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de Kwaasteniet BP, Rive MM, Ruhé HG, Schene AH, Veltman DJ, Fellinger L, van Wingen GA, Denys D. Decreased Resting-State Connectivity between Neurocognitive Networks in Treatment Resistant Depression. Front Psychiatry 2015; 6:28. [PMID: 25784881 PMCID: PMC4345766 DOI: 10.3389/fpsyt.2015.00028] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Accepted: 02/09/2015] [Indexed: 12/28/2022] Open
Abstract
Approximately one-third of patients with major depressive disorder (MDD) do not achieve remission after various treatment options and develop treatment resistant depression (TRD). So far, little is known about the pathophysiology of TRD. Studies in MDD patients showed aberrant functional connectivity (FC) of three "core" neurocognitive networks: the salience network (SN), cognitive control network (CCN), and default mode network (DMN). We used a cross-sectional design and performed resting-state FC MRI to assess connectivity of the SN, CCN, and both anterior and posterior DMN in 17 severe TRD, 18 non-TRD, and 18 healthy control (HC) subjects. Relative to both non-TRD and HC subjects, TRD patients showed decreased FC between the dorsolateral prefrontal cortex and angular gyrus, which suggests reduced FC between the CCN and DMN, and reduced FC between the medial prefrontal cortex and precuneus/cuneus, which suggests reduced FC between the anterior and posterior DMN. No significant differences in SN FC were observed. Our results suggest that TRD is characterized by a disturbance in neurocognitive networks relative to non-TRD and HC.
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Affiliation(s)
- Bart P de Kwaasteniet
- Department of Psychiatry, Academic Medical Center , Amsterdam , Netherlands ; Brain Imaging Center, Academic Medical Center , Amsterdam , Netherlands
| | - Maria M Rive
- Department of Psychiatry, Academic Medical Center , Amsterdam , Netherlands ; Brain Imaging Center, Academic Medical Center , Amsterdam , Netherlands
| | - Henricus G Ruhé
- Department of Psychiatry, Academic Medical Center , Amsterdam , Netherlands ; Brain Imaging Center, Academic Medical Center , Amsterdam , Netherlands ; Department of Psychiatry, Mood and Anxiety Disorders, University Medical Center Groningen, University of Groningen , Groningen , Netherlands
| | - Aart H Schene
- Department of Psychiatry, Academic Medical Center , Amsterdam , Netherlands ; Department of Psychiatry, Radboud University Medical Center , Nijmegen , Netherlands ; Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen , Nijmegen , Netherlands
| | - Dick J Veltman
- Department of Psychiatry, Academic Medical Center , Amsterdam , Netherlands ; Department of Psychiatry, VU University Medical Center , Amsterdam , Netherlands
| | - Lisanne Fellinger
- Department of Psychiatry, Academic Medical Center , Amsterdam , Netherlands ; Brain Imaging Center, Academic Medical Center , Amsterdam , Netherlands
| | - Guido A van Wingen
- Department of Psychiatry, Academic Medical Center , Amsterdam , Netherlands ; Brain Imaging Center, Academic Medical Center , Amsterdam , Netherlands
| | - Damiaan Denys
- Department of Psychiatry, Academic Medical Center , Amsterdam , Netherlands ; Brain Imaging Center, Academic Medical Center , Amsterdam , Netherlands ; Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences , Amsterdam , Netherlands
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202
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Belden AC, Barch DM, Oakberg TJ, April LM, Harms MP, Botteron KN, Luby JL. Anterior insula volume and guilt: neurobehavioral markers of recurrence after early childhood major depressive disorder. JAMA Psychiatry 2015; 72:40-8. [PMID: 25390502 PMCID: PMC5103694 DOI: 10.1001/jamapsychiatry.2014.1604] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE This is the first study to date to examine volumetric alterations in the anterior insula (AI) as a potential biomarker for the course of childhood major depressive disorder (MDD). OBJECTIVES To examine whether children with a history of preschool-onset (PO) MDD show reduced AI volume, whether a specific symptom of PO MDD (pathological guilt) is related to AI volume reduction (given the known relationship between AI and guilt processing), and whether AI volumes predict subsequent likelihood of having an episode of MDD. DESIGN, SETTING, AND PARTICIPANTS In a prospective longitudinal study, 306 children (age range, 3.00-5.11 years) and caregivers completed DSM diagnostic assessments at 6 annual time points during 10 years as part of the Preschool Depression Study. Magnetic resonance imaging was completed on a subset of 145 school-age children (age range, 6.11-12.11 years). MAIN OUTCOMES AND MEASURES Whole-brain-adjusted AI volume measured using magnetic resonance imaging at school age and children's diagnosis of MDD any time after their imaging. RESULTS Compared with children without a history of PO MDD, school-age children previously diagnosed as having PO MDD had smaller left and right AI volumes (Wilks Λ = 0.94, F2,124 = 3.37, P = .04, Cohen d = 0.23). However, the effect of PO