Psychological And Neuroimaging Characteristics Of Depressive Episode With Psychotic Symptoms In Adolescent

Objective There are still controversies about the psychological mechanism of psychotic symptoms in adolescent patients with depressive episode.This study aimed to explore the influencing factors of psychotic symptoms in adolescents with depression,to investigate whether childhood trauma and negative life events play an intermediary role between depressive symptoms and psychotic symptoms in adolescent patients with depressive episode,and to explore brain imaging characteristics in adolescent major depressive disorder（MDD）patients with psychotic symptoms,to provide valuable guidance for the prevention and treatment of adolescent depressive disorder from the perspective of psychological and neuroimaging mechanisms,and to improve the overall prognosis of the disease.Methods Study 1:From August 2020 to December 2021,adolescent patients with MDD in Shenzhen Kangning Hospital were enrolled in this study.Assessment of negative life events using Adolescent Self-Rating Life Events Check-list（ASLEC）.Independent sample T test and chi-square test were used to compare the differences in measurement indicators.Study 2:From August 2020 to December 2021,adolescent patients with depressive episode in Shenzhen Kangning Hospital were enrolled in this study.The patients were assessed by ASLEC,Self-Rating Depression Scale,Psychotic-like experiences and Childhood Trauma Questionnaire.Unconditional logistic regression method was used to predict the influencing factors of psychotic symptoms.Bootstrap method was used to analyze whether childhood trauma and negative life events play a mediating role between depressive symptoms and psychotic symptoms in adolescent patients with depression.Study 3:From August 2020 to December 2021,adolescent patients with MDD in Shenzhen Kangning Hospital were enrolled in this study,the healthy control group was healthy volunteers recruited through advertisements at the same time,GE3.0T MRI system was used for resting-state MRI data acquisition,the ALFF,Re Ho and independent component analysis were used for data analysis.The analysis of variance was used to test the brain regions where Re Ho and ALFF/f ALFF existed differences and the differences of brain networks among the patient group with psychotic symptoms,the patient group without psychotic symptoms and the healthy control group.Results Study 1:165 subjects were finally included in this part of the study,（14.12±1.56）years.（1）Patients with MDD with psychotic symptoms have a higher incidence of abnormal overall psychological stress（χ~2=4.439,P=0.035）.（2）the Incidence rate of 3-5negative life events was higher in patients with MDD with psychotic symptoms（χ~2=4.366,P=0.037）.（3）multiple negative life events may be a risk factor for MDD with psychotic symptoms in adolescents（OR=1.938,95%CI:1.039-3.617）.Study 2:190 subjects were finally included in this part of the study,（13.94±1.52）years.（1）the number of psychotic symptoms was positively correlated with depression and adolescent life event（correlation coefficients were 0.211,0.322）;depressive symptoms was correlated with childhood trauma and adolescent life event（correlation coefficients were 0.225,0.533）.（2）negative life events may be a risk factor for adolescent patients with depressive episode with multiple psychotic symptoms（OR=1.038,95%CI:1.010-1.067）.（3）negative life events mediated the relationship between depressive symptoms and the number of psychotic symptoms in adolescent patients with depressive episode（effect 0.03,95%CI:0.01-0.08）.Study 3:In this part of the study,we found that the functional connectivity of bilateral posterior cingulate gyrus and bilateral lentiform nucleus of default mode network was significantly decreased in MDD with psychotic symptoms and MDD without psychotic symptoms compared with healthy controls;We found that the functional connectivity of the left insula and the bilateral middle cingulate cortex,left dorsal anterior cingulate gyrus and the right superior occipital gyrus of salience network was significantly decreased in MDD with psychotic symptoms compared with healthy controls and MDD without psychotic symptoms.Conclusions This study found that adolescent MDD patients with psychotic symptoms had higher severity of negative life events than patients without psychotic symptoms.Negative life events may be risk factors for adolescent patients with depressive episode with multiple psychotic symptoms.Negative life events play a partial mediating role between depressive symptoms and the number of psychotic symptoms in adolescent patients with depressive episode.In this study,we found that there were changes in the functional connectivity of default mode network and salience network brain regions at rest in adolescent MDD patients,and abnormal function of these brain regions may be related to the pathomechanism of adolescent MDD.