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A comparative diagnostic study using clinical and multimodal assessment, including functional neuroimaging and oculomotricity tools, to differentiate ADHD in young patients from healthy control group

Ma G, Eng AE, Chiang SK, Hao F, McIntyre RS, Zhou D, et al.

Psychiatry Clin Neurosci, 2025 Apr;79(4):165-175.
PMID: 39901842 DOI: 10.1111/pcn.13788

AIM: Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that may persist into adulthood, with no established objective diagnostic tool yet. This study aims to propose a multimodal objective assessment tool involving clinical assessments, functional neuroimaging, and oculomotricity measurement for ADHD in young adults.
METHODS: Seventy-one medication-naïve patients and 71 healthy controls (HCs) aged 18 to 28 underwent clinical interviews, Conners' Adult ADHD Rating Scale (CAARS) questionnaire, functional near-infrared spectroscopy (fNIRS), oculomotricity task, and Conners' Continuous Performance Task (CPT) 3rd edition. Student's t-tests with Bonferroni's correction were performed to compare the performance between groups, and logistic regression was used for classification.
RESULTS: ADHD patients had significantly lower frontal hemodynamic response during verbal fluency task (VFT) (P = 0.0003), more anticipatory eye movements during overlap task (P = 0.0006), higher latency (P
Functional near-infrared spectroscopy during the verbal fluency task of English-Speaking adults with mood disorders: A preliminary study

Husain SF, McIntyre RS, Tang TB, Abd Latif MH, Tran BX, Linh VG, et al.

J Clin Neurosci, 2021 Dec;94:94-101.
PMID: 34863469 DOI: 10.1016/j.jocn.2021.10.009

Functional near-infrared spectroscopy (fNIRS) provides a direct and objective assessment of cerebral cortex function. It may be used to determine neurophysiological differences between psychiatric disorders with overlapping symptoms, such as major depressive disorder (MDD) and bipolar disorder (BD). Therefore, this preliminary study aimed to compare fNIRS signals during the verbal fluency task (VFT) of English-speaking healthy controls (HC), patients with MDD and patients with BD. Fifteen HCs, 15 patients with MDD and 15 patients with BD were recruited. Groups were matched for age, gender, ethnicity and education. Relative oxy-haemoglobin and deoxy-haemoglobin changes in the frontotemporal cortex was monitored with a 52-channel fNIRS system. Integral values of the frontal and temporal regions were derived as a measure cortical haemodynamic response magnitude. Both patient groups had lower frontal and temporal region integral values than HCs, and patients with MDD had lower frontal region integral value than patients with BD. Moreover, patients could be differentiated from HCs using the frontal and temporal integral values, and patient groups could be differentiated using the frontal region integral values. VFT performance, clinical history and symptom severity were not associated with integral values. These results suggest that prefrontal cortex haemodynamic dysfunction occurs in mood disorders, and it is more extensive in MDD than BD. The fNIRS-VFT paradigm may be a potential tool for differentiating MDD from BD in clinical settings, and these findings need to be verified in a larger sample of English-speaking patients with mood disorders.
Changes in Cerebral Hemodynamic Among Patients With Schizophrenia or Bipolar Disorder Receiving Electroconvulsive Therapy: A Task-Related Functional Near-Infrared Spectroscopy Study

Chhoa KH, Chiang SK, Ong KY, Yong CK, Ng BZ, Othman SZ, et al.

J ECT, 2025 Jan 24.
PMID: 39853313 DOI: 10.1097/YCT.0000000000001110

There remains a scarcity of studies to evaluate the treatment effect of electroconvulsive therapy (ECT). Functional near-infrared spectroscopy (fNIRS) offers a cost-effective method to measure cerebral hemodynamics. This study used fNIRS to evaluate the effect of ECT in patients suffering from schizophrenia or bipolar disorder (manic phase). Thirty patients with mania and 31 with schizophrenia were recruited. Each participant received 6 sessions of ECT. This study utilized the Positive and Negative Syndrome Scale, Young Mania Rating Scale, and fNIRS-verbal fluency test paradigm at baseline and after each session of ECT. The prefrontal cortex hemodynamic response during the performance of verbal fluency test was recorded via a commercial wireless high-density continuous-wave fNIRS system device. The effect of categorical and continuous variables was determined using Pearson's chi-square test and Student's t test or 1-way analysis of variance with Bonferroni-corrected post hoc pairwise comparison, respectively. Comparing the Positive and Negative Syndrome Scale and Young Mania Rating Scale scores between baseline, sessions 3 and 6, the scores were significantly decreased (P < 0.001), with both patient groups achieving more than 50% reduction in scores from baseline to session 6. The fNIRS also showed significant increases in oxy-hemoglobin levels (session 6 vs baseline) in the right ventrolateral prefrontal cortex and left dorsolateral prefrontal cortex for both patient groups (P < 0.05). There were significant correlations in the reduction of symptom severity and increase in HbO2 levels in people with bipolar disorder (manic phase) and schizophrenia (P < 0.05). Monitoring the activation in the right ventrolateral prefrontal cortex and left dorsolateral prefrontal cortex is an objective ECT monitoring indicator for patients suffering from bipolar disorder (manic phase) or schizophrenia.
Functional Near-Infrared Spectroscopy of English-Speaking Adults With Attention-Deficit/Hyperactivity Disorder During a Verbal Fluency Task

Husain SF, Chiang SK, Vasu AA, Goh CP, McIntyre RS, Tang TB, et al.

