Abstract:The clinical treatment of depressive disorder has long faced core challenges， such as limited drug efficacy and cognitive side effects associated with electroconvulsive therapy. This situation has driven the rapid development of non-invasive brain stimulation techniques（ NIBS） techniques characterized by precision， safety， and individualization. Magnetic resonance imaging（ MRI）， as a key technological carrier that bridges the brain function mapping and anatomical localization， provides a reliable technical pathway for guiding precisetargeted interventions. Among these， the three representative technologies of repetitive transcranial magnetic stimulation（ rTMS）， transcranial focused ultrasound（ tFUS）， and transcranial temporal interference stimulation （tTIS） are driving the transformation of depressive disorder treatment from conventional experiential localization to individualized and precise-targeted neuromodulation paradigm. This paper systematically reviews the current state and progress of MRI-guided modulation techniques for the treatment of depressive disorder， while also highlighting key challenges in this field. Looking ahead， the development of closed-loop control systems， deep integration of multimodal data with artificial intelligence-assisted decision-making， and the advancement of standardized processes and multicenter validation will become the core directions for development in this field. As technology continues to evolve， personalized modulation strategies based on multimodal imaging and artificial intelligence are expected to revolutionize the treatment paradigm for depressive disorder， ultimately propelling psychiatry from empirical medicine toward precision medicine.

Abstract:Objective To explore the changes in neurobiochemical metabolites in the ventromedial prefrontal cortex of patients with bipolar depression accompanied by somatic symptoms and their correlation with psychological status， so as to provide an objective basis for clinical identification and intervention. Methods A total of 40 patients with bipolar depression who were treated at the Department of Clinical Psychology of the People's Hospital of Xinjiang Uygur Autonomous Region from January to October 2025 were selected as the study group. Participants were divided into a bipolar depression with somatic symptom group（ n=23） and a bipolar depression without somatic symptom group（ n=17） according to whether there were somatic symptoms. During the same period， 20 healthy volunteers were recruited from various communities and schools in Urumqi， to serve as the healthy control group. Hamilton Anxiety Scale（ HAMA）， 24-item Hamilton Depression Scale（ HAMD-24）， Young Mania Rating Scale（ YMRS）， and Symptom Checklist 90（ SCL-90） were used to assess the psychological status of all participants. Neurobiochemical metabolite ratios of N-acetylaspartate/creatine（ NAA/Cr）， choline/ creatine（ Cho/Cr）， inositol/creatine（ mI/Cr）， and glutamate-glutamine complex/creatine（ Glx/Cr） in the ventromedial prefrontal cortex were measured in all participants using MRS. Differences in psychological status and neurobiochemical metabolites were compared across the three groups. Pearson or Spearman correlation analysis was used to examine the correlation between somatic symptoms and neurobiochemical metabolites. Binary Logistic regression was used to analyze the influencing factors of somatic symptoms in patients with bipolar depression. Results There were statistically significant differences in the HAMA， HAMD-24， YMRS， and SCL-90 scores among the three groups of participants（ Z=40.806， 40.358， 13.082， 42.655； all P ＜ 0.05）. Post-hoc analysis showed that the SCL-90 total scores were higher in the bipolar depression with somatic symptom group than in the bipolar depression without somatic symptom group， and the difference was statistically significant（ Z=-3.622， P=0.001）. The differences in NAA/Cr and Glx/Cr among the three groups of participants were statistically significant（ Z=9.113， 11.237； both P ＜ 0.05）. Post-hoc pairwise comparisons， adjusted using the Bonferroni method， revealed that the NAA/Cr in the bipolar depression with somatic symptom group was lower than that in the bipolar depression without somatic symptom group， and the Glx/Cr in the bipolar depression with somatic symptom group was higher than that in the healthy control group， and these differences were statistically significant（ Z=2.931，3.217；both P＜0.05）. There were no statistically