Cognitive-behavioral therapy for patients with somatoform disorders: A pilot preliminary randomized controlled trial.

Background and objective: Cognitive-behavioral therapy (CBT) for somatoform disorders (SFDs) is understudied in China. Western findings may not be applicable to Chinese culture. This preliminary study evaluated the efficacy of CBT for patients in China, relative to treatment-as-usual (TAU). Methods: Seventy patients with SFDs randomly received either combined CBT and TAU (CBT + TAU), or TAU alone between January 2018 to May 2019. The CBT + TAU group received 12 weekly individual 50-minute CBT sessions. Participants were blindly assessed at 4 timepoints (baseline, week 6, end of treatment: week 12; 12 weeks post-treatment: week 24) using the following outcome measures: SQSS (Self-screening Questionnaire for Somatic Symptoms); PHQ-15 (Patient-Health-Questionnaire-15) and the WI (Whiteley Index); GAD-7 (General Anxiety Disorder-7); HAMD-17 (Hamilton Depression Rating Scale-17); Family Burden Interview Schedule (FBIS); Sheehan Disability Scale (SDS); and the Short Form of Quality-of-Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q-SF). The primary endpoint was the difference between the SQSS total score at week 24 and the baseline. A mixed model for repeated measures was used to analyze inter- and intra-group changes from the baseline. Results: At week 24, The least-squares mean (LSM) change of the total score on the SQSS was -18.87 points and -9.69 points, respectively in the CBT + TAU group and in the TAU group (LSM difference, -9.18 points; 95% confidence interval, -15.72 to -2.64; P = 0.0068). At week 24, the LSM changes from baseline in the WI, HAMD, PHQ15, FBIS and SDS total scores were significantly different between the two groups, however, there was no significant difference in the Q-LES-Q-SF. The SQSS of group effect sizes were 0.63 at 24 weeks. The dropout rates of the CBT + TAU and TAU groups were comparable (22.9% and 19.3%). Conclusions: These preliminary findings suggest that CBT may be helpful for improving the symptoms of patients with SFDs in China.

Study on symptom dimensions and clinical characteristics in patients with obsessive-compulsive disorder.

BACKGROUND AND OBJECTIVE: The aim of this study was to explore the symptom dimensions and clinical characteristics of obsessive-compulsive disorder in the context of Chinese culture. METHODS: In this cross-sectional study, the severity of obsessive-compulsive symptoms, the distribution of symptoms, and symptom scores of 263 patients with obsessive-compulsive disorder were assessed using the Yale-Brown Obsessive-Compulsive Scale and Yale-Brown Obsessive-Compulsive Inventory Symptoms Checklist. System cluster analysis and Pearson analysis were performed to explore the relationships between the main clinical characteristics and symptom dimensions. RESULTS: Cluster analysis identified four symptom dimensions of obsessive-compulsive disorder: (1) symmetry precision; (2) contamination cleaning; (3) aggression examination; and (4) taboo thinking. The symmetry precision dimension showed an association with years of education. The compulsive score, total Yale-Brown Obsessive Compulsive Scale score, contamination cleaning dimension, and aggression examination dimension had significant relationships. Age, age at onset, obsessive score, and compulsive score had a significant correlation with the taboo-thinking dimension. CONCLUSION: The symptom dimensions of obsessive-compulsive disorder in China are similar to those in other regions. Each of the four symptom dimensions had distinct clinical characteristics.

The efficacy of cognitive behavioral therapies for depression in China in comparison with the rest of the world: A systematic review and meta-analysis.

OBJECTIVE: There is consistent evidence that cognitive behavioral therapies (CBTs) are effective interventions for adult depression. While some evidence has compared these effects in different countries, no prior systematic review and meta-analysis has compared the efficacy of CBTs between Chinese and people from the rest of the world. The current meta-analysis addressed this gap by a systematic review of eligible studies from Chinese and worldwide databases. METHOD: Hedges' g was calculated using a random-effects model. Subgroup analyses and multilevel meta-analytic models were conducted to examine the relationship among effect sizes and the characteristics in Chinese studies. Metaregression analyses were conducted to explore the difference of the efficacy of CBTs between Chinese studies and non-Chinese studies after controlling for the moderators. RESULTS: A total of 34 (n = 3,710) studies in China and 307 (n = 30,333) studies from the rest of the world were included. The effect size of CBTs on depression for Chinese participants was 1.19 (95% CI [0.86, 1.52]), which was higher (Q = 4.63, p = .03) than the effect size of the rest of the world (0.82, 95% CI [0.74, 0.90]). After controlling for moderators, the effect size of Chinese studies was still higher than non-Chinese studies (ß = 0.351, p = .011). CONCLUSIONS: CBTs are effective interventions for adult depression and deserve more attention in China for depression management. Moderators related to study design, clinical features, and cultural factors need to be considered in the interpretation of the results. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Exploring the thalamus: a crucial hub for brain function and communication in patients with bulimia nervosa.

