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Cong Z, Yang L, Zhao Z, Zheng G, Bao C, Zhang P, Wang J, Zheng W, Yao Z, Hu B. Disrupted dynamic brain functional connectivity in male cocaine use disorder: Hyperconnectivity, strongly-connected state tendency, and links to impulsivity and borderline traits. J Psychiatr Res 2024; 176:218-231. [PMID: 38889552 DOI: 10.1016/j.jpsychires.2024.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 05/28/2024] [Accepted: 06/08/2024] [Indexed: 06/20/2024]
Abstract
Cocaine use is a major public health problem with serious negative consequences at both the individual and societal levels. Cocaine use disorder (CUD) is associated with cognitive and emotional impairments, often manifesting as alterations in brain functional connectivity (FC). This study employed resting-state functional magnetic resonance imaging (rs-fMRI) to examine dynamic FC in 38 male participants with CUD and 31 matched healthy controls. Using group spatial independent component analysis (group ICA) combined with sliding window approach, we identified two recurring distinct connectivity states: the strongly-connected state (state 1) and weakly-connected state (state 2). CUD patients exhibited significant increased mean dwell and fraction time in state 1, and increased transitions from state 2 to state 1, demonstrated significant strongly-connected state tendency. Our analysis revealed abnormal FC patterns that are state-dependent and state-shared in CUD patients. This study observed hyperconnectivity within the default mode network (DMN) and between DMN and other networks, which varied depending on the state. Furthermore, after adjustment for multiple comparisons, we found significant correlations between these altered dynamic FCs and clinical measures of impulsivity and borderline personality disorder. The disrupted FC and repetitive effects of precuneus and angular gyrus across correlations suggested that they might be the important hub of neural circuits related behaviorally and mentally in CUD. In summary, our study highlighted the potential of these disrupted FC as neuroimaging biomarkers and therapeutic targets, and provided new insights into the understanding of the neurophysiologic mechanisms of CUD.
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Affiliation(s)
- Zhaoyang Cong
- Gansu Provincial Key Laboratory of Wearable Computing, School of Information Science and Engineering, Lanzhou University, Lanzhou, 730000, China; State Key Laboratory of Digital Medical Engineering, School of Instrument Science and Engineering, Southeast University, Nanjing, 210096, China
| | - Lin Yang
- Gansu Provincial Key Laboratory of Wearable Computing, School of Information Science and Engineering, Lanzhou University, Lanzhou, 730000, China
| | - Ziyang Zhao
- Gansu Provincial Key Laboratory of Wearable Computing, School of Information Science and Engineering, Lanzhou University, Lanzhou, 730000, China
| | - Guowei Zheng
- Gansu Provincial Key Laboratory of Wearable Computing, School of Information Science and Engineering, Lanzhou University, Lanzhou, 730000, China; School of Computer Science and Technology, Harbin Institute of Technology, Harbin, 150006, China
| | - Cong Bao
- Gansu Provincial Key Laboratory of Wearable Computing, School of Information Science and Engineering, Lanzhou University, Lanzhou, 730000, China
| | - Pengfei Zhang
- Second Clinical School, Lanzhou University, Lanzhou, 730000, China
| | - Jun Wang
- Second Clinical School, Lanzhou University, Lanzhou, 730000, China
| | - Weihao Zheng
- Gansu Provincial Key Laboratory of Wearable Computing, School of Information Science and Engineering, Lanzhou University, Lanzhou, 730000, China
| | - Zhijun Yao
- Gansu Provincial Key Laboratory of Wearable Computing, School of Information Science and Engineering, Lanzhou University, Lanzhou, 730000, China.
| | - Bin Hu
- Gansu Provincial Key Laboratory of Wearable Computing, School of Information Science and Engineering, Lanzhou University, Lanzhou, 730000, China; School of Medical Technology, Beijing Institute of Technology, China; CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, China; Joint Research Center for Cognitive Neurosensor Technology of Lanzhou University & Institute of Semiconductors, Chinese Academy of Sciences, China.
