Psychiatry Investigation最新文献

{"title":"Shared Decision Making as a Policy and Clinical Framework for the Responsible Introduction of Repetitive Transcranial Magnetic Stimulation Therapy in Japan.","authors":"Yoshihiro Noda","doi":"10.30773/pi.2025.0442","DOIUrl":"10.30773/pi.2025.0442","url":null,"abstract":"<p><strong>Objective: </strong>Repetitive transcranial magnetic stimulation (rTMS) has expanded in Japan since its inclusion under public insurance in 2019. This review examines systemic barriers to equitable adoption, ethical and legal challenges, and proposes Shared Decision Making (SDM) as a clinical and policy framework to ensure patient-centered care.</p><p><strong>Methods: </strong>A narrative policy and practice review was conducted, synthesizing evidence from peer-reviewed studies, registry data, government guidance, and professional society statements. Comparative analysis with the United States and Europe was used to contextualize Japan's distinctive financing and governance arrangements.</p><p><strong>Results: </strong>Implementation of rTMS in Japan remains concentrated in tertiary hospitals and metropolitan centers, with limited diffusion to rural areas. Strict eligibility criteria under public insurance restrict access, while private-pay clinics have proliferated with heterogeneous protocols and variable disclosure practices. These structural imbalances generate inequities in access, ethical tensions regarding transparency, and legal concerns about informed consent. Additional barriers include limited public awareness, variability in provider expertise, and constrained outpatient consultation time. International comparisons highlight broader indications and more flexible reimbursement abroad, supported by stronger governance structures.</p><p><strong>Conclusion: </strong>Embedding SDM into both insured and private rTMS practice in Japan is essential to safeguard equity, transparency, and sustainability. A pragmatic SDM framework, incorporating standardized information materials, AI-enabled decision aids, multidisciplinary collaboration, and registry-linked accountability, can transform rTMS adoption into a model of patient-centered governance. Institutionalizing SDM will not only improve treatment concordance and patient trust in Japan but also provide lessons for global mental health policy.</p>","PeriodicalId":21164,"journal":{"name":"Psychiatry Investigation","volume":"23 6","pages":"711-718"},"PeriodicalIF":2.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13284558/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148278625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in Functional Brain Activity in School-Age Children 10 Years Later: A Resting State Functional Magnetic Resonance Imaging Study.","authors":"Lin Li, Yanshu Ding, Lihan Chen, Fei Liu, Yunzhi Ling, Renzhang Lin, Wanchao Zhang, Kaihua Jiang","doi":"10.30773/pi.2025.0436","DOIUrl":"10.30773/pi.2025.0436","url":null,"abstract":"<p><strong>Objective: </strong>Children's cognitive function is undergoing great dynamic changes with age. This study aims to explore the characteristics of changes in children's cognitive function before and after 10 years, and discover brain areas where brain function has undergone significant changes.</p><p><strong>Methods: </strong>In 2008, functional magnetic resonance imaging (fMRI) data were collected from 30 students aged 7-12 from ordinary primary schools in Changzhou. In 2017, fMRI data of 30 primary school students matched for age and sex were collected again on the same MRI machine using the same parameters. Amplitude of low frequency fluctuation (ALFF) and degree centrality (DC) values were calculated respectively for the two sets of data and analyzed by paired t-test.</p><p><strong>Results: </strong>The brain areas with ALFF values higher than those of 10 years after 10 years were left posterior cerebellar lobe, right posterior cerebellar lobe, and left middle occipital gyrus; the brain areas with ALFF values lower than those of 10 years after 10 years were left hippocampus, left inferior frontal gyrus, right inferior frontal gyrus, and left medial frontal gyrus. The left superior occipital gyrus was found in the brain area with a higher DC value after 10 years and the left inferior parietal lobe was found in the brain area with a lower DC value after 10 years.</p><p><strong>Conclusion: </strong>After 10 years, children's overall attention, memory, and cognition related brain areas are developing. Some brain areas show improvement in brain function, and some brain areas play a role more efficiently. This study provides a basis for predicting the development of brain function in school-age children.</p>","PeriodicalId":21164,"journal":{"name":"Psychiatry Investigation","volume":"23 6","pages":"790-796"},"PeriodicalIF":2.