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1.
Psychiatr Serv ; : appips201900481, 2020 Jan 21.
Artigo em Inglês | MEDLINE | ID: mdl-31960777

RESUMO

OBJECTIVES: Mood disorders are among the most burdensome public health concerns. The National Network of Depression Centers (NNDC) is a nonprofit consortium of 26 leading clinical and academic member centers in the United States providing care for patients with mood disorders, including depression and bipolar disorder. The NNDC has established a measurement-based care program called the Mood Outcomes Program whereby participating sites follow a standard protocol to electronically collect patient-reported outcome assessments on depression, anxiety, and suicidal ideation in routine clinical care. This article describes the approaches taken to develop and implement the program. METHODS: Since 2015, eight pilot sites have implemented the program and followed more than 10,000 patients. This pilot study presents descriptive statistics based on the first 24-month period of data collection. RESULTS: In this sample, 58.6% of patients with bipolar disorder (N=849) and 57.5% of patients with unipolar depression (N=3,998) remained symptomatic at follow-up. Lifetime rates of planned or actual suicide attempts were high, ranging from 27.6% for patients with unipolar mood disorders to 33.5% for patients with bipolar disorder. Men, unmarried individuals, and those with comorbid anxiety had a poorer longitudinal course. This initial snapshot of clinical burden is consistent with public health data indicating that mood disorders are severely debilitating. CONCLUSIONS: This study demonstrates the potential of the Mood Outcomes Program to create a nationwide "learning health system" for mood disorders. This goal will be further realized as the program expands in reach and scope across additional NNDC sites.

2.
Neuropsychopharmacology ; 45(3): 561-569, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31756730

RESUMO

Structural variations of neural regions implicated in fear responses have been well documented in the pathophysiology of anxiety and may play an important role in treatment response. We examined whether gray matter volume of three neural regions supporting fear and avoidance responses [bilateral amygdala, nucleus accumbens (NAcc), and ventromedial prefrontal cortex (PFC)] predicted cognitive-behavioral therapy (CBT) and selective serotonin reuptake inhibitor (SSRI) treatment outcome in two independent samples of patients with anxiety disorders. Study 1 consisted of 81 adults with anxiety disorders and Study 2 included 55 children and adolescents with anxiety disorders. In both studies, patients completed baseline structural MRI scans and received either CBT or SSRI treatment. Clinician-rated interviews of anxiety symptoms were assessed at baseline and posttreatment. Among the adult sample, greater pre-treatment bilateral NAcc volume was associated with a greater reduction in clinician-rated anxiety symptoms pre-to-post CBT and SSRI treatment. Greater left NAcc volume also predicted greater decreases in clinician-rated anxiety symptoms pre-to-post CBT and SSRI treatment among youth with current anxiety. Across studies, results were similar across treatments, and findings were maintained when adjusting for patient's age, sex, and total intracranial brain volume. We found no evidence for baseline amygdala or ventromedial PFC volume serving as treatment predictors across the two samples. Together, these findings provide promising support for the role of NAcc volume as an objective marker of anxiety treatment improvement that spans across development. Future studies should clarify the specific mechanisms through which NAcc volume exerts its therapeutic effects.

3.
Stress Health ; 2019 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-31693291

RESUMO

Adults with type 2 diabetes (T2DM) and depression are associated with higher hemoglobin A1C (HbA1C ) compared to their nondepressed counterparts. Little is known about related clinical and demographic components contributing to these differences. We examined differences in HbA1C between adults who have T2DM with and without major depression. T tests and chi-square analyses measured differences in HbA1C and clinical/demographic variables. HbA1C was statistically higher in depressed participants compared to nondepressed participants. The difference was no longer statistically significant after controlling for age. Age and HbA1C were negatively correlated across the sample and were still correlated in each group independently. The interaction of age and HbA1C was moderated by depression status. Additionally, mechanisms for diabetes severity differences were assessed using moderation analyses and Blinder-Oaxaca decomposition technique. Seventy-four percent of the mean outcome HbA1C difference between depressed and nondepressed diabetic participants was explained by age. Furthermore, age was negatively correlated with clinical variables, such as diastolic blood pressure and cholesterol. Comparing age to smoking and nonsmoking participants, smokers were statistically younger. Younger adults with T2DM may require more attention regarding self-management, particularly in the context of depression. Depression should be screened and treated among individuals with diabetes since this exacerbates diabetes severity.