BACKGROUND: Bulimia nervosa (BN) is an eating disorder characterized by recurrent binge eating and compensatory behaviors. The thalamus plays a crucial role in the neural circuitry related to eating behavior and needs to be further explored in BN. METHODS: In this study, 49 BN patients and 44 healthy controls (HCs) were recruited. We applied the fractional amplitude of low-frequency fluctuation to investigate regional brain activity in the thalamus and functional connectivity (FC) to examine the synchronization of activity between thalamic subregions and other brain regions in both groups. All results underwent false discovery rate (p < 0.05, FDR correction) correction. Pearson correlation analysis was performed to assess the relationship between the patients' abnormal clinical performance and the thalamic alterations (p < 0.05, FDR correction). RESULTS: We found no significant differences in neural activity between BN patients and HCs in the sixteen thalamic subregions. However, compared to the HCs, the individuals with BN showed decreased FC between the thalamic subregions and several regions, including the bilateral prefrontal cortex, right inferior parietal lobule, right supplementary motor area, right insula, cingulate gyrus and vermis. Additionally, BN patients showed increased FC between the thalamic subregions and visual association regions, primary sensorimotor cortex, and left cerebellum. These altered FC patterns in the thalamus were found to be correlated with clinical variables (the frequency of binge eating/purging per week and external eating behavior scale scores) in the BN group. All results have passed FDR correction. CONCLUSIONS: Our study provides evidence that there is disrupted FC between thalamic subregions and other brain regions in BN patients during resting state. These regions are primarily located within the frontoparietal network, default mode network, somatosensory, and visual network. These findings elucidate the neural activity characteristics underlying BN and suggest that thalamic subregions have potential as targets for future neuromodulation interventions.

The high recurrence rate of bulimia nervosa (BN) poses a clinical challenge, and thus, it is crucial to improve the characterization and identification of brain functional abnormalities as direct targets for novel therapies. To investigate the neural circuitry associated with BN, the thalamus is a critical node since it serves as a higher-order relay point in the cortico-thalamo-cortical information pathway. Our findings reveal that altered functional connectivity (FC) between thalamic nuclei and other brain regions is evident throughout the whole brain, particularly within the frontoparietal network, default mode network, somatosensory, and visual network. These changes in FC are significantly associated with disordered eating behavior and the severity of illness in BN patients. Therefore, these findings help identify the neural mechanisms underlying disordered eating behavior and BN severity and suggest potential targets for future neuromodulation interventions.

Alterations of interhemispheric functional homotopic connectivity and corpus callosum microstructure in bulimia nervosa.

Background: Accumulating evidence indicates maladaptive neural information interactions between different brain regions underlie bulimia nervosa (BN). However, little is known about the alterations in interhemispheric communication of BN, which is facilitated by the corpus callosum (CC), the major commissural fiber connecting the two hemispheres. To shed light on the interhemispheric communications in BN, the present study aims to explore alterations of interhemispheric homotopic functional connectivity and the CC microstructure in BN. Methods: Based on magnetic resonance imaging (MRI) data collected from 42 BN patients and 38 healthy controls (HCs), the group differences of voxel-mirrored homotopic connectivity (VMHC) index and CC white matter microstructure were compared. Then brain regions with significant group differences in VMHC were selected as seeds for subsequent functional connectivity (FC) analysis. Seed-based fiber tracking and correlation analysis were used to analyze the relationship between VMHC and CC changes. And correlation analysis was used to reveal the correlation between abnormal imaging variables and the clinical features of BN. Results: Compared with HCs, the BN group showed decreased fractional anisotropy (FA) in middle part of CC (CCMid) and increased VMHC in bilateral orbitofrontal cortex (OFC) and middle temporal gyrus (MTG) [false discovery rate (FDR) correction with a corrected threshold of P<0.05]. Subsequent FC analyses indicated increased FC between left OFC and right OFC, bilateral MTG, left middle occipital gyrus and right precuneus (PCUN); between right OFC and left cerebellum crus II and right PCUN; and between left MTG and right inferior temporal gyrus, right cerebellum lobule VI and right medial superior frontal gyrus (FDR correction with a corrected threshold of P<0.05). The VMHC values of OFC and MTG showed no correlations with FA values of the CCMid and the white fibers between the bilateral OFC and MTG were not through the CCMid. In addition, several regions with abnormal FC had a potential correlation trend with abnormal eating behaviors in BN patients (P<0.05, uncorrected). Conclusions: Aberrant interhemispheric homotopic functional connectivity and CC microstructure were observed in BN, and they may be independent of each other. Regions with aberrant interhemispheric homotopic functional connectivity showed hyperconnectivity with regions related to reward processing, body shape perception, and self-reference.