J Atten Disord, 2023 Nov;27(13):1448-1459.
PMID: 37341192 DOI: 10.1177/10870547231180111

OBJECTIVE: Functional near-infrared spectroscopy (fNIRS) provides direct and quantitative assessment of cortical hemodynamic response. It has been used to identify neurophysiological alterations in medication-naïve adults with attention-deficit/hyperactivity disorder (ADHD). Hence, this study aimed to distinguish both medication-naïve and medicated adults with ADHD from healthy controls (HC).
METHOD: 75 HCs, 75 medication-naïve, and 45 medicated patients took part in this study. fNIRS signals during a verbal fluency task (VFT) were acquired using a 52-channel system and relative oxy-hemoglobin changes in the prefrontal cortex were quantified.
RESULTS: Prefrontal cortex hemodynamic response was lower in patients than HCs (p ≤ ≤.001). Medication-naïve and medicated patients did not differ in hemodynamic response or symptom severity (p > .05). fNIRS measurements were not associated with any clinical variables (p > .05). 75.8% patients and 76% HCs were correctly classified using hemodynamic response.
CONCLUSION: fNIRS may be a potential diagnostic tool for adult ADHD. These findings need to be replicated in larger validation studies.
Fulltext An fNIRS investigation of novel expressed emotion stimulations in schizophrenia

Wang C, Zhang Y, Lim LG, Cao W, Zhang W, Wan X, et al.

Sci Rep, 2023 Jul 10;13(1):11141.
PMID: 37429942 DOI: 10.1038/s41598-023-38057-1

Living in high expressed emotion (EE) environments tends to increase the relapse rate in schizophrenia (SZ). At present, the neural substrates responsible for high EE in SZ remain poorly understood. Functional near-infrared spectroscopy (fNIRS) may be of great use to quantitatively assess cortical hemodynamics and elucidate the pathophysiology of psychiatric disorders. In this study, we designed novel low- (positivity and warmth) and high-EE (criticism, negative emotion, and hostility) stimulations, in the form of audio, to investigate cortical hemodynamics. We used fNIRS to measure hemodynamic signals while participants listened to the recorded audio. Healthy controls (HCs, [Formula: see text]) showed increased hemodynamic activation in the major language centers across EE stimulations, with stronger activation in Wernicke's area during the processing of negative emotional language. Compared to HCs, people with SZ ([Formula: see text]) exhibited smaller hemodynamic activation in the major language centers across EE stimulations. In addition, people with SZ showed weaker or insignificant hemodynamic deactivation in the medial prefrontal cortex. Notably, hemodynamic activation in SZ was found to be negatively correlated with the negative syndrome scale score at high EE. Our findings suggest that the neural mechanisms in SZ are altered and disrupted, especially during negative emotional language processing. This supports the feasibility of using the designed EE stimulations to assess people who are vulnerable to high-EE environments, such as SZ. Furthermore, our findings provide preliminary evidence for future research on functional neuroimaging biomarkers for people with psychiatric disorders.
Fulltext The impact of COVID-19 pandemic on physical and mental health of Asians: A study of seven middle-income countries in Asia

Wang C, Tee M, Roy AE, Fardin MA, Srichokchatchawan W, Habib HA, et al.

PLoS One, 2021;16(2):e0246824.
PMID: 33571297 DOI: 10.1371/journal.pone.0246824

The coronavirus disease (COVID-19) pandemic has impacted the economy, livelihood, and physical and mental well-being of people worldwide. This study aimed to compare the mental health status during the pandemic in the general population of seven middle income countries (MICs) in Asia (China, Iran, Malaysia, Pakistan, Philippines, Thailand, and Vietnam). All the countries used the Impact of Event Scale-Revised (IES-R) and Depression, Anxiety and Stress Scale (DASS-21) to measure mental health. There were 4479 Asians completed the questionnaire with demographic characteristics, physical symptoms and health service utilization, contact history, knowledge and concern, precautionary measure, and rated their mental health with the IES-R and DASS-21. Descriptive statistics, One-Way analysis of variance (ANOVA), and linear regression were used to identify protective and risk factors associated with mental health parameters. There were significant differences in IES-R and DASS-21 scores between 7 MICs (p<0.05). Thailand had all the highest scores of IES-R, DASS-21 stress, anxiety, and depression scores whereas Vietnam had all the lowest scores. The risk factors for adverse mental health during the COVID-19 pandemic include age <30 years, high education background, single and separated status, discrimination by other countries and contact with people with COVID-19 (p<0.05). The protective factors for mental health include male gender, staying with children or more than 6 people in the same household, employment, confidence in doctors, high perceived likelihood of survival, and spending less time on health information (p<0.05). This comparative study among 7 MICs enhanced the understanding of metal health in the general population during the COVID-19 pandemic.