Previous resting-state functional magnetic resonance imaging (rs-fMRI) studies have revealed intrinsic regional activity alterations in obsessive-compulsive disorder (OCD), but those results were based on group analyses, which limits their applicability to clinical diagnosis and treatment at the level of the individual. We examined fractional amplitude low-frequency fluctuation (fALFF) and applied support vector machine (SVM) to discriminate OCD patients from healthy controls on the basis of rs-fMRI data. Values of fALFF, calculated from 68 drug-naive OCD patients and 68 demographically matched healthy controls, served as input features for the classification procedure. The classifier achieved 72% accuracy (p ≤ 0.001). This discrimination was based on regions that included the left superior temporal gyrus, the right middle temporal gyrus, the left supramarginal gyrus and the superior parietal lobule. These results indicate that OCD-related abnormalities in temporal and parietal lobe activation have predictive power for group membership; furthermore, the findings suggest that machine learning techniques can be used to aid in the identification of individuals with OCD in clinical diagnosis.

A body of studies has focused on the olfactory impairment among people with schizophrenia. The effect of sex on this relationship has attracted the attention of researchers. These issues have not been studied much in Chinese schizophrenia patients. We conducted a case-control study of 110 first-episode antipsychotic medicine naïve schizophrenia patients aged 18–35 years and 110 controls, matched by age and sex. Odour threshold, discrimination and identification were assessed by the “Sniffin’ Sticks” test. Psychotic symptoms were assessed by the Positive and Negative Syndrome Scale (PANSS). The odour threshold, discrimination and identification scores of patients with schizophrenia were significantly lower than those of the healthy control group. The difference in identification score had statistical significance between male and female patients with schizophrenia (t = − 2.45, P < 0.05). Controlling for confounding factor, in male schizophrenia participants, the negative subscale score was significantly and inversely correlated with the discrimination (γ = − 0.37, p < 0.008), identification (γ = − 0.45, p < 0.008) and TDI (γ = − 0.50, p < 0.008) scores; the general psychopathology subscale score was inversely and significantly correlated with the identification (γ = − 0.47, p < 0.008) and TDI (γ = − 0.41, p < 0.008) scores. For female schizophrenia patients, positive and general psychopathology subscale scores had a significant inverse correlation with the identification score (positive: γ = − 0.47, p < 0.008; general psychopathology: γ = − 0.42, p < 0.008). Controlling for confounder, negative symptoms were related to impaired odour discrimination and identification in male schizophrenia patients, while positive symptoms were correlated with impaired odour identification in female schizophrenia patients. This sex dimorphism could provide useful information for future studies aiming to finding biomarkers of schizophrenia.

Backgrounds: Deep brain stimulation (DBS) is an emerging and promising therapeutic approach for treatment-refractory obsessive-compulsive disorder (OCD). The most common DBS targets include the anterior limb of internal capsule (ALIC) and nucleus accumbens (NAcc). This protocol aims to explore the efficacy and safety of the combined ALIC- and NAcc-DBS for treatment-refractory OCD. Methods: We will recruit 64 patients with refractory OCD from six centers, randomly allocate them to active and sham-stimulation groups through a three-month double-blind phase, then enter a three-month open-label phase. In the open-label stage, both groups experience real stimulation. Outcome measures: The primary outcome will be the efficacy and safety of combined ALIC- and NAcc-DBS, determined by treatment response rate between the active and sham-stimulation groups at the double-blind stage and spontaneously reported adverse events. The secondary outcomes are comparisons of change in Y–BOCS, CGI, HAMD, and HAMA scores at the third and sixth months compared to baseline between the active and sham-control groups, as well as the scores of the third month minus the sixth month between the two groups.

Rationale: Zolpidem, a non-benzodiazepine sedative-hypnotic, is considered safer for the treatment of insomnia compared to benzodiazepines. However, in recent years, there have been growing reports of Zolpidem dependence, addiction, and withdrawal symptoms. We reported a case of Zolpidem addiction and successful detoxification, reviewed similar cases in the literature, and proposed a potential mechanism underlying Zolpidem addiction. Patient concerns: The patient was a 46-year-old Tibetan woman who had been using Zolpidem intermittently to treat insomnia for at least 8 years. She was overweight, with a BMI of 28.04 kg/m², and had hypertension, diabetes, a 20-year smoking history, and several years of alcohol abuse, often seeking instant gratification. She voluntarily increased both the dosage and frequency of Zolpidem, experiencing euphoria, anxiolysis, and increased appetite at higher doses, which led her to gradually escalate her dosage to 280 mg per day in divided doses. However, upon stopping Zolpidem, she experienced withdrawal symptoms, including insomnia, tension, and palpitations. Diagnoses: She was diagnosed with a combination of hypnotic use disorder, anxiety disorder, hypertension, and diabetes. Interventions: She underwent diazepam replacement therapy, along with antianxiety medications and mindfulness-based cognitive therapy, to address Zolpidem addiction. Outcomes: After 13 days of inpatient treatment, the patient successfully quit Zolpidem. During a 3-month follow-up, she returned to work and remained free from Zolpidem use. Lessons: We speculate that Zolpidem addiction is likely linked to the drug’s euphoric effects and certain patient characteristics, such as sensation-seeking behavior. A comprehensive approach, involving both pharmacological and psychological interventions, is essential for an effective detoxification strategy for Zolpidem addiction.

Previous studies have highlighted alterations of white matter (WM) integrity underlying mechanisms of obsessive-compulsive disorder (OCD). However, whole-brain WM abnormalities in OCD at the tract-level still remain largely unknown. In current study, we evaluated the integrity of 42 WM tracts in individuals with OCD using the novel tractography toolbox, TRActs Constrained by UnderLying Anatomy (TRACULA), and investigated the grey matter changes linked to the white matter alterations. Furthermore, we investigated the association of diffusion measures with clinical symptom severity. DTI and T1-weighted image data were collected from 54 medication-free OCD patients and 39 age- and sex-matched healthy controls (HCs). TRACULA was used to reconstruct 42 WM tracts and produce tract volume, fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), and axial diffusivity (AD) of each tract, and grey matter measures were extracted from T1-weighted images. Group comparisons of these measures were evaluated with analysis of covariance. Comparing to HCs, OCD patients showed widespread decreased FA, including rostrum of the corpus callosum, uncinate fasciculus, frontal aslant tract, inferior longitudinal fasciculus, acoustic radiation and optic radiation. Additionally, we found grey matter changes linking to the detected white matter changes, including abnormalities in the medial orbital frontal cortex, superior frontal gyrus, pars opercularis, precentral gyrus, postcentral gyrus, lingual gyrus, and Heschl’s Gyrus. Our results demonstrated that OCD had structural disconnection not only within the traditional frontal-limbic networks but also extended to the visual and auditory systems.