Uncovering neural pathways underlying bulimia nervosa: resting-state neural connectivity disruptions correlate with maladaptive eating behaviors.

PURPOSE: Bulimia nervosa (BN) is characterized by recurrent binge-eating episodes and inappropriate compensatory behaviors. This study investigated alterations in resting-state surface-based neural activity in BN patients and explored correlations between brain activity and eating behavior. METHODS: A total of 26 BN patients and 28 healthy controls were enrolled. Indirect measurement of cerebral cortical activity and functional connectivity (FC) analyses were performed in Surfstat. A principal component analysis (PCA) model was used to capture the commonalities within the behavioral questionnaires from the BN group. RESULTS: Compared with the healthy control group, the BN group showed decreased surface-based two-dimensional regional homogeneity in the right superior parietal lobule (SPL). Additionally, the BN group showed decreased FC between the right SPL and the bilateral lingual gyrus and increased FC between the right SPL and the left caudate nucleus and right putamen. In the FC-behavior association analysis, the second principal component (PC2) was negatively correlated with FC between the right SPL and the left caudate nucleus. The third principal component (PC3) was negatively correlated with FC between the right SPL and the left lingual gyrus and positively correlated with FC between the right SPL and the right lingual gyrus. CONCLUSION: We revealed that the right SPL undergoes reorganization with respect to specific brain regions at the whole-brain level in BN. In addition, our results suggest a correlation between brain reorganization and maladaptive eating behavior. These findings may provide useful information to better understand the neural mechanisms of BN. LEVEL OF EVIDENCE: V, descriptive study.

Functional and structural MRI based obsessive-compulsive disorder diagnosis using machine learning methods.

BACKGROUND: The success of neuroimaging in revealing neural correlates of obsessive-compulsive disorder (OCD) has raised hopes of using magnetic resonance imaging (MRI) indices to discriminate patients with OCD and the healthy. The aim of this study was to explore MRI based OCD diagnosis using machine learning methods. METHODS: Fifty patients with OCD and fifty healthy subjects were allocated into training and testing set by eight to two. Functional MRI (fMRI) indices, including amplitude of low-frequency fluctuation (ALFF), fractional ALFF (fALFF), regional homogeneity (ReHo), degree of centrality (DC), and structural MRI (sMRI) indices, including volume of gray matter, cortical thickness and sulcal depth, were extracted in each brain region as features. The features were reduced using least absolute shrinkage and selection operator regression on training set. Diagnosis models based on single MRI index / combined MRI indices were established on training set using support vector machine (SVM), logistic regression and random forest, and validated on testing set. RESULTS: SVM model based on combined fMRI indices, including ALFF, fALFF, ReHo and DC, achieved the optimal performance, with a cross-validation accuracy of 94%; on testing set, the area under the receiver operating characteristic curve was 0.90 and the validation accuracy was 85%. The selected features were located both within and outside the cortico-striato-thalamo-cortical (CSTC) circuit of OCD. Models based on single MRI index / combined fMRI and sMRI indices underperformed on the classification, with a largest validation accuracy of 75% from SVM model of ALFF on testing set. CONCLUSION: SVM model of combined fMRI indices has the greatest potential to discriminate patients with OCD and the healthy, suggesting a complementary effect of fMRI indices on the classification; the features were located within and outside the CSTC circuit, indicating an importance of including various brain regions in the model.

A comparison of 'not just right experiences' in obsessive-compulsive disorder, anxiety and depressive disorders and non-clinical controls in China.

