Relationship Between Functional MRI Characteristics And Me Ntal Flexibility In Children And Adolescents With First-episode Major Depressive Disorder

BackgroundDepression disorder is a kind of mental and psychological diseases mainly manifested by low mood or mood.Among them,the most common is depression,with significant and persistent "three low symptoms" as the core symptoms--low mood,anhedria and loss of interest.Children and adolescents are in an important period of physical and mental development.Major depressive disorder in children and adolescents has a serious impact on their physical and mental health and social function.However,the causes of depression are complex and the mechanism is unknown.In recent years,with the development of neuroimaging,new tools have been provided for the clinical and scientific research of mental disorders.Some studies have shown that mental flexibility is an important psychological mechanism to mediate the onset of depression,but there is no relevant research on its neural mechanism.Therefore,it is necessary to conduct further studies on major depressive disorder in children and adolescents,to explore the functional imaging changes of major depressive disorder in children and adolescents,to explore the potential neural mechanisms,and to provide reference for a deeper understanding of major depressive disorder in children and adolescents.Objective1.To investigate the correlation between the changes in mental flexibility and the severity of major depressive disorder in children and adolescents with the first episode;2.To investigate whether there are abnormal changes in brain functional activities in children and adolescents with major depressive disorder at the first episode;3.To investigate the correlation between the changes in brain functional activities and the level of mental flexibility in children and adolescents with major depressive disorder for the first episode.MethodsIt was included in the Diagnostic and Statistical Manual of Mental Disorders,5th edition（DSM-V）The diagnostic criteria of Major depressive disorder were 44 children and adolescents with the first episode（case group）and 44 healthy controls matched with their sex,age and education（control group）.The clinical symptom score was conducted using Hamilton 24（HAMD 24）.In cognitive questionnaire（CFQ）and take action in the second edition（AAQ-Ⅱ）to carry on the mental flexibility evaluation,and resting state functional MRI（fMRI）scans.After preprocessing the image data,the low-frequency amplitude zALFF value and the standardized local consistency zReHo value of the whole brain in the two groups were calculated respectively.The medial prefrontal cortex medial superior frontal gyrus,orbital superior frontal gyrus and rectus gyrus were selected as seed points,and the functional connection analysis with the whole brain was conducted to obtain the zFC value.Of two independent samples t test case group and control group CFQ score and AAQ-Ⅱ score difference,Pearson correlation analysis cases CFQ score,AAQ-Ⅱscore correlated with HAMD-24;In MATLAB software on two groups of imaging data of two independent samples t test,extract the abnormal brain z value,and with the HAMD-24 score,CFQ rating and AAQ-Ⅱ correlation analysis.Result1.The score of cognitive integration questionnaire and acceptance coitment questionnaire（second edition）in the case group was significantly higher than that in the control group.In the case group,the score of HAMD24 was positively correlated with the score of cognitive integration questionnaire,and positively correlated with the score of acceptance action questionnaire（second edition）.2.1 compared with control group,cases from cortex/the fusiform gyrus,cerebellum₆,straight back,back in the right temporal and paracentral lobule brain regions zALFF value is reduced,or so in return,right temporal lobe,frontal medial frontal gyrus,left inferior frontal gyrus,right frontal,left the top,right corner next time back to last time,back in the cingulate/precuneus,right marginal zALFF value increased in areas such as the last time.2.2 Compared with the control group,zReHo values in the talar cortex,rectus gyrus,fusiform gyrus,right insula,and right posterior central gyrus were decreased in the case group,while zReHo values in the right insula,left and right middle frontal gyrus,medial superior frontal gyrus,left inferior parietal gyrus,and supplementary motor area were increased.2.3 Compared with the control group,zFC values in the cerebral regions of the straight gyrus,left fusiform gyrus/left inferior temporal gyrus,and right lentiform nucleus were decreased in the case group.The zFC values in the superior frontal gyrus of orbit and inferior frontal gyrus of left and right triangle were decreased in case group.The zFC values of medial superior frontal gyrus,left and right middle temporal gyrus and left and right trigonometric inferior frontal gyrus decreased.In the case group,HAMD-24 score was negatively correlated with zReHo value of the left middle frontal gyrus.Cognitive integration questionnaire score was positively correlated with zALFF value of medial superior frontal gyrus,and negatively correlated with zFC value of medial superior frontal gyrus--left triangle inferior frontal gyrus.And zFC values of superior frontal gyrus and left triangle inferior frontal gyrus in orbit were negatively correlated.Adoptive Action Questionnaire（2nd edition）score was negatively correlated with zALFF value of right temporal lobe and positively correlated with zReHo value and zALFF value of medial superior frontal gyrus.Conclusion1.The first episode of children and adolescents with major depressive disorder has a general and significant decrease in mental flexibility,psychological flexibility is related to the severity of the patient’s disease,which provides a reference for the severity assessment of adolescent major depressive disorder.2 for onset of child and adolescent patients with major depressive disorder is a wide range of spontaneous activities and local consistency change,involving the frontal lobe,occipital lobe,temporal lobe,cerebellum,and many other brain regions,including the functions of the medial prefrontal cortex activity and the connection to change with the first attack of child and adolescent are closely related to major depressive disorder,could be a potential biomarkers.3.The decrease of mental flexibility in children and adolescents with major depressive disorder for the first episode may be related to the changes of functional activities and functional connections in brain regions such as medial superior frontal gyrus.