| BackgroundMajor Depressive Disorder(MDD)is a kind of mental Disorder,and its main symptoms are depression,lack of energy and depression of happiness.Stress,accompanying anxiety,and somatic symptoms are common in MDD patients.MDD is a complex and common mental disease in terms of its clinical manifestations,treatment prognosis and pathological mechanism of its occurrence and development.In one study,Fawcett et al.found that MDD patients had a high proportion of moderate to severe worry,mental and physical anxiety.MDD accompanied by anxiety symptoms is a common clinical phenomenon,and about 90% of MDD patients have anxiety symptoms of varying degrees.Currently,depressive disorder is considered to be a complex disease with various clinical symptoms,including multiple subtypes with heterogeneity,and MDD with anxiety is one of them.In the American Diagnostic and Statistical Manual of Mental Disorders(DSM-5),such patients are referred to as depressive disorders with anxiety symptoms.Previous studies have found that most Depressive disorders with anxiety symptoms are worse than those without anxiety symptoms(n AMDD),poor prognosis,more residual symptoms and higher risk of suicide.Further development is extremely likely to evolve into refractory MDD.Due to the difference in severity and outcome of treatment between the two,there may be differences between the two,so it is speculated that the pathogenesis of the two is different,and attention should be paid in diagnosis and treatment.With the rapid development of functional imaging technology in recent years,it provides a new method to explore its etiology and pathogenesis.Therefore,it is necessary to further explore the clinical and brain functional characteristics of adolescents with major depressive disorder with anxiety symptoms,so as to clarify the underlying mechanism of anxiety symptoms.Objective1.To analyze the effect of anxiety symptoms on the severity of major depressive disorder in first-episode adolescent patients with anxiety symptoms.2.To explore the resting-state brain function changes in first-episode adolescent major depressive disorder with anxiety symptoms,and to provide evidence for the possible neuropathological mechanism of first-episode adolescent major depressive disorder with anxiety symptoms.MethodsSixty adolescents with a first episode of depressive disorder who met the diagnostic criteria for major depressive disorder in the United States DSM-5(Diagnostic and Statistical Manual of Mental Disorders,fifth Edition)were enrolled.By calculating the anxiety/somatization factor scores in the 17-item Hamilton Rating Scale for Depression(HAMD-17),according to whether the factor scores ≥7,The patients were divided into depressive disorder group with anxiety symptoms(n=33)and depressive disorder group without anxiety symptoms(n=27).At the same time,25 healthy adolescents matched in gender,age and years of education were recruited as the control group(n=25),and were evaluated by Hamilton Depression Scale(HAMD-17).All subjects completed general data collection and resting-state functional magnetic resonance imaging.SPSS23.0 software was used to statistically analyze the general data,Dpabi4.0 software was used to preprocess the imaging data,and low-frequency amplitude analysis was used to compare the differences in the intensity of spontaneous brain activity among the three groups of subjects.ZALFF brain map with normal distribution was obtained after the Z-score was standardized,and the variance analysis and post hoc test were performed.ZALFF values of different brain regions were extracted and correlated with HAMD-17 total score and anxiety somatization factor scores.Results1.There was no significant difference in gender(P=0.692)between AMDD,n AMDD and HC groups,but there was significant difference in age(P=0.001)and years of education(P<0.001).The HAMD-17 score(P <0.001)and anxiety/somatization factor score(P <0.001)in the AMDD group were significantly higher than those in the n AMDD group,and the differences between the two groups were statistically significant.2.There were statistically significant differences in z ALFF values in multiple brain regions among the three groups(P<0.05,FWE correction).The z ALFF values in the Frontal＿Sup＿Medial R 、 Occipital＿Inf/Mid＿L 、 Cingulum＿Mid 、Occipital＿Sup/Inf＿R Calcarine 、 Precuneus＿R and other brain regions were significantly different among the three groups.3.Post hoc analysis showed that compared with HC group,z ALFF values in the Occipital＿Inf/Mid＿L 、 Occipital＿Sup/Inf＿R 、 Calcarine 、 Frontal＿Mid＿L 、Frontal＿Sup＿L(MNI:-15,39,42)and other brain regions were increased in both AMDD and n AMDD groups;z ALFF values in the Frontal＿Mid＿Orb＿R 、Frontal＿Sup＿Medial R、Cingulum＿Mid 、Frontal＿Sup＿L(MNI:-21,60,9)were decreased in both AMDD and n AMDD groups(Bonferroni correction,P<0.05);ZALFF values were lower in the Cuneus＿L 、 Lingual＿L 、 Calcarine 、Frontal＿Sup＿Medial in the AMDD group than in the n AMDD group(Bonferroni correction,P<0.05).4.Regions of Interes(ROIs)were extracted from the brain region(Frontal＿Sup＿Medial R、Lingual＿L、Calcarine、Cuneus＿L)with significant difference in z ALFF value between the above AMDD group and the AMDD group.The z ALFF value of the two groups was correlated with HAMD-17 score and anxiety/somalization factor score,and the results showed that: There was no correlation between z ALFF values and clinical variables for all regions of interest in either group.Conclusions(1)The first-episode adolescent major depressive disorder patients with anxiety symptoms showed more severe depression and anxiety clinically,and the accompanying anxiety symptoms aggravated the disease to a certain extent.(2)First-episode adolescent major depressive disorder patients with anxiety symptoms have abnormal activity in multiple brain regions,mainly involving the occipital /frontal and cuneus,which are involved in the regulation of emotion and memory recognition.Their functional changes may be the neuropathological basis and biological markers of anxiety symptoms in depressive disorder patients. |
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