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13284551/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148278540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Comparative Analysis of Cortical Thickness in Female Youth With Non-Suicidal Self-Injury.","authors":"Hyanghee Jeong, Tae Young Choi, Sujin Bae, Jung Yeon Moon","doi":"10.30773/pi.2025.0268","DOIUrl":"10.30773/pi.2025.0268","url":null,"abstract":"<p><strong>Objective: </strong>Non-suicidal self-injury (NSSI), prevalent among children and youth, is a risk factor for future suicidal behavior. Nonetheless, the neurobiological mechanisms of NSSI remain under-explored. This study compares the cortical thickness in female youth with NSSI and a healthy control (HC) group using brain magnetic resonance imaging (MRI) and ascertains its associations with relevant factors.</p><p><strong>Methods: </strong>The NSSI group comprised inpatients meeting NSSI diagnostic criteria according to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, while the HC group included youth without psychiatric symptoms. Both groups included female adolescents and young adults aged 9-24 years. Clinical data were collected for the NSSI group, and brain MRIs were obtained for both groups. Cortical thickness differences between groups were explored, adjusting for age, and correlations between cortical thickness and clinical variables in the NSSI group were analyzed.</p><p><strong>Results: </strong>Both groups included 32 participants, with no statistically significant difference in average age (NSSI group: mean age 15.47± 3.20 years; HC group: mean age 15.56±4.83 years; p>0.05). Significant intergroup differences in mean cortical thickness were observed in both the left and right hemispheres (both p=0.001). Specifically, the NSSI group exhibited significantly thinner cortical thickness in the right cingulate cortex compared to the healthy HC group (corrected p<0.05). However, correlation analysis between the cortical thickness of the right cingulate cortex and anxiety (State Anxiety Inventory for Children: r=-0.547, p=0.053) (Trait Anxiety Inventory for Children: r=-0.257, p=0.396) and Children's Depression Inventory (r=-0.231, p=0.447) scales in the NSSI group did not reveal statistically significant correlations.</p><p><strong>Conclusion: </strong>The study identified a noteworthy reduction in cortical thickness in the right cingulate cortex in the NSSI group.</p>","PeriodicalId":21164,"journal":{"name":"Psychiatry Investigation","volume":" ","pages":"829-836"},"PeriodicalIF":2.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13284556/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147983016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting Probable Persistent PTSD Following the Sewol Ferry Disaster: Development of an AI Algorithm Based on Psychological Assessments and Biological Markers.","authors":"Daun Shin, Beomgi So, Jeong-Ho Chae, Byung-Joo Ham, So Hee Lee","doi":"10.30773/pi.2026.0026","DOIUrl":"10.30773/pi.2026.0026","url":null,"abstract":"<p><strong>Objective: </strong>Prolonged post-traumatic stress disorder (PTSD) carries substantial personal and public-health costs, yet early identification of individuals at risk remains difficult. This study aimed to develop a novel artificial intelligence (AI)-based predictive algorithm using psychological, biological, and psychosocial data collected at initial assessment to enhance early identification of individuals at heightened risk for probable persistent PTSD.</p><p><strong>Methods: </strong>This study included 88 bereaved family members of the victims of the Sewol ferry disaster, divided into probable persistent PTSD (n=67) and probable remitted (n=21) groups based on 4-year follow-up assessments. Demographic, blood test, and psychological data were collected during initial evaluations. Models compared linear discriminant analysis (LDA) with tree-based learners under stratified cross-validation; class imbalance was addressed with Borderline Synthetic Minority Oversampling Technique, and recursive feature elimination identified parsimonious predictors.</p><p><strong>Results: </strong>The LDA model demonstrated the highest performance, with an area under the receiver operating characteristic curve of 0.858. Psychosocial features dominated prediction: higher anxiety, depression, insomnia, and intrusive rumination increased risk, whereas greater positive resources and functional social support were protective. Routine physiological markers showed limited incremental value.</p><p><strong>Conclusion: </strong>Findings support a practical intake pathway in which brief psychosocial measures are used with an interpretable classifier to triage high-risk individuals to targeted interventions. External validation, calibration, decision-curve analysis, and broader biomarker panels are needed to confirm transportability and optimize clinical utility.</p>","PeriodicalId":21164,"journal":{"name":"Psychiatry Investigation","volume":"23 6","pages":"754-765"},"PeriodicalIF":2.