significant differences in Cho/Cr and mI/Cr among the three groups of participants（ F/H=2.206，4.539； both P ＞ 0.05）. Correlation analysis showed that the SCL-90 somatization factor was positively correlated with Glx/Cr（ r=0.406， P＜ 0.05）， negatively correlated with NAA/Cr（ r=-0.334， P＜ 0.05）； no statistically significant correlations were found with Cho/Cr or mI/Cr（ both P＞ 0.05）. Binary Logistic regression analysis showed that an elevated NAA/Cr ratio was a protective factor for patients with bipolar depression accompanied by somatic symptoms ［OR=0.020， 95%CI（ 0.000， 0.801）， P ＜ 0.05］； an elevated Glx/Cr ratio was a risk factor for patients with bipolar depression accompanied by somatic symptoms［ OR=19.435， 95%CI（ 1.202， 314.218）， P ＜ 0.05］. Conclusions Bipolar depression patients exhibit significant symptoms of anxiety and depression， as well as neurobiochemical metabolic abnormalities. In patients with bipolar depression accompanied by somatic symptoms， the NAA/Cr ratio is reduced and the Glx/Cr ratio is elevated in the ventromedial prefrontal cortex. Somatic symptoms in patients with bipolar depression may be associated with NAA/Cr and Glx/Cr ratios in the ventromedial prefrontal cortex. NAA/Cr may be a protective factor for patients with bipolar depression accompanied by somatic symptoms， while Glx/Cr may be a risk factor for such patients.

Abstract:Objective To explore the differences in co-altered patterns of gray matter and white matter in patients with mood disorders during depressive episodes with and without suicidal ideation， and investigate imaging biomarkers for predicting suicidal ideation. Methods A total of 48 patients with mood disorders during depressive episodes who were treated at Beijing Anding Hospital， Capital Medical University， between May 2022 and November 2023 were selected for this study. Patients were divided into a suicidal ideation（ SI） group and a non-suicidal ideation（ NSI） group using item 3 of the 17-item Hamilton Depression Scale（ HAMD-17）. Multimodal canonical correlation analysis-joint independent component analysis（ mCCA-jICA） was used to identify joint discriminative independent components and modality-specific discriminative independent components of gray matter and white matter between two groups. Support vector machine（ SVM） was used for differential diagnosis of mood disorders in patients with and without suicidal ideation during depressive episodes. Results Among 48 patients with mood disorders during depressive episodes， there were 26 in the SI group and 22 in the NSI group. There was no statistically significant difference in age， gender， disease duration， and medication use between the two groups（ all P＞0.05）. Patients in the SI group had statistically higher HAMD- 17 total scores and HAMD-17 item 3 scores than those in the NSI group［ （20.27±3.95） vs.（ 15.59±3.45）； 2.00（ 1.00，3.00） vs. 0；t/Z=4.335，-6.289； both P＜ 0.001］. Compared with the NSI group， patients in the SI group exhibited changes in gray matter volume in the left parahippocampal gyrus， left thalamus， bilateral frontal lobes， right temporal lobe， and posterior cerebellar lobe（ t=-2.96， FDR-corrected P=0.029）， and were associated with destroyed fiber integrity in the frontal radiation of the corpus callosum and the left corticospinal tract（ r=0.57，P＜0.001）， and all differences were statistically significant. In addition， statistically significant changes in gray matter volume were observed in the left occipital lobe and right temporal lobe of patients in the SI group（ t=-2.67， FDR-corrected P=0.024）. The best predictive performance for suicidal ideation was achieved by joint discriminative independent components and modality-specific discriminative independent components identified from the gray and white matter of two patient groups， yielding an area under the ROC curve of 0.760. Conclusions This study reveals the co-altered pattern of gray-white matter in patients with mood disorders accompanied by suicidal ideation during depressive episodes by integrating structural imaging and diffusion tensor imaging. Specifically， changes in gray matter volume in the left parahippocampal gyrus， left thalamus， bilateral frontal lobes， right temporal lobe， and posterior cerebellar lobe are associated with destroyed fiber integrity in the frontal radiation of the corpus callosum and the left corticospinal tract. The co-alteration of gray matter and white matter structures may be an imaging biomarker for predicting suicidal ideation.