4.
Am J Geriatr Psychiatry ; 27(12): 1316-1330, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31477459

RESUMO

The significant public health burden associated with late-life depression (LLD) is magnified by the high rates of recurrence. In this manuscript, we review what is known about recurrence risk factors, conceptualize recurrence within a model of homeostatic disequilibrium, and discuss the potential significance and challenges of new research into LLD recurrence. The proposed model is anchored in the allostatic load theory of stress. We review the allostatic response characterized by neural changes in network function and connectivity and physiologic changes in the hypothalamic-pituitary-adrenal axis, autonomic nervous system, immune system, and circadian rhythm. We discuss the role of neural networks' instability following treatment response as a source of downstream disequilibrium, triggering and/or amplifying abnormal stress response, cognitive dysfunction and behavioral changes, ultimately precipitating a full-blown recurrent episode of depression. We propose strategies to identify and capture early change points that signal recurrence risk through mobile technology to collect ecologically measured symptoms, accompanied by automated algorithms that monitor for state shifts (persistent worsening) and variance shifts (increased variability) relative to a patient's baseline. Identifying such change points in relevant sensor data could potentially provide an automated tool that could alert clinicians to at-risk individuals or relevant symptom changes even in a large practice.

5.
Neuropsychopharmacology ; 44(9): 1639-1648, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31060042

RESUMO

Mechanisms and predictors for the successful treatment of anxiety and depression have been elusive, limiting the effectiveness of existing treatments and curtailing the development of new interventions. In this study, we evaluated the utility of three widely used neural probes of emotion (experience, regulation, and perception) in their ability to predict symptom improvement and correlate with symptom change following two first-line treatments-selective serotonin reuptake inhibitors (SSRIs) and cognitive-behavioral therapy (CBT). Fifty-five treatment-seeking adults with anxiety and/or depression were randomized to 12 weeks of SSRI or CBT treatment (ClinicalTrials.gov identifier: NCT01903447). Functional magnetic resonance imaging (fMRI) was used to examine frontolimbic brain function during emotion experience, regulation, and perception, as probed by the Emotion Regulation Task (ERT; emotion experience and regulation) and emotional face assessment task (EFAT; emotion perception). Brain function was then related to anxiety and depression symptom change. Results showed that both SSRI and CBT treatments similarly attenuated insula and amygdala activity during emotion perception, and greater treatment-related decrease in insula and amygdala activity was correlated with greater reduction in anxiety symptoms. Both treatments also reduced amygdala activity during emotion experience but brain change did not correlate with symptom change. Lastly, greater pre-treatment insula and amygdala activity during emotion perception predicted greater anxiety and depression symptom improvement. Thus, limbic activity during emotion perception is reduced by both SSRI and CBT treatments, and predicts anxiety and depression symptom improvement. Critically, neural reactivity during emotion perception may be a non-treatment-specific mechanism for symptom improvement.

6.
Neuroimage ; 196: 152-160, 2019 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-30980900

RESUMO

Cardiovascular disease risk factors (CVD-RFs) are associated with decreased gray and white matter integrity and cognitive impairment in older adults. Less is known regarding the interplay between CVD-RFs, brain structural connectome integrity, and cognition. We examined whether CVD-RFs were associated with measures of tract-based structural connectivity in 94 non-demented/non-depressed older adults and if alterations in connectivity mediated associations between CVD-RFs and cognition. Participants (age = 68.2 years; 52.1% female; 46.8% Black) underwent CVD-RF assessment, MRI, and cognitive evaluation. Framingham 10-year stroke risk (FSRP-10) quantified CVD-RFs. Graph theory analysis integrated T1-derived gray matter regions of interest (ROIs; 23 a-priori ROIs associated with CVD-RFs and dementia), and diffusion MRI-derived white matter tractography into connectivity matrices analyzed for local efficiency and nodal strength. A principal component analysis resulted in three rotated factor scores reflecting executive function (EF; FAS, Trail Making Test (TMT) B-A, Letter-Number Sequencing, Matrix Reasoning); attention/information processing (AIP; TMT-A, TMT-Motor, Digit Symbol); and memory (CVLT-II Trials 1-5 Total, Delayed Free Recall, Recognition Discriminability). Linear regressions between FSRP-10 and connectome ROIs adjusting for word reading, intracranial volume, and white matter hyperintensities revealed negative associations with nodal strength in eight ROIs (p-values<.05) and negative associations with efficiency in two ROIs, and a positive association in one ROI (p-values<.05). There was mediation of bilateral hippocampal strength on FSRP-10 and AIP, and left rostral middle frontal gyrus strength on FSRP-10 and AIP and EF. Stroke risk plays differential roles in connectivity and cognition, suggesting the importance of multi-modal neuroimaging biomarkers in understanding age-related CVD-RF burden and brain-behavior.