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Ye ZX, Xu HL, Chen NP, Chen XY, Li MC, Yuan RY, Lin W, Qiu L, Lin M, Chen WJ, Wang N, Hu JP, Fu Y, Gan SR. Disease Progression and Multiparametric Imaging Characteristics of Spinocerebellar Ataxia Type 3 With Spastic Paraplegia. Neurol Genet 2024; 10:e200162. [PMID: 38841628 PMCID: PMC11152645 DOI: 10.1212/nxg.0000000000200162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 04/12/2024] [Indexed: 06/07/2024]
Abstract
Background and Objectives Spinocerebellar ataxia type 3 (SCA3) is a hereditary ataxia that occurs worldwide. Clinical patterns were observed, including the one characterized by marked spastic paraplegia. This study investigated the clinical features, disease progression, and multiparametric imaging aspects of patients with SCA3. Methods We retrospectively analyzed 249 patients with SCA3 recruited from the Organization for Southeast China for cerebellar ataxia research between October 2014 and December 2020. Of the 249 patients, 145 were selected and assigned to 2 groups based on neurologic examination: SCA3 patients with spastic paraplegia (SCA3-SP) and SCA3 patients with nonspastic paraplegia (SCA3-NSP). Participants underwent 3.0-T brain MRI examinations, and voxel-wise and volume-of-interest-based approaches were used for the resulting images. A tract-based spatial statistical approach was used to investigate the white matter (WM) alterations using diffusion tensor imaging, neurite orientation dispersion, and density imaging metrics. Multiple linear regression analyses were performed to compare the clinical and imaging parameters between the 2 groups. The longitudinal data were evaluated using a linear mixed-effects model. Results Forty-three patients with SCA3-SP (mean age, 37.58years ± 11.72 [SD]; 18 women) and 102 patients with SCA3-NSP (mean age, 47.42years ± 12.50 [SD]; 39 women) were analyzed. Patients with SCA3-SP were younger and had a lower onset age but a larger cytosine-adenine-guanine repeat number, as well as higher clinical severity scores (all corrected p < 0.05). The estimated progression rates of the Scale for the Assessment and Rating of Ataxia (SARA) and International Cooperative Ataxia Rating Scale scores were higher in the SCA3-SP subgroup than in the SCA3-NSP subgroup (SARA, 2.136 vs 1.218 points; ICARS, 5.576 vs 3.480 points; both p < 0.001). In addition, patients with SCA3-SP showed gray matter volume loss in the precentral gyrus with a decreased neurite density index in the WM of the corticospinal tract and cerebellar peduncles compared with patients with SCA3-NSP. Discussion SCA3-SP differs from SCA3-NSP in clinical features, multiparametric brain imaging findings, and longitudinal follow-up progression.
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Affiliation(s)
- Zhi-Xian Ye
- From the Department of Neurology and Institute of Neurology of First Affiliated Hospital (Z.-X.Y., H.-L.X., R.-Y.Y., W.L., L.Q., M.L., W.-J.C., N.W., Y.F., S.-R.G.), Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology; Department of Radiology of First Affiliated Hospital (N.-P.C., M.-C.L., J.-P.H.); Department of Rehabilitation Medicine of First Affiliated Hospital (X.-Y.C.); and Department of Neurology (L.Q., M.L., W.-J.C., N.W., Y.F., S.-R.G.), National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Hao-Ling Xu
- From the Department of Neurology and Institute of Neurology of First Affiliated Hospital (Z.-X.Y., H.-L.X., R.-Y.Y., W.L., L.Q., M.L., W.-J.C., N.W., Y.F., S.-R.G.), Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology; Department of Radiology of First Affiliated Hospital (N.-P.C., M.-C.L., J.-P.H.); Department of Rehabilitation Medicine of First Affiliated Hospital (X.-Y.C.); and Department of Neurology (L.Q., M.L., W.-J.C., N.W., Y.F., S.-R.G.), National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Na-Ping Chen
- From the Department of Neurology and Institute of Neurology of First Affiliated Hospital (Z.-X.Y., H.-L.X., R.-Y.Y., W.L., L.Q., M.L., W.-J.C., N.W., Y.F., S.-R.G.), Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology; Department of Radiology of First Affiliated Hospital (N.-P.C., M.-C.L., J.-P.H.); Department of Rehabilitation Medicine of First Affiliated Hospital (X.-Y.C.); and Department of Neurology (L.Q., M.L., W.-J.C., N.W., Y.F., S.-R.G.), National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Xin-Yuan Chen
- From the Department of Neurology and Institute of Neurology of First Affiliated Hospital (Z.-X.Y., H.-L.X., R.-Y.Y., W.L., L.Q., M.L., W.-J.C., N.W., Y.F., S.-R.G.), Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology; Department of Radiology of First Affiliated Hospital (N.-P.C., M.-C.L., J.-P.H.); Department of Rehabilitation Medicine of First Affiliated Hospital (X.-Y.C.); and Department of Neurology (L.Q., M.L., W.-J.C., N.W., Y.F., S.-R.G.), National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Meng-Cheng Li