Abstract:Objective To explore the effects of continuous theta-burst stimulation（ cTBS） applied to the right dorsolateral prefrontal cortex（ DLPFC） on local spontaneous brain activity in patients with depressive disorder， and to analyze its potential neuroimaging mechanisms based on fractional amplitude of low-frequency fluctuation（ fALFF）. Methods This study was a randomized， double-blind， sham-controlled clinical trial. A total of 59 patients with depressive disorder who completed treatment between April 2023 and March 2024 at Beijing Anding Hospital， Capital Medical University and passed imaging quality control were selected as study subjects and randomly assigned to the real-stimulus group（ n=31） and the sham-stimulus group（ n=28）. The realstimulus group received individualized cTBS targeting the right DLPFC， while the sham-stimulus group received matched sham stimulation intervention， with a treatment duration of 10 days for both groups. All participants completed the 17-item Hamilton Depression Scale（ HAMD-17） assessments and resting-state functional magnetic resonance imaging（ fMRI） scans before treatment and within three days after treatment. Whole-brain voxel-level fALFF analysis was performed， and a 2（ group： real-stimulus group/sham-stimulus group） × 2（ time： pre-test/ post-test） repeated-measures analysis of variance was conducted to test for a group × time interaction effect. Results The HAMD-17 score reduction rate was higher in the real-stimulus group than in the sham-stimulus group［ （60.10±20.80）% vs.（ 20.30±27.10）%］， and the difference was statistically significant（ t=6.360， P＜0.001）. Whole-brain analysis revealed a group × time interaction effect（ peak coordinates： -2，-58，44； 80 voxels） in the bilateral precuneus（ cluster-level PFWE=0.001）. Post-hoc analysis showed that fALFF values in the precuneus of the real-stimulus group increased from（ 1.47±0.40） to（ 1.69±0.42）， while those in the shamstimulus group decreased from（ 1.82±0.40） to（ 1.43±0.42）. An analysis of the correlation between changes in fALFF values and clinical efficacy showed that there was no statistically significant correlation in either the realstimulus group or the sham-stimulus group（ both P ＞ 0.05）. Network localization analysis indicated that this brain region was primarily located in the paracingulate network（ 55/80 voxels） of the executive control subnetwork and partially overlapped with the core region of the default mode network. Conclusions cTBS applied to the right DLPFC enhances local spontaneous brain functional activity in the precuneus of the paracingulate network in patients with depressive disorder， suggesting that altered local activity in posterior medial cortical regions such as the precuneus may be one of the potential neuroimaging mechanisms underlying the antidepressant effects of cTBS.

