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Gan J, Liu W, Fan J, Yi J, Tan C, Zhu X. Correlates of poor insight: A comparative fMRI and sMRI study in obsessive-compulsive disorder and schizo-obsessive disorder. J Affect Disord 2023; 321:66-73. [PMID: 36162685 DOI: 10.1016/j.jad.2022.09.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 09/01/2022] [Accepted: 09/20/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Despite the several researches on the correlates of insight in psychosis, less is known regarding the specificity of disease diagnosis on the relationship between insight and the correlates. The current study sought to explore the effects of insight and disease diagnosis on those in patients with obsessive-compulsive disorder (OCD) and patients with schizo-obsessive disorder (SOD). METHODS We evaluated clinical symptoms and neurocognitions among 111 patients (including 41 OCD with good insight, 40 OCD with poor insight, 14 SOD with good insight and 16 SOD with poor insight. Gray matter volume and spontaneous neural activity were also examined by analyzing the voxel-based morphometry and amplitude of low frequency fluctuation (ALFF), respectively. RESULTS Interactive effects of insight and diagnosis was found on working memory and the gray matter volume in right superior and middle temporal gyrus. Main effect of insight was found on working and visual memory, compulsion and obsession, and ALFF in right middle and superior occipital cortex. Main effect of diagnosis was found on severity of compulsion, relative verbal IQ, executive function, verbal and visual memory, working memory and ALFF in precuneus, medial superior frontal gyrus, anterior cingulate and paracingulate gyri, and inferior parietal, postcentral gyrus, paracentral lobule. CONCLUSIONS As a common feature in mental disorders, insight has its own special influence on neurocognition and possible structural/functional alterations in brain, and the influence is partly dependent of disease diagnosis.
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Affiliation(s)
- Jun Gan
- Medical Psychological center, the Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; College of Education, Hunan Agricultural University, Changsha, Hunan 410128, China
| | - Wanting Liu
- Medical Psychological center, the Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Medial Psychological institute of Central South University, Changsha, Hunan 410011, China
| | - Jie Fan
- Medical Psychological center, the Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Medial Psychological institute of Central South University, Changsha, Hunan 410011, China.; National Clinical Research Center for Mental Disorders, Changsha, Hunan, China
| | - Jinyao Yi
- Medical Psychological center, the Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Medial Psychological institute of Central South University, Changsha, Hunan 410011, China
| | - Changlian Tan
- Department of Radiology, Second Xiangya Hospital, Central South University, 139 Renmin Middle Road, Changsha, Hunan 410011, China.
| | - Xiongzhao Zhu
- Medical Psychological center, the Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Medial Psychological institute of Central South University, Changsha, Hunan 410011, China.; National Clinical Research Center for Mental Disorders, Changsha, Hunan, China.
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2
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Wang B, Pan T, Guo M, Li Z, Yu X, Li D, Niu Y, Cui X, Xiang J. Abnormal dynamic reconfiguration of the large-scale functional network in schizophrenia during the episodic memory task. Cereb Cortex 2022; 33:4135-4144. [PMID: 36030383 DOI: 10.1093/cercor/bhac331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/27/2022] [Accepted: 07/28/2022] [Indexed: 11/13/2022] Open
Abstract
Episodic memory deficits are the core feature in schizophrenia (SCZ). Numerous studies have revealed abnormal brain activity associated with this disorder during episodic memory, however previous work has only relied on static analysis methods that treat the brain as a static monolithic structure, ignoring the dynamic features at different time scales. Here, we applied dynamic functional connectivity analysis to functional magnetic resonance imaging data during episodic memory and quantify integration and recruitment metrics to reveal abnormal dynamic reconfiguration of brain networks in SCZ. In the specific frequency band of 0.06-0.125 Hz, SCZ showed significantly higher integration during encoding and retrieval, and the abnormalities were mainly in the default mode, frontoparietal, and cingulo-opercular modules. Recruitment of SCZ was significantly higher during retrieval, mainly in the visual module. Interestingly, interactions between groups and task status in recruitment were found in the dorsal attention, visual modules. Finally, we observed that integration was significantly associated with memory performance in frontoparietal regions. Our findings revealed the time-varying evolution of brain networks in SCZ, while improving our understanding of cognitive decline and other pathophysiologies in brain diseases.