- From the Department of Neurology and Institute of Neurology of First Affiliated Hospital (Z.-X.Y., H.-L.X., R.-Y.Y., W.L., L.Q., M.L., W.-J.C., N.W., Y.F., S.-R.G.), Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology; Department of Radiology of First Affiliated Hospital (N.-P.C., M.-C.L., J.-P.H.); Department of Rehabilitation Medicine of First Affiliated Hospital (X.-Y.C.); and Department of Neurology (L.Q., M.L., W.-J.C., N.W., Y.F., S.-R.G.), National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Ru-Ying Yuan
- From the Department of Neurology and Institute of Neurology of First Affiliated Hospital (Z.-X.Y., H.-L.X., R.-Y.Y., W.L., L.Q., M.L., W.-J.C., N.W., Y.F., S.-R.G.), Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology; Department of Radiology of First Affiliated Hospital (N.-P.C., M.-C.L., J.-P.H.); Department of Rehabilitation Medicine of First Affiliated Hospital (X.-Y.C.); and Department of Neurology (L.Q., M.L., W.-J.C., N.W., Y.F., S.-R.G.), National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Wei Lin
- From the Department of Neurology and Institute of Neurology of First Affiliated Hospital (Z.-X.Y., H.-L.X., R.-Y.Y., W.L., L.Q., M.L., W.-J.C., N.W., Y.F., S.-R.G.), Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology; Department of Radiology of First Affiliated Hospital (N.-P.C., M.-C.L., J.-P.H.); Department of Rehabilitation Medicine of First Affiliated Hospital (X.-Y.C.); and Department of Neurology (L.Q., M.L., W.-J.C., N.W., Y.F., S.-R.G.), National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Liangliang Qiu
- From the Department of Neurology and Institute of Neurology of First Affiliated Hospital (Z.-X.Y., H.-L.X., R.-Y.Y., W.L., L.Q., M.L., W.-J.C., N.W., Y.F., S.-R.G.), Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology; Department of Radiology of First Affiliated Hospital (N.-P.C., M.-C.L., J.-P.H.); Department of Rehabilitation Medicine of First Affiliated Hospital (X.-Y.C.); and Department of Neurology (L.Q., M.L., W.-J.C., N.W., Y.F., S.-R.G.), National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Minting Lin
- From the Department of Neurology and Institute of Neurology of First Affiliated Hospital (Z.-X.Y., H.-L.X., R.-Y.Y., W.L., L.Q., M.L., W.-J.C., N.W., Y.F., S.-R.G.), Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology; Department of Radiology of First Affiliated Hospital (N.-P.C., M.-C.L., J.-P.H.); Department of Rehabilitation Medicine of First Affiliated Hospital (X.-Y.C.); and Department of Neurology (L.Q., M.L., W.-J.C., N.W., Y.F., S.-R.G.), National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Wan-Jin Chen
- From the Department of Neurology and Institute of Neurology of First Affiliated Hospital (Z.-X.Y., H.-L.X., R.-Y.Y., W.L., L.Q., M.L., W.-J.C., N.W., Y.F., S.-R.G.), Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology; Department of Radiology of First Affiliated Hospital (N.-P.C., M.-C.L., J.-P.H.); Department of Rehabilitation Medicine of First Affiliated Hospital (X.-Y.C.); and Department of Neurology (L.Q., M.L., W.-J.C., N.W., Y.F., S.-R.G.), National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Ning Wang
- From the Department of Neurology and Institute of Neurology of First Affiliated Hospital (Z.-X.Y., H.-L.X., R.-Y.Y., W.L., L.Q., M.L., W.-J.C., N.W., Y.F., S.-R.G.), Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology; Department of Radiology of First Affiliated Hospital (N.-P.C., M.-C.L., J.-P.H.); Department of Rehabilitation Medicine of First Affiliated Hospital (X.-Y.C.); and Department of Neurology (L.Q., M.L., W.-J.C., N.W., Y.F., S.-R.G.), National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Jian-Ping Hu
- From the Department of Neurology and Institute of Neurology of First Affiliated Hospital (Z.-X.Y., H.-L.X., R.-Y.Y., W.L., L.Q., M.L., W.-J.C., N.W., Y.F., S.-R.G.), Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology; Department of Radiology of First Affiliated Hospital (N.-P.C., M.-C.L., J.-P.H.); Department of Rehabilitation Medicine of First Affiliated Hospital (X.-Y.C.); and Department of Neurology (L.Q., M.L., W.-J.C., N.W., Y.F., S.-R.G.), National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Ying Fu