Assuntos
Encéfalo/patologia , Doenças Cardiovasculares/complicações , Cognição , Substância Cinzenta/patologia , Substância Branca/patologia , Idoso , Idoso de 80 Anos ou mais , Encéfalo/diagnóstico por imagem , Doenças Cardiovasculares/patologia , Doenças Cardiovasculares/psicologia , Conectoma/métodos , Feminino , Substância Cinzenta/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Substância Branca/diagnóstico por imagem
7.
Neuroimage ; 186: 338-349, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30391563

RESUMO

Emotion regulation deficits are commonly observed in social anxiety disorder (SAD). We used manifold-learning to learn the phase-space connectome manifold of EEG brain dynamics in twenty SAD participants and twenty healthy controls. The purpose of the present study was to utilize manifold-learning to understand EEG brain dynamics associated with emotion regulation processes. Our emotion regulation task (ERT) contains three conditions: Neutral, Maintain and Reappraise. For all conditions and subjects, EEG connectivity data was converted into series of temporally-consecutive connectomes and aggregated to yield this phase-space manifold. As manifold geodesic distances encode intrinsic geometry, we visualized this space using its geodesic-informed minimum spanning tree and compared neurophysiological dynamics across conditions and groups using the corresponding trajectory length. Results showed that SAD participants had significantly longer trajectory lengths during Neutral and Maintain. Further, trajectory lengths during Reappraise were significantly associated with the habitual use of reappraisal strategies, while Maintain trajectory lengths were significantly associated with the negative affective state during Maintain. In sum, an unsupervised connectome manifold-learning approach can reveal emotion regulation associated phase-space features of brain dynamics.


Assuntos
Encéfalo/fisiopatologia , Conectoma/métodos , Eletroencefalografia , Emoções/fisiologia , Fobia Social/fisiopatologia , Adulto , Feminino , Humanos , Masculino , Testes Neuropsicológicos , Aprendizado de Máquina não Supervisionado , Adulto Jovem
8.
Artigo em Inglês | MEDLINE | ID: mdl-30009871

RESUMO

A large number of studies have attempted to use neuroimaging tools to aid in treatment prediction models for major depressive disorder (MDD). Most such studies have reported on only one dimension of function and prediction at a time. In this study, we used three different tasks across domains of function (emotion processing, reward anticipation, and cognitive control, plus resting state connectivity completed prior to start of medication to predict treatment response in 13-36 adults with MDD. For each experiment, adults with MDD were prescribed only label duloxetine (all experiments), whereas another subset were prescribed escitalopram. We used a KeyNet (both Task derived masks and Key intrinsic Network derived masks) approach to targeting brain systems in a specific match to tasks. The most robust predictors were (Dichter et al., 2010) positive response to anger and (Gong et al., 2011) negative response to fear within relevant anger and fear TaskNets and Salience and Emotion KeyNet (Langenecker et al., 2018) cognitive control (correct rejections) within Inhibition TaskNet (negative) and Cognitive Control KeyNet (positive). Resting state analyses were most robust for Cognitive control Network (positive) and Salience and Emotion Network (negative). Results differed by whether an -fwhm or -acf (more conservative) adjustment for multiple comparisons was used. Together, these results implicate the importance of future studies with larger sample sizes, multidimensional predictive models, and the importance of using empirically derived masks for search areas.