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Affiliation(s)
- Bin Wang
- College of Information and Computer, Taiyuan University of Technology, Taiyuan, 030024, China
| | - Tingting Pan
- College of Information and Computer, Taiyuan University of Technology, Taiyuan, 030024, China
| | - Min Guo
- College of Information and Computer, Taiyuan University of Technology, Taiyuan, 030024, China
| | - Zhifeng Li
- College of Information and Computer, Taiyuan University of Technology, Taiyuan, 030024, China
| | - Xuexue Yu
- College of Information and Computer, Taiyuan University of Technology, Taiyuan, 030024, China
| | - Dandan Li
- College of Information and Computer, Taiyuan University of Technology, Taiyuan, 030024, China
| | - Yan Niu
- College of Information and Computer, Taiyuan University of Technology, Taiyuan, 030024, China
| | - Xiaohong Cui
- College of Information and Computer, Taiyuan University of Technology, Taiyuan, 030024, China
| | - Jie Xiang
- College of Information and Computer, Taiyuan University of Technology, Taiyuan, 030024, China
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3
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Underwood R, Mason L, O'Daly O, Dalton J, Simmons A, Barker GJ, Peters E, Kumari V. You read my mind: fMRI markers of threatening appraisals in people with persistent psychotic experiences. NPJ SCHIZOPHRENIA 2021; 7:49. [PMID: 34635671 PMCID: PMC8505497 DOI: 10.1038/s41537-021-00173-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 08/06/2021] [Indexed: 11/09/2022]
Abstract
Anomalous perceptual experiences are relatively common in the general population. Evidence indicates that the key to distinguishing individuals with persistent psychotic experiences (PEs) with a need for care from those without is how they appraise their anomalous experiences. Here, we aimed to characterise the neural circuits underlying threatening and non-threatening appraisals in people with and without a need for care for PEs, respectively. A total of 48 participants, consisting of patients with psychosis spectrum disorder (clinical group, n = 16), non-need-for-care participants with PEs (non-clinical group, n = 16), and no-PE healthy control participants (n = 16), underwent functional magnetic resonance imaging while completing the Telepath task, designed to induce an anomalous perceptual experience. Appraisals of the anomalous perceptual experiences were examined, as well as functional brain responses during this window, for significant group differences. We also examined whether activation co-varied with the subjective threat appraisals reported in-task by participants. The clinical group reported elevated subjective threat appraisals compared to both the non-clinical and no-PE control groups, with no differences between the two non-clinical groups. This pattern of results was accompanied by reduced activation in the superior and inferior frontal gyri in the clinical group as compared to the non-clinical and control groups. Precuneus activation scaled with threat appraisals reported in-task. Resilience in the context of persistent anomalous experiences may be explained by intact functioning of fronto-parietal regions, and may correspond to the ability to contextualise and flexibly evaluate psychotic experiences.
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Affiliation(s)
- Raphael Underwood
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychology, London, UK. .,South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Kent, UK.