MDD on reduced AI volumes was better explained by children's experience of pathological guilt during preschool (Λ = 0.91, F2,120 = 6.17, P = .003, d = .30). When covarying for children's lifetime history of MDD episodes, their experience of pathological guilt during preschool, as well as their sex and age at the time of imaging, schoolchildren's right-side AI volume was a significant predictor of being diagnosed as having an MDD episode after imaging (odds ratio, 0.96; 95% CI, 0.01-0.75; P = .03). CONCLUSIONS AND RELEVANCE These results provide evidence that structural abnormalities in AI volume are related to the neurobiology of depressive disorders starting in early childhood. The present findings are consistent with mounting research in adult MDD suggesting that insula function and structure may be a target biomarker for major depression.
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Affiliation(s)
- Andy C. Belden
- Department of Psychiatry, Washington University in St Louis, St Louis, Missouri
| | - Deanna M. Barch
- Department of Psychiatry, Washington University in St Louis, St Louis, Missouri2Program in Neuroscience, Washington University in St Louis, St Louis, Missouri3Department of Psychology, Washington University in St Louis, St Louis, Missouri4Department of Ra
| | - Timothy J. Oakberg
- Department of Psychiatry, Washington University in St Louis, St Louis, Missouri
| | - Laura M. April
- Department of Psychiatry, Washington University in St Louis, St Louis, Missouri
| | - Michael P. Harms
- Department of Psychiatry, Washington University in St Louis, St Louis, Missouri
| | - Kelly N. Botteron
- Department of Psychiatry, Washington University in St Louis, St Louis, Missouri4Department of Radiology, Washington University in St Louis, St Louis, Missouri
| | - Joan L. Luby
- Department of Psychiatry, Washington University in St Louis, St Louis, Missouri
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203
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He Y, Evans A. Magnetic resonance imaging of healthy and diseased brain networks. Front Hum Neurosci 2014; 8:890. [PMID: 25404910 PMCID: PMC4217377 DOI: 10.3389/fnhum.2014.00890] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 10/16/2014] [Indexed: 11/21/2022] Open
Affiliation(s)
- Yong He
- State Key Laboratory of Cognitive Neuroscience and Learning, IDG/McGovern Institute for Brain Research, Beijing Normal University Beijing, China ; Center for Collaboration and Innovation in Brain and Learning Sciences, Beijing Normal University Beijing, China
| | - Alan Evans
- McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University Montreal Montreal, QC, Canada
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204
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Wang L, Xia M, Li K, Zeng Y, Su Y, Dai W, Zhang Q, Jin Z, Mitchell PB, Yu X, He Y, Si T. The effects of antidepressant treatment on resting-state functional brain networks in patients with major depressive disorder. Hum Brain Mapp 2014; 36:768-78. [PMID: 25332057 DOI: 10.1002/hbm.22663] [Citation(s) in RCA: 141] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 10/06/2014] [Accepted: 10/08/2014] [Indexed: 12/13/2022] Open
Abstract
Although most knowledge regarding antidepressant effects is at the receptor level, the neurophysiological correlates of these neurochemical changes remain poorly understood. Such an understanding could benefit from elucidation of antidepressant effects at the level of neural circuits, which would be crucial in identifying biomarkers for monitoring treatment efficacy of antidepressants. In this study, we recruited 20 first-episode drug-naive major depressive disorder (MDD) patients and performed resting-state functional magnetic resonance imaging (MRI) scans before and after 8 weeks of treatment with a selective serotonin reuptake inhibitor-escitalopram. Twenty healthy controls (HCs) were also scanned twice with an 8-week interval. Whole-brain connectivity was analyzed using a graph-theory approach-functional connectivity strength (FCS). The analysis of covariance of FCS was used to determine treatment-related changes. We observed significant group-by-time interaction on FCS in the bilateral dorsomedial prefrontal cortex and bilateral hippocampi. Post hoc analyses revealed that the FCS values in the bilateral dorsomedial prefrontal cortex were significantly higher in the MDD patients compared to HCs at baseline and were significantly reduced after treatment; conversely, the FCS values in the bilateral hippocampi were significantly lower in the patients at baseline and were significantly increased after treatment. Importantly, FCS reduction in the dorsomedial prefrontal cortex was significantly correlated with symptomatic improvement. Together, these findings provided evidence that this commonly used antidepressant can selectively modulate the intrinsic network connectivity associated with the medial prefrontal-limbic system, thus significantly adding to our understanding of antidepressant effects at a circuit level and suggesting potential imaging-based biomarkers for treatment evaluation in MDD.