OBJECTIVE: The aim of this study is to investigate the characteristics of 'not just right experiences' (NJREs) in patients with obsessive-compulsive disorder (OCD), anxiety disorders (ADs) or major depressive disorder (MDD), compared with those of healthy controls (HCs). METHOD: One hundred adults with OCD, 86 adults with ADs, 57 adults with MDD and 60 HCs were enrolled in the study. The Not Just Right Experiences Questionnaire Revised (NJRE-QR), Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) were used to evaluate clinical symptoms in patients with OCD, ADs or MDD. The Obsessive Belief Questionnaire-44 (OBQ-44) was used to evaluate OC beliefs in the OCD patients. The HCs only received assessment using the NJRE-QR. Analysis of variance (ANOVA) and covariance (ANCOVA) were performed to compare the NJREs scores across the groups, while Pearson correlation and partial correlation analyses were used to examine the association between NJREs and other clinical features. The contribution of NJREs to predict OC symptoms was determined by multiple stratified linear regression. RESULTS: Individuals with OCD had significantly higher scores for the number of NJREs than ADs, but not MDD. The severity of NJREs was also significantly higher in patients with OCD than those with MDD or ADs (F = 5.23 and F = 19.79, respectively, P < 0.01). All the clinical scores in the NJRE-QR were significantly higher than those in the HC group. The number and severity of NJREs correlated significantly with the Y-BOCS total score (r = 0.29 and r = 0.39, respectively, P < 0.01). NJREs showed an independent contribution to OC symptoms, which alone explained 8% of the variation (F = 16.49, ΔR2 = 0.08; P < 0.01). CONCLUSION: NJREs are related closely to OC symptoms, with their severity discriminating between OCD patients and those with ADs or MDD. NJREs were more specific for OCD in the Chinese population and are therefore worthy of further study in the future.

The role of functional and structural properties of the nucleus accumbens subregions in eating behavior regulation of bulimia nervosa.

OBJECTIVE: Although studies have demonstrated the involvement of the nucleus accumbens (NAc) in the neurobiology of eating disorders, its alterations in bulimia nervosa (BN) remain largely unknown. This study investigated the structural and functional properties of NAc in patients with BN. METHOD: Based on the resting-state functional MRI and high-resolution anatomical T1-weighted imaging data acquired from 43 right-handed BN patients and 40 sex-, age- and education-matched right-handed healthy controls (HCs), the group differences in gray matter volume (GMV) and fractional amplitude of low-frequency fluctuation (fALFF) in slow-4 and -5 bands and functional connectivity (FC) of NAc subregions (core and shell) were compared. The relationships between MRI and clinical data were explored in the BN group. RESULTS: Compared with HCs, BN patients showed preserved GMV, decreased fALFF in slow-5 band of the left NAc core and shell, decreased FC between left NAc core and right caudate, and increased FC between all NAc subregions and frontal regions, between all NAc subregions (except the right NAc core) and the supramarginal gyrus (SMG), and between right NAc shell and left middle temporal gyrus. FC between the NAc and SMG was correlated with emotional eating behaviors. DISCUSSION: Our study revealed preserved GMV, local neuronal activity reduction and functional network reorganization of the NAc in BN. The functional network reorganization of the NAc mainly occurred in the frontal cortex and was correlated with emotional eating behavior. These findings may provide novel insights into the BN using NAc as an entry point. PUBLIC SIGNIFICANCE: Although studies have demonstrated the involvement of the nucleus accumbens (NAc) in the neurobiology of eating disorders, its alterations in bulimia nervosa (BN) remain largely unknown. We used a multimodal MRI technique to systematically investigate structural and functional alterations in NAc subregions of BN patients and explored the associations between such alterations and maladaptive eating behaviors, hoping to provide novel insights into BN.

Characteristics and economic burden of patients with somatoform disorders in Chinese general hospitals: a multicenter cross-sectional study.

