The Clinical And Resting-state Brain FMRI Study About The Hypomanic Symptoms Of The Patients With Mood Disorders

Clinical study Validity and reliability of the Chinese version Mood Disorder Questionnaire,32-item Hypomania ChecklistObjective(1) To investigate the validity and reliability of the Chinese version Mood Disorder Questionnaire,32-item hypomania checklist (HCL-32) in the patients with mood disorders.(2) To investigate the results of the HCL-32, MDQ administered as a screening instrument in clinical settings to mood disorders patients in the depressive phase in multicenters in China.Methods(1) Consecutive patients with bipolar disorder (BP) and patients with major depressive disorder (UP) in outpatients and inpatients departments diagnosed by the citeria of DSM-IV were rated by Chinese version of MDQ and HCL-32.(2) In multicenters study, the patients diagnosed and being treated for MDD in12mental health centers across China were self-rated by the MDQ and HCL-32. All the patients were independently examined by the Mini International Neuropsychiatric Interview (MINI).Results(1) MDQ results:A two-factor solution was preferred by the factors analysis. The first two factors together accounted for40.3%of the total variance and the Eigenvalues were3.15,2.09respectively. The internal consistency (Cronbach’s alpha) was0.79. The frequency of positive responses to various items ranged from32.4%to78.2%. A C-MDQ screening score of7or more was chosen as the optimal cutoff between the patients with BP and UP (SEN0.64, SPE0.80).HCL-32results:A three-factor solution was preferred by the factors analysis. The three factors together accounted for38.34%of the total variance and the Eigenvalues were5.16,2.72and2.48respectively. The Cronbach’s alpha was0.88. The frequency of positive responses to various items ranged from11.6%to89.7%. AHCL-32screening score of14was chosen as the optimal cutoff between the patients with BP and UP (SEN0.74, SPE0.66).(2) In multicenters, after examination by the MINI,309(20.8%) of the1487patients clinically diagnosed as having MDD satisfied DSM-IV criteria for bipolar disorders (BD).When only part one of the MDQ was scored, the best cutoff was7between BD and UD (SEN0.66, SPE0.88),6between BD-II and UD. If all three parts of the MDQ were scored, the MDQ could not distinguish between BD and UD at a cutoff of7(or6), and the sensitivity was only0.22(or0.24).The HCL-32distinguished between BD and UD (best cutoff score14), between BD-II and UD (best cutoff12).Conclusions(1) The study demonstrated the suitable validity and reliability of Chinese version MDQ and HCL-32, suggesting that the MDQ and HCL-32is supplementary instrument to screen bipolar disorders in clinical circumstance.(2) In the multicenter study, the results of HCL-32and MDQ in the patients with mood disorders during depressive episode were similar to those of earlier, generally smaller-scale studies which patients could be in any mood phase. A score of12for HCL-32,6for MDQ could be used as the optimal cutoff between BD and UD to improve screening BD-Ⅱ if the HCL-32, MDQ was applied in clinical settings respectively in China. Part two and part three of the MDQ should not be scored when it is being used as a screening tool for BD in clinical settings. Resting-state of fMRI study The Impact of Subthreshold Hypomanic Symptoms to the brain function of the Patients with Major Depressive Disorder in resting-state:an fMRI StudyObjectiveTo investigate the impact of subthreshold hypomanic symptoms (SHS) to the brain neural activity in the resting-state of the patients with major depressive disorder (MDD).MethodsThe patients with MDD were divided into two subgroups according to32-item hypomania checklist (HCL-32) ratings.19MDD depressed patients with subthreshold hypomanic symptoms (MDD with SHS) and19depressed patients without subthreshold hypomanic symptoms (MDD without SHS), as well as19healthy controls (HC) matched for gender, age and educational levels, were included in the final study from60patients with MDD and36HC participated in this study. All the subjects in the study were scanned the brain in the resting-state.We analyzed the impact of subthreshold hypomanic symptoms (SHS) to the regional brain function of the patients with MDD by regional homogeneity (ReHo) and amplitude of low-frequency fluctuation (ALFF) in resting-state. Then, on the basis of ReHo and ALFF results, we analyzed their whole-brain functional connectivity of the two subgroups MDD patients by selected the right gyrus rectus and right orbitofrontal cortex (OFC) as regions of interest (ROIs). Results(1) ReHo analyses:The patients with MDD had a diffuse abnormal resting-state brain activity compared to HC by the ReHo analyses. Compared to the patients without SHS, the ReHo of the depressed MDD patients with SHS were significantly higher in the right orbitalfrontal cortex (OFC), gyrus rectus, anterior cingulated cortex (ACC) and left inferior parietal cortex; while lower in right thalamus. Correlation analysis of ReHo at each voxel in the whole brain against the HCL-32in the patients with MDD (N=38) revealed significantly positive correlation in the right OFC, right gyrus rectus and left inferior parietal cortex.(2) ALFF analyses:The patients with MDD had a diffuse abnormal resting-state brain activity compared to HC by the ALFF analyses. Compared to the patients without SHS, the ALFF of the depressed MDD patients with SHS were significantly higher in the bilateral OFC and superior frontal cortex; while lower in bilateral thalamus and left fusiform gyrus. Correlation analysis of ALFF at each voxel in the whole brain against the HCL-32in the patients with MDD revealed significantly positive correlation in bilateral OFC, negative correlation in bilateral thalamus and left fusiform gyrus.(3) Functional connectivity analyses:Compared to the MDD patients without SHS, the functional connectivity between right gyrus rectus and right OFC, between right OFC and left inferior parietal cortex increased; while between right OFCand left thalamus, bilateral fusiform gyrus decreased significantly in the MDD patients with SHS.ConclusionsWe found some brain regions showing resting-state ReHo or ALFF differences between the depressed MDD patients with SHS and MDD patients without SHS and the functional connectivity of right gyrus rectus and OFC also showed significant differences.The results of this study suggested that the brain regions especially the bilateral OFC (right lateral more obvious), right gyrus rectus, left inferior parietal cortex and bilateral thalamus, may be the right ACC are important to the subthreshold hypomanic symptoms in the patients with MDD. There is may be one functional path that is "right gyrus rectus-right OFC-left parietal cortex" which the right OFC is the center. The decrease of ReHo in right thalamus and ALFF in the bilateral thalamus, left fusiform gyrus and decrease of functional connectivity between right OFC and left thalamus, right OFC and bilateral fusiform gyrus may relate to the physiological symtoms of SHS.There is maybe one network which the OFC (especially the right OFC) is the centre and is formed by right gyrus rectus, left inferior parietal cortex, thalamus and left fusiform gyrus in the MDD patients with SHS. The network may play an important role in the pathogenesis of subthreshold hypomanic symptoms in the depressed patients with MDD, even the hypomanic or manic symptoms in the patients with bipolar disorders.The results of this study also indicated that the MDD patients with SHS may represent a clinical subgroup in the patients with mood disorders.