Improving the mental health of children and adolescents is a critical priority in China. However, only minimal information is available concerning the prevalence of mental disorders. In the present ...study, a two-stage national survey has been completed in five regions of China. In the first stage, data from the Achenbach Child Behavior Checklist (CBCL) were collected for each participant to identify the prevalence of the behavioral and emotional problems in China. A multistage cluster stratified random sampling design was used, and a total of 71,929 individuals aged 6–16 years were collected. In this large cohort, 36,893 (49.86%) were males, and 49,015 (66.24%) were living in urban communities. Overall, 17.6% (90% confidence interval 17.4%, 17.9%) of the children and adolescents were identified as having behavioral and emotional problems. Moreover, age and sex effect was found for the CBCL scores. The boys’ cohort had a higher prevalence of behavioral and emotional problems than girls (18.6% versus 16.6%). In the older cohort aged 12–16, the prevalence was higher than for the younger cohort aged 6–11 (19.0% versus 15.9%). Notably, it seems that the prevalence of the behavioral and emotional problems for children and adolescents had a rise in the past 30 years, but the scarcity of pediatric psychiatrists in China needs to be addressed. To reduce the behavioral and emotional problems, the whole society, including mental health providers, educators, and parents, needs to focus on and pay more attention to it. It will have long-term benefits for China.
Abstract Background and purpose Autoimmune disorders are growing alarmingly high in prevalence across the globe. Autoimmune encephalitis has had a dramatic impact on the medical field, effectually ...altering diagnostic and treatment paradigms in regard to neuropsychiatric disorders. Our primary goal in conducting this study was to analyze the clinical characteristics of autoimmune encephalitis patients, with special focus on psychiatric presentations, in the West China Hospital and report patient prognoses after immunotherapy. Methods Data for patients admitted to the West China Hospital with autoimmune encephalitis diagnoses from 2015 to 2016 were collected and the corresponding clinical features were analyzed. Results We ultimately included 70 patients with autoimmune encephalitis: 56 (80%) anti-NMDAR encephalitis patients, 8 (11%) LGI1 antibody encephalitis patients, and 6 (9%) GABAbR antibody encephalitis patients. The median age of the 70 patients was 33 years, 40% were female, and the initial symptoms in 31 patients (44%) were psychiatric in nature. Psychiatric disturbance appeared in 58 patients (83%) during inpatient treatment, after which 57 patients (81%) recovered. Conclusions Many patients with autoimmune encephalitis present psychotic symptoms; psychiatric symptoms typically appear before neurological features emerge. Timely diagnosis and treatment may yield favorable prognosis.
To explore alterations of regional and network-level neural function using resting-state functional magnetic resonance (MR) imaging in children and adolescents with attention deficit hyperactivity ...disorder (ADHD) and to assess the association between these alterations of intrinsic neural activity and executive dysfunction in ADHD.
This prospective study was approved by the local ethical committee, and written informed consent was obtained from guardians of all participants. Thirty-three boys with ADHD who were not receiving medication and who were without comorbidity (aged 6-16 years) and 32 healthy control subjects (aged 8-16 years) underwent imaging by using resting-state functional MR imaging. Amplitude of low-frequency fluctuation (ALFF) and seed-based functional connectivity (FC) were calculated to examine regional neural function and functional integration, respectively, and were compared between patients and control subjects by using the voxel-based two-sample t test, while Pearson correlation analyses were performed to identify neural correlates of executive function measured with the Wisconsin Card Sorting Test and the Stroop Color-Word Test.
Relative to healthy control subjects, patients with ADHD showed impaired executive function (P < .05), along with the following: lower ALFF in the left orbitofrontal cortex (P = .004) and the left ventral superior frontal gyrus (P = .003); higher ALFF in the left globus pallidus (P = .004), the right globus pallidus (P = .002), and the right dorsal superior frontal gyrus (P = .025); lower long-range FC in the frontoparietal and frontocerebellar networks; and higher FC in the frontostriatal circuit that correlated across subjects with ADHD with the degree of executive dysfunction (P < .05).
These findings of focal spontaneous hyper- and hypofunction, together with altered brain connectivity in the large-scale resting-state networks, which correlates with executive dysfunction, point to a connectivity-based pathophysiologic process in ADHD.