BACKGROUND: In China, patients with somatoform disorders (SFD) often seek medical treatment repeatedly in outpatient clinics of general hospitals, which increases unreasonable medical expenses. It is imperative to provide early screening to these patients and specialized treatment to reduce the unnecessary cost. This study aimed to screen patients with SFD in general hospitals using a new Chinese questionnaire and explore the characteristics and economic burden of these patients. METHODS: Patients (n = 1497) from the outpatient department of neurology, cardiology and gastroenterology of three large general hospitals were included. Participants were screened using a newly developed questionnaire, the Self-screening Questionnaire for Somatic Symptoms (SQSS), to identify the patients with SFD (total SQSS score ≥ 29 points). We compared the demographics and clinical information of patients with and without SFD. Logistic regression was used to explore potential factors related to medical expenses, visits to doctors and sick leave days taken. RESULTS: The frequency of detection of patients with SFD was 17.03%. There were significant differences in employment, doctor visits, symptom duration, medical expenses, sick leave days, PHQ-15 scores, and PHQ-9 scores between patients with SFD and without SFD. General nonspecific somatic symptoms were frequently present in patients with SFD. Several potential factors were associated with higher medical expenses, repeated doctor visits, and sick leave days taken in the regression analysis. CONCLUSION: The findings indicate that patients with SFD are common in general hospitals, and their direct and indirect economic burden is higher than that of non-SFD patients, which indicates that more screening effort should be made to this group to early identify their problems. Certain characteristics were identified among patients with SFD and several factors were associated with negative consequences of SFD, all of which might be prevented by developing a preventive intervention program to reduce the economic burden of the patients.

Fronto-temporal dysfunction in appetitive regulation of bulimia nervosa with affective disorders: A regional homogeneity and remote connectivity pattern analysis.

OBJECTIVE: The aim of this study was to assess brain functional alterations in BN patients with affective disorders and their association with maladaptive eating behaviors. METHODS: A total of 42 BN patients with affective disorders (anxiety and depression) and 47 healthy controls (HCs) were enrolled in this study. The resting-state fMRI data were analyzed for functional changes as indicated by regional homogeneity based on Kendall's coefficient of concordance (KCC-ReHo) and seed-based functional connectivity (FC). A principal component analysis (PCA) model was used to identify the commonalities within the behavioral questionnaires from the BN group. RESULTS: Patients in the BN group showed decreased ReHo in the bilateral middle frontal gyrus (MFG) and right supramarginal gyrus (SMG). Additionally, the BN group showed increased FC between the left MFG and the right inferior temporal gyrus (ITG); decreased FC between the right MFG and the bilateral insula and the left middle temporal gyrus (MTG); and decreased FC between the right SMG and the left superior temporal gyrus (STG) and right inferior frontal gyrus (IFG). In the FC-behavior association analysis, the second principal component (PC2) was negatively correlated with FC between the left MFG and the right ITG. CONCLUSION: Based on a brain functional analysis (ReHo and FC), this study revealed significant aberrant changes in the frontal-temporal regions of BN patients with affective disorders. These regions, which serve as fronto-temporal circuitry, are associated with restraint and emotional eating behaviors. Our findings shed new light on the neural mechanisms underlying the condition.

Characteristics of white matter alterations along fibres in patients with bulimia nervosa: A combined voxelwise and tractography study.

Accumulating evidence supports the hypothesis that white matter (WM) abnormalities are involved in the pathophysiology of bulimia nervosa (BN); however, findings from in vivo neuroimaging studies have been inconsistent. We aimed to investigate the possible brain WM alterations, including WM volume and microstructure, in patients with BN. We recruited 43 BN patients and 31 healthy controls (HCs). All participants underwent structural and diffusion tensor imaging. Differences in WM volume and microstructure were evaluated using voxel-based morphometry, tract-based spatial statistics, and automated fibre quantification analysis. Compared with HCs, BN patients showed significantly decreased fractional anisotropy in the middle part of the corpus callosum (nodes 31-32) and increased mean diffusivity in the right cranial nerve V (CN V) (nodes 27-33 and nodes 55-88) and vertical occipital fasciculus (VOF) (nodes 58-85). Moreover, we found decreased axial diffusivity in the right inferior fronto-occipital fasciculus (node 67) and increased radial diffusivity in the CN V (nodes 22-34 and nodes 52-89) and left VOF (nodes 60-66 and nodes 81-85). Meanwhile, WM microstructural changes were correlated with patients' clinical manifestations. We did not find any significant differences in WM volume and the main WM fibre bundle properties between BN patients and HCs. Taken together, these findings provide that BN shows significant brain WM reorganization, but primarily in microstructure (part of WM fibre bundle), which is not sufficient to cause changes in WM volume. The automated fibre quantification analysis could be more sensitive to detect the subtle pathological changes in a point or segment of the WM fibre bundle.

Increased functional connectivity of amygdala subregions in patients with drug-naïve panic disorder and without comorbidities.

