Computerized, self-adaptive cognitive training has emerged as a promising digital therapeutic for cognitive impairment; however, its underlying training mechanisms in schizophrenia remain poorly understood. This double-blind, randomized trial compared self-adaptive difficulty (SAD) with fixed-difficulty (FD) computerized cognitive training program, evaluating both domain-specific cognitive and clinical outcomes, and exploring difficulty-performance coupling as a potential active therapeutic mechanism. Seventy-two patients with schizophrenia (SAD = 41, FD = 31) completed 4 weeks of training, and 40 patients (n = 20 per group) were assessed at week 8. Cognitive outcomes were measured using the Cognitive Index (CI) and MATRICS Consensus Cognitive Battery (MCCB), while clinical symptoms were also assessed. Linear mixed-effects models (LMMs) revealed significantly greater and faster cognitive improvements in the SAD compared with the FD group in attention and agility, with faster improvement also observed in thinking. Robust difficulty-performance coupling was observed across all cognitive domains. Additionally, positive symptoms improved significantly in the SAD group compared to the FD group at week 4. Self-adaptive cognitive training enhances and accelerates cognitive improvements in schizophrenia, particularly in attention and processing speed, and also benefits positive symptoms. Difficulty-performance coupling may reflect dynamic load calibration as a key therapeutic mechanism in digital cognitive training. Trial registration: Chictr.org.cn, number, ChiCTR2000040326, registered 2020-11-27.

Enhancing quality of life (QoL) is a crucial goal in the rehabilitation of patients with schizophrenia (SCZ). Identifying factors associated with the outcomes of rehabilitation is of clinical importance. This study examined predictors of subjective QoL (SQoL) outcomes in SCZ patients undergoing a structured 24-week rehabilitation program. A total of 235 patients with SCZ completed the program. SQoL was assessed using the Schizophrenia Quality of Life Scale (SQLS), comprising three subdomains: psychosocial (PS), motivation/ energy (ME), and symptoms/side effects (SS). Clinical symptoms were evaluated using the Brief Psychiatric Rating Scale (BPRS), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder Scale (GAD-7). Cognitive impairment was assessed using the Ascertain Dementia 8 (AD8). Medication side effects were assessed using the Treatment Emergent Symptom Scale and Rating Scale for Extrapyramidal Side Effects. After 24 weeks, the response rate (≥ 20

Background: Although intermittent theta burst stimulation (iTBS) has shown effectiveness in addressing working memory (WM) deficits in individuals with schizophrenia (SZ), the current body of evidence is limited and the specific mechanisms involved remain unclear. Therefore, this pilot fMRI study aimed to examine the efficacy of parietal iTBS in ameliorating WM impairments and explore its influence on the resting-state effective connectivity within the frontoparietal network in patients with SZ. Method: A total of 48 patients diagnosed with SZ were randomly assigned to an active or sham iTBS group and underwent 20 sessions of active or sham iTBS over 4 weeks. Subsequently, all patients underwent cognitive tests, clinical symptom assessments, and resting-state functional MRI (rs-fMRI) scans. The effective connectivity between the frontal and parietal brain regions during the rs-fMRI scans was analyzed using a spectral dynamic causal modeling approach. Additionally, this trial was registered at the Chinese Clinical Trial Registry in November 2022 (registry number: ChiCTR2200057286). Results: iTBS treatment improved the positive symptoms, negative symptoms, general psychopathology, and WM deficits. Following the iTBS intervention, the active group demonstrated a significant increase in connectivity strengths from the right MFG to the right SPL (p = 0.031) and from the left SPL to the left MFG (p = 0.010) compared to the pre-treatment levels. Additionally, compared to the sham group, the active group displayed a significantly higher connectivity strength from the right MFG to the right SPL (p = 0.042) after iTBS treatment. Conclusion: All these findings suggest that iTBS targeting the parietal region may influence the resting-state effective connectivity within the frontoparietal network, thereby offering promising therapeutic implications for alleviating the cognitive deficits in SZ.

