Zhenjiang Liao

Background: Etomidate use disorder (EUD) is an escalating public health issue in East and Southeast Asia, yet its neuroimaging features remain poorly understood. This study used simultaneous electroencephalography (EEG) and functional near-infrared spectroscopy (fNIRS) to examine multimodal functional connectivity alterations in individuals with EUD. Methods: A total of 54 individuals with EUD and 46 healthy controls (HCs) were recruited and underwent simultaneous resting-state EEG and fNIRS recordings. Psychological dimensions including impulsivity, aggression, and craving were evaluated using standardized and validated scales. Source-level EEG functional connectivity and fNIRS hemodynamic connectivity were analyzed to identify group differences. Associations between altered connectivity features and clinical measures were examined within the EUD group. Machine learning analyses were conducted as exploratory assessments of the discriminative information contained in multimodal connectivity features. Results: In unadjusted exploratory analyses of BIS-11 and BPAQ subscales, the EUD group showed higher cognitive impulsivity, non-planning impulsivity, physical aggression, anger and self-directed aggression (t=2.32 to 4.54, p<0.05), but lower motor impulsivity, compared with HCs. Source-level EEG analysis revealed significant group differences only in the delta band, with reduced large-scale connectivity in EUD involving default mode, dorsal attention, visual and sensorimotor systems. fNIRS analysis showed reduced hemodynamic connectivity across multiple frontal subregions and motor-related areas. Weaker connectivity between the primary motor cortex and the triangular part of the inferior frontal gyrus was associated with stronger negative reinforcement craving (rho=-0.471, p_FDR<0.05). Exploratory machine learning analysis showed preliminary discriminative performance, with the random forest model producing the numerically highest test-set AUC (0.80) in this particular data split. Conclusions: Convergent EEG-fNIRS findings suggest delta-band network decoupling and reduced frontal hemodynamic connectivity as multimodal neural features of EUD. These findings provide preliminary evidence for the neural mechanisms of EUD and may inform future objective assessment and treatment-monitoring studies.

Background:Etomidate misuse (EM) has recently become an increasing public health concern in East and Southeast Asia, but its neurobiological mechanisms are still not well understood. Although substance use disorders (SUDs) are commonly associated with disruptions in large-scale brain network organization, the effects of EM on brain network topology remain largely unexplored.Methods:Resting-state functional magnetic resonance imaging (rs-fMRI) data were acquired from individuals with EM and healthy controls (HC). Graph theoretical analyses were employed to and characterize global and nodal topological properties of functional brain networks. Clinical assessments captured substance use characteristics, craving, impulsivity, and addiction severity. Partial correlation analyses were conducted to examine associations between network metrics and substance use characteristics. Additonally, a support vector machine (SVM) classifier was implemented to discriminate individuals with EM from HC based on network features.Results:A total of 103 individuals with EM and 57 HC were included in the final analysis. Global topological organization that appeared was largely preserved in the EM group, with the exception of a significantly reduced clustering coefficient. At the nodal level, individuals with EM exhibited significant alterations in degree centrality, betweenness centrality, and nodal efficiency across regions predominantly distributed within the default mode, attention, and sensorimotor networks. Correlation analyses revealed no significant associations between network metrics and substance use characteristics following correction for multiple comparisons. Furthermore, the SVM model achieved moderate classification performance (accuracy = 66.7%) with an area under the curve (AUC) of 0.711.Conclusions:This study provides the first systematic investigation of the brain network topology in EM. The findings indicate widespread alterations in nodal network properties alongside relatively preserved global topological organization. While these results may offer preliminary indicators related to EM, their clinical relevance requires further in future research.