Assuntos
Antidepressivos/uso terapêutico , Transtorno Depressivo Maior/diagnóstico por imagem , Transtorno Depressivo Maior/tratamento farmacológico , Emoções/fisiologia , Imagem por Ressonância Magnética/métodos , Estimulação Luminosa/métodos , Adulto , Encéfalo/diagnóstico por imagem , Encéfalo/efeitos dos fármacos , Citalopram/uso terapêutico , Transtorno Depressivo Maior/psicologia , Cloridrato de Duloxetina/uso terapêutico , Emoções/efeitos dos fármacos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neuroimagem/métodos , Valor Preditivo dos Testes , Desempenho Psicomotor/efeitos dos fármacos , Desempenho Psicomotor/fisiologia , Resultado do Tratamento
9.
Mol Psychiatry ; 24(12): 1844-1855, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-29880885

RESUMO

Major depressive disorder is a common mood disorder in the elderly. Although the neuroanatomical abnormalities have been identified in patients with late-life depression (LLD), the precise biological basis of LLD remains largely unknown. The purpose of this study was to examine the biophysical integrity of macromolecular protein pools in the nodal regions of the "uncinate circuit," a component of fronto-limbic circuitry that is connected by the uncinate fasciculus and is critical in the regulation of mood and emotions, using novel magnetization transfer (MT) imaging. Twenty-four patients with LLD and 27 non-depressed healthy control subjects (HCs) of comparable age, sex, and race were recruited from the communities of the greater Chicago Area. The nodal regions of the uncinate circuit, i.e., bilateral amygdala, hippocampus, and lateral and medial orbitofrontal cortices (OFCs), were examined. Compared with HCs, patients with LLD had significantly lower magnetization transfer ratio (MTR), a measure of the biophysical integrity of macromolecular protein pools, in bilateral amygdala and hippocampus. The lower MTR was negatively correlated with the depression score. Moreover, the MTR of these regions decreased with age and positively correlated with neuropsychological performance in the LLD group but not in the HC group. These findings suggest that LLD is associated with compromised biophysical integrity of macromolecular protein pools in nodal regions of the uncinate circuit, and that major depression may accentuate age-related attenuation of the biophysical integrity of macromolecular protein pools in this circuit. These findings provide important new insights into the neurobiological mechanisms of the pathophysiology of LLD.

10.
Brain Connect ; 8(9): 527-536, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30411975

RESUMO

Attrition is a major problem in longitudinal neuroimaging studies, as it may lead to unreliable estimates of the stability of trait-like processes over time, of the identification of risk factors for clinical outcomes, and of the effects of treatment. Identification of characteristics associated with attrition has implications for participant recruitment and participant retention to achieve representative longitudinal samples. We investigated inhibitory control deficits, head motion, and resting-state functional connectivity within the cognitive control network (CCN) as predictors of attrition. Ninety-seven individuals with remitted major depressive disorder or healthy controls completed a functional magnetic resonance imaging scan, which included a go/no-go task and resting-state functional connectivity. Approximately 2 months later, participants were contacted and invited to return for a second scan. Seventeen individuals were lost to follow-up or declined to participate in the follow-up scan. Worse inhibitory control was correlated with greater movement within the scanner, and each predicted a greater likelihood of attrition, with movement mediating the effects of inhibitory control on attrition. Individuals who dropped out of the study exhibited greater movement than nondropouts across 9 of the 14 runs of the scan, with medium-to-large effect sizes. Finally, exploratory analyses suggested that attenuated resting-state connectivity with the CCN (particularly in bilateral dorsolateral prefrontal cortex) was associated with greater likelihood of attrition after accounting for head motion at several levels of analysis. Inhibitory control and movement within the scanner are associated with attrition, and should be considered for strategic oversampling and participant retention strategies to ensure generalizability of results in longitudinal studies.


Assuntos
Previsões/métodos , Perda de Seguimento , Imagem por Ressonância Magnética/métodos , Adolescente , Biomarcadores , Encéfalo/fisiopatologia , Mapeamento Encefálico/métodos , Cognição/fisiologia , Conectoma/métodos , Transtorno Depressivo Maior/diagnóstico por imagem , Transtorno Depressivo Maior/psicologia , Feminino , Movimentos da Cabeça/fisiologia , Humanos , Processamento de Imagem Assistida por Computador , Estudos Longitudinais , Masculino , Vias Neurais/fisiopatologia , Neuroimagem/métodos , Testes Neuropsicológicos , Descanso , Adulto Jovem
11.
Neuroimage Clin ; 20: 1001-1009, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30321791

