilaterally in the posterior cingulate and medial parietal cortex, temporo-parietal cortex, prefrontal cortex, and the middle and inferior temporal gyrus (uncorrected, p<0.001). In the analysis of each individual subject, the location of declined posterior cingulate and medial parietal cortex, temporo-parietal cortex and temporal lobe were found highly consistent with relevant characteristic regions obtained in the group analysis and were selected for diagnostic purposes. Complete typical hypo-metabolic pattern was observed in 67% and 54% of AD patients in two sets of 3D scans, respectively. Only 27% and 33.3% patients showed full typical pattern in two sets of 2D scans. The results indicated that FDG PET measures and SPM can 4 provide a valuable reference for clinical diagnosis of AD patients. The potential influence of acquisition mode on the clinical diagnosis of AD was suggested for further evaluation.

[Change of cerebral metabolism rate of glucose of cerebral white matter in Alzheimer's disease: a study with statistical parametric mapping software].

OBJECTIVE: To study the change of cerebral metabolism rate of glucose (CMRglc) of cerebral white matter in Alzheimer's Disease. METHODS: Positron emission tomography (PET) was performed on 13 AD patients, 6 with behavioral and psychological symptoms of dementia (BPSD) and 7 without BPSD, and 10 healthy controls. The regional cerebral metabolism of glucose (rCMRglc) of some brain regions and nuclei were detected. RESULTS: (1) The rCMRglc of the cerebral white matter decreased extensively in the AD patients, especially in the right frontal lobe, superior gyrus of the left frontal lobe (P = 0.001). (2) The rCMRglc of subcortical white matter of the left medial prefrontal lobe and the left cuneus of occipital lobe increased in the AD patients. (3) The levels of rCMRglc of the subcortical white matter of both side middle occipital lobe, left cuneus of occipital lobe, right inferior parietal lobule, left fusiform gyrus of temporal lobe and the left medial prefrontal lobe were all significantly higher in the AD patients with BPSD than in those without BPSD (P = 0.001). While the levels of rCMRglc of the subcortical white matter of both side paracentral lobule, right superior and middle frontal lobe, and left superior temporal lobe were all significantly lower in the AD patients with BPSD than in those without BPSD (all P = 0.001). CONCLUSION: There is diffuse abnormal rCMRglc in the cerebral white matter in the AD patients: the rCMRglc decreases in the frontal-temporal-occipital association area, and the rCMRglc of the medial prefrontal lobe and cuneus of occipital lobe increases. BPSD is correlated with the abnormal metabolism of related cerebral regions.

[Measurement of regional cerebral metabolism rate of glucose in patients with Alzheimer's disease in different levels of severity].

OBJECTIVE: To measure the changes of regional cerebral metabolism rate of glucose (rCMRglc) in patients with Alzheimer's disease (AD) and explore their value to diagnosis of AD. METHODS: 10 patients with AD who met the diagnostic criteria of DSM-IV and 10 normal controls (NC) were assessed with (18)F-2-fluoro-deoxy-D-glucose positron emission tomography (PET). RESULTS: The two groups were matched in age, gender and education. The mean total scores of the mini-mental status examination (MMSE) were 16.5 +/- 6.1 for AD and 28.7 +/- 1.6 for NC. The mean total memory quotient of Wechsler Memory Scales (MQ) were 32.3 +/- 19.6 for AD and 93.1 +/- 9.0 for NC. Comparing to NC, the AD groups showed statistically significant decline of rCMRglc in frontal lobe, temporal lobe and the hippocampal formation with decreased rates ranged from 3.3% to 28.4% (P < 0.05, P < 0.01). The hypo-metabolism was more salient in the regions of upper and middle frontal gyri, middle temporal gyrus, orbital gyrus and anterior cingulate gyrus, in which areas the metabolism decreased over 20% compared to NC. The hypo-metabolism was correlated to the severity of dementia. Discriminant analysis demonstrated that the variables of right inferior temporal gyrus, left upper temporal gyrus, left hippocampus and right insular lobe were entered into the discriminant functions and the total discriminant accuracy reached 100%. CONCLUSIONS: (18)F-FDG PET is a very sensitive tool in measurement of the changes of rCMRglc in patients with AD. The findings show a frontal-temporal type of metabolism in AD patients and suggest that hypo-metabolism in hippocampal formation and temporal lobe is helpful in early detection of AD.

