This study provides strong converging evidence that a blunted neural response to rewards precedes adolescent-onset depression and symptom emergence. Blunted neural response may therefore constitute an important target for screening and prevention.
Objective Social impairment is a long recognized core feature of schizophrenia and common in other psychotic disorders. Still, to date the long-term trajectories of social impairment in psychotic disorders have rarely been studied systematically. Methods Data came from the Suffolk County Mental Health Project, a 20-year prospective study of first-admission patients with psychotic disorders. A never psychotic comparison group was assessed. We applied Latent Class Growth Analysis to longitudinal data on social functioning from 485 respondents with schizophrenia spectrum disorders and psychotic mood disorders and examined associations of the empirically derived trajectories with premorbid social adjustment, diagnosis, and 20-year outcomes. Results Four mostly stable trajectories of preserved (n = 82; 59th percentile of comparison group sample distribution), moderately impaired (n =148; 17th percentile), severely impaired (n = 181; 3rd percentile), and profoundly impaired (n = 74; 1st percentile) functioning best described the 20-year course of social functioning across diagnoses. Functioning in the preserved group did not differ from that of never psychotic individuals at 20-years, but the other groups functioned worse (all p < 0.001). Differences among trajectories were already evident in childhood. The two most impaired trajectories started to diverge in early adolescence. Poorer social functioning trajectories were strongly associated with other real-world outcomes at 20-years. Multiple trajectories were represented within each disorder. However, relatively more participants with schizophrenia spectrum disorders were in the impaired trajectories, and relatively more with mood disorders in the better functioning ones. Conclusions The results highlight substantial variability of social outcomes within diagnoses – albeit overall worse social outcomes in schizophrenia spectrum disorders- and show remarkably stable long-term impairments in social functioning after illness onset across all diagnoses.
Background Ineffective emotion regulation and abnormal amygdala activation have each been found in adolescent-onset major depressive disorder. However, amygdala activation during emotion regulation has not been studied in adolescent-onset major depressive disorder. Method Fourteen unmedicated adolescents diagnosed with current depression without comorbid psychiatric disorders and fourteen well-matched controls ages 13 to 17 years underwent an emotional regulation task during functional magnetic resonance imaging. During this task, participants viewed negatively-valence images and were asked to notice how they were feeling without trying to change it and maintain their emotional reaction (“Maintain”) or to interpret the image in such a way as minimize their emotional response (“Reduce”). Results Imaging analyses demonstrated that adolescents with depression showed: (1) greater right amygdala activation during the maintain condition relative to controls, (2) less connectivity during the maintain condition between the amygdala and both the insula and medial prefrontal cortex than controls, and (3) a significant positive correlation between amygdala-seeded connectivity during maintenance of emotion and psychosocial functioning. Limitations The current study is cross-sectional comparison and longitudinal investigations with larger sample sizes are needed to examine the association between amygdala reactivity and emotion regulation over time in adolescent MDD. Conclusions During the maintain condition, adolescents with depression showed a heightened amygdala response and less reciprocal activation in brain regions that may modulate the amygdala. A poorly modulated, overreactive amygdala may contribute to poor emotion regulation.
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