Pre-treatment Resting-State Functional MR Imaging Predicts the Long-Term Clinical Outcome After Short-Term Paroxtine Treatment in Post-traumatic Stress Disorder

Background: The chronic phase of post-traumatic stress disorder (PTSD) and the limited effectiveness of existing treatments creates the need for the development of potential biomarkers to predict response to antidepressant medication at an early stage. However, findings at present focus on acute therapeutic effect without following-up the long-term clinical outcome of PTSD. So far, studies predicting the long-term clinical outcome of short-term treatment based on both pre-treatment and post-treatment functional MRI in PTSD remains limited.Methods: Twenty-two PTSD patients were scanned using resting-state functional MRI (rs-fMRI) before and after 12 weeks of treatment with paroxetine. Twenty patients were followed up using the same psychopathological assessments 2 years after they underwent the second MRI scan. Based on clinical outcome, the follow-up patients were divided into those with remitted PTSD or persistent PTSD. Amplitude of low-frequency fluctuations (ALFF) and degree centrality (DC) derived from pre-treatment and post-treatment rs-fMRI were used as classification features in a support vector machine (SVM) classifier.Results: Prediction of long-term clinical outcome by combined ALFF and DC features derived from pre-treatment rs-fMRI yielded an accuracy rate of 72.5% (p < 0.005). The most informative voxels for outcome prediction were mainly located in the precuneus, superior temporal area, insula, dorsal medial prefrontal cortex, frontal orbital cortex, supplementary motor area, lingual gyrus, and cerebellum. Long-term outcome could not be successfully classified by post-treatment imaging features with accuracy rates <50%.Conclusions: Combined information from ALFF and DC from rs-fMRI data before treatment could predict the long-term clinical outcome of PTSD, which is critical for defining potential biomarkers to customize PTSD treatment and improve the prognosis

A protocol of Chinese expert consensuses for the management of health risk in the general public

IntroductionNon-communicable diseases (NCDs) represent the leading cause of mortality and disability worldwide. Robust evidence has demonstrated that modifiable lifestyle factors such as unhealthy diet, smoking, alcohol consumption and physical inactivity are the primary causes of NCDs. Although a series of guidelines for the management of NCDs have been published in China, these guidelines mainly focus on clinical practice targeting clinicians rather than the general population, and the evidence for NCD prevention based on modifiable lifestyle factors has been disorganized. Therefore, comprehensive and evidence-based guidance for the risk management of major NCDs for the general Chinese population is urgently needed. To achieve this overarching aim, we plan to develop a series of expert consensuses covering 15 major NCDs on health risk management for the general Chinese population. The objectives of these consensuses are (1) to identify and recommend suitable risk assessment methods for the Chinese population; and (2) to make recommendations for the prevention of major NCDs by integrating the current best evidence and experts’ opinions.Methods and analysisFor each expert consensus, we will establish a consensus working group comprising 40–50 members. Consensus questions will be formulated by integrating literature reviews, expert opinions, and an online survey. Systematic reviews will be considered as the primary evidence sources. We will conduct new systematic reviews if there are no eligible systematic reviews, the methodological quality is low, or the existing systematic reviews have been published for more than 3 years. We will evaluate the quality of evidence and make recommendations according to the GRADE approach. The consensuses will be reported according to the Reporting Items for Practice Guidelines in Healthcare (RIGHT)

Qualitative research investigating the mental health care service gap in Chinese burn injury patients

Abstract Background Psychological disturbances are prevalent in people with burn injuries; however, psychological services are rarely accessiblepost-burn injury in China. The objective of this qualitative study was to explore and conceptualize the obstacles to delivering mental health care in burn injury patients. Methods The researchers used a grounded theory research approach to interview sixteen burn injury patients, five nurses, four rehabilitation therapists, five medical doctors, and eight caregivers regarding their experiences with current health care services and barriers. Results An explorative model was generated from the data, and the relationships among the categories were identified. People’s beliefs, knowledge, socioeconomic status, cultural understanding of mental health, and social stigma appear to play key roles in the public health approach to post-burn health promotion and post-burn psychosocial interventions. Conclusion The model proposed in our research highlights the need to focus on the underlying social, economic, and cultural determinants of mental health care. The underlying social determinants of the mental health care gap that is responsible for the ill-prepared health care must be addressed

THE EFFECTS OF SELF-CONSTRUAL AND THE LIVING ENVIRONMENT ON INTERNALIZED HOMOPHOBIA AMONG CHINESE GAY MEN

Background and Objective Internalized homophobia is common among gay men. Gay men who live in high-tolerance social environments tend to have less internalized homophobia than gay men who live in low-tolerance environments. The interaction between the living environment and self-construal influences gay men’s internalized homophobia. Material and Methods This study examined the association between self-construal and homophobia according to the living environment using a sample of gay men (N=521) aged 14–43 years. The data were collected between January and August 2017 using an online questionnaire that included an internalized homophobia scale, self-construal items, and demographic characteristics. The two-way ANOVA analyses revealed that the self-construal type was differentially associated with internalized homophobia depending on the living environment of the study participants. Results Living in a high-tolerance area while having an independent self-construal was associated with lower internalized homophobia scores than living in a low-tolerance area. In contrast, alternating between independent and dependent self-construals was associated with higher internalized homophobia scores. Conclusion Mental health services for participants with conflicted self-construals are emerging. Self-acceptance and compassion-focused practices should be explored as a way to help gay men adjust their conflicted self-construals