Suicide is a complex behavior strongly associated with depression. Despite extensive research, an objective biomarker for evaluating suicide risk precisely and timely is still lacking. Using the precision resting-state fMRI method, we studied 61 depressive patients with suicide ideation (SI) or suicide attempt (SA), and 35 patients without SI to explore functional biomarkers of suicide risk. Among them, 21 participants also completed electroconvulsive therapy (ECT) treatment, allowing the examination of functional changes across different risk states within the same individual. Functional networks were localized in each subject using resting-state fMRI and then an individualized connectome was constructed to represent the subject’s functional brain organization. We identified a set of connections that track suicide risk (r = 0.41, p = 0.001) and found that these risk-associated connections were hyper-connected in the frontoparietal network (FPN, p = 0.008, Cohen’s d = 0.58) in patients with suicide risk compared to those without. Moreover, ECT treatment significantly reduced (p = 0.001, Cohen’s d = 0.56) and normalized these FPN hyper-connections. These findings suggest that connections involving FPN may constitute an important biomarker for evaluating suicide risk and may provide potential targets for interventions such as non-invasive brain stimulation.

The global surge in depression rates, notably severe in China with over 95 million affected, underscores a dire public health issue. This is exacerbated by a critical shortfall in mental health professionals, highlighting an urgent call for innovative approaches. The advancement of Artificial Intelligence (AI), particularly Large Language Models, offers a promising solution by improving mental health diagnostics. However, there is a lack of real data for reliable training and accurate evaluation of AI models. To this end, this paper presents a high-quality multimodal depression consultation dataset, namely Parallel Data of Depression Consultation and Hamilton Depression Rating Scale (PDCH). The dataset is constructed based on clinical consultations from Beijing Anding Hospital, which provides audio recording and transcribed text, as well as corresponding HAMD-17 scales annotated by professionals. The dataset contains 100 consultations and the audio exceeds 2,937 minutes. Each of them is about 30-min long with more than 150 dialogue turns. It enables to fill the gap in mental health services and benefit the creation of more accurate AI models.

Early identification of individuals with clinical high risk (CHR) for psychosis relies heavily on subjective assessments, necessitating the exploration of objective markers to enhance diagnostic accuracy. This study aimed to evaluate the temporal integration window (TIW) of sensory processing in individuals with CHR, first-episode schizophrenia (FES), and healthy controls (HC) to assess its utility as an objective neuropsychological marker for identifying CHR individuals. Ninety participants (30 CHR, 30 FES, 30 HC) completed temporal order judgment of visual and auditory(TOJV and TOJA) and simultaneity judgment of the flash-beep (SJF) tasks. Unisensory (visual and auditory) thresholds and TIW were measured and compared across groups. Cognitive function was assessed using the MATRICS Consensus Cognitive Battery (MCCB). The associations between cognition with unisensory thresholds and TIW were analyzed. The TIW was significantly prolonged in both the CHR (336.95 ± 108.30 ms) and FES (413.15 ± 121.27 ms) groups compared to the HC group (229.95 ± 54.53 ms) (P < 0.05). Visual and auditory thresholds and TIW were negatively correlated with information processing speed and attention (both P < 0.05). Notably, TIW effectively discriminates across three groups. Compared to HC, each 50 ms increase in TIW was associated with a 2.3-fold increased risk of CHR (95

Background: Electroconvulsive therapy (ECT) provides rapid relief of depressive symptoms. However, the relationship between intracranial electric field (E-field) distribution, dosage, and antidepressant outcomes remains underexplored. Methods: Thirty patients with depressive episodes received bifrontal ECT. Clinical symptoms were assessed using the 17-Item Hamilton Rating Scale for Depression at baseline and post-ECT treatment. Magnetic resonance imaging was performed at baseline to calculate E-field strength and intracranial E-field dosage. Results: No significant associations were found between accumulated or average E-field dosage and overall antidepressant outcomes. However, significant associations were observed between antidepressant outcomes and Efield dosage during the initial ECT session in key brain regions, including the amygdala, anterior cingulate cortex, cerebellum, hippocampus, medial para-hippocampal cortex, postcentral gyrus, thalamus, and superior frontal lobe (P all < 0.05). Conclusions: While no significant associations were found between cumulative or average E-field dosage and antidepressant outcomes of ECT, significant associations were observed between E-field dosage in key brain regions and antidepressant outcomes during the initial ECT session. These findings suggest that individualized ECT protocols, tailored to patient-specific neuroanatomy and E-field dosage in specific brain regions, may enhance ECT's therapeutic efficacy. Future research should explore personalized ECT protocols using computer-modeled E-field distribution and ECT parameters.

