Chang Liu

Objective: Previous research has identified aberrant functional connectivity (FC) in the neural circuits of patients with bipolar mania (BD-M) and bipolar depression (BD-D), yet the specificity of these FC patterns to each mood state remains unelucidated. This study was designed to compare the cerebral-limbic FC characteristics among BD-M, BD-D patients and healthy control (HC) subjects. Method: Resting-state functional magnetic resonance imaging (fMRI) was performed on 30 BD-M patients, 31 BD-D patients and 30 HC subjects. Interregional cerebral FC values were calculated for group-wise comparisons, and the correlation between abnormal FC and depressive symptom severity was further explored. Results: No significant group differences in cerebral-limbic functional connectivity survived false discovery rate (FDR) correction for multiple comparisons (p<0.05); thus, all reported abnormal FC patterns were identified at a stringent uncorrected statistical threshold of p<0.001 and should be strictly interpreted as exploratory neurofunctional trends without statistical validation at the individual connection level. Abnormal cerebral-limbic FC in the default mode network (DMN), attention network and limbic areas was observed in both BD-M and BD-D groups. Specifically, BD-D patients showed elevated FC mainly in the DMN [posterior cingulate gyrus (PCG), precuneus (PCUN)], attention network [superior parietal gyrus (SPG), inferior parietal gyrus (IPG)] and limbic regions [hippocampus (HIP), parahippocampus (PHG)], while BD-M patients displayed reduced cerebral-limbic FC in the DMN and limbic areas. Conclusions: BD-M and BD-D show distinct and divergent cerebral-limbic FC patterns: reduced DMN FC in BD-M and increased DMN FC in BD-D. These exploratory patterns suggest potential neurofunctional correlates of mood states in bipolar disorder, offering preliminary clues to state-related differences that require validation in larger independent cohorts.

Objective: We sought to investigate differences in gray matter (GM) volume among patients with bipolar depression (BD), unipolar depression (UD), and healthy controls (HCs) to identify distinct gray matter volume abnormality patterns that may help differentiate BD from UD. Methods: In total, 23 patients with BD, 22 patients with UD, and 24 HCs were recruited to undergo dimensional, structural magnetic resonance imaging. Using voxel-based morphometry (VBM), we investigated gray matter volume across the three groups. Results: Both patient groups showed significantly reduced gray matter volume in the right superior temporal gyrus and right insula compared to the HCs. Moreover, the right posterior cingulate cortex exhibited decreased gray matter volume in the BD group but increased gray matter volume in the UD group. In addition, gray matter reductions in the right superior temporal gyrus and right insula were significantly positively correlated with the total Hamilton Depression Rating Scale (HAMD) score in the UD group. Conclusion: Patients with BD and UD demonstrate different patterns of gray matter abnormalities in the right posterior cingulate cortex, which might be a biomarker for differentiating these two depressive disorders.

Objective: There are increasing numbers of patients suffering from gastrointestinal disorders who are at primary risk for depression. These patients often have no awareness of their depression and therefore choose to see their gastroenterologists. Normally gastroenterologists advise the patients to undergo gastroscopy to investigate their possible digestive disorders while overlooking their depression. This study investigated the prevalence of the comorbidities between depression, depression-anxiety and organic diseases of upper gastrointestinal tract (UGI) among patients receiving gastroscopy in a large general hospital in China.Methods: A total of 707 patients who agreed to recommendation for gastroscopy were investigated using the nine-item Patient Health Questionnaire (PHQ-9). The patients of PHQ-9 scores ≥10 were further interviewed using the Hamilton depressive scale (HAMD), Hamilton anxiety scale (HAMA) and DSM-IV to confirm the diagnosis.Results: Altogether, 412 patients were found to suffer from organic diseases of UGI based on the gastroscopy results. Of these, 51 patients and 34 were diagnosed with major depression and depression-anxiety respectively. The detection rate of depression by gastroenterologists was 3.92% while no depression-anxiety was diagnosed. Multiple logistic regression showed the course of disease, number of gastroscopies and age were significantly associated with major depression while educational level, income, age, and number of gastroscopies were significantly associated with depression-anxiety.Conclusion: The comorbidities rates between depression, depression-anxiety and organic diseases of UGI are higher than the general population in China. However, the detection rates of the comorbidities by gastroenterologists are low.