Background: The co-occurrence of etomidate use disorder (EUD) and antisocial personality disorder (ASPD) poses significant challenges in clinical assessment and management. This study aims to develop a predictive model to estimate the risk of ASPD in EUD patients. Methods: Male patients with EUD were recruited from a drug rehabilitation center between March and December 2024. Behavioral, health, psychological, and sociodemographic variables were collected, and diagnoses of ASPD were established using the Mini-International Neuropsychiatric Interview (MINI). The baseline variables were screened to identify potential predictors associated with EUD co-occurring with ASPD, via least absolute shrinkage and selection operator (LASSO) regression and Boruta algorithm. A predictive nomogram model was constructed based on multivariate logistic regression analysis. The performance of the predictive model was comprehensively evaluated through the ROC curve and calibration curve. Internal validation was performed using the Bootstrap method. Results: A total of 122 patients with EUD were included in the analysis, of whom 60 (49.2%) presented with ASPD. The final predictive model incorporated five variables: Craving (OR = 1.52; 95% CI: 1.08–2.15), Attentional impulsiveness (OR = 1.06; 95% CI: 1.03–1.09), Physical Aggression (OR = 1.04; 95% CI: 1.02–1.07), Trauma (OR = 3.08; 95% CI: 1.12–8.48), and Crime (OR = 3.48; 95% CI: 1.40–8.67). The ROC curve indicated AUC of 0.840 ( p < 0.001, 95% CI: 0.770–0.909), and calibration curves indicated excellent agreement between predicted and observed outcomes in predicting EUD with comorbid ASPD. Conclusions: We have successfully developed, evaluated and interpreted a nomogram model for predicting the co-occurrence of EUD and ASPD, which demonstrates favorable predictive performance and clinical utility. Clinical trial number: Not applicable.

Background: Non-medical use of etomidate has emerged as a novel psychoactive substance (NPS) threat in China. Although stress-related mechanisms have been widely implicated in substance use disorders, evidence specific to etomidate use disorder (EUD) remains limited. This study examined whether anxiety symptoms (AS) severity mediates the association between perceived stress and EUD severity, and whether difficulties in emotion regulation strengthen the stress–AS severity link. Methods: A total of 556 male patients diagnosed with EUD were recruited from drug rehabilitation centers in Hunan Province, China (M _age = 22.19, SD = 5.96). Participants completed measures of perceived stress (CPSS), AS severity (BAI), and difficulties in emotion regulation (DERS). EUD severity was indexed by DSM-5 criterion count (0–11). A moderated mediation model was tested using PROCESS (Model 7) with bias-corrected bootstrapping (5,000 resamples), controlling for age, educational attainment, only-child status, single-parent family status, and residence (rural vs. urban). Results: Perceived stress was positively associated with EUD severity. AS severity partially mediated the association between perceived stress and EUD severity. Moreover, DERS moderated the perceived stress–AS severity path, such that perceived stress was more strongly related to AS severity at higher levels of emotion regulation difficulties. Consistently, the indirect effect of perceived stress on EUD severity through AS severity was stronger among individuals reporting greater emotion regulation difficulties. Conclusion: These findings suggest that AS severity serves as a potential emotional correlate in the relationship between perceived stress and EUD severity, particularly among individuals with substantial emotion regulation difficulties. Individuals with greater deficits in emotion regulation exhibited a stronger indirect effect of stress on EUD severity via AS severity. This highlights the clinical importance of targeting emotion regulation in interventions for EUD, as improving emotional coping strategies may mitigate the impact of stress. Future longitudinal studies are needed to clarify the causal direction of these associations and investigate how changes in emotion regulation over time influence EUD progression.

Background: The Systemic Inflammation Response Index (SIRI) has recently been investigated as a new marker of inflammation. This study investigated the association between SIRI and all‐cause and cardiovascular mortality risks in patients with depression. Methods: Based on data from the National Health and Nutrition Examination Survey (NHANES), 2410 participants with depression were included and followed up for all‐cause and cardiovascular‐related deaths through December 31, 2019. Depression was identified as a 9‐item Patient Health Questionnaire (PHQ‐9) score ≥10. Weighted multivariate Cox proportional hazards regression analyses assessed the relationship between SIRI and all‐cause and cardiovascular mortality. Time‐dependent receiver operating characteristic (ROC) curve analysis evaluated SIRI's accuracy in predicting survival outcomes. Results: Among the 2410 participants, 282 all‐cause death events and 84 cardiovascular disease (CVD)‐related death events were documented. In the fully adjusted models, the highest SIRI tertile was significantly associated with increased risk of all‐cause and cardiovascular mortality with hazard ratios (HRs) (95% CIs) of 1.26 (0.79, 2.02) for all‐cause mortality and 2.50 (1.22, 5.13) for cardiovascular mortality. This association remained consistent in subgroup and sensitivity analyses. The time‐dependent ROC curve showed that the areas under the curve of the 3‐, 5‐, and 10‐year survival rates were 0.702, 0.692, and 0.644 for all‐cause mortality, and 0.685, 0.714, and 0.653 for cardiovascular mortality, respectively. Conclusion: An elevated SIRI is associated with an increased risk of all‐cause and cardiovascular mortality among patients with depression.