- From the Department of Neurology and Institute of Neurology of First Affiliated Hospital (Z.-X.Y., H.-L.X., R.-Y.Y., W.L., L.Q., M.L., W.-J.C., N.W., Y.F., S.-R.G.), Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology; Department of Radiology of First Affiliated Hospital (N.-P.C., M.-C.L., J.-P.H.); Department of Rehabilitation Medicine of First Affiliated Hospital (X.-Y.C.); and Department of Neurology (L.Q., M.L., W.-J.C., N.W., Y.F., S.-R.G.), National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Shi-Rui Gan
- From the Department of Neurology and Institute of Neurology of First Affiliated Hospital (Z.-X.Y., H.-L.X., R.-Y.Y., W.L., L.Q., M.L., W.-J.C., N.W., Y.F., S.-R.G.), Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology; Department of Radiology of First Affiliated Hospital (N.-P.C., M.-C.L., J.-P.H.); Department of Rehabilitation Medicine of First Affiliated Hospital (X.-Y.C.); and Department of Neurology (L.Q., M.L., W.-J.C., N.W., Y.F., S.-R.G.), National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
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Schinz D, Schmitz-Koep B, Tahedl M, Teckenberg T, Schultz V, Schulz J, Zimmer C, Sorg C, Gaser C, Hedderich DM. Lower cortical thickness and increased brain aging in adults with cocaine use disorder. Front Psychiatry 2023; 14:1266770. [PMID: 38025412 PMCID: PMC10679447 DOI: 10.3389/fpsyt.2023.1266770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Background Cocaine use disorder (CUD) is a global health issue with severe behavioral and cognitive sequelae. While previous evidence suggests a variety of structural and age-related brain changes in CUD, the impact on both, cortical thickness and brain age measures remains unclear. Methods Derived from a publicly available data set (SUDMEX_CONN), 74 CUD patients and 62 matched healthy controls underwent brain MRI and behavioral-clinical assessment. We determined cortical thickness by surface-based morphometry using CAT12 and Brain Age Gap Estimate (BrainAGE) via relevance vector regression. Associations between structural brain changes and behavioral-clinical variables of patients with CUD were investigated by correlation analyses. Results We found significantly lower cortical thickness in bilateral prefrontal cortices, posterior cingulate cortices, and the temporoparietal junction and significantly increased BrainAGE in patients with CUD [mean (SD) = 1.97 (±3.53)] compared to healthy controls (p < 0.001, Cohen's d = 0.58). Increased BrainAGE was associated with longer cocaine abuse duration. Conclusion Results demonstrate structural brain abnormalities in CUD, particularly lower cortical thickness in association cortices and dose-dependent, increased brain age.
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Affiliation(s)
- David Schinz
- Department of Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany
- TUM-NIC Neuroimaging Center, School of Medicine, Technical University of Munich, Munich, Germany
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen- (FAU), Nürnberg, Germany
| | - Benita Schmitz-Koep
- Department of Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany
- TUM-NIC Neuroimaging Center, School of Medicine, Technical University of Munich, Munich, Germany
| | - Marlene Tahedl
- Department of Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany
- TUM-NIC Neuroimaging Center, School of Medicine, Technical University of Munich, Munich, Germany
| | - Timo Teckenberg
- Digital Management & Transformation, SRH Fernhochschule - The Mobile University, Riedlingen, Germany
| | - Vivian Schultz
- Department of Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany
- TUM-NIC Neuroimaging Center, School of Medicine, Technical University of Munich, Munich, Germany
| | - Julia Schulz
- Department of Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany
- TUM-NIC Neuroimaging Center, School of Medicine, Technical University of Munich, Munich, Germany
| | - Claus Zimmer
- Department of Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany
- TUM-NIC Neuroimaging Center, School of Medicine, Technical University of Munich, Munich, Germany
| | - Christian Sorg
- Department of Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany
- TUM-NIC Neuroimaging Center, School of Medicine, Technical University of Munich, Munich, Germany
- Department of Psychiatry, School of Medicine, Technical University of Munich, Munich, Germany
| | - Christian Gaser
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
- Department of Neurology, Jena University Hospital, Jena, Germany
- German Center for Mental Health (DZPG), Site Jena-Magdeburg-Halle, Germany
- Center for Intervention and Research on Adaptive and Maladaptive Brain Circuits Underlying Mental Health (C-I-R-C), Jena-Magdeburg-Halle, Germany
| | - Dennis M. Hedderich
- Department of Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany
