| Objective: Bipolar Disorder(BD)is one of the common chronic mental diseases in the world.The decision-making function of patients with bipolar disorder has received increasing attention from the society.Relevant mechanisms of neuropsychology and brain functional imaging are still being explored.In the neuropsychological study of bipolar disorder,it has been previously believed that bipolar disorder has a maladaptive decision-making style.In functional imaging studies,previous studies have suggested that decision-making function of bipolar disorder is related to structural and functional decompensation of decision-making related brain networks.Our study was divided into two major parts.Patients with depressive episodes of bipolar disorder were the main subjects,and patients with Major Depressive Disorder(MDD)were positive controls and negative for healthy controls(HC).On the one hand,the Melbourne Decision Making Questionnaire(MDMQ)was used as a neuropsychological assessment tool to conduct neuropsychological research on the response patterns of individuals with depressive episodes in the face of decision-making pressure,trying to reveal relevant decision-making style characteristics of patients with depressive episodes of bipolar disorder in the decision-making processing.At the same time,we furtherly explored the correlation between clinical symptoms and decision factors.On the other hand,functional magnetic resonance imaging(f MRI)is used to construct a dynamic salience network of patients with depressive episodes of bipolar disorder based on Regions of Interest(ROIs),and to analyze the differences in functional connectivity between specific populations,seeking possible related brain function imagingmechanisms,and provide possible evidence clues for the differential diagnosis of MDD and BD.Methods: The study was divided into two parts: The first part included 30 patients with bipolar disorder depressive episodes and thirty-one patients with depressive episodes of major depressive disorder who met the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders(DSM-5).36 healthy controls were recruited online with matched age,gender,and education.Study follow-up nodes were 0 week,4th weeks and 12 nd week.We improved general demographic information and clinical information,then evaluated the Melbourne Decision Questionnaire(MDMQ),the 24-item Hamilton Depression Scale(HAMD-24),the Hamilton Anxiety Scale(HAMA),Sheehan Disability Scale(SDS),Young's Mania Rating Scale(YMRS),Hypomania Check List(HCL-32),etc in enrolling period.After routine clinical treatment such as psychology and physical treatments,follow-up evaluation was performed on the 4th week(30 cases in MDD group,30 cases in BD group)and 12 nd week.The differences between baseline and follow-up of different scales between BD,MDD and HC were compared by statistical analysis.The correlation between clinical symptoms and scale scores was analyzed by Pearson correlation.The second part included 28 patients with bipolar disorder depressive episodes and 29 patients with major depressive disorder who met the fifth edition of the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders(DSM-5).And 29 healthy volunteers matched for gender,age,and education level were recruited online as a healthy control group.After that,the relevant samples were excluded according to the correction results such as image head motion correction and preprocessing.Eventually 28 healthy subjects,21 patients in depressive episodes with major depression and 27 patients in depressive episodes with bipolar disorder were enrolled respectively.After improving population informatics and clinical data,we evaluate the clinical symptom scales such as HAMD and HAMA,and use the resting state f MRI to construct a salience network(SN)based on Regions of Interest(ROIs)to explore the differences in functional connectivity between groups.RESULTS: 1.Patients with depressive episodes of bipolar disorder are more likely to address problem with decision-making style of procrastination,buck-passing and hypervigilance during the process of decision-making.After treatment intervention,BD group scored lower in the dimension of procrastination,suggesting that the turning from procrastination decision-making style to other decision-making styles may be a more specific decision-making style change in patients with depressive episodes of bipolar disorder after treatment intervention.2.For the BD group,there is a negative correlation between the BD group and the SDS disability scale total score in the hypervigilance dimension,and there is a positive correlation between HAMA and the HAMA in the vigilance dimension,suggesting that the degree of anxiety of BD patients with decision-making problems is positively correlated with the degree of psychological stress and coping style of patients in the process of decision-making.There is a positive correlation between the degree of psychological stress and the coping style in the decision-making process.However,with the change of disease status in BD group,HAMD score tends to decrease,and there is a positive correlation between the change of HAMD score and the score change of MDMQ buck-passing dimension.A reasonable explanation may be that as the clinical symptoms are relieved,the patient's social function and sense of responsibility gradually recover,and the decision-making style of hypervigilance is more likely to be transformed into other decision-making styles in the decision-making process.Brain functional imaging: 3.The salience network of patients with depressive episodes of bipolar disorder has dynamic volatility,suggesting that the traditional “static” explicit network based on entire-time series may not reflect its dynamic volatility.By using the average analysis of the dynamic connection weights of the salience network,the average dynamic brain network map of the salience network of patients with depressive episodes of bipolar disorder is constructed,reflecting the characteristics of the actual damage of the network in patients with depressive episodes of bipolar disorder.4.Compared with the healthy control and MDD group,there is a significant difference in the dynamic functionalconnectivity volatility of salience network of patients in depressive episodes of bipolar disorder.Conclusion: 1.The decision-making style characteristics of patients with bipolar depressive episodes in the decision-making process are consistent with“decision-making conflict theory”.2.While at the baseline,BD patients in depressive episodes have a more specific maladaptive decision-making style compared with health controls.After treatment intervention,BD patients with depressive episodes have a change in decision-making style dimension,which is related with the relief of clinical symptoms and recovery of society function.It has the potential value of clinically assessing the severity of symptoms and determining the efficacy of patients with bipolar disorder depressive episodes.3.The salience network of patients with depressive episodes of bipolar disorder has dynamic volatility,suggesting that the traditional “static” explicit network based on the entire-time series may not reflect its dynamic volatility.By using the mean value analysis of the dynamic connection weights of the salience network,the average dynamic brain network map of the salience network of patients with depressive episodes of bipolar disorder is different,which further reveals the characteristics of the actual damage of BD patients with depressive episodes,reflecting potential imaging evidence clues to the progression of decision-making function in BD patients with depressive episodes.The bipolar disorder depressive episode highlights the difference in network group differences and dynamic changes need to be further explored. |
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