Brain glucose metabolism and neuropsychological test in patients with mild cognitive impairment.

OBJECTIVE: To investigate the features of regional cerebral metabolic rate of glucose (rCMRglc) in patients with mild cognitive impairment (MCI) by positron emission-tomography and its relationship with neuropsychological test. METHODS: Positron emission tomography, mini-mental state examination and Wechsler memory scale were applied in 10 patients with MCI and 10 healthy volunteers as the control group. RESULTS: Scores of mini-mental state examination and Wechsler memory scale in MCI patients were lower than those in the control group (P < 0.01). rCMRglc of the left orbital gyrus, right middle temporal gyrus and right putamen was lower in the MCI group than in the control group (P < 0.05). Correlation analysis in the MCI group indicated that rCMRglc of many brain regions such as the orbital gyrus, putamen, left hippocampus and parahippocampal gyrus, cingulate gyrus, left amygdaloid body, precentral gyrus, postcentral gyrus, and medial occipitotemporal gyrus in MCI patients, were correlated negatively with age; while the rCMRglc of many parts of the brain such as the left putamen, temporal lobe, anterior cingulate gyrus, left insular lobe, amygdaloid body, precentral gyrus, postcentral gyrus and medial occipitotemporal gyrus were correlated positively with mini-mental state examination; and rCMRglc of the left putamen, temporal lobe, left insular lobe, precentral gyrus and postcentral gyrus were correlated positively with Wechsler memory scale. The right putamen, the right inferior temporal gyrus, precentral gyrus, and left postcentral gyrus were correlated positively with the length of education. However, only rCMRglc of the left amygdaloid body were correlated positively with gender. CONCLUSION: The rCMRglc was lower in the orbital gyrus and putamen of MCI patients. Their rCMRglc were correlated with their cognitive impairment severity, age, length of education and sex.

[The comparison of the regional cerebral metabolism rate of glucose in Alzheimer's disease with mild cognitive impairment].

OBJECTIVE: To study the feature of regional cerebral metabolism rate of glucose (rCMRglc) of Alzheimer's disease (AD) and mild cognitive impairment (MCI) by positron emission tomography (PET) and the relationship between MCI and AD. METHODS: 13 AD patients, 10 MCI patients and 10 health volunteers as a control group (HC) were underwent 18F-fluoro deoxyglucose (18F-FDG)-PET scanning. RESULTS: (1) There was lightly decreasing of radioactivity of temporal lobe and parietal lobe in HC group, a little severer decrease in MCI group, markedly decrease of radioactivity of temporal lobe, parietal lobe and frontal lobe in AD group examined by naked-eye. (2) The rCMRglc of many parts of brain such as frontal lobe, including superior, middle and inferior frontal gyrus, orbital gyrus and rectus gyrus, temporal lobe, including superior, middle and inferior temporal gyrus, parietal lobe, including superior parietal lobe, supramarginal gyrus and angular gyrus, limbic system, including anterior cingulate gyrus, insular lobe, basal ganglions, including thalamus, caudate nucleus and amygdaloid nucleus decreased significantly in AD group, compared to MCI and HC groups (p < 0.05 to p < 0.001). (3) The rCMRglc of many parts of brain such as frontal lobe, temporal lobe, parietal lobe, limbic system, and basal ganglions in MCI group was lower than that in HC group, but not significantly (p > 0.05). Only that of the left caudate nucleus in MCI decreased significantly compared to that in HC group (p < 0.05). CONCLUSION: Decreasing of rCMRglc of parietal lobe is sensitive in evaluating cognitive function, next one is temporal lobe, and then frontal lobe. The rCMRglc of frontal lobe, temporal lobe, parietal lobe, limbic system, and basal ganglions decreasing markedly indicates that global function decayed in AD patients. While the rCMRglc of those parts in MCI patients' brain decreases mildly. This indicates that MCI is the middle state of AD and HC. Decreasing of rCMRglc of the left caudate nucleus has a certain role in diagnosis of MCI.