To enhance the differentiation between unipolar depression (UPD) and bipolar depression (BPD), this study integrates machine learning and deep learning models with electroencephalography (EEG) data and clinical features. Utilizing Python for data preprocessing and feature extraction, we analyzed 370 patients diagnosed with either UPD or BPD. The experimental design featured 5-fold cross-validation and leave-one-out cross-validation to assess model generalization and optimize hyperparameters through grid search. Models included Support Vector Machine, Random Forest, and neural networks such as Fully Connected Neural Network(FCNN), Recurrent Neural Network, Long Short-Term Memory networks, and Transformers. Evaluation metrics highlighted FCNN's superior performance with 76 % accuracy, 80 % sensitivity, 73 % specificity, and 76 % F1-score. Results underscore the importance of EEG biomarkers, particularly beta band activity, in distinguishing between the two conditions. The study demonstrates the potential of deep learning in identifying complex mental disorder patterns and advocates for a shift towards data-driven diagnostics in mood disorders. Future research should aim to enhance model interpretability, integrate multimodal data, and develop advanced feature extraction techniques to further precision psychiatry.

Working memory (WM) deficits are a significant component of neurocognitive impairment in individuals with schizophrenia (SCZ). Two previous meta-analyses, conducted on randomized controlled trials (RCTs), examined the effectiveness of repetitive transcranial magnetic stimulation (rTMS) in addressing WM deficits in individuals diagnosed with SCZ. However, the conclusions drawn from these analyses were inconsistent. Additionally, the commonly used random effects (RE) models might underestimate statistical errors, attributing a significant portion of perceived heterogeneity between studies to variations in study quality. Therefore, this review utilized both RE and quality effects (QE) models to assess relevant RCTs comparing TMS with sham intervention in terms of clinical outcomes. A comprehensive literature search was conducted using PubMed and Scopus databases, resulting in the inclusion of 13 studies for data synthesis. Overall, regardless of whether the RE or QE model was used, eligible RCTs suggested that the TMS and sham groups exhibited comparable therapeutic effects after treatment. The current state of research regarding the use of rTMS as a treatment for WM deficits in patients with SCZ remains in its preliminary phase. Furthermore, concerning the mechanism of action, the activation of brain regions focused on the dorsolateral prefrontal cortex and alterations in gamma oscillations may hold significant relevance in the therapeutic application of rTMS for addressing WM impairments. Finally, we believe that the application of closed-loop neuromodulation may contribute to the optimization of rTMS for WM impairment in patients with SCZ.

OBJECTIVES:Electroconvulsive therapy (ECT) is an effective somatic treatment, but it may be limited by cognitive adverse effects. The existing cognitive screening instruments often lack specificity to ECT-associated cognitive deficits. The ElectroConvulsive Therapy Cognitive Assessment was developed and validated in a clinical setting, but the reliability and validity of the Chinese version of ElectroConvulsive Therapy Cognitive Assessment (ECCA-C) have not been studied in a large clinical sample. METHODS:The ECCA-C and the Montreal Cognitive Assessment (MoCA) were administered to patients with major depressive disorder (MDD) undergoing ECT at 3 time points: pretreatment (baseline), before the fifth treatment, and 1 week posttreatment. The instruments were also administered to a sample of healthy subjects. RESULTS:Sixty-five patients with MDD and 50 age- and sex-matched healthy controls were recruited in this study. Overall, the patient group had statistically significantly lower MoCA and ECCA-C scores than the control group (both P values <0.001). The Cronbach α of the ECCA-C was 0.88 at baseline. Statistically significant decreases over time were observed in ECCA-C: pre-ECT (23.9 ± 4.0) > mid-ECT (21.3 ± 3.4) > post-ECT (18.7 ± 4.8) (all P values <0.001), whereas no statistically significant changes in MoCA scores were found at these 3 time points ( F = 1.86, P = 0.165). A cutoff score of 26.5 on the ECCA-C was found to best differentiate between MDD patients and healthy controls. CONCLUSIONS:The ECCA-C showed satisfactory psychometric properties and may be a more sensitive instrument than the MoCA to assess cognitive impairment associated with ECT.