| | - Liam Mason
- University College London, Max Planck Centre for Computational Psychiatry and Ageing Research, London, UK.,University College London, Research Department of Clinical, Educational and Health Psychology, London, UK
| | - Owen O'Daly
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Neuroimaging, London, UK
| | - Jeffrey Dalton
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Neuroimaging, London, UK
| | - Andrew Simmons
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Neuroimaging, London, UK
| | - Gareth J Barker
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Neuroimaging, London, UK
| | - Emmanuelle Peters
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychology, London, UK.,South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Kent, UK
| | - Veena Kumari
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychology, London, UK.,Brunel University London, College of Health, Medicine and Life Sciences, Centre for Cognitive Neuroscience, Uxbridge, UK
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4
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Sheng X, Chen H, Shao P, Qin R, Zhao H, Xu Y, Bai F. Brain Structural Network Compensation Is Associated With Cognitive Impairment and Alzheimer's Disease Pathology. Front Neurosci 2021; 15:630278. [PMID: 33716654 PMCID: PMC7947929 DOI: 10.3389/fnins.2021.630278] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 01/26/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Structural network alterations in Alzheimer's disease (AD) are related to worse cognitive impairment. The aim of this study was to quantify the alterations in gray matter associated with impaired cognition and their pathological biomarkers in AD-spectrum patients. METHODS We extracted gray matter networks from 3D-T1 magnetic resonance imaging scans, and a graph theory analysis was used to explore alterations in the network metrics in 34 healthy controls, 70 mild cognitive impairment (MCI) patients, and 40 AD patients. Spearman correlation analysis was computed to investigate the relationships among network properties, neuropsychological performance, and cerebrospinal fluid pathological biomarkers (i.e., Aβ, t-tau, and p-tau) in these subjects. RESULTS AD-spectrum individuals demonstrated higher nodal properties and edge properties associated with impaired memory function, and lower amyloid-β or higher tau levels than the controls. Furthermore, these compensations at the brain regional level in AD-spectrum patients were mainly in the medial temporal lobe; however, the compensation at the whole-brain network level gradually extended from the frontal lobe to become widely distributed throughout the cortex with the progression of AD. CONCLUSION The findings provide insight into the alterations in the gray matter network related to impaired cognition and pathological biomarkers in the progression of AD. The possibility of compensation was detected in the structural networks in AD-spectrum patients; the compensatory patterns at regional and whole-brain levels were different and the clinical significance was highlighted.
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Affiliation(s)
- Xiaoning Sheng
- Department of Neurology, Affiliated Drum Tower Hospital of Medical School and The State Key Laboratory of Pharmaceutical Biotechnology, Institute of Brain Science, Nanjing University, Nanjing, China
| | - Haifeng Chen
- Department of Neurology, Affiliated Drum Tower Hospital of Medical School and The State Key Laboratory of Pharmaceutical Biotechnology, Institute of Brain Science, Nanjing University, Nanjing, China
- Jiangsu Province Stroke Center for Diagnosis and Therapy, Nanjing, China
- Nanjing Neuropsychiatry Clinic Medical Center, Nanjing, China
| | - Pengfei Shao
- Department of Neurology, Affiliated Drum Tower Hospital of Medical School and The State Key Laboratory of Pharmaceutical Biotechnology, Institute of Brain Science, Nanjing University, Nanjing, China
| | - Ruomeng Qin
- Department of Neurology, Affiliated Drum Tower Hospital of Medical School and The State Key Laboratory of Pharmaceutical Biotechnology, Institute of Brain Science, Nanjing University, Nanjing, China
- Jiangsu Province Stroke Center for Diagnosis and Therapy, Nanjing, China
- Nanjing Neuropsychiatry Clinic Medical Center, Nanjing, China
| | - Hui Zhao
- Department of Neurology, Affiliated Drum Tower Hospital of Medical School and The State Key Laboratory of Pharmaceutical Biotechnology, Institute of Brain Science, Nanjing University, Nanjing, China
- Jiangsu Province Stroke Center for Diagnosis and Therapy, Nanjing, China
- Nanjing Neuropsychiatry Clinic Medical Center, Nanjing, China
| | - Yun Xu
- Department of Neurology, Affiliated Drum Tower Hospital of Medical School and The State Key Laboratory of Pharmaceutical Biotechnology, Institute of Brain Science, Nanjing University, Nanjing, China
- Jiangsu Province Stroke Center for Diagnosis and Therapy, Nanjing, China