Abstract:Objective To investigate brain functional abnormalities associated with the severity of insomnia in patients with depressive disorder using the cortical surface-based degree centrality. Methods A total of 317 patients with depressive disorder from 9 subcenters of the Depression Imaging REsearch ConsorTium （DIRECT） and 287 healthy controls were included in the study. Resting-state functional magnetic resonance imaging data were collected from all participants. The severity of depressive disorder in patients was evaluated using the 17-item Hamilton Depression Scale（ HAMD-17）. Patients were further divided into a high-insomnia group（ ≥ 4， n=202） and a low-insomnia group（ ≤ 3， n=115） based on the total scores of the HAMD-17 Insomnia Subscale. DPABISurf toolbox was used for data preprocessing and cortical surface-based degree centrality calculation. One-way covariance analysis was used to compare differences in cortical surface-based degree centrality among the high-insomnia group， low-insomnia group， and healthy control group. The degree centrality values of brain regions with statistically significant differences were extracted， and Spearman correlation was used to analyze the correlation between degree centrality and the severity of depressive disorder and insomnia in subgroups of patients with depressive disorder. Results There were no statistically significant differences in gender or mean framewise displacement among the three groups of participants（ all P＞0.05）. The age， adjusted HAMD-17 total score， and proportion of patients taking medication in the high-insomnia group were higher than those in the low-insomnia group， and the education years were lower than those in the healthy control group， with statistically significant differences（ all P＜0.05）. The cortical surface-based degree centrality of right Brodmann area 3b in the high-insomnia group and the low-insomnia group（ without global signal regression： F=16.35， P ＜ 0.001； with global signal regression： F=10.38， P ＜ 0.001） and the posterior pole of the right frontal lobe area 10（ without global signal regression： F=12.87， P＜0.001； with global signal regression： F=12.38， P＜ 0.001） was lower than that in the healthy control group， and these differences were statistically significant and were not affected by the global signal. There was no statistically significant difference in the cortical surfacebased degree centrality between the high-insomnia group and the low-insomnia group（ P＞ 0.05）. In the highinsomnia group， the degree centrality in right Brodmann area 3b was positively correlated with the adjusted HAMD-17 total score（ without global signal regression： r=0.19， P=0.006； with global signal regression： r=0.16， P=0.021）， and the difference was statistically significant. Conclusions Reduced cortical surfacebased degree centrality in the right Brodmann area 3b and the posterior pole of the right frontal lobe area 10 in patients with depressive disorder may reflect the core pathological feature of depressive disorder itself， rather than a state-dependent change associated with fluctuations in the severity of insomnia

Abstract:Temporal interference stimulation（ TIS）， an emerging non-invasive deep neural modulation technique， generates a low-frequency envelope field through two high-frequency currents that interfere within the body. This allows for precise modulation of deep brain regions while maintaining a low intensity of electrical stimulation at the surface. Studies have shown that TIS is well-tolerated and safe， and modulatory effects on specific neural circuits have been observed in both animal experiments and early human trials. However， numerous key scientific questions regarding the mechanism of action of TIS， optimization of multi-parametric stimulation modes， targeting characteristics of different brain regions， principles of cross-species transformation， and its clinical effects in neuropsychiatric disorders remain to be systematically elucidated. Based on the latest research advances， this structured review examines the electrophysiological and neurobiological mechanisms of TIS， evidence from animal models， and the feasibility and efficacy of preliminary clinical studies. This paper also focuses on the potential applications and challenges of TIS in neuropsychiatric disorders such as Parkinson's disease and depressive disorders.