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Affiliation(s)
- Li Wang
- Peking University Sixth Hospital, Beijing, China; Ministry of Health Key Laboratory of Mental Health, Beijing, China; Institute of Mental Health, Peking University, Beijing, China
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205
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Belleau EL, Taubitz LE, Larson CL. Imbalance of default mode and regulatory networks during externally focused processing in depression. Soc Cogn Affect Neurosci 2014; 10:744-51. [PMID: 25274576 DOI: 10.1093/scan/nsu117] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Accepted: 09/01/2014] [Indexed: 02/05/2023] Open
Abstract
Attentional control difficulties likely underlie rumination, a core cognitive vulnerability in major depressive disorder (MDD). Abnormalities in the default mode, executive and salience networks are implicated in both rumination and attentional control difficulties in MDD. In the current study, individuals with MDD (n = 16) and healthy controls (n = 16) completed tasks designed to elicit self-focused (ruminative) and externally-focused thinking during fMRI scanning. The MDD group showed greater default mode network connectivity and less executive and salience network connectivity during the external-focus condition. Contrary to our predictions, there were no differences in connectivity between the groups during the self-focus condition. Thus, it appears that when directed to engage in self-referential thinking, both depressed and non-depressed individuals similarly recruit networks supporting this process. In contrast, when instructed to engage in non-self-focused thought, non-depressed individuals show a pattern of network connectivity indicative of minimized self-referential processing, whereas depressed individuals fail to reallocate neural resources in a manner consistent with effective down regulation of self-focused thought. This is consistent with difficulties in regulating self-focused thinking in order to engage in more goal-directed behavior that is seen in individuals with MDD.
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Affiliation(s)
- Emily L Belleau
- Department of Psychology, University of Wisconsin-Milwaukee, 2441 East Hartford Avenue, Milwaukee, WI 53211, USA
| | - Lauren E Taubitz
- Department of Psychology, University of Wisconsin-Milwaukee, 2441 East Hartford Avenue, Milwaukee, WI 53211, USA
| | - Christine L Larson
- Department of Psychology, University of Wisconsin-Milwaukee, 2441 East Hartford Avenue, Milwaukee, WI 53211, USA
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206
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Henje Blom E, Duncan LG, Ho TC, Connolly CG, LeWinn KZ, Chesney M, Hecht FM, Yang TT. The development of an RDoC-based treatment program for adolescent depression: "Training for Awareness, Resilience, and Action" (TARA). Front Hum Neurosci 2014; 8:630. [PMID: 25191250 PMCID: PMC4137278 DOI: 10.3389/fnhum.2014.00630] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 07/28/2014] [Indexed: 01/08/2023] Open
Abstract
Major depressive disorder (MDD) is one of the current leading causes of disability worldwide. Adolescence is a vulnerable period for the onset of depression, with MDD affecting 8–20% of all youth. Traditional treatment methods have not been sufficiently effective to slow the increasing prevalence of adolescent depression. We therefore propose a new model for the treatment of adolescent depression – Training for Awareness, Resilience, and Action (TARA) – that is based on current understanding of developmental and depression neurobiology. The TARA model is aligned with the Research Domain Criteria (RDoC) of the National Institute of Mental Health. In this article, we first address the relevance of RDoC to adolescent depression. Second, we identify the major RDoC domains of function involved in adolescent depression and organize them in a way that gives priority to domains thought to be driving the psychopathology. Third, we select therapeutic training strategies for TARA based on current scientific evidence of efficacy for the prioritized domains of function in a manner that maximizes time, resources, and feasibility. The TARA model takes into consideration the developmental limitation in top-down cognitive control in adolescence and promotes bottom-up strategies such as vagal afference to decrease limbic hyperactivation and its secondary effects. The program has been informed by mindfulness-based therapy and yoga, as well as modern psychotherapeutic techniques. The treatment program is semi-manualized, progressive, and applied in a module-based approach designed for a group setting that is to be conducted one session per week for 12 weeks. We hope that this work may form the basis for a novel and more effective treatment strategy for adolescent depression, as well as broaden the discussion on how to address this challenge.