Previous reports have shown that running wheel activity or voluntary exercise prevents hyperphagia and obesity in various animal models of obesity, but such effects seem only minimal in obese animals ...lacking leptin or leptin receptors. The mechanisms underlying this ineffectiveness remain unclear. Here, we identified the action of neuronal activation in the dorsomedial hypothalamus (DMH) in modulating physical activity, food intake and body weight using leptin receptor mutant obese Zucker (
, ZF) and Koletsky (
, SHROB) rats. Ad lib-fed SHROB rats with locked running wheels became hyperphagic and gained body weight rapidly. These alterations were not ameliorated in ad lib-fed SHROB rats with voluntary access to running wheels, but the body weight of SHROB rats with running wheel access was significantly decreased when they were pair-fed to the amounts consumed by lean controls. Determinations of hypothalamic gene expression revealed that sedentary ad lib-fed SHROB rats had increased expression of neuropeptide Y (
) and decreased expression of pro-opiomelanocortin (
) in the arcuate nucleus (ARC). Both ARC
and
expression were further altered under running and pair-fed conditions, indicating that both genes are appropriately regulated in response to increased energy demands or alterations caused by running activity and food restriction. Strikingly, c-Fos immunohistochemistry revealed that while voluntary running activity elevated the number of c-Fos positive cells in the DMH (particularly in the ventral and caudal subregions) of intact rats, such activation was not observed in ZF rats. Using adeno-associated virus (AAV)-mediated expression of the designer receptors hM3D(Gq) in the ventral and caudal DMH of ZF rats, we found that chemogenetic stimulation of neurons in these DMH subregions via injection of the designer drug clozapine N-oxide (CNO) significantly increased their running activity and reduced their food intake and body weight. Together, these results demonstrate that activation of ventral and caudal DMH neurons promotes physical activity and decreases food intake and body weight and suggest that intact DMH neural signaling is likely crucial for exercise-induced reductions of food intake and body weight in obese rats lacking leptin receptors.
•Children with attention-deficit/hyperactivity disorder exhibited an increased cortical volume in the left frontal eye field, a decreased surface area in the left ventral frontal cortex, and a ...reduced subcortical volume in the right putamen.•There were significant age-related differences in the left frontal eye field and ventral frontal cortex between the two groups.•This study characterized the cortical morphometry of children with ADHD at the whole brain level providing detailed information about neuroanatomical alterations beyond previous region-of-interest studies.
The current study was designed to investigate the anatomical differences in cortical and subcortical morphometry between drug-naive boys with attention-deficit/hyperactivity disorder (ADHD) and healthy controls (HCs) using three-dimensional T1-weighted imaging and to explore the effects of age on morphometric abnormalities.
Fifty-three drug-naive boys with ADHD and 53 HCs underwent high-resolution anatomical magnetic resonance (MR) imaging using a 3-T MR scanner. The FreeSurfer image analysis suite was used to obtain measures of cortical volume, thickness, and surface area, as well as the volumes of 14 subcortical structures. Statistically significant differences in measures between children with ADHD and HCs were evaluated using a least general linear model, with the intracranial volume and age as covariates.
Compared to HCs, boys with ADHD exhibited an increased cortical volume in the left frontal eye field (FEF), a decreased surface area in the left ventral frontal cortex (VFC), and a decreased volume in the right putamen (cluster-wise p < 0.05; Monte Carlo-corrected). Moreover, we also observed age-related differences in FEF and VFC between groups.
The cross-sectional study design limited inferences about the effects of age on regions displaying morphometric differences.
To our knowledge, this study is the first to characterize the cortical morphometry, including volume, thickness and surface area, of drug-naive boys with ADHD at the whole brain level; which provided detailed information about neuroanatomical alterations in attention systems beyond effects reported in previous studies at the lobe and sub-lobe levels. Based on our results, boys with ADHD presented significant alterations in cortical and subcortical morphology in several important nodes of the attention network.
To investigate the point prevalence of mental disorders in school students, multistage cluster stratified random sampling and two-phase survey methods were used to identify 40 primary and middle ...schools. The students were screened using the Chinese version of the Child Behavior Checklist and diagnosed using the Mini International Neuropsychiatric Interview. The prevalence of behavioral problems was 19.13%. The prevalence of behavioral problems significantly differed by sex, age, city of residence, and caretaker. The six-month prevalence of any mental disorder was 15.24% (95% CI: 15.49%-16.97%). Psychiatric disorders were more prevalent in boys (17.33%) relative to girls (13.11%; p < 0.01). The prevalence of mental disorders significantly differed by community and caretaker, and 36.46% of students exhibited comorbidity. Results demonstrated important mental health issues, with a high incidence of comorbidities, in this population. Students' mental health requires increased attention, particularly in poverty-stricken areas and left-behind children and adolescents.
Brain extraction is an essential pre-processing step for neuroimaging analysis. It is difficult to achieve high-precision extraction from low-quality brain MRI images with artifacts and gray ...inconsistencies which often result in irregular hole regions in the extracted brain tissues. In addition, the U-Net based brain extraction method trends to output over-smoothed brain boundary. To remove those irregular holes in the extracted mask, we proposed a new U-Net based model for brain extraction named O-Net. O-Net replaces the skip-connection path in the U-Net with dual shortcut paths including an attention module of an O-shaped network, which uses deep semantic information to highlight the target area while retaining more image details. O-Net effectively reduces the impact of intensity differences caused by artifacts or gray inconsistencies in the brain MRI images on the extraction results. To more accurately identify brain boundary, we designed a new GAN based brain extraction method, which used above O-Net as the segmentation network. The discrimination network of the proposed GAN model adopts the residual structure to enhance the nonlinear expression ability of the network to balance the adversarial training of the two networks. To speed up the convergence of the proposed model, a segmentation loss was added to the adversarial loss to supervise the feature learning of the segmentation network. This method was compared with other popular brain extraction methods on two public datasets (IBSR18 and LPBA40). The mean Dice similarity coefficients obtained by the proposed method were 97.26% and 98.29% on IBSR18 and LPBA40 respectively. In the comparative experiment, the results of the proposed method are the best on the two public datasets. Experimental results show that the proposed model can stably output high-precision brain tissue extraction images and the influence of artifacts and gray inconsistencies is small.