Abstract:Objective To explore the effects of high-frequency repetitive transcranial magnetic stimulation（ rTMS） combined with virtual reality（ VR） technology on psychological craving， anxiety symptoms， cognitive function， and relapse rates in alcohol dependence patients during the detoxification and rehabilitation period. Methods A total of 140 patients with alcohol dependence admitted to Hebei Mental Health Center between May 2023 and August 2024 were selected. Patients were randomly divided into a control group， rTMS group， VR group， and combination group using a block randomization method， with 35 cases in each group. A total of 127 cases completed the study（ 32 in the control group， 31 in the rTMS group， 33 in the VR group， and 31 in the combination group）. The control group received medication and rehabilitation training； the rTMS group received high-frequency rTMS on the basis of the control group； the VR group received VR therapy on the basis of the control group， and the combination group received rTMS combined with VR therapy on the basis of the control group. The treatment frequency was 5 times a week， for a total of 4 weeks. Psychological craving and anxiety symptoms were assessed using the Penn Alcohol Craving Scale（ PACS） and the Self-Rating Anxiety Scale（ SAS） at baseline， 2， 4， 8， and 12 weeks of treatment. Cognitive function was assessed using the Montreal Cognitive Assessment（ MoCA） at baseline， 4， 8， 12 and 24 weeks of treatment. Telephone follow-up was conducted at the end of the 12-week treatment period to assess relapse rates. Repeated measures analysis of variance（ ANOVA） was used to compare the main effects of group and time， as well as the group × time interaction effect. Pairwise comparisons were corrected using the Bonferroni method. Results There was no statistically significant difference in PACS total scores among the four groups at baseline（ P＞0.05）. After 2， 4， 8， and 12 weeks of treatment， repeated measures ANOVA showed that the group main effect， time main effect， and group × time interaction effect of the total score of PACS in the four groups were statistically significant （F=6.915，181.488， 8.134； all P＜0.001）. Over time， psychological cravings decreased across all four groups， but the combination group showed an earlier reduction compared to the other groups， with effects more pronounced than those observed in the VR and rTMS groups. There was no statistically significant difference in the total SAS scores among the four groups at baseline（ P＞0.05）. At the weekends of treatment 2， 4， 8， and 12， repeated measures analysis of variance revealed that the group main effect， time main effect， and time x group interaction were all statistically significant for the total SAS scores across the four groups（ F=11.503， 184.225， 16.640； all P＜ 0.001）. This indicated that over time， the VR group， the rTMS group， and the combined group all reduced patients' anxiety symptoms， and the combined group achieved this improvement earlier and with more significant effects than the VR group and rTMS group. There was no statistically significant difference in MoCA total scores among the four groups at baseline（ P ＞ 0.05）. After 4， 8， 12 and 24 weeks of treatment， repeated measures ANOVA revealed statistically significant main effects of group on MoCA total scores across the four groups （F=3.626， P=0.015）， as well as statistically significant main effects of time and a statistically significant group × time interaction effect（ F=48.970， 3.478； both P＜0.001）. In terms of the total score of the MoCA， simple effect analysis revealed that there were statistically significant differences between the combination group and the control group 8， 12 and 24 weeks of treatment（ all P＜0.05）. There was a statistically significant difference between the VR group and the control group at 12 and 24 weeks of treatment（ both P ＜ 0.001）， while there was no statistically significant difference between the rTMS group and the control group at each time period（ all P ＞ 0.05）. There was a statistically significant difference between the combination group and the rTMS group at 12 and 24 weeks of treatment（ both P ＜ 0.01）， while the combination group and the VR group only had a statistically significant difference at 24 weeks of treatment（ P=0.001）. There was a statistically significant difference in the relapse rate among the four groups（ χ2=8.234， P=0.041）. Conclusions Both combined and standalone applications of rTMS and VR can reduce psychological craving and anxiety symptoms， and improve cognitive function in alcohol dependence patients during the rehabilitation period. However， standalone rTMS shows limited efficacy in enhancing cognitive function， whereas combined application yields superior effects.