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13284561/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148278550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interaction Effect of Panic Disorder Diagnosis and Early Trauma History on Cortical Gyrification Patterns.","authors":"Myung Sin Kim, Hyun-Ju Kim, Sang-Hyuk Lee","doi":"10.30773/pi.2025.0414","DOIUrl":"10.30773/pi.2025.0414","url":null,"abstract":"<p><strong>Objective: </strong>Early trauma (ET) occurring during critical periods of brain development has been associated with structural brain alterations. ET history and structural brain changes have been linked to panic disorder (PD). Abnormalities in cortical gyrification patterns have been reported in both patients with PD and individuals with a history of ET. This study aimed to examine the interaction between ET history and PD diagnosis in relation to cortical gyrification patterns.</p><p><strong>Methods: </strong>The study included 83 patients with PD and 83 age- and sex-matched healthy controls. High-resolution T1-weighted brain images were analyzed using vertex-based methods to evaluate the local gyrification index (LGI). ET history was assessed using the Early Trauma Inventory Self-Report Short Form. Anxiety symptomatology was evaluated using the Panic Disorder Severity Scale (PDSS) and the Intolerance of Uncertainty Scale (IUS).</p><p><strong>Results: </strong>A significant interaction between PD diagnosis and ET history was observed in the LGI of the gyrus portion of the superior parietal lobule (SPL). Patients with PD who had experienced ET showed significantly higher LGI values in the SPL than those without ET. SPL LGI values were positively correlated with PDSS and IUS total scores across all participants.</p><p><strong>Conclusion: </strong>These findings suggest an interaction effect of PD diagnosis and ET history on cortical gyrification alterations in the SPL. The results underscore the importance of considering both ET and brain structural characteristics when investigating the pathophysiology of PD. Further studies are warranted to elucidate the mechanisms linking ET, cortical gyrification, and PD.</p>","PeriodicalId":21164,"journal":{"name":"Psychiatry Investigation","volume":"23 6","pages":"729-737"},"PeriodicalIF":2.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13284552/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148278619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychosocial and Behavioral Correlates of Self-Rated Health in Psychiatric Outpatients and Community Adults.","authors":"Yujin Ko, Shin-Gyeom Kim, Soyoung Irene Lee, Jeewon Lee, Han-Yong Jung, HyunChul Youn","doi":"10.30773/pi.2025.0429","DOIUrl":"10.30773/pi.2025.0429","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to identify psychosocial and behavioral factors influencing self-rated health-related quality of life (HRQoL) in psychiatric and community settings.</p><p><strong>Methods: </strong>Cross-sectional data were collected from 128 psychiatric outpatients and 500 general population participants. HRQoL was measured using the EuroQol Visual Analogue Scale (EQ-VAS). Psychological and behavioral variables included the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Connor-Davidson Resilience Scale, Pittsburgh Sleep Quality Index, Morningness-Eveningness Questionnaire, Charlson Comorbidity Index, and Multidimensional Scale of Perceived Social Support. Separate stepwise multiple linear regression analyses were conducted for each group to identify factors associated with EQ-VAS scores.</p><p><strong>Results: </strong>In the psychiatric sample, sleep quality and family cohabitation were positively associated with HRQoL. In the general population, HRQoL was significantly related to depressive symptoms, resilience, comorbidity burden, body mass index, sleep quality, and morningness preference. Each group showed a distinct pattern of associations, reflecting their respective psychosocial contexts.</p><p><strong>Conclusion: </strong>Results indicate that HRQoL is affected by a complex interplay of emotional, behavioral, and environmental factors, which vary by population. Interventions to improve subjective health may benefit from addressing sleep and social support in psychiatric clinical settings, and broader lifestyle and emotional health in community contexts.</p>","PeriodicalId":21164,"journal":{"name":"Psychiatry Investigation","volume":"23 5","pages":"605-612"},"PeriodicalIF":2.