BackgroundPrevious studies have documented thalamic functional connectivity (FC) abnormalities in schizophrenia, typically examining the thalamus as a whole. The specific link between subregional thalamic FC and cognitive deficits in first-episode schizophrenia (FES) remains unexplored.MethodsUsing data from resting-state functional magnetic resonance imaging, we compared whole-brain FC with thalamic subregions between patients and HCs, and analyzed FC changes in drug-naïve patients separately. We then examined correlations between FC abnormalities with both cognitive impairment and clinical symptoms.ResultsA total of 33 FES patients (20 drug-naïve) and 32 age- and sex-matched healthy controls (HCs) were included. Compared to HCs, FES patients exhibited increased FC between specific thalamic subregions and cortical regions, particularly bilateral middle temporal lobe and cuneus gyrus, left medial superior frontal gyrus, and right inferior/superior occipital gyrus. Decreased FC was observed between certain thalamic subregions and the left inferior frontal triangle. These findings were largely consistent in drug-naïve patients. Notably, deficits in social cognition and visual learning in FES patients correlated with increased FC between certain thalamic subregions and cortical regions involving the right superior occipital gyrus and cuneus gyrus. The severity of negative symptoms was associated with increased FC between a thalamic subregion and the left middle temporal gyrus.ConclusionOur findings suggest FC abnormalities between thalamic subregions and cortical areas in FES patients. Increased FC correlated with cognitive deficits and negative symptoms, highlighting the importance of thalamo-cortical connectivity in the pathophysiology of schizophrenia.

Many factors contribute to quality of life (QoL) in patients with schizophrenia, yet limited research examined these factors in patients in China. This cross-sectional study explores subjective QoL and its associated factors in patients. The QoL was assessed using the Schizophrenia Quality of Life Scale (SQLS). Clinical symptoms were evaluated using the Brief Psychiatric Rating Scale (BPRS) and seven factors were extracted. Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder Scale (GAD-7) were used to assess depression and anxiety. Cognitive impairment was assessed using the Ascertain Dementia 8 (AD8). The Treatment Emergent Symptom Scale (TESS) and Rating Scale for Extrapyramidal Side Effects (RSESE) were used to evaluate the side effects of medications. We recruited 270 patients (male:142,52.6

Suicide is a complex behavior strongly associated with depression. Despite extensive research, an objective biomarker for evaluating the suicide risk precisely and timely is still lacking. Using the precision resting-state fMRI method, we studied 61 depressive patients with suicide ideation (SI) or suicide attempt (SA), and 35 patients without SI to explore functional biomarkers of suicide risk. Among them, 21 participants also completed electroconvulsive therapy (ECT) treatment, allowing the examination of functional changes across different risk states within the same individual. Functional networks were localized in each subject using resting-state fMRI and then an individualized connectome was constructed to represent the subject’s functional brain organization. Compared to patients without SI, patients with suicide risk showed hyper-connectivity involving the frontoparietal network (FPN, p = 0.001). ECT treatment normalized these hyper-connections, with connectivity between the FPN and limbic system (LMB) showing the most significant reduction ( p < 0.001). Post-hoc analysis indicated that the FPN-LMB connectivity was also significantly altered in the SA group compared to the SI group ( p = 0.001), which may reflect the elevation of suicide risk across these two groups. These findings suggest that functional coupling between the FPN and LMB may constitute an important biomarker for evaluating suicide risk and may provide potential targets for interventions such as non-invasive brain stimulation.