BACKGROUND: Amygdala plays an important role in the neurobiological basis of panic disorder (PD), and the amygdala contains different subregions, which may play different roles in PD. The aim of the present study was to examine whether there are common or distinct patterns of functional connectivity of the amygdala subregions in PD using resting-state functional magnetic resonance imaging and to explore the relationship between the abnormal spontaneous functional connectivity patterns of the regions of interest (ROIs) and the clinical symptoms of PD patients. METHODS: Fifty-three drug-naïve, non-comorbid PD patients and 70 healthy controls (HCs) were recruited. Seed-based resting-state functional connectivity (rsFC) analyses were conducted using the bilateral amygdalae and its subregions as the ROI seed. Two samples t test was performed for the seed-based Fisher's z -transformed correlation maps. The relationship between the abnormal spontaneous functional connectivity patterns of the ROIs and the clinical symptoms of PD patients was investigated by Pearson correlation analysis. RESULTS: PD patients showed increased rsFC of the bilateral amygdalae and almost all the amygdala subregions with the precuneus/posterior cingulate gyrus compared with the HC group (left amygdala [lAMY]: t  = 4.84, P  <0.001; right amygdala [rAMY]: t  = 4.55, P  <0.001; left centromedial amygdala [lCMA]: t  = 3.87, P  <0.001; right centromedial amygdala [rCMA]: t  = 3.82, P  = 0.002; left laterobasal amygdala [lBLA]: t  = 4.33, P  <0.001; right laterobasal amygdala [rBLA]: t  = 4.97, P  <0.001; left superficial amygdala [lSFA]: t  = 3.26, P  = 0.006). The rsFC of the lBLA with the left angular gyrus/inferior parietal lobule remarkably increased in the PD group ( t  = 3.70, P  = 0.003). And most of the altered rsFCs were located in the default mode network (DMN). A significant positive correlation was observed between the severity of anxiety and the rsFC between the lSFA and the left precuneus in PD patients ( r  = 0.285, P  = 0.039). CONCLUSIONS: Our research suggested that the increased rsFC of amygdala subregions with DMN plays an important role in the pathogenesis of PD. Future studies may further explore whether the rsFC of amygdala subregions, especially with the regions in DMN, can be used as a biological marker of PD.

Early warning model of credit risk for family farms and ranches in Inner Mongolia based on Probit regression-Kmeans clustering.

Early warning models credit risk play a crucial role in helping the financial institutions to reasonably predict the credit status of family farms and ranches. An attempt is made in this paper to construct a new credit risk early warning model based on Probit regression and Kmeans clustering algorithm, and testing the model by using data from 246 family farms in 12 leagues and cities in Inner Mongolia. First, the credit risk evaluation indicators of family farms and ranches were screened out through a three-combination model with partial correlation analysis, tolerance analysis and Probit regression. Second, the ratios of the Z-squared statistic of a single indicator to the sum of the Z-squared statistics of all the selected indicators were used to measure the weights of the credit evaluation indicators. Finally, four warning levels containing heavy alert level Ⅰ, medium alert level Ⅱ, light alert level Ⅲ and no alert level Ⅳ were classified by Kmeans clustering with large intra-cluster similarity and small inter-cluster similarity. The empirical evidence shows that the early warning model of credit risk for family farms and ranches is effective.

Exploration of the relationships between clinical traits and functional connectivity based on surface morphology abnormalities in bulimia nervosa.

BACKGROUND: Bulimia nervosa is a recurrent eating disorder with uncertain pathogenesis. Recently, there has been growing interest in using neuroimaging techniques to explore brain structural and functional alterations in bulimia nervosa, but the findings of previous studies have a great number of inconsistencies. METHODS: Here, we collected anatomical and resting-state functional magnetic resonance imaging data from 43 bulimia nervosa patients and 34 matched healthy controls (HCs). We applied a surface-based morphology analysis to explore brain cortical morphology differences and a novel surface-based functional connectivity (FC) analysis to investigate functional abnormalities. Principal component analysis was performed to analyze the behavioral data of the participants. We further analyzed the relationships between abnormalities in cortical characteristics or FC and clinical features. RESULTS: We observed increased greater sulcal depth in the right superior temporal gyrus (STG) and the right medial orbitofrontal cortex (mOFC) in bulimia nervosa patients than in the HCs. Additionally, the patients exhibited increased FC between the right STG and right ventral tegmental area but decreased function between the right mOFC and right putamen, which was significantly negatively correlated with the first principal component reflecting the severity of bulimia nervosa symptom. CONCLUSIONS: Our findings provide evidence of neuroanatomical and functional abnormalities in bulimia nervosa patients. Moreover, the FC between the right mOFC and right putamen was associated with symptom severity of bulimia nervosa, which may be a neural marker and involved in the neuropathological mechanism of bulimia nervosa.