Abstract:Objective To analyze the situation and risk factors of non-suicidal self-injury（ NSSI） behavior in adolescents with nightmare disorder. Methods This study was a cross-sectional study. A questionnaire survey was conducted among students enrolled in five high schools and five middle schools in Ju County， Shandong Province， from May 1 to 30， 2022. The questionnaires were distributed via the Wenjuanxing platform. A total of 7 734 questionnaires were distributed， and 7 002 valid questionnaires were recovered， with an effective recovery rate of 90.54%. A total of 6 700 cases that met the inclusion criteria were selected. Based on scores of the Chinese version of the Nightmare Disorder Index（ NDI-CV）， participants whose answer to Item 1 was "0" were classified as the non-nightmare disorder group（ n=3 674）； those whose answer to Item 1 was not "0" but answers to Items 2-4 were "0" or "1" were classified as the subthreshold or partial nightmare disorder symptom group（ n=2 812）； those whose answer to Item 1 was not "0" but whose answers to Items 2-4 were "2" or higher were classified as the possible nightmare disorder group（ n=214）. The general information and Adolescent Non-suicidal Self-injury Assessment Questionnaire（ ANSAQ） scores of adolescents with different nightmare disorders were compared respectively， and post-hoc pairwise comparisons were conducted. The incidence of NSSI behavior in adolescents with possible nightmare disorder was recorded and divided into the NSSI group（ n=125） and the non-NSSI group（ n=89）. The NDI-CV， Insomnia Severity Index（ ISI）， Chinese Adolescent Daytime Sleepiness Scale（ CADSS）， Patient Health Questionnaire-4 items（ PHQ-4）， Self- Hate Scale（ SHS）， and Adverse Childhood Experiences Questionnaire-Revised（ ACEQ-R） were used to record adolescents' scores on sleep problems， emotional status， self-hatred， and adverse childhood experiences. Multivariate Logistic regression was used to analyze the influencing factors of NSSI in adolescents， and the risk prediction model was constructed. The receiver operating characteristic（ ROC） curve was drawn to validate the predictive performance of the model. Results The ANSAQ total scores for the non-nightmare disorder group， the subthreshold or partial nightmare disorder symptoms group， and the possible nightmare disorder group were 0（0，1.00）， 0（0，1.00）， and 6.50（0，17.00）， respectively， there were statistically significant differences in ANSAQ scores among adolescents in different nightmare disorder groups（ H=566.380，P ＜ 0.001）， and all post-hoc pairwise comparisons were statistically significant（ all P＜ 0.001）. One-way analysis revealed statistically significant differences between the NSSI group and the non-NSSI group in terms of scores for ISI， PHQ-4， SHS，ACEQ-R （Z=-2.174，-6.046，-12.671，-6.312； all P ＜ 0.05）. Multivariate Logistic regression analysis showed that anxiety and depression［ OR=1.170， 95%CI（ 1.011，1.354），P=0.035］， selfhatred ［ OR=1.084， 95%CI（ 1.047， 1.123），P＜ 0.001］， adverse childhood experiences［ OR=1.232， 95%CI （1.053，1.441），P=0.009］ were all independent risk factors for NSSI behavior among adolescents with nightmare disorder， and these differences were statistically significant. A risk prediction model for NSSI behavior among adolescents with nightmare disorder was constructed according to multivariate Logistic regression analysis. ROC curve analysis showed that the area under the curve for the risk prediction model was 0.838［ 95%CI（ 0.783， 0.894）， P ＜ 0.05］， with the sensitivity of 72.0% and the specificity of 85.4%， indicating good predictive performance. Conclusions The incidence of NSSI behavior in adolescents with nightmare disorder is high， and is affected by multiple factors. Anxiety and depression， self-hatred， and adverse childhood experiences were risk factors. The prediction model based on risk factors has good predictive value for the occurrence of NSSI behavior.

Abstract:Bipolar disorder（ BD） is one of the most common mental disorders and a major cause of the burden of mental illness and disability worldwide. Obstructive sleep apnea syndrome（ OSAS） is a common sleepdisordered breathing. The two are often comorbid and have a close interaction， which not only exacerbates the severity of the disease， but also increases the difficulty of treatment. However， research is still ongoing regarding the mechanism of comorbidity between the two， clinical implications caused by comorbidities， and diagnostic and treatment strategies. This paper reviews four key aspects of the comorbid BD and OSAS： epidemiology， potential pathophysiology， implications of comorbidities， and treatment， with the aim of enhancing clinical awareness of this comorbidity， facilitating early identification and timely intervention， and ultimately improving patient prognosis.

Abstract:Vascular dementia is the second most common age-related dementia. It is a syndrome characterized by cognitive impairment resulting from insufficient blood perfusion and hemodynamic changes of brain tissue caused by various factors， and its etiology is closely linked to stroke. The pathogenesis of vascular dementia is highly complex， and a growing body of literature highlights the role of microglia in the onset and progression of the disease. This paper reviews the different roles of different polarization states of microglia in normal brain tissue and vascular dementia， and further analyzes the possibility of microglial membrane protein as a molecular marker of vascular dementia， and explores the potential therapeutic strategy of targeting microglia for the treatment of vascular dementia.