- Nanjing Neuropsychiatry Clinic Medical Center, Nanjing, China
| | - Feng Bai
- Department of Neurology, Affiliated Drum Tower Hospital of Medical School and The State Key Laboratory of Pharmaceutical Biotechnology, Institute of Brain Science, Nanjing University, Nanjing, China
- Jiangsu Province Stroke Center for Diagnosis and Therapy, Nanjing, China
- Nanjing Neuropsychiatry Clinic Medical Center, Nanjing, China
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5
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Pijnenborg GHM, Larabi DI, Xu P, Hasson-Ohayon I, de Vos AE, Ćurčić-Blake B, Aleman A, Van der Meer L. Brain areas associated with clinical and cognitive insight in psychotic disorders: A systematic review and meta-analysis. Neurosci Biobehav Rev 2020; 116:301-336. [PMID: 32569706 DOI: 10.1016/j.neubiorev.2020.06.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 03/04/2020] [Accepted: 06/13/2020] [Indexed: 02/06/2023]
Abstract
In the past years, ample interest in brain abnormalities related to clinical and cognitive insight in psychosis has contributed several neuroimaging studies to the literature. In the current study, published findings on the neural substrates of clinical and cognitive insight in psychosis are integrated by performing a systematic review and meta-analysis. Coordinate-based meta-analyses were performed with the parametric coordinate-based meta-analysis approach, non-coordinate based meta-analyses were conducted with the metafor package in R. Papers that could not be included in the meta-analyses were systematically reviewed. Thirty-seven studies were retrieved, of which 21 studies were included in meta-analyses. Poorer clinical insight was related to smaller whole brain gray and white matter volume and gray matter volume of the frontal gyri. Cognitive insight was predominantly positively associated with structure and function of the hippocampus and ventrolateral prefrontal cortex. Impaired clinical insight is not associated with abnormalities of isolated brain regions, but with spatially diffuse global and frontal abnormalities suggesting it might rely on a range of cognitive and self-evaluative processes. Cognitive insight is associated with specific areas and appears to rely more on retrieving and integrating self-related information.
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Affiliation(s)
- G H M Pijnenborg
- Department of Psychotic Disorders, GGZ Drenthe, Dennenweg 9, 9404 LA, Assen, the Netherlands; Department of Clinical and Developmental Neuropsychology and Experimental Psychopathology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, the Netherlands.
| | - D I Larabi
- University of Groningen, University Medical Center Groningen, Department of Biomedical Sciences of Cells and Systems, Cognitive Neuroscience Center, A. Deusinglaan 2, 9713 AW, Groningen, the Netherlands; Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Research Centre Jülich, Jülich, Germany; Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - P Xu
- Shenzhen Key Laboratory of Affective and Social Neuroscience, Center for Brain Disorders and Cognitive Sciences, Shenzhen University, Shenzhen 518060, China; Center for Neuroimaging, Shenzhen Institute of Neuroscience, Shenzhen 518054, China; Great Bay Neuroscience and Technology Research Institute (Hong Kong), Kwun Tong, Hong Kong
| | - I Hasson-Ohayon
- Department of Psychology, Bar-Ilan University, Ramat-Gan 5290002, Israel
| | - A E de Vos
- Department of Psychotic Disorders, GGZ Drenthe, Dennenweg 9, 9404 LA, Assen, the Netherlands
| | - B Ćurčić-Blake
- University of Groningen, University Medical Center Groningen, Department of Biomedical Sciences of Cells and Systems, Cognitive Neuroscience Center, A. Deusinglaan 2, 9713 AW, Groningen, the Netherlands
| | - A Aleman
- Department of Psychotic Disorders, GGZ Drenthe, Dennenweg 9, 9404 LA, Assen, the Netherlands; University of Groningen, University Medical Center Groningen, Department of Biomedical Sciences of Cells and Systems, Cognitive Neuroscience Center, A. Deusinglaan 2, 9713 AW, Groningen, the Netherlands; Shenzhen Key Laboratory of Affective and Social Neuroscience, Center for Brain Disorders and Cognitive Sciences, Shenzhen University, Shenzhen 518060, China
| | - L Van der Meer
- Department of Rehabilitation, Lentis Mental Health Care, PO box 128, 9470 KA, Zuidlaren, the Netherlands; Department of Clinical and Developmental Neuropsychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, the Netherlands
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6
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Ren P, Anthony M, Aarsland D, Wu D. Commentary: A posterior-to-anterior shift of brain functional dynamics in aging. Front Aging Neurosci 2020; 11:341. [PMID: 31920623 PMCID: PMC6916628 DOI: 10.3389/fnagi.2019.00341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 11/25/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ping Ren
- Shenzhen Mental Health Center, Shenzhen, China.,Department of Geriatric Psychiatry, Shenzhen Kangning, Shenzhen, China