The Common Traits of the ACC and PFC in Anxiety Disorders in the DSM-5: Meta-Analysis of Voxel-Based Morphometry Studies

<div><p>Background</p><p>The core domains of social anxiety disorder (SAD), generalized anxiety disorder (GAD), panic disorder (PD) with and without agoraphobia (GA), and specific phobia (SP) are cognitive and physical symptoms that are related to the experience of fear and anxiety. It remains unclear whether these highly comorbid conditions that constitute the anxiety disorder subgroups of the Diagnostic and Statistical Manual for Mental Disorders – Fifth Edition (DSM-5) represent distinct disorders or alternative presentations of a single underlying pathology.</p><p>Methods</p><p>A systematic search of voxel-based morphometry (VBM) studies of SAD, GAD, PD, GA, and SP was performed with an effect-size signed differential mapping (ES-SDM) meta-analysis to estimate the clusters of significant gray matter differences between patients and controls.</p><p>Results</p><p>Twenty-four studies were eligible for inclusion in the meta-analysis. Reductions in the right anterior cingulate gyrus and the left inferior frontal gyrus gray matter volumes (GMVs) were noted in patients with anxiety disorders when potential confounders, such as comorbid major depressive disorder (MDD), age, and antidepressant use were controlled for. We also demonstrated increased GMVs in the right dorsolateral prefrontal cortex (DLPFC) in comorbid depression-anxiety (CDA), drug-naïve and adult patients. Furthermore, we identified a reduced left middle temporal gyrus and right precentral gyrus in anxiety patients without comorbid MDD.</p><p>Conclusion</p><p>Our findings indicate that a reduced volume of the right ventral anterior cingulate gyrus and left inferior frontal gyrus is common in anxiety disorders and is independent of comorbid depression, medication use, and age. This generic effect supports the notion that the four types of anxiety disorders have a clear degree of overlap that may reflect shared etiological mechanisms. The results are consistent with neuroanatomical DLPFC models of physiological responses, such as worry and fear, and the importance of the ventral anterior cingulate (ACC)/medial prefrontal cortex (mPFC) in mediating anxiety symptoms.</p></div

Lire une œuvre du patrimoine : Boucle d'or et les trois ours

Boucle d'or et les trois ours est un conte du patrimoine très apprécié par les enfants, et contrairement à ce qui est communément admis, il ne s'adresse pas exclusivement aux élèves de Petite Section. En effet, ce conte permet un travail très riche basé sur le réseau littéraire dans la mesure où il existe de nombreuses versions de celui-ci. Ainsi, les enseignants de Grande Section peuvent l'utiliser pour travailler la compétence "connaître un conte dans différentes versions ; établir des comparaisons précises entre elles". Pour cela, ils devront familiariser leurs élèves avec le texte-source avant de leur proposer ce travail de comparaison. Ils pourront aussi leur faire découvrir de nombreuses réécritures et détournements qui seront compréhensibles par les élèves que si cette familiarisation a eu lieu. Cela permettra également de faire prendre conscience aux élèves qu'un album peut donner une autre vision du conte, mais aussi qu'un conte peut être continué, ou encore qu'un conte peut être terminé ou enfin qu'un conte peut être repris et modifié. En ce sens, Boucle d'or et les trois ours est un conte du patrimoine qui permet de développer réellement un comportement de lecteur et de construire facilement une véritable culture littéraire chez les élèves

Whole brain functional connectivity in clinically isolated syndrome without conventional brain MRI lesions

Objective To investigate brain functional connectivity (FC) alterations in patients with clinically isolated syndromes (CIS) presenting without conventional brain MRI lesions, and to identify the FC differences between the CIS patients who converted to multiple sclerosis (MS) and those not converted during a 5-year follow-up. Methods We recruited 20 CIS patients without conventional brain lesions, 28 patients with MS and 28 healthy controls (HC). Normalized voxel-based functional connectivity strength (nFCS) was determined using resting-state fMRI (R-fMRI) and compared among groups. Furthermore, 5-years clinical follow-up of the CIS patients was performed to examine the differences in nFCS between converters and non-converters. Results Compared to HC, CIS patients showed significantly decreased nFCS in the visual areas and increased nFCS in several brain regions predominately in the temporal lobes. MS patients revealed more widespread higher nFCS especially in deep grey matter (DGM), compared to CIS and HC. In the four CIS patients converting to MS, significantly higher nFCS was found in right anterior cingulate gyrus (ACC) and fusiform gyrus (FG), compared to non-converted patients. Conclusion We demonstrated both functional impairment and compensation in CIS by R-fMRI. nFCS alteration in ACC and FG seems to occur in CIS patients at risk of developing MS

Characteristics of included studies.

<p>TTM, trichotillomania; BDD, body dysmorphic disorder; AUD, alcohol use disorder (abuse or dependence); CON, control subjects; DUD, drug use disorder (abuse or dependence); GAD, generalized anxiety disorder; MDD, major depressive disorder; OCD, obsessive compulsive disorder; PD, panic disorder; SAD, social anxiety disorder; SP, specific phobia; AG, agoraphobia;SSRI, selective serotonin reuptake inhibitor; SNRI, serotonin and noradrenaline reuptake inhibitors; BEN, benzodiazepine; TCA, tetracyclic antidepressant.</p><p>*subgroup analysis within the same study as it showed with the same serial-number</p