RESUMO

BACKGROUND: Major Depressive Disorder (MDD) is a prevalent, disruptive illness. A majority of those with MDD are at high risk for recurrence and increased risk for morbidity and mortality. This study examined whether multimodal baseline (and retest) Cognitive Control performance and neuroimaging markers (task activation and neural connectivity between key brain nodes) could differentiate between those with and without future recurrence of a major depressive (MD) episode within one year. We hypothesized that performance and neuroimaging measures of Cognitive Control would identify markers that differ between these two groups. METHODS: A prospective cohort study of young adults (ages 18-23) with history (h) of early-onset MDD (N = 60), now remitted, and healthy young adults (N = 49). Baseline Cognitive Control measures of performance, task fMRI and resting state connectivity (and reliability retest 4-12 weeks later) were used to compare those with future recurrence of MDD (N = 21) relative to those without future recurrence of MDD (N = 34 with resilience). The measures tested were (1) Parametric Go/No-Go (PGNG) performance, and task activation for (2) PGNG Correct Rejections, (3) PGNG Commission errors, and (4 & 5), resting state connectivity analyses of Cognitive Control Network to and from subgenual anterior cingulate. RESULTS: Relative to other groups at baseline, the group with MDD Recurrence had less bilateral middle frontal gyrus activation during commission errors. MDD Recurrence exhibited greater connectivity of right middle frontal gyrus to subgenual anterior cingulate (SGAC). SGAC connectivity was also elevated in this group to numerous regions in the Cognitive Control Network. Moderate to strong ICCs were present from test to retest, and highest for rs-fMRI markers. There were modest, significant correlations between task, connectivity and behavioral markers that distinguished between groups. CONCLUSION: Markers of Cognitive Control function could identify those with early course MD who are at risk for depression recurrence. Those at high risk for recurrence would benefit from maintenance or preventative treatments. Future studies could test and validate these markers as potential predictors, accounting for sample selection and bias in feature detection.


Assuntos
Cognição/fisiologia , Depressão/fisiopatologia , Transtorno Depressivo Maior/fisiopatologia , Neuroimagem , Adolescente , Adulto , Encéfalo/patologia , Encéfalo/fisiopatologia , Mapeamento Encefálico , Feminino , Humanos , Masculino , Vias Neurais/fisiopatologia , Neuroimagem/métodos , Reprodutibilidade dos Testes , Adulto Jovem
12.
Netw Neurosci ; 2(3): 344-361, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30294703

RESUMO

We introduce NeuroCave, a novel immersive visualization system that facilitates the visual inspection of structural and functional connectome datasets. The representation of the human connectome as a graph enables neuroscientists to apply network-theoretic approaches in order to explore its complex characteristics. With NeuroCave, brain researchers can interact with the connectome-either in a standard desktop environment or while wearing portable virtual reality headsets (such as Oculus Rift, Samsung Gear, or Google Daydream VR platforms)-in any coordinate system or topological space, as well as cluster brain regions into different modules on-demand. Furthermore, a default side-by-side layout enables simultaneous, synchronized manipulation in 3D, utilizing modern GPU hardware architecture, and facilitates comparison tasks across different subjects or diagnostic groups or longitudinally within the same subject. Visual clutter is mitigated using a state-of-the-art edge bundling technique and through an interactive layout strategy, while modular structure is optimally positioned in 3D exploiting mathematical properties of platonic solids. NeuroCave provides new functionality to support a range of analysis tasks not available in other visualization software platforms.