Background: Etomidate abuse has emerged as a novel psychoactive-substance threat in China, yet the symptom architecture and temporal dynamics of etomidate use disorder (EUD) remain poorly characterized. This study aims to elucidate the static and dynamic interactions among craving, compulsive drug seeking and cognitive-control deficits in individuals with EUD through cross-sectional and longitudinal network analyses. Methods: From June 2023 to December 2024, a total of 361 male individuals diagnosed with EUD, with a median age of 21 years (interquartile range: 18–26), were assessed upon admission (T0) and one month thereafter (T1) at a rehabilitation center in Hunan Province. Craving was measured with the Drug Desire Questionnaire; compulsive seeking with the Obsessive Compulsive Drug Use Scale; impulsivity with the Barratt Impulsivity Scale; and cognitive control via the Stop Signal Task. Cross-sectional symptom networks were estimated using Gaussian graphical models with GLASSO regularization. Temporal dynamics were examined with cross-lagged panel network modeling. Network centrality and stability were evaluated through bootstrap analyses. Results: Both at T0 and T1, craving, impulsivity, and compulsive drug seeking formed a stable network, while the network structure dynamically reconstructed during abstinence. Drug craving and intention acted as the core node (highest centrality across abstinence stages). Longitudinal network analysis showed that resistance to thoughts and intentions strongly predicted subsequent impulsivity. The results highlight the dynamic interplay between craving and impulsivity in driving EUD symptoms over time. Conclusion: The findings provide insights into the temporal dynamics of EUD symptoms and suggest that craving and impulsivity play pivotal roles in the disorder’s progression. These results emphasize the need for targeted interventions that address these central symptoms to improve treatment outcomes.

Reducing psychological craving is critical for preventing relapse in methamphetamine use disorder (MUD). This study aimed to evaluate the efficacy of virtual reality (VR)-based cue exposure therapy (CET) and cue exposure with aversion therapy (CETA) in reducing methamphetamine craving in men with MUD. In this randomized controlled trial, 89 men with MUD were assigned to three groups: VR-based cue exposure therapy (CET, n = 30), VR-based cue exposure combined with aversion therapy (CETA, n = 29), and neutral scenes (NS, n = 30). The intervention comprised 16 sessions over 8 weeks. Primary outcomes were tonic craving and cue-induced craving. Secondary outcomes included attentional bias, rehabilitation confidence, drug refusal self-efficacy, anxiety, and depression. Both CET and CETA groups demonstrated significant reductions in tonic craving post-intervention (CET: p = 0.001; CETA: p = 0.010), while the NS group showed no change (p = 0.217). The CET group demonstrated significantly lower post-intervention tonic craving compared to the NS group (p = 0.047). All groups showed decreased cue-induced craving in drug use scenes (p < 0.05). The CETA group showed significantly improved drug refusal self-efficacy compared to baseline (p = 0.001) and the NS group (p = 0.018). The CET group demonstrated reduced anxiety compared to the NS group (p = 0.014). No serious adverse events were reported during VR exposure. VR-based cue exposure therapy, particularly when combined with aversion therapy, effectively reduces psychological craving and improves drug refusal self-efficacy in MUD patients. This study provides evidence supporting VR-based interventions as a safe and promising tool for MUD treatment, though larger-scale trials are needed to confirm long-term efficacy. Clinical trial number: This randomized controlled trial was registered with the Chinese Clinical Trial Registry (Code: ChiCTR1800020014).