| | - Mia Anthony
- School of Nursing, University of Rochester Medical Center, Rochester, NY, United States
| | - Dag Aarsland
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Donghui Wu
- Shenzhen Mental Health Center, Shenzhen, China.,Department of Geriatric Psychiatry, Shenzhen Kangning, Shenzhen, China
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7
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Abstract
The concept of insight is used to indicate the propensity of patients with schizophrenia and other severe mental disorders to recognize their illness and engage in treatment. Thus, insight may have notable consequences for the ill individual: Those who lack insight are at higher risk of nonadherence to treatments, negative clinical outcomes, and worse community functioning. Although insight is an intuitive concept, its essence remains difficult to capture. However, many rating scales are available to aid assessment, both for clinical and research purposes. Insight cannot be reduced to a symptom, a psychological mechanism, or a neuropsychological function. It is likely to have dynamic relationships with all these dimensions and with responses to personal events and contextual factors. In particular, social consequences of mental illness and explanatory models that are alternative to the medical model may fundamentally shape insight and treatment choice. Moreover, the cultural or individual stigmatization of mental illness may turn the acquisition of insight into a painful event and increase the risk of depression. Clinicians need to carefully evaluate and promote insight through a personalized approach to aid patient process of care and personal growth.
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Affiliation(s)
- Martino Belvederi Murri
- Psychiatric Clinic, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Science, University of Genoa, Genoa, Italy
- Istituto di Ricovero e Cura a Carattere Scientifico per l’Oncologia, Ospedale Policlinico San Martino, Genoa, Italy
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Mario Amore
- Psychiatric Clinic, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Science, University of Genoa, Genoa, Italy
- Istituto di Ricovero e Cura a Carattere Scientifico per l’Oncologia, Ospedale Policlinico San Martino, Genoa, Italy
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8
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Chang CC, Tzeng NS, Chao CY, Yeh CB, Chang HA. The Effects of Add-on Fronto-Temporal Transcranial Direct Current Stimulation (tDCS) on Auditory Verbal Hallucinations, Other Psychopathological Symptoms, and Insight in Schizophrenia: A Randomized, Double-Blind, Sham-Controlled Trial. Int J Neuropsychopharmacol 2018; 21:979-987. [PMID: 30107404 PMCID: PMC6209860 DOI: 10.1093/ijnp/pyy074] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 08/08/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The efficacy of fronto-temporal transcranial direct current stimulation in treating auditory verbal hallucinations and other psychopathological symptoms of schizophrenia patients has been examined in a small number of clinical trials with limited sample sizes, but the results are mixed. Fronto-temporal transcranial direct current stimulation has also been demonstrated to enhance patients' insight into their mental illness in an open-label pilot study. The current investigation aimed to investigate the therapeutic effects of fronto-temporal transcranial direct current stimulation on the severity of auditory verbal hallucinations, other schizophrenia symptoms, and insight in a large double blind, randomized, sham-controlled trial. METHODS Sixty patients with medication-refractory auditory verbal hallucinations were randomized over 2 conditions: transcranial direct current stimulation with 2-mA, twice-daily sessions for 5 consecutive days, with anodal stimulation to the left prefrontal cortex and cathodal stimulation to the left temporo-parietal junction, and sham treatment. RESULTS Fronto-temporal transcranial direct current stimulation failed to cause significant changes in the severity of auditory verbal hallucinations and other schizophrenia symptoms. The levels of insight into illness (effect size=0.511, P<.001) and positive symptoms (effect size=0.781, P<.001) were largely promoted by 5 days of transcranial direct current stimulation relative to sham treatment. The beneficial effects on the 2 insight dimensions remained 1 month after transcranial direct current stimulation. CONCLUSIONS Fronto-temporal transcranial direct current stimulation is not more effective for auditory verbal hallucinations and other schizophrenia symptoms than sham treatment. But the results of transcranial direct current stimulation-associated improvement in awareness of illness and positive symptoms show promise and provide a new direction for future research into insight promotion interventions in schizophrenia.