13.
Front Psychiatry ; 9: 365, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30150944

RESUMO

Connectomics is a framework that models brain structure and function interconnectivity as a network, rather than narrowly focusing on select regions-of-interest. MRI-derived connectomes can be structural, usually based on diffusion-weighted MR imaging, or functional, usually formed by examining fMRI blood-oxygen-level-dependent (BOLD) signal correlations. Recently, we developed a novel method for assessing the hierarchical modularity of functional brain networks-the probability associated community estimation (PACE). PACE uniquely permits a dual formulation, thus yielding equivalent connectome modular structure regardless of whether positive or negative edges are considered. This method was rigorously validated using the 1,000 functional connectomes project data set (F1000, RRID:SCR_005361) (1) and the Human Connectome Project (HCP, RRID:SCR_006942) (2, 3) and we reported novel sex differences in resting-state connectivity not previously reported. (4) This study further examines sex differences in regard to hierarchical modularity as a function of age and clinical correlates, with findings supporting a basal configuration framework as a more nuanced and dynamic way of conceptualizing the resting-state connectome that is modulated by both age and sex. Our results showed that differences in connectivity between men and women in the 22-25 age range were not significantly different. However, these same non-significant differences attained significance in both the 26-30 age group (p = 0.003) and the 31-35 age group (p < 0.001). At the most global level, areas of diverging sex difference include parts of the prefrontal cortex and the temporal lobe, amygdala, hippocampus, inferior parietal lobule, posterior cingulate, and precuneus. Further, we identified statistically different self-reported summary scores of inattention, hyperactivity, and anxiety problems between men and women. These self-reports additionally divergently interact with age and the basal configuration between sexes.

14.
Brain Inform ; 5(2): 7, 2018 Jul 19.
Artigo em Inglês | MEDLINE | ID: mdl-30022317

RESUMO

The Nash embedding theorem demonstrates that any compact manifold can be isometrically embedded in a Euclidean space. Assuming the complex brain states form a high-dimensional manifold in a topological space, we propose a manifold learning framework, termed Thought Chart, to reconstruct and visualize the manifold in a low-dimensional space. Furthermore, it serves as a data-driven approach to discover the underlying dynamics when the brain is engaged in a series of emotion and cognitive regulation tasks. EEG-based temporal dynamic functional connectomes are created based on 20 psychiatrically healthy participants' EEG recordings during resting state and an emotion regulation task. Graph dissimilarity space embedding was applied to all the dynamic EEG connectomes. In order to visualize the learned manifold in a lower dimensional space, local neighborhood information is reconstructed via k-nearest neighbor-based nonlinear dimensionality reduction (NDR) and epsilon distance-based NDR. We showed that two neighborhood constructing approaches of NDR embed the manifold in a two-dimensional space, which we named Thought Chart. In Thought Chart, different task conditions represent distinct trajectories. Properties such as the distribution or average length in the 2-D space may serve as useful parameters to explore the underlying cognitive load and emotion processing during the complex task. In sum, this framework is a novel data-driven approach to the learning and visualization of underlying neurophysiological dynamics of complex functional brain data.

15.
J Med Internet Res ; 20(7): e241, 2018 07 20.
Artigo em Inglês | MEDLINE | ID: mdl-30030209

RESUMO

BACKGROUND: Mood disorders are common and associated with significant morbidity and mortality. Better tools are needed for their diagnosis and treatment. Deeper phenotypic understanding of these disorders is integral to the development of such tools. This study is the first effort to use passively collected mobile phone keyboard activity to build deep digital phenotypes of depression and mania. OBJECTIVE: The objective of our study was to investigate the relationship between mobile phone keyboard activity and mood disturbance in subjects with bipolar disorders and to demonstrate the feasibility of using passively collected mobile phone keyboard metadata features to predict manic and depressive signs and symptoms as measured via clinician-administered rating scales. METHODS: Using a within-subject design of 8 weeks, subjects were provided a mobile phone loaded with a customized keyboard that passively collected keystroke metadata. Subjects were administered the Hamilton Depression Rating Scale (HDRS) and Young Mania Rating Scale (YMRS) weekly. Linear mixed-effects models were created to predict HDRS and YMRS scores. The total number of keystrokes was 626,641, with a weekly average of 9791 (7861), and that of accelerometer readings was 6,660,890, with a weekly average 104,076 (68,912). RESULTS: A statistically significant mixed-effects regression model for the prediction of HDRS-17 item scores was created: conditional R2=.63, P=.01. A mixed-effects regression model for YMRS scores showed the variance accounted for by random effect was zero, and so an ordinary least squares linear regression model was created: R2=.34, P=.001. Multiple significant variables were demonstrated for each measure. CONCLUSIONS: Mood states in bipolar disorder appear to correlate with specific changes in mobile phone usage. The creation of these models provides evidence for the feasibility of using passively collected keyboard metadata to detect and monitor mood disturbances.