Background and aim: The 11th Revision of the International Classification of Diseases (ICD-11) recognizes gaming disorder (GD) as a behavioral addiction, but its implications for the clinical diagnostic practice of GD remain underexplored. This study examines the clinical diagnosis of GD since its inclusion in ICD-11 to understand trends in diagnosis rates in psychiatric departments and patient characteristics, particularly comorbidities. Method: This multicenter, retrospective observational study was conducted in five large tertiary hospitals and mental health centers across four Chinese provinces. Diagnoses of GD in each hospital were based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) or ICD-11 criteria. Data were extracted from hospital records, including demographics, diagnoses, and medical history. Result: Of the 7,877,415 total visitors, 3,517 unique patients (0.045%) met GD diagnostic criteria. GD diagnoses showed a significant linear increase (χ ² = 83.143, p < 0.001) from 2018 to 2023. 37.59% of GD patients had comorbidities, mostly mood disorders, followed by impulse control disorders, schizophrenia or other primary psychotic disorders, and attention deficit hyperactivity disorder. Patients were younger ( F = 48.69, p < 0.001), mainly aged 12–18. Discussion and conclusions: This study reveals an upward trend in GD diagnosis from 2018 to 2023, showing a trend toward younger diagnosis age, especially in males. Notably, there's a high rate of comorbidities, with mood disorders being the most common. While ICD-11 may have improved GD identification, further research is needed to clarify whether the increased rates are due to higher prevalence or better recognition.

Background: Emotional eating, the tendency to eat in response to negative emotions, is rising among adolescents and linked to obesity and mental health issues. While negative life events contribute to emotional eating, the roles of self-control and social support remain unclear. Aims: This study examined the relationship between negative life events and emotional eating in adolescents, testing self-control as a mediator and perceived social support as a moderator. Method: A sample of 740 Chinese high school students (aged 14–18) completed validated measures of negative life events, self-control, perceived social support, and emotional eating. Data were analyzed using SPSS 25.0 (IBM Corp., Armonk, New York, USA)and PROCESS macro for mediation/moderation effects. Results: Negative life events predicted higher emotional eating (β = 0.11, p < 0.01), while lower self-control mediated this relationship (β = −0.15, p < 0.001). Perceived social support moderated the association (β = −0.09, p < 0.05), weakening it among adolescents with stronger support. Conclusions: Negative life events increase emotional eating, but self-control and social support play key roles. Interventions targeting these factors may reduce emotional eating and improve adolescent well-being.

This study developed a virtual reality (VR) drug cue exposure paradigm for individuals with methamphetamine use disorder (MUD) to investigate the characteristics of withdrawal craving and cue-induced craving and their relationship. A total of 150 male participants diagnosed with MUD completed questionnaires to assess their demographic characteristics and substance addiction profiles. Withdrawal craving for methamphetamine (MA) was measured using the visual analogue scale (VAS). VR technology was utilized to expose participants to three types of scenarios: neutral scenes, MA-related paraphernalia, and drug-use scene, while cue-induced craving in different scenes was assessed using the VAS in VR environment. The results showed that:1) In the VR cue environment, MUD participants’ craving in the drug use scene was significantly higher than in the neutral and MA paraphernalia scenes (p < 0.001) and significantly higher than the pre-exposure withdrawal craving (p < 0.05). 2) Withdrawal craving scores were positively correlated with craving scores in all three VR scenarios (p < 0.01). 3) Both withdrawal craving and cue-induced craving scores were positively correlated with the total score of the MUD severity scale (p < 0.05). Withdrawal craving scores were positively correlated with MA use dosage and abstinence duration (p < 0.05). These findings suggest that the VR-based cue exposure paradigm can serve as an effective tool for assessing MA-related cue-induced craving. By identifying specific scenarios that elicit strong craving responses, this study provides a foundation for designing immersive VR therapies that can reduce craving and prevent relapse, potentially enhancing treatment outcomes for MUD. It contributes to a deeper understanding of the roles of withdrawal craving and cue-induced craving in the addiction process and their interrelationship.