Altered White Matter Network Topology in Panic Disorder.

Panic disorder (PD) is an anxiety disorder that impairs life quality and social function and is associated with distributed brain regions. However, the alteration of the structural network remains unclear in PD patients. This study explored the specific characteristics of the structural brain network in patients with PD by graph theory analysis of diffusion tensor images (DTI). A total of 81 PD patients and 48 matched healthy controls were recruited for this study. The structural networks were constructed, and the network topological properties for individuals were estimated. At the global level, the network efficiency was higher, while the shortest path length and clustering coefficient were lower in the PD group compared to the healthy control (HC) group. At the nodal level, the PD group showed a widespread higher nodal efficiency and lower average shortest path length in the prefrontal, sensorimotor, limbic, insula, and cerebellum regions. Overall, the current results showed that the alteration of information processing in the fear network might play a role in the pathophysiology of PD.

Predicting responses to cognitive behavioral therapy in obsessive-compulsive disorder based on multilevel indices of rs-fMRI.

OBJECTIVE: This study aimed to identify neuroimaging predictors to predict the response of cognitive behavioral therapy (CBT) in patients with obsessive-compulsive disorder (OCD) based on indices of resting-state functional magnetic resonance imaging (rs-fMRI). METHODS: Fifty patients with OCD were enrolled and allocated to either high or low responder groups after CBT using a 50 % response rate as the delineator. The pre-treatment amplitude of low-frequency fluctuation (ALFF), fractional ALFF (fALFF), regional homogeneity (ReHo), and degree centrality (DC) in each cerebrum region, defined by automated anatomical labeling atlas, were extracted. Least absolute shrinkage and selection operator and logistic regression were used to select features and establish models. RESULTS: The combination of multilevel rs-fMRI indices achieved the best performance, with a cross-validation area under the receiver operating characteristic curve (AUC) of 0.900. In this combined model, an increase of interquartile range (IQR) in fALFF of right inferior orbital frontal gyrus (IOFG), and ReHo of left hippocampus and superior occipital gyrus (SOG) corresponded to a 26.52 %, 38.67 % and 24.38 % increase in the possibility to be high responders of CBT, respectively. ALFF of left thalamus and ReHo of left putamen were negatively associated with the response to CBT, with a 14.30 % and 19.91 % decrease per IQR increase of the index value. CONCLUSION: The combination of ALFF, fALFF and ReHo achieved a better predictive performance than separate index. Pre-treatment ALFF of the left thalamus, fALFF of the right IOFG, ReHo of the left hippocampus, SOG and putamen can be used as predictors of CBT response.

The efficacy of a transdiagnostic group cognitive behavioral intervention for Chinese elderly with emotional disorders: A one-year follow-up randomized clinical trial.