Impaired working memory is thought to be a core feature of attention deficit hyperactivity disorder (ADHD). Previous imaging studies investigating working memory in ADHD have used tasks involving ...different cognitive resources and ignoring the categorical judgments about objects that are essential parts of performance in visual working memory tasks, thus complicating the interpretation of their findings. In the present study, we explored differential neural activation in children and adolescents with ADHD and in healthy controls using functional magnetic resonance imaging (fMRI) with the categorical n-back task (CN-BT), which maximized demands for executive reasoning while holding memory demands constant.
A total of 33 drug-naive, right-handed male ADHD without comorbidity (mean age 9.9±2.4years) and 27 right-handed, healthy male controls (mean age 10.9±2.7years) were recruited in the present study. Event-related fMRI was used to study differences in brain activity during the CN-BT between the two groups.
The two groups did not differ in their accuracy in the CN-BT, although the ADHD patients showed significantly shorter reaction times to correct responses than did the controls. During the CN-BT, both ADHD patients and controls showed significant positive and negative activations by the correct responses, mainly in the sensory-motor pathways and the striato-cerebellum circuit. Additionally, the ADHD patients showed significantly higher activation in the bilateral globus pallidus and the right hippocampus compared with the controls. There was also a positive correlation between hyperactivation of the left globus pallidus and the reaction time to correct responses in ADHD.
In contrast to controls, ADHD patients showed neural hyperactivation in the striatum and mediotemporal areas during a working memory task involving categorization. Hyperfunction in these areas might be the pathophysiological foundation of ADHD, related to the deficits of working memory and the impulsive symptoms.
•Neural mechanism of working memory in ADHD children at early illness stage•The categorical n-back test is a complex visual-object working memory paradigm.•Hyperfunction in the globus pallidus and hippocampus might be an ADHD pathophysiology.
Background Attention-deficit/hyperactivity disorder (ADHD) is an early-onset neurodevelopmental disorder with multiple behavioural problems and executive dysfunctions for which neuroimaging studies ...have reported a variety of abnormalities, with inconsistencies partly owing to confounding by medication and concurrent psychiatric disease. We aimed to investigate the microstructural abnormalities of white matter in unmedicated children and adolescents with pure ADHD and to explore the association between these abnormalities and behavioural symptoms and executive functions. Methods We assessed children and adolescents with ADHD and healthy controls using psychiatric interviews. Behavioural problems were rated using the revised Conners’ Parent Rating Scale, and executive functions were measured using the Stroop Colour-Word Test and the Wisconsin Card Sorting test. We acquired diffusion tensor imaging data using a 3 T MRI system, and we compared diffusion parameters, including fractional anisotropy (FA) and mean, axial and radial diffusivities, between the 2 groups. Results Thirty-three children and adolescents with ADHD and 35 healthy controls were included in our study. In patients compared with controls, FA was increased in the left posterior cingulum bundle as a result of both increased axial diffusivity and decreased radial diffusivity. In addition, the averaged FA of the cluster in this region correlated with behavioural measures as well as executive function in patients with ADHD. Limitations This study was limited by its cross-sectional design and small sample size. The cluster size of the significant result was small. Conclusion Our findings suggest that white matter abnormalities within the limbic network could be part of the neural underpinning of behavioural problems and executive dysfunction in patients with ADHD.
Abstract Imaging studies of schizophrenia (SCZ) have repeatedly demonstrated volume differences in superior temporal gyrus (STG) and its subregions. Among them, some studies employed the Region of ...Interest (ROI) method. We carried out a systematic review of the published literature on STG volumetry MRI studies to examine the potential of ROI method for identifying specific structural differences and correlations with clinical variables including hallucinations and thought disorder symptoms in SCZ. Forty-six studies were identified as suitable for review and analysis including 1444 patients with SCZ and 1327 controls. Female and left-handed subjects are under-represented in the literature and insight from sex and handedness differences may be lost. Thirty-five studies reported significant differences in STG or subregional volumes including bilateral or unilateral ROI, and volume reduction was the most common change in SCZ. Thirty studies reported correlations between volume changes and clinical symptoms or syndromes and 18 found positive results. Among them, left STG or subregions appear to be more involved in the generation of hallucinations and thought disorder than right side. The majority of five follow-up studies found evidence of progressive changes in volumes. Clinical heterogeneity, MRI acquisition parameters, anatomical landmarks for ROI, and sample characteristics, are likely to be the main factors leading to heterogeneous results. Clearly this research links pathophysiological changes in the STG with the development of hallucinations and thought disorder in patients with SCZ, especially in the left side. There is a suggestion that these changes may be progressive but this requires more thorough and comprehensive assessment.
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