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Affiliation(s)
- Eva Henje Blom
- Department of Clinical Neuroscience, Karolinska Institutet Stockholm, Sweden ; Department of Psychiatry, Division of Child and Adolescent Psychiatry, University of California San Francisco San Francisco, CA, USA
| | - Larissa G Duncan
- Department of Family and Community Medicine, University of California San Francisco San Francisco, CA, USA ; Osher Center for Integrative Medicine, University of California San Francisco San Francisco, CA, USA
| | - Tiffany C Ho
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, University of California San Francisco San Francisco, CA, USA
| | - Colm G Connolly
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, University of California San Francisco San Francisco, CA, USA
| | - Kaja Z LeWinn
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, University of California San Francisco San Francisco, CA, USA
| | - Margaret Chesney
- Osher Center for Integrative Medicine, University of California San Francisco San Francisco, CA, USA ; Department of Medicine, University of California San Francisco San Francisco, CA, USA
| | - Frederick M Hecht
- Osher Center for Integrative Medicine, University of California San Francisco San Francisco, CA, USA ; Department of Medicine, University of California San Francisco San Francisco, CA, USA
| | - Tony T Yang
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, University of California San Francisco San Francisco, CA, USA
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207
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Kennis M, Rademaker AR, van Rooij SJH, Kahn RS, Geuze E. Altered functional connectivity in posttraumatic stress disorder with versus without comorbid major depressive disorder: a resting state fMRI study. F1000Res 2013; 2:289. [PMID: 25309726 PMCID: PMC4184309 DOI: 10.12688/f1000research.2-289.v2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/14/2014] [Indexed: 12/26/2022] Open
Abstract
Posttraumatic stress disorder (PTSD) is an anxiety disorder that is often diagnosed with comorbid depressive disorder. Therefore, neuroimaging studies investigating PTSD typically include both patients with and without comorbid depression. Differences in activity of the anterior cingulate cortex (ACC) and insula have been shown to differentiate PTSD patients with and without major depressive disorder (MDD). Whether or not comorbid MDD affects resting state functional connectivity of PTSD patients has not been investigated to our knowledge. Here, resting state functional connectivity of PTSD patients with (PTSD+MDD; n=27) and without (PTSD-MDD; n=23) comorbid MDD was investigated. The subgenual ACC and insula were investigated as seed regions. Connectivity between the subgenual ACC and perigenual parts of the ACC was increased in PTSD+MDD versus PTSD-MDD, which may reflect the presence of depressive specific symptoms such as rumination. Functional connectivity of the subgenual ACC with the thalamus was reduced, potentially related to more severe deficits in executive functioning in the PTSD+MDD group versus the PTSD-MDD group. In addition, the PTSD+MDD group showed reduced functional connectivity of the insula with the hippocampus compared to the PTSD-MDD group. However, this cluster was no longer significantly different when PTSD patients that were using medication were excluded from analyses. Thus, resting state functional connectivity of the subgenual ACC can distinguish PTSD+MDD from PTSD-MDD, and this may therefore be used as a neurobiological marker for comorbid MDD in the presence of PTSD. As PTSD+MDD are more treatment resistant, these findings can also guide treatment development, for example by targeting the subgenual ACC network with treatment.