Background: With the global aging, geriatric emotional disorders have received more and more attention. Psychotherapy is an effective approach for alleviating the symptoms associated with emotional disorder, but the number of experienced therapists is low. Studies should be conducted to explore a low-cost and efficient treatment method. Previous findings indicate that transdiagnostic cognitive behavior therapy is an effective approach for treatment of emotional disorders. Group therapy is appropriate for the elderly as they are characterized by high levels of loneliness. In this study, we compared and explored the effects of a transdiagnostic group cognitive behavioral intervention (TD-GCBT), a transdiagnostic individual cognitive behavioral intervention (TD-CBT), and treatment as usual (TAU) on treatment of emotional disorders among the elderly. Method: A total of 120 elderly patients diagnosed with emotional disorders were randomly assigned to the TD-GCBT group (40), TD-CBT group (40), and TAU group (40). Changes in symptoms were assessed using HAMD, PHQ-9, HAMA, and GAD-7 scales at baseline, post-treatment (three months), six-month and twelve-months follow-up. The efficacies of the three intervention strategies were compared using linear mixed-effects models. Post-hoc and simple effect analyses were conducted to determine the differences among the three groups. Results: The HAMD, PHQ-9, HAMA, and GAD-7 scores revealed a significant effect from baseline to 12 months for time (p < 0.001), group (p < 0.001) and time × group interaction (p < 0.001) in TD-GCBT group compared with the TD-CBT group and TAU group. The effect of TD-GCBT (HAMD: Cohen's d (3th month, 6th month, 12th month) = 2.69, 3.98, 4.51; HAMA: Cohen's d = 2.84, 4.13, 5.20) and TD-CBT (HAMD: Cohen's d = 2.55, 2.87, 2.63; HAMA: Cohen's d = 2.43, 2.83, 2.78) group was better relative to that of the TAU group (HAMD: Cohen's d = 0.41, 1.13, 1.46; HAMA: Cohen's d = 0.64, 1.22, 1.57) (p < 0.001). The scores of the TD-GCBT group showed the most significant decrease compared with the other two groups. Conclusion: The findings indicate that TD-GCBT method is effective for treatment of emotional disorders among the elderly. TD-GCBT is effective for alleviating depression and anxiety symptoms up to at least nine months after treatment. The results indicate that TD-GCBT is a cost-effective and resource-effective strategy and can be used an alternative therapy for treatment of mental disorders. Clinical trial registration: [https://www.chictr.org.cn], identifier [ChiCTR1900021806].

Effect of Al Addition on Microstructure and Properties of CoCrNi Medium-Entropy Alloy Prepared by Powder Metallurgy.

Powder metallurgy possesses the advantages of low energy consumption, less material consumption, uniform composition, and near-final forming. In order to improve the mechanical properties and high-temperature oxidation resistance of CoCrNi medium-entropy alloy (MEA), CoCrNiAlX (X = 0, 0.1, 0.3, 0.5, 0.7) MEAs were prepared using mechanical alloying (MA) and spark-plasma sintering (SPS). The effect of aluminum content on the microstructure and properties of the MEAs was investigated. The results show that the CoCrNi MEA is composed of face center cubic (fcc) phase and some carbides (Cr23C6). With the increase in Al content, there exists Al2O3 precipitation. When the Al content is increased to Al0.5 and Al0.7, the body center cubic (bcc) phase begins to precipitate. The addition of aluminum significantly enhances the properties of the alloys, especially those containing fcc+bcc dual-phase solid solutions. The yield strength, compressive strength, and hardness of CoCrNiAl0.7 alloy are as high as 2083 MPa, 2498 MPa, and 646 HV, respectively. The high-temperature resistance also reaches the oxidation resistance level. Different oxides include Cr2O3, Al2O3, and (Co, Ni) Cr2O4 and NiCrO3 spinel oxides formed on the surface of alloys. The formation of an Al2O3 oxidation film prevents the further erosion of the matrix by oxygen elements.

Altered gray matter volume and functional connectivity in medial orbitofrontal cortex of bulimia nervosa patients: A combined VBM and FC study.

Brain structural and functional abnormalities have been shown to be involved in the neurobiological underpinnings of bulimia nervosa (BN), while the mechanisms underlying this dysregulation are unclear. The main goal of this investigation was to explore the presence of brain structural alterations and relevant functional changes in BN. We hypothesized that BN patients had regional gray matter volume abnormalities and corresponding resting-state functional connectivity (rsFC) changes compared with healthy controls. Thirty-one BN patients and twenty-eight matched healthy controls underwent both high-resolution T1-weighted magnetic resonance imaging (MRI) and resting-state functional MRI. Structural analysis was performed by voxel-based morphometry (VBM), with subsequent rsFC analysis applied by a seed-based, whole-brain voxelwise approach using the abnormal gray matter volume (GMV) region of interest as the seed. Compared with the controls, the BN patients showed increased GMV in the left medial orbitofrontal cortex (mOFC). The BN patients also exhibited significantly increased rsFC between the left mOFC and the right superior occipital gyrus (SOG) and decreased rsFC between the left mOFC and the left precentral gyrus, postcentral gyrus, and supplementary motor area (SMA). Furthermore, the z values of rsFC between the left mOFC and right SOG was positively correlated with the Dutch Eating Behavior Questionnaire-external eating scores. Findings from this investigation further suggest that the mOFC plays a crucial role in the neural pathophysiological underpinnings of BN, which may lead to sensorimotor and visual regions reorganization and be related to representations of body image and the drive behind eating behavior. These findings have important implications for understanding neural mechanisms in BN and developing strategies for prevention.