Suicidality is a common and serious symptom of depression and patients with depression and suicidality often respond to electroconvulsive therapy (ECT), but the mechanism of its effect is poorly understood. We used resting-state functional magnetic resonance imaging (rs-fMRI) to explore changes in brain connectivity before and after ECT in depressed patients with suicidality. Twenty-three depressed patients with suicidality underwent rs-fMRI at baseline and after 8–12 ECT sessions. Thirty-two age-, sex-, and education-matched healthy controls (HCs) underwent rs-fMRI once. We used functional connectivity (FC) analysis to identify brain regions with altered connectivity in patients compared to HCs and assess changes in FC before and after ECT. We also assessed the clinical symptoms using the Hamilton Depression Scale, 17-item (HAMD-17), and Beck Scale for Suicide Ideation (BSSI). Compared to HCs, at baseline, patients had reduced FC between the left orbitofrontal cortex (OFC_ Ant_L) and left angular gyrus (Angular_L) (t = 3.849, P < 0.05) with OFC_Ant_L as ROI. With left superior frontal gyrus (Frontal_sup_L) as ROI, patients also had reduced FC between Frontal_sup_L and left superior medial frontal gyrus, medial orbital (Frontal_Med_Orb_L) and left precuneus (Precuneus_L) (t = 3.650, P < 0.05), and increased FC between Frontal_sup_L and right middle frontal gyrus (Frontal_Mid_R) (t = -4.220, P < 0.05). After ECT, with Frontal_sup_L as ROI, patients showed increased FC between Frontal_sup_L and Angular_L after ECT (t = -3.982, P < 0.05) and decreased FC between Frontal_sup_L and right superior and inferior parietal gyrus (Parietal_Sup Inf_R). In ECT responders, the change in FC between Frontal_sup_L and Angular_L was negatively correlated with the change of the score of BSSI (r = -0.645, P = 0.042), and the change in FC between Frontal_sup_L and Parietal_Sup Inf_R was positively correlated with the change of the score of BSSI (r = 0.714, P = 0.023). There was no correlation between changes in FC with changes in HAMD-17 score (all P > 0.05). Our findings suggest that FC between Frontal_sup_L and Angular_L, and FC between Frontal_sup_L and Parietal_Sup Inf_R may be involved in the mechanisms by which ECT exerts its effects on suicidality in patients with depression. Our findings provide insights into the neural underpinnings of ECT and may inform the development of more targeted novel therapeutic strategies for suicidality. Chinese Clinical Trial Registry, ChiCTR2100048182, Registered 04 July 2021, www.chictr.org.cn

Objective: Insomnia is a significant health issue associated with various systemic diseases. Transcranial alternating current stimulation (tACS) has been proposed as a potential intervention for insomnia. However, the efficacy and mechanisms of tACS in chronic insomnia remain unclear. Accordingly, this study aimed to investigate the efficacy of tACS in treating chronic insomnia in adults and assess the impact of age on its effectiveness using a large sample from two centers. Methods: A total of 120 participants with chronic insomnia underwent 20 daily sessions of tACS (duration: 40 min, frequency: 77.5 Hz, and intensity: 15 mA) or sham tACS targeting the forehead and both mastoid areas over 4 weeks. Assessments were conducted at baseline, post-treatment, and 4-week follow-up. Primary outcomes included sleep quality and efficiency, onset latency, total sleep time, and daily disturbances. Secondary outcomes included depression, anxiety, and clinical impression. Results: Compared with the control group, the tACS group demonstrated improved sleep quality and efficiency, increased total sleep time, and reduced daily disturbance (allps < 0.01). Moreover, tACS had a significant effect on clinical impression (p < 0.001), but not depression and anxiety scores. Subgroup analyses revealed that older participants experienced significant benefits from tACS in sleep quality, efficiency, and overall insomnia reduction at post-treatment and follow-up (p < 0.001). Notably, improved insomnia correlated with attenuated depressive and anxiety symptoms. Conclusions: These findings suggest that tACS may be an effective intervention for chronic insomnia within an eight-week timeframe, and age affects the response to tACS in terms of insomnia improvement.

Background: Major depressive disorder (MDD) is the leading cause of disability among all mental illnesses with increasing prevalence. The diagnosis of MDD is susceptible to interference by several factors, which has led to a trend of exploring objective biomarkers. Electroencephalography (EEG) is a non-invasive procedure that is being gradually applied to detect and diagnose MDD through some features such as functional connectivity (FC). Methods: In this research, we analyzed the resting-state EEG of patients with MDD and healthy controls (HCs) in both eyes-open (EO) and eyes-closed (EC) conditions. The phase locking value (PLV) method was utilized to explore the connection and synchronization of neuronal activities spatiotemporally between different brain regions. We compared the PLV between participants with MDD and HCs in five frequency bands (theta, 4-8 Hz; alpha, 8-12 Hz; beta1, 12-16 Hz; beta2, 16-24 Hz; and beta3, 24-40 Hz) and further analyzed the correlation between the PLV of connections with significant differences and the severity of depression (via the scores of 17-item Hamilton Depression Rating Scale, HDRS-17). Results: During the EO period, lower PLVs were found in the right temporal-left midline occipital cortex (RT-LMOC; theta, alpha, beta1, and beta2) and posterior parietal-right temporal cortex (PP-RT; beta1 and beta2) in the MDD group compared with the HC group, while PLVs were higher in the MDD group in LT-LMOC (beta2). During the EC period, for the MDD group, lower theta and beta (beta1, beta2, and beta3) PLVs were found in PP-RT, as well as lower theta, alpha, and beta (beta1, beta2, and beta3) PLVs in RT-LMOC. Additionally, in the left midline frontal cortex-right temporal cortex (LMFC-RT) and posterior parietal cortex-right temporal cortex (PP-RMOC), higher PLVs were observed in beta2. There were no significant correlations between PLVs and HDRS-17 scores when connections with significantly different PLVs (all p > 0.05) were checked. Conclusion: Our study confirmed the presence of differences in FC between patients with MDD and healthy individuals. Lower PLVs in the connection of the right temporal-left occipital cortex were mostly observed, whereas an increase in PLVs was observed in patients with MDD in the connections of the left temporal with occipital lobe (EO), the circuits of the frontal-temporal lobe, and the parietal-occipital lobe. The trends in FC involved in this study were not correlated with the level of depression. Limitations: The study was limited due to the lack of further analysis of confounding factors and follow-up data. Future studies with large-sampled and long-term designs are needed to further explore the distinguishable features of EEG FC in individuals with MDD.