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Affiliation(s)
- Mitzy Kennis
- Research Centre-Military Mental Healthcare, Ministry of Defence, 3584 CX Utrecht, Netherlands ; Brain Center Rudolph Magnus, University Medical Center Utrecht, 3584 CX Utrecht, Netherlands
| | - Arthur R Rademaker
- Research Centre-Military Mental Healthcare, Ministry of Defence, 3584 CX Utrecht, Netherlands ; Brain Center Rudolph Magnus, University Medical Center Utrecht, 3584 CX Utrecht, Netherlands
| | - Sanne J H van Rooij
- Research Centre-Military Mental Healthcare, Ministry of Defence, 3584 CX Utrecht, Netherlands ; Brain Center Rudolph Magnus, University Medical Center Utrecht, 3584 CX Utrecht, Netherlands
| | - René S Kahn
- Brain Center Rudolph Magnus, University Medical Center Utrecht, 3584 CX Utrecht, Netherlands
| | - Elbert Geuze
- Research Centre-Military Mental Healthcare, Ministry of Defence, 3584 CX Utrecht, Netherlands ; Brain Center Rudolph Magnus, University Medical Center Utrecht, 3584 CX Utrecht, Netherlands
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208
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Kennis M, Rademaker AR, van Rooij SJ, Kahn RS, Geuze E. Altered functional connectivity in posttraumatic stress disorder with versus without comorbid major depressive disorder: a resting state fMRI study. F1000Res 2013; 2:289. [PMID: 25309726 PMCID: PMC4184309 DOI: 10.12688/f1000research.2-289.v1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/14/2014] [Indexed: 12/20/2023] Open
Abstract
Posttraumatic stress disorder (PTSD) is an anxiety disorder that is often diagnosed with comorbid depressive disorder. Therefore, neuroimaging studies investigating PTSD typically include both patients with and without comorbid depression. Differences in activity of the anterior cingulate cortex (ACC) and insula have been shown to differentiate PTSD patients with and without major depressive disorder (MDD). Whether or not comorbid MDD affects resting state functional connectivity of PTSD patients has not been investigated to our knowledge. Here, resting state functional connectivity of PTSD patients with (PTSD+MDD; n=27) and without (PTSD-MDD; n=23) comorbid MDD was investigated. The subgenual ACC and insula were investigated as seed regions. Connectivity between the subgenual ACC and perigenual parts of the ACC was increased in PTSD+MDD versus PTSD-MDD, which may reflect the presence of depressive specific symptoms such as rumination. Functional connectivity of the subgenual ACC with the thalamus was reduced, potentially related to more severe deficits in executive functioning in the PTSD+MDD group versus the PTSD-MDD group. In addition, the PTSD+MDD group showed reduced functional connectivity of the insula with the hippocampus compared to the PTSD-MDD group. However, this cluster was no longer significantly different when PTSD patients that were using medication were excluded from analyses. Thus, resting state functional connectivity of the subgenual ACC can distinguish PTSD+MDD from PTSD-MDD, and this may therefore be used as a neurobiological marker for comorbid MDD in the presence of PTSD. As PTSD+MDD are more treatment resistant, these findings can also guide treatment development, for example by targeting the subgenual ACC network with treatment.
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Affiliation(s)
- Mitzy Kennis
- Research Centre-Military Mental Healthcare, Ministry of Defence, 3584 CX Utrecht, Netherlands
- Brain Center Rudolph Magnus, University Medical Center Utrecht, 3584 CX Utrecht, Netherlands
| | - Arthur R. Rademaker
- Research Centre-Military Mental Healthcare, Ministry of Defence, 3584 CX Utrecht, Netherlands
- Brain Center Rudolph Magnus, University Medical Center Utrecht, 3584 CX Utrecht, Netherlands
| | - Sanne J.H. van Rooij
- Research Centre-Military Mental Healthcare, Ministry of Defence, 3584 CX Utrecht, Netherlands
- Brain Center Rudolph Magnus, University Medical Center Utrecht, 3584 CX Utrecht, Netherlands
| | - René S. Kahn
- Brain Center Rudolph Magnus, University Medical Center Utrecht, 3584 CX Utrecht, Netherlands
| | - Elbert Geuze
- Research Centre-Military Mental Healthcare, Ministry of Defence, 3584 CX Utrecht, Netherlands
- Brain Center Rudolph Magnus, University Medical Center Utrecht, 3584 CX Utrecht, Netherlands
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