Distinctive patterns of functional connectivity (FC) abnormalities in neural circuitry has been reported in patients with bipolar depression (BD) and unipolar depression (UD). However, it is unclear that whether this distinct functional connectivity patterns are diagnosis specific between BD and UD. This study aimed to compare patterns of functional connectivity among BD, UD and healthy controls (HC) and determine the distinct functional connectivity patterns which can differentiate BD from UD. Totally 23 BD, 22 UD, and 24 HC were recruited to undergo resting-state fMRI scanning. FC between each pair of brain regions was calculated and compared among the three groups, the associations of FC with depressive symptom were also analyzed. Both patient groups showed significantly decreased cerebral-limbic FC located between the default mode network [posterior cingulated gyrus (PCG) and precuneus] and limbic regions (hippocampus, amygdala and thalamus) than HC. Moreover, the BD group exhibited more decreased FC mainly in the cortical regions (middle temporal gyrus, PCG, medial superior frontal gyrus, inferior occipital gyrus and superior temporal gyrus), but the UD group is more associated with limbic alterations. These decreased FCs were negatively correlated with HAMD scores in both BD and UD patients. BD and UD patients demonstrate different patterns of abnormal cerebral-limbic FC, reflected by decreased FC within cerebral cortex and limbic regions in BD and UD, respectively. The distinct FC abnormal pattern of the cerebral-limbic circuit might be applied as biomarkers to differentiate these two depressive patient groups.

Objective: To investigate the volumetric and functional connectivity of the habenular nucleus in treatment‐resistant depression (TRD) patients using the resting‐state functional magnetic resonance imaging (rs‐fMRI) approach.Methods: A total of 15 TRD patients, who visited the Mental Health Institute of the First Hospital Affiliated with Jilin University between August 2014 and March 2015, along with 15 normal subjects, were enrolled into this study for structural and functional imaging. Functional connectivity analysis was performed using bilateral habenular nuclei as the region of interest in contrast to whole‐brain voxels.Results: No significant difference of absolute volume was found in bilateral habenular nuclei between TRD patients and healthy controls, or after controlling for individual total intracranial volume. However, functional connectivity analysis showed increased connectivity between the right habenular nucleus with the medial superior frontal gyrus, anterior cingulate cortex and medial orbitofrontal gyrus, and decreased connectivity with the corpus callosum in the TRD group. For the left habenular nucleus seed, the brain region with increased functional connectivity in the inferior temporal gyrus and decreased functional connectivity in the insular was found in the TRD patients.Conclusion: Abnormal functional connectivity was present between the habenular nucleus and the default mode network in TRD patients. Dysfunction in habenular nucleus‐related circuitry for processing negative emotion might form the pathological basis for TRD. Significant asymmetric functional connectivity was also found between bilateral habenular nuclei in TRD patients. Such asymmetry suggests potentially divergent strategy for intervention on bilateral habenular nucleus regions in the future management of depression.

Background: Malingering detection has emerged as an important issue in clinical and forensic settings. The Structured Interview of Reported Symptoms-2 (SIRS-2) was designed to assess the feigned symptoms in both clinical and non-clinical subjects. The aim of the study was to examine the reliability and validity of the Chinese version of this scale. Methods: Two studies were conducted to evaluate the reliability and validity of the Chinese Version of SIRS-2. In Study one, with a simulation design, the subjects included a. 40 students asked to simulate symptoms of mental illness; b. 40 general psychiatric inpatients and c. 40 students asked to reply to questions honestly. Scales scores for feigning symptoms among three groups were carried out for discriminant validity of the Chinese Version of SIRS-2. Minnesota Multiphasic Personality Inventory-2(MMPI-2) was administered in 80 undergraduate students. In Study two, with a known-groups comparison design, scales scores for feigning symptoms were compared between 20 suspected malingerers and 80 psychiatric outpatients from two forensic centers using the Chinese Version of SIRS-2. Results: The Chinese Version of SIRS-2 demonstrated satisfactory internal consistency in both study one and two. In study one, criterion validity of this scale was supported by its significantly positive correlation with the MMPI-2 (r = 0.282 ~ 0.481 for Infrequency), and by its significantly negative correlation with the MMPI-2 (r = -0.255 ~ -0.519 for Lie and -0.205 ~ 0.391 for Correction). Scores of 10 out of 13 subscales of the Chinese Version of SIRS-2 for simulators were significantly higher than scores of honest students and general psychiatric patients. In study two, the mean scores of the Chinese Version of 13 subscales for suspected malingerers were significantly higher than those of psychiatric outpatients. For discriminant validity, it yielded a large effect size (d = 1.80) for the comparison of the participant groups in study one and two. Moreover, the sensitivity (proportion of malingerers accurately identified by the measure) and specificity (proportion of people accurately classified as responding honestly) of the Chinese version of SIRS-2 in the detection of malingering in these two studies are acceptable. Conclusions: The Chinese version of the SIRS-2 has good psychometric properties and is a valid and reliable tool for detection of malingering in Chinese populations.