Assuntos
Telefone Celular/instrumentação , Transtornos do Humor/diagnóstico , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos do Humor/patologia , Fenótipo
16.
Front Psychiatry ; 9: 244, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29937738

RESUMO

There is substantial variability across studies of default mode network (DMN) connectivity in major depressive disorder, and reliability and time-invariance are not reported. This study evaluates whether DMN dysconnectivity in remitted depression (rMDD) is reliable over time and symptom-independent, and explores convergent relationships with cognitive features of depression. A longitudinal study was conducted with 82 young adults free of psychotropic medications (47 rMDD, 35 healthy controls) who completed clinical structured interviews, neuropsychological assessments, and 2 resting-state fMRI scans across 2 study sites. Functional connectivity analyses from bilateral posterior cingulate and anterior hippocampal formation seeds in DMN were conducted at both time points within a repeated-measures analysis of variance to compare groups and evaluate reliability of group-level connectivity findings. Eleven hyper- (from posterior cingulate) and 6 hypo- (from hippocampal formation) connectivity clusters in rMDD were obtained with moderate to adequate reliability in all but one cluster (ICC's range = 0.50 to 0.76 for 16 of 17). The significant clusters were reduced with a principle component analysis (5 components obtained) to explore these connectivity components, and were then correlated with cognitive features (rumination, cognitive control, learning and memory, and explicit emotion identification). At the exploratory level, for convergent validity, components consisting of posterior cingulate with cognitive control network hyperconnectivity in rMDD were related to cognitive control (inverse) and rumination (positive). Components consisting of anterior hippocampal formation with social emotional network and DMN hypoconnectivity were related to memory (inverse) and happy emotion identification (positive). Thus, time-invariant DMN connectivity differences exist early in the lifespan course of depression and are reliable. The nuanced results suggest a ventral within-network hypoconnectivity associated with poor memory and a dorsal cross-network hyperconnectivity linked to poorer cognitive control and elevated rumination. Study of early course remitted depression with attention to reliability and symptom independence could lead to more readily translatable clinical assessment tools for biomarkers.

17.
J Clin Psychiatry ; 79(4)2018 06 12.
Artigo em Inglês | MEDLINE | ID: mdl-29894598

RESUMO

OBJECTIVE: Reward positivity (RewP), a neurophysiologic index of reward responsivity, is consistently reduced in participants with depression and, to a lesser extent, anxiety. It remains unknown, however, whether RewP can be altered as psychiatric symptoms change with treatment. The current study addressed this question by examining differences in RewP within patients before and after 12 weeks of treatment with a selective serotonin reuptake inhibitor (SSRI) or cognitive-behavioral therapy (CBT). We also examined the utility of RewP as a predictor of symptom change during CBT and SSRI treatment. METHODS: Participants were recruited between 2014 and 2017 and included adults with a primary DSM-5 anxiety or depressive disorder (n = 63) and healthy controls (n = 25). At baseline and 12 weeks, participants completed a monetary award task while electroencephalogram (EEG) was recorded. Between EEG sessions, patients completed CBT or SSRI treatment. RESULTS: At baseline, higher levels of depressive symptoms were associated with a more attenuated RewP. We found no significant differences between patients and healthy controls in the degree of RewP change across the 12 weeks; however, among patients, the extent of increase in RewP robustly correlated with the extent of decline in depressive (t = -2.21, P = .03) and anxiety (t = -2.57, P = .02) symptoms following CBT and SSRI treatment. Additionally, a more attenuated RewP at baseline predicted a greater reduction in depressive symptoms following treatment with SSRIs (t = -2.04, P < .05), but not after CBT. CONCLUSIONS: These findings highlight neural responsiveness to reward as both a mechanism and a predictor of depressive symptom change that may be used serve as an objective index of symptom improvement. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01903447.