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Affiliation(s)
- Chuan-Chia Chang
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Nian-Sheng Tzeng
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan,Student Counseling Center, National Defense Medical Center, Taipei, Taiwan
| | - Che-Yi Chao
- Department of Psychiatry, Cardinal Tien Hospital, New Taipei, Taiwan
| | - Chin-Bin Yeh
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Hsin-An Chang
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan,Correspondence: Hsin-An Chang, MD, Department of Psychiatry, Tri-Service General Hospital, No. 325, Cheng-Kung Road, Sec. 2, Nei-Hu District, Taipei, 114, Taiwan, ROC ()
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9
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Lysaker PH, Pattison ML, Leonhardt BL, Phelps S, Vohs JL. Insight in schizophrenia spectrum disorders: relationship with behavior, mood and perceived quality of life, underlying causes and emerging treatments. World Psychiatry 2018; 17:12-23. [PMID: 29352540 PMCID: PMC5775127 DOI: 10.1002/wps.20508] [Citation(s) in RCA: 141] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Poor insight in schizophrenia is prevalent across cultures and phases of illness. In this review, we examine the recent research on the relationship of insight with behavior, mood and perceived quality of life, on its complex roots, and on the effects of existing and emerging treatments. This research indicates that poor insight predicts poorer treatment adherence and therapeutic alliance, higher symptom severity and more impaired community function, while good insight predicts a higher frequency of depression and demoralization, especially when coupled with stigma and social disadvantage. This research also suggests that poor insight may arise in response to biological, experiential, neuropsychological, social-cognitive, metacognitive and socio-political factors. Studies of the effects of existing and developing treatments indicate that they may influence insight. In the context of earlier research and historical models, these findings support an integrative model of poor insight. This model suggests that insight requires the integration of information about changes in internal states, external circumstances, others' perspectives and life trajectory as well as the multifaceted consequences and causes of each of those changes. One implication is that treatments should, beyond providing education, seek to assist persons with schizophrenia to integrate the broad range of complex and potentially deeply painful experiences which are associated with mental illness into their own personally meaningful, coherent and adaptive picture.
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Affiliation(s)
- Paul H Lysaker
- Roudebush VA Medical Center, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Michelle L Pattison
- College of Applied Behavioral Sciences, University of Indianapolis, Indianapolis, IN, USA
| | - Bethany L Leonhardt
- Indiana University School of Medicine, Eskenazi Health-Midtown Community Mental Health, Indianapolis, IN, USA
| | | | - Jenifer L Vohs
- Indiana University School of Medicine, Indianapolis, IN, USA
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10
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Orlov ND, O'Daly O, Tracy DK, Daniju Y, Hodsoll J, Valdearenas L, Rothwell J, Shergill SS. Stimulating thought: a functional MRI study of transcranial direct current stimulation in schizophrenia. Brain 2017; 140:2490-2497. [PMID: 29050384 DOI: 10.1093/brain/awx170] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 05/26/2017] [Indexed: 11/15/2022] Open
Abstract
Individuals with schizophrenia typically suffer a range of cognitive deficits, including prominent deficits in working memory and executive function. These difficulties are strongly predictive of functional outcomes, but there is a paucity of effective therapeutic interventions targeting these deficits. Transcranial direct current stimulation is a novel neuromodulatory technique with emerging evidence of potential pro-cognitive effects; however, there is limited understanding of its mechanism. This was a double-blind randomized sham controlled pilot study of transcranial direct current stimulation on a working memory (n-back) and executive function (Stroop) task in 28 individuals with schizophrenia using functional magnetic resonance imaging. Study participants received 30 min of real or sham transcranial direct current stimulation applied to the left frontal cortex. The 'real' and 'sham' groups did not differ in online working memory task performance, but the transcranial direct current stimulation group demonstrated significant improvement in performance at 24 h post-transcranial direct current stimulation. Transcranial direct current stimulation was associated with increased activation in the medial frontal cortex beneath the anode; showing a positive correlation with consolidated working memory performance 24 h post-stimulation. There was reduced activation in the left cerebellum in the transcranial direct current stimulation group, with no change in the middle frontal gyrus or parietal cortices. Improved performance on the executive function task was associated with reduced activity in the anterior cingulate cortex. Transcranial direct current stimulation modulated functional activation in local task-related regions, and in more distal nodes in the network. Transcranial direct current stimulation offers a potential novel approach to altering frontal cortical activity and exerting pro-cognitive effects in schizophrenia.
