Subgrouping time-dependent prescribing patterns of first-onset major depressive episodes by psychotropics dissection

BACKGROUND Subgrouping patients with major depressive disorder is a promising solution for the issue of heterogeneity.However,the link between available subtypes and distinct pathological mechanisms is weak and yields disappointing results in clinical application.AIM To develop a novel approach for classification of patients with time-dependent prescription patterns at first onset in real-world settings.METHODS Drug-naive patients experiencing their first major depressive episode(n=105)participated in this study.Psychotropic agents prescribed in the first 24 mo following disease onset were recorded monthly and categorized as antidepressants,augmentation agents,and hypnosedatives.Monthly cumulative doses of agents in each category were converted into relevant equivalents.Four parameters were used to summarize the time-dependent prescription patterns for each psychotropic load:Stability,amount,frequency,and the time trend of monthly prescriptions.A K-means cluster analysis was used to derive subgroups of participants based on these input parameters of psychotropic agents across 24 mo.Clinical validity of the resulting data-driven clusters was compared using relevant severity indicators.RESULTS Four distinct clusters were derived from K-means analysis,which matches experts’consent:"Short-term antidepressants use","long-term antidepressants use","long-term antidepressants and sedatives use",and"long-term antidepressants,sedatives,and augmentation use".At the first 2 years of disease course,the four clusters differed on the number of antidepressants used at adequate dosage and duration,frequency of outpatient service use,and number of psychiatric admissions.After the first 2 years following disease onset,depression severity was differed in the four subgroups.CONCLUSION Our findings suggested a new approach to optimize the subgrouping of patients with major depressive disorder,which may assist future etiological and treatment response studies.

Cortical thickness abnormalities in patients with first episode psychosis:a meta-analysis of psychoradiologic studies and replication in an independent sample

Background:Abnormalities of cortical thickness(CTh)in patients with their first episode psychosis(FEP)have been frequently reported,but findings are inconsistent.Objective:To define the most consistent CTh changes in patients with FEP by meta-analysis of publishedwholebrain studies.Methods:The meta-analysis used seed-based dmapping(SDM)software to obtain the most prominent regional CTh changes in FEP,and meta-regression analyses to explore the effects of demographics and clinical characteristics.The meta-analysis results were verified in an independent sample of 142 FEP patients and 142 age-and sex-matched healthy controls(HCs),using both a vertex-wise and a region of interest analysis,with multiple comparisons correction.Results:The meta-analysis identified lower CTh in the rightmiddle temporal cortex(MTC)extending to superior temporal cortex(STC),insula,and anterior cingulate cortex(ACC)in FEP compared with HCs.No significant correlations were identified between CTh alterations and demographic or clinical variables.These results were replicated in the independent dataset analysis.Conclusion:This study identifies a robust pattern of cortical abnormalities in FEP and extends understanding of gray matter abnormalities and pathological mechanisms in FEP.

Nonspecific Effect of Stress on Brain Gray Matter Volume in Drug-naive Female Patients with First Depressive Episode

Background： This study aimed to observe the differences in brain gray matter volume in drug-naive female patients after the first episode of major depression with and without stressful life events （SLEs） before the onset of depression.Methods： Forty-three drug-naive female patients voluntarily participated in the present study after the first major depressive episode.The life event scale was used to evaluate the severity of the impact of SLEs during 6 months before the onset of the major depressive episode.High-field magnetic resonance imaging （MRI） scans were obtained, and the VBM and SPM8 software process were used to process and analyze the MRI.Results： Compared to that in patients without SLEs, the volume of brain gray matter was lower in the bilateral temporal lobe, right occipital lobe, and right limbic lobe in the SLE group.However, the gray matter volume did not differ significantly between the two groups after the application of false discovery rate （FDR） correction.Conclusions： Although the results of the present study suggest the absence of significant differences in brain gray matter volume between female drug-naive patients after the first episode of major depression with and without SLEs after FDR correction, the study provides useful information for exploring the definitive role of stress in the onset of depression.

Decreased regional homogeneity in major depression as revealed by resting-state functional magnetic resonance imaging

Backgroud Functional imaging studies indicate abnormal activities in cortico-limbic network in depression during either task or resting state. The present work was to explore the abnormal spontaneous activity shown with regional homogeneity （ReHo） in depression by resting-state functional magnetic resonance imaging （fMRI）.Methods Using fMRI, the differences of regional brain activity were measured in resting state in depressed vs. healthy participants. Sixteen participants firstly diagnosed with major depressive disorder and 16 controls were scanned during resting state. A novel method based on ReHo was used to detect spontaneous hemodynamic responses across the whole brain.Results ReHo in the left thalamus, left temporal lobe, left cerebellar posterior lobe, and the bilateral occipital lobe was found to be significantly decreased in depression compared to healthy controls in resting state of depression.Conclusions Abnormal spontaneous activity exists in the left thalamus, left temporal lobe, left cerebellar posterior lobe,and the bilateral occipital lobe. And the ReHo may be a potential reference in understanding the distinct brain activity in resting state of depression.