Assuntos
Transtornos de Ansiedade/fisiopatologia , Transtornos de Ansiedade/terapia , Terapia Cognitivo-Comportamental , Transtorno Depressivo/fisiopatologia , Transtorno Depressivo/terapia , Potenciais Evocados/efeitos dos fármacos , Recompensa , Inibidores de Captação de Serotonina/uso terapêutico , Adulto , Transtornos de Ansiedade/tratamento farmacológico , Transtorno Depressivo/tratamento farmacológico , Potenciais Evocados/fisiologia , Feminino , Humanos , Masculino , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
19.
Neuropsychopharmacology ; 43(5): 1146-1155, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29052616

RESUMO

Depression is a commonly occurring symptom in obsessive-compulsive disorder (OCD), and is associated with worse functional impairment, poorer quality of life, and poorer treatment response. Understanding the underlying neurochemical and connectivity-based brain mechanisms of this important symptom domain in OCD is necessary for development of novel, more globally effective treatments. To investigate biopsychological mechanisms of comorbid depression in OCD, we examined effective connectivity and neurochemical signatures in the pregenual anterior cingulate cortex (pACC), a structure known to be involved in both OCD and depression. Resting-state functional magnetic resonance imaging (fMRI) and 1H magnetic resonance spectroscopy (MRS) data were obtained from participants with OCD (n=49) and healthy individuals of equivalent age and sex (n=25). Granger causality-based effective (directed) connectivity was used to define causal networks involving the right and left pACC. The interplay between fMRI connectivity, 1H MRS and clinical data was explored by applying moderation and mediation analyses. We found that the causal influence of the right dorsal anterior midcingulate cortex (daMCC) on the right pACC was significantly lower in the OCD group and showed significant correlation with depressive symptom severity in the OCD group. Lower and moderate levels of glutamate (Glu) in the right pACC significantly moderated the interaction between right daMCC-pACC connectivity and depression severity. Our results suggest a biochemical-connectivity-psychological model of pACC dysfunction contributing to depression in OCD, particularly involving intracingulate connectivity and glutamate levels in the pACC. These findings have implications for potential molecular and network targets for treatment of this multi-faceted psychiatric condition.


Assuntos
Depressão/fisiopatologia , Giro do Cíngulo/fisiopatologia , Transtorno Obsessivo-Compulsivo/fisiopatologia , Adulto , Estudos de Casos e Controles , Depressão/complicações , Feminino , Neuroimagem Funcional , Ácido Glutâmico/metabolismo , Giro do Cíngulo/metabolismo , Humanos , Imagem por Ressonância Magnética , Masculino , Vias Neurais/fisiopatologia , Transtorno Obsessivo-Compulsivo/complicações , Espectroscopia de Prótons por Ressonância Magnética , Adulto Jovem
20.
Neuropsychopharmacology ; 43(6): 1355-1363, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29182160

RESUMO

Increased neural error monitoring, as measured by the error-related negativity (ERN), is a transdiagnostic neurobiological marker of anxiety. To date, little is known about whether the ERN can inform the choice between first-line anxiety disorder treatments and whether the ERN changes following treatment completion. The aim of the study was to therefore assess whether the ERN is a treatment moderator and index of symptom change during cognitive-behavioral therapy (CBT) or selective serotonin reuptake inhibitors (SSRIs). Participants included adult volunteers (M age=25.8±8.5; 67% female) with principal anxiety disorders (n=60) or no lifetime history of Axis I psychopathology (ie, healthy controls; n=26). A flanker task was used to elicit the ERN at baseline and 12 weeks later, following either CBT or SSRIs in the patient sample. Results indicated that baseline ERN was a significant treatment moderator such that a more enhanced baseline ERN was associated with greater reduction in anxiety symptoms within individuals who received CBT but not SSRIs. Results also revealed that the ERN increased pre- to post-treatment among patients randomized to SSRIs, but remained stable among patients randomized to CBT and healthy controls. Together, these novel findings highlight that ERN may help guide treatment decisions regarding engagement in CBT or SSRIs, especially among individuals with an enhanced ERN. The findings also suggest that SSRIs have the capacity to alter individual differences in the ERN, providing evidence that the ERN is not entirely static in patients with anxiety disorders.


Assuntos
Transtornos de Ansiedade/fisiopatologia , Transtornos de Ansiedade/terapia , Encéfalo/efeitos dos fármacos , Encéfalo/fisiopatologia , Terapia Cognitivo-Comportamental , Inibidores de Captação de Serotonina/uso terapêutico , Adulto , Transtornos de Ansiedade/epidemiologia , Comorbidade , Eletroencefalografia , Potenciais Evocados , Feminino , Humanos , Masculino , Resultado do Tratamento , Adulto Jovem
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