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    Original Investigation
    October 30, 2019

    Shared Neural Phenotypes for Mood and Anxiety Disorders: A Meta-analysis of 226 Task-Related Functional Imaging Studies

    Author Affiliations
    • 1Icahn School of Medicine at Mount Sinai, New York, New York
    • 2Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
    • 3School of Medicine and Psychology, Department of Neuroscience, Mental Health and Sensory Organs, Sapienza University, Sant'Andrea Hospital, Rome, Italy
    • 4Centro Lucio Bini-Aretæus, Rome, Italy
    • 5Institute of Neuroscience and Medicine (Brain and Behavior), Research Centre Jülich, Jülich, Germany
    • 6Institute of Systems Neuroscience, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
    JAMA Psychiatry. 2020;77(2):172-179. doi:10.1001/jamapsychiatry.2019.3351
    Key Points

    Question  Is the clinical overlap seen in major depressive disorder, bipolar disorder, anxiety disorders, and posttraumatic stress disorder reflected at the neurobiological level?

    Findings  In this meta-analysis of 226 task-related functional imaging studies, transdiagnostic clusters of hypoactivation were identified in the inferior prefrontal cortex/insula, inferior parietal lobule, and putamen.

    Meaning  Across mood and anxiety disorders, the most consistent transdiagnostic abnormalities in task-related brain activity converge in regions that are primarily associated with inhibitory control and salience processing.

    Abstract

    Importance  Major depressive disorder, bipolar disorder, posttraumatic stress disorder, and anxiety disorders are highly comorbid and have shared clinical features. It is not yet known whether their clinical overlap is reflected at the neurobiological level.

    Objective  To detect transdiagnostic convergence in abnormalities in task-related brain activation.

    Data Source  Task-related functional magnetic resonance imaging articles published in PubMed, Web of Science, and Google Scholar during the last decade comparing control individuals with patients with mood, posttraumatic stress, and anxiety disorders were examined.

    Study Selection  Following Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guidelines, articles were selected if they reported stereotactic coordinates of whole-brain–based activation differences between adult patients and control individuals.

    Data Extraction and Synthesis  Coordinates of case-control differences coded by diagnosis and by cognitive domain based on the research domain criteria were analyzed using activation likelihood estimation.

    Main Outcomes and Measures  Identification of transdiagnostic clusters of aberrant activation and quantification of the contribution of diagnosis and cognitive domain to each cluster.

    Results  A total of 367 experiments (major depressive disorder, 149; bipolar disorder, 103; posttraumatic stress disorder, 55; and anxiety disorders, 60) were included comprising observations from 4507 patients and 4755 control individuals. Three right-sided clusters of hypoactivation were identified centered in the inferior prefrontal cortex/insula (volume, 2120 mm3), the inferior parietal lobule (volume, 1224 mm3), and the putamen (volume, 888 mm3); diagnostic differences were noted only in the putamen (χ23 = 8.66; P = .03), where hypoactivation was more likely in bipolar disorder (percentage contribution = 72.17%). Tasks associated with cognitive systems made the largest contribution to each cluster (percentage contributions >29%). Clusters of hyperactivation could only be detected using a less stringent threshold. These were centered in the perigenual/dorsal anterior cingulate cortex (volume, 2208 mm3), the left amygdala/parahippocampal gyrus (volume, 2008 mm3), and the left thalamus (volume, 1904 mm3). No diagnostic differences were observed (χ23 < 3.06; P > .38), while tasks associated with negative valence systems made the largest contribution to each cluster (percentage contributions >49%). All findings were robust to the moderator effects of age, sex, and magnetic field strength of the scanner and medication.

    Conclusions and Relevance  In mood disorders, posttraumatic stress disorder, and anxiety disorders, the most consistent transdiagnostic abnormalities in task-related brain activity converge in regions that are primarily associated with inhibitory control and salience processing. Targeting these shared neural phenotypes could potentially mitigate the risk of affective morbidity in the general population and improve outcomes in clinical populations.

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