目的:研究不同起病年龄段双相障碍患者的特征和用药情况.方法:利用电子病历系统,收集住院双相障碍患者的人口学资料、临床资料和用药情况,将患者按起病年龄分为早发型、中间型和晚发型,比较3组的人口学特征、临床特征和用药差异.结果:共纳入双相障碍患者8184例,其中早发型1575例(19.24％),中间型5383例(65.77％),晚发型1226例(14.98％).早发型年龄更小,男性和未婚比例更高,病程和住院时间更长,混合状态的比例更高(P<0.05).早发型使用两种心境稳定剂联合抗精神病药的比例较高,药物组合以锂盐+丙戊酸盐+喹硫平/奥氮平为主(P<0.05).晚发型使用1种心境稳定剂联合抗精神病药的比例较高,药物组合以丙戊酸盐+喹硫平/奥氮平为主(P<0.05).晚发型联用抗抑郁药的比例较高(P<0.05).结论:不同年龄起病的双相障碍患者在人口学特征、临床特征和用药上均存在显著差异,双相障碍的起病年龄应引起重视.

Venous thromboembolism (VTE) comprises pulmonary embolism (PE) and deep vein thrombosis (DVT). PE, as the most severe manifestation of VTE, can cause increased mortality in patients with mental disorders. Here we describe two cases of young male patients with catatonia who developed PE and DVT during their hospital stay. We also discuss the possible pathogenesis, with a focus on immune and inflammatory mechanisms.

ObjectiveSuicidality is commonly observed in patients with depressive episodes, and electroconvulsive therapy (ECT) has been found to be effective in treating these patients. However, the role of ECT in suicidality remains unclear. This study used resting-state functional magnetic resonance imaging (rs-fMRI) to explore the changes in brain function before and after ECT in depressed patients with suicidality.MethodsIn total, 26 depressed patients with suicidality underwent rs-fMRI at baseline and after 8–12 sessions of ECT. In addition, 32 healthy controls (HCs) matched for age, gender, and educational level underwent rs-fMRI once. The amplitude of low-frequency fluctuations (ALFF), the fractional amplitude of low-frequency fluctuations (fALFF), and regional homogeneity (ReHo) were measured to evaluate whole brain function. Differences between the groups and time points (before and after ECT) were compared. Clinical symptoms were assessed using the 17-item Hamilton Depression Scale (HAMD-17) and Beck Scale for Suicide Ideation (BSSI).ResultsAt baseline, patients exhibited decreased ALFF in the right postcentral and precentral gyrus and decreased fALFF in the right supramarginal and postcentral gyrus, left superior frontal gyrus (SFG), as well as the superior and middle temporal gyrus compared to HCs. Patients also had lower ReHo in the left amygdala, anterior cingulate, and postcentral gyrus, and in the right thalamus, insula, and postcentral gyrus. They also exhibited higher ALFF in the bilateral temporal gyrus and insula as well as higher fALFF in the cerebellum. Following ECT, fALFF in the left SFG and orbital frontal cortex (OFC) significantly increased and was inversely correlated with the reduction of BSSI scores (r = −0.416, p = 0.048), whereas no correlation was found with changes in HAMD-17scores.ConclusionOur findings suggest that the left SFG and OFC may play a key role in the mechanism of ECT for suicidality. The decrease of fALFF in the left SFG and OFC may represent a potential mechanism through which ECT effectively treats suicidality in depressed patients.