- TUM-NIC Neuroimaging Center, School of Medicine, Technical University of Munich, Munich, Germany
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Gasparyan A, Maldonado Sanchez D, Navarrete F, Sion A, Navarro D, García-Gutiérrez MS, Rubio Valladolid G, Jurado Barba R, Manzanares J. Cognitive Alterations in Addictive Disorders: A Translational Approach. Biomedicines 2023; 11:1796. [PMID: 37509436 PMCID: PMC10376598 DOI: 10.3390/biomedicines11071796] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/02/2023] [Accepted: 06/06/2023] [Indexed: 07/30/2023] Open
Abstract
The cognitive decline in people with substance use disorders is well known and can be found during both the dependence and drug abstinence phases. At the clinical level, cognitive decline impairs the response to addiction treatment and increases dropout rates. It can be irreversible, even after the end of drug abuse consumption. Improving our understanding of the molecular and cellular alterations associated with cognitive decline could be essential to developing specific therapeutic strategies for its treatment. Developing animal models to simulate drug abuse-induced learning and memory alterations is critical to continue exploring this clinical situation. The main aim of this review is to summarize the most recent evidence on cognitive impairment and the associated biological markers in patients addicted to some of the most consumed drugs of abuse and in animal models simulating this clinical situation. The available information suggests the need to develop more studies to further explore the molecular alterations associated with cognitive impairment, with the ultimate goal of developing new potential therapeutic strategies.
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Affiliation(s)
- Ani Gasparyan
- Instituto de Neurociencias, Universidad Miguel Hernández-CSIC, Avda de Ramón y Cajal s/n, 03550 San Juan de Alicante, Spain
- Redes de Investigación Cooperativa Orientada a Resultados en Salud (RICORS), Red de Investigación en Atención Primaria de Adicciones (RIAPAd), Instituto de Salud Carlos III, MICINN and FEDER, 28029 Madrid, Spain
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), 03010 Alicante, Spain
| | | | - Francisco Navarrete
- Instituto de Neurociencias, Universidad Miguel Hernández-CSIC, Avda de Ramón y Cajal s/n, 03550 San Juan de Alicante, Spain
- Redes de Investigación Cooperativa Orientada a Resultados en Salud (RICORS), Red de Investigación en Atención Primaria de Adicciones (RIAPAd), Instituto de Salud Carlos III, MICINN and FEDER, 28029 Madrid, Spain
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), 03010 Alicante, Spain
| | - Ana Sion
- Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain
- Faculty of Psychology, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Daniela Navarro
- Instituto de Neurociencias, Universidad Miguel Hernández-CSIC, Avda de Ramón y Cajal s/n, 03550 San Juan de Alicante, Spain
- Redes de Investigación Cooperativa Orientada a Resultados en Salud (RICORS), Red de Investigación en Atención Primaria de Adicciones (RIAPAd), Instituto de Salud Carlos III, MICINN and FEDER, 28029 Madrid, Spain
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), 03010 Alicante, Spain
| | - María Salud García-Gutiérrez
- Instituto de Neurociencias, Universidad Miguel Hernández-CSIC, Avda de Ramón y Cajal s/n, 03550 San Juan de Alicante, Spain
- Redes de Investigación Cooperativa Orientada a Resultados en Salud (RICORS), Red de Investigación en Atención Primaria de Adicciones (RIAPAd), Instituto de Salud Carlos III, MICINN and FEDER, 28029 Madrid, Spain
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), 03010 Alicante, Spain
| | - Gabriel Rubio Valladolid
- Redes de Investigación Cooperativa Orientada a Resultados en Salud (RICORS), Red de Investigación en Atención Primaria de Adicciones (RIAPAd), Instituto de Salud Carlos III, MICINN and FEDER, 28029 Madrid, Spain
- Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain
- Department of Psychiatry, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Rosa Jurado Barba
- Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain
- Faculty of Health, Universidad Camilo José Cela, 28001 Madrid, Spain
| | - Jorge Manzanares
- Instituto de Neurociencias, Universidad Miguel Hernández-CSIC, Avda de Ramón y Cajal s/n, 03550 San Juan de Alicante, Spain
- Redes de Investigación Cooperativa Orientada a Resultados en Salud (RICORS), Red de Investigación en Atención Primaria de Adicciones (RIAPAd), Instituto de Salud Carlos III, MICINN and FEDER, 28029 Madrid, Spain
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), 03010 Alicante, Spain
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