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13211999/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148034183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interplay of Subjective Symptoms Across the Stages of the Schizophrenia Spectrum.","authors":"Hye Yoon Park, Minji Bang, Suk Kyoon An","doi":"10.30773/pi.2025.0054","DOIUrl":"10.30773/pi.2025.0054","url":null,"abstract":"<p><strong>Objective: </strong>Schizophrenia (SPR) spectrum disorders involve various subjective symptoms, including disruptions in self-awareness, cognitive complaints, and schizotypy. While tools such as the Examination of Anomalous Self-Experience (EASE), Frankfurt Complaint Questionnaire (Frankfurter Beschwerde-Fragebogen, FBF), and Chapman Psychosis Proneness Scales (CPPS) have been employed, research on their interrelations across different stages of the SPR spectrum remains limited, particularly in ultra-high risk (UHR) and SPR groups.</p><p><strong>Methods: </strong>This study examined the EASE, FBF, and CPPS scores among healthy controls (HC), individuals at UHR, and those with SPR. Group differences and the interplay of subjective symptoms were analysed to understand how these dimensions interact and evolve across the psychosis continuum.</p><p><strong>Results: </strong>HCs scored significantly lower on all subjective symptom measures compared to both UHR and SPR groups. Specifically, the HC group (0.82±1.51) scored significantly lower on the EASE than both the UHR (13.90±9.67) and SPR (10.13±9.16) groups (p<0.001). Similarly, the FBF scores for HCs (9.75±10.30) were significantly lower than for the UHR (36.27±22.73, p<0.001) and SPR (26.77±26.15, p=0.017) groups. Significant differences were also found in CPPS subscales, with HCs scoring significantly lower than UHR and SPR groups on the Physical Anhedonia Scale (UHR, p<0.001; SPR, p=0.026) and the Social Anhedonia Scale (HC vs. UHR: p<0.001, HC vs. SPR: p<0.001). The differences in subjective disturbances between the UHR and SPR groups were less pronounced and not statistically significant for any of the main measures. Stronger associations among the EASE, FBF, and CPPS were observed in the SPR group.</p><p><strong>Conclusion: </strong>The findings indicate that the UHR and SPR groups share elevated levels of disturbed subjective experiences, with the SPR group showing greater disruptions in the interplay of these experiences. These findings suggest a continuous spectrum of shared experiential anomalies and support the value of integrated assessment approaches. Such combined evaluations may enhance the precision of early psychosis risk detection and longitudinal monitoring, offering a foundational basis for future interventions grounded in phenomenological understanding.</p>","PeriodicalId":21164,"journal":{"name":"Psychiatry Investigation","volume":"23 5","pages":"635-643"},"PeriodicalIF":2.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13212000/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148034644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bipolar Disorder Versus Unipolar Depressive Disorder in Female Psycho-Oncology Outpatients With Breast Cancer.","authors":"Kyeong A Kang, C Hyung Keun Park","doi":"10.30773/pi.2025.0386","DOIUrl":"10.30773/pi.2025.0386","url":null,"abstract":"<p><strong>Objective: </strong>A substantial number of patients with breast cancer experience psychological challenges, but little is known about the prevalence and characteristics of bipolar disorder (BD) among those with mood disorders. This study aimed to investigate the prevalence of BD among psycho-oncology outpatients with breast cancer comorbid with a mood disorder and compare the sociodemographic, clinical, and psychological factors between BD and unipolar depressive disorder (UDD) groups.</p><p><strong>Methods: </strong>Data from 83 female outpatients with breast cancer visiting a psycho-oncology clinic who were diagnosed with mood disorder based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition were analyzed.</p><p><strong>Results: </strong>The results revealed that 32.5% of the patients were diagnosed with BD, with bipolar II disorder being the most prevalent subtype (81.5%). Patients with BD were more likely to be younger, employed, and have a history of suicide attempts compared to those with UDD. No significant differences were observed in psychiatric symptoms or quality of life between the two groups.</p><p><strong>Conclusion: </strong>Although thorough psychiatric attention should be provided irrespective of the specific mood disorder diagnosis, these findings highlighted the considerable prevalence of BD among psycho-oncology outpatients with both breast cancer and mood disorder, emphasizing the importance of identifying and addressing this condition within this specific population.</p>","PeriodicalId":21164,"journal":{"name":"Psychiatry Investigation","volume":"23 5","pages":"597-604"},"PeriodicalIF":2.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13212006/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148034604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interpersonal Psychological Group Therapy for Parents Improves Self-Injurious Behavior and Family Intimacy in Non-Suicidal Self-Injurious Adolescents: A Randomized Controlled Study.","authors":"Yingqi Yin, Lan Yu, Wen Liu, Guilin Yu, Shufang Zhang","doi":"10.30773/pi.2025.0425","DOIUrl":"10.30773/pi.2025.0425","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to assess the efficacy of combining adolescent treatment as usual (TAU) with interpersonal psychological group therapy (IPT-G) for parents in adolescents with non-suicidal self-injury (NSSI). The primary focus was to compare this combined intervention with TAU alone, particularly examining its effects on parental interpersonal relationships, family cohesion, and the frequency of adolescent self-injury.</p><p><strong>Methods: </strong>A randomized controlled trial was conducted from August 2023 to May 2024. Participants included 64 adolescents aged 10 to 18 years, diagnosed with NSSI, and one parent per adolescent. The intervention group received TAU for adolescents and IPT-G for parents, while the control group received only TAU. Data were collected using the Ottawa Self-Injury Scale, Family Adaptability and Cohesion Evaluation Scales II-Chinese Version, and the Quality of Social Relationships Scale at baseline, post-intervention, and 1-month follow-up. Statistical analysis involved chi-square tests, independent samples t-tests, and repeated measures analysis of variance.</p><p><strong>Results: </strong>Ultimately, 48 participants completed the study. The IPT-G group showed significant improvements compared to the TAU group in family intimacy and adaptability, interpersonal relationships, and a substantial reduction in adolescent self-injury frequency (all p<0.05) at post-intervention and follow-up assessments.</p><p><strong>Conclusion: </strong>The combined treatment of TAU and IPT-G for parents is effective in reducing self-injury behaviors in adolescents, enhancing family cohesion, and improving parental interpersonal relationships. This approach highlights the importance of parental involvement in managing adolescent NSSI and offers promising implications for future treatments. Further studies with larger samples and extended follow-up periods are recommended to assess long-term outcomes.</p>","PeriodicalId":21164,"journal":{"name":"Psychiatry Investigation","volume":"23 5","pages":"624-634"},"PeriodicalIF":2.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13212007/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148034650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Glymphatic Dysfunction and Related Brain Structure Changes in Major Depressive Disorder: Effects of Glymphatic Function in Mediating Neuroinflammation.","authors":"Daun Shin, Kyu-Man Han, Youbin Kang, Dorothee P Auer, Woo Suk Tae, Byung-Joo Ham","doi":"10.30773/pi.2025.0456","DOIUrl":"10.30773/pi.2025.0456","url":null,"abstract":"<p><strong>Objective: </strong>The glymphatic system, responsible for cerebrospinal fluid flow and waste clearance, is increasingly implicated in the pathophysiology of major depressive disorder (MDD) through its influence on neuroinflammation. This study investigated the association between glymphatic dysfunction, systemic inflammation, and brain volume changes in patients with MDD.</p><p><strong>Methods: </strong>Glymphatic function was assessed using the diffusion tensor image analysis along the perivascular space (DTI-ALPS) index in 176 patients with MDD and 178 controls. Inflammatory cytokine levels, including plasma C-reactive protein (CRP) levels, were measured in 68 patients with MDD and 54 controls. Depressive symptoms were evaluated using the Hamilton Depression Rating Scale. Statistical analyses included a multivariate analysis of covariance and Pearson's partial correlations adjusted for covariates. Mediation analysis examined the relationships between CRP, glymphatic function, and brain volume.</p><p><strong>Results: </strong>Patients with MDD showed reduced glymphatic function compared to healthy controls. Reduced DTI-ALPS indices were correlated with higher CRP levels and increased ventricular volumes, including the choroid plexus. CRP levels were negatively correlated with DTI-ALPS indices and right choroid plexus volumes. Mediation analysis indicated that glymphatic dysfunction partially mediated the relationship between elevated CRP levels and decreased choroid plexus volume in patients with MDD.</p><p><strong>Conclusion: </strong>This study found that in MDD, glymphatic dysfunction is associated with higher CRP and mediates the link between systemic inflammation and right choroid plexus volume. Given sample size and limited covariate control, these results are preliminary and need confirmation in larger longitudinal cohorts. Even so, impaired glymphatic function may represent a therapeutic target.</p>","PeriodicalId":21164,"journal":{"name":"Psychiatry Investigation","volume":"23 5","pages":"644-657"},"PeriodicalIF":2.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13212005/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148034647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}