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Affiliation(s)
- Natasza D Orlov
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.,University of Roehampton, London SW15 5PU
| | - Owen O'Daly
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Derek K Tracy
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.,Oxleas National Health Service (NHS) Trust, London, UK
| | - Yusuf Daniju
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.,University of Roehampton, London SW15 5PU
| | - John Hodsoll
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Lorena Valdearenas
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.,South London and Maudsley NHS Trust, London, UK
| | - John Rothwell
- Institute of Neurology, University College London, UK
| | - Sukhi S Shergill
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.,South London and Maudsley NHS Trust, London, UK
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11
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Abstract
BACKGROUND Insight in schizophrenia is defined as awareness into illness, symptoms, and need for treatment and has long been associated with cognition, other psychopathological symptoms, and several adverse clinical and functional outcomes. However, the biological basis of insight is not clearly understood. OBJECTIVE The aim of this systematic review was to critically evaluate and summarize advances in the study of the biological basis of insight in schizophrenia and to identify gaps in this knowledge. METHODS A literature search of PubMed, CINAHL, PsycINFO, and EMBASE databases was conducted using search terms to identify articles relevant to the biology of insight in schizophrenia published in the last 6 years. Articles that focused on etiology of insight in schizophrenia and those that examined the neurobiology of insight in schizophrenia or psychoses were chosen for analysis. Articles on insight in conditions other than schizophrenia or psychoses and which did not investigate the neurobiological underpinnings of insight were excluded from the review. RESULTS Twenty-six articles met the inclusion criteria for this review. Of the 26 articles, 3 focused on cellular abnormalities and 23 were neuroimaging studies. Preliminary data identify the prefrontal cortex, cingulate cortex, and regions of the temporal and parietal lobe (precuneus, inferior parietal lobule) and hippocampus as the neural correlates of insight. DISCUSSION A growing body of literature attests to the neurobiological basis of insight in schizophrenia. Current evidence supports the neurobiological basis of insight in schizophrenia and identifies specific neural correlates for insight types and its dimensions. Further studies that examine the precise biological mechanisms of insight are needed to apply this knowledge to effective clinical intervention development.
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Sapara A, Ffytche DH, Cooke MA, Williams SCR, Kumari V. Voxel-based magnetic resonance imaging investigation of poor and preserved clinical insight in people with schizophrenia. World J Psychiatry 2016; 6:311-321. [PMID: 27679770 PMCID: PMC5031931 DOI: 10.5498/wjp.v6.i3.311] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 07/13/2016] [Indexed: 02/05/2023] Open
Abstract
AIM To define regional grey-matter abnormalities in schizophrenia patients with poor insight (Insight-), relative to patients with preserved clinical insight (Insight+), and healthy controls.
METHODS Forty stable schizophrenia outpatients (20 Insight- and 20 Insight+) and 20 healthy controls underwent whole brain magnetic resonance imaging (MRI). Insight in all patients was assessed using the Birchwood Insight Scale (BIS; a self-report measure). The two patient groups were pre-selected to match on most clinical and demographic parameters but, by design, they had markedly distinct BIS scores. Voxel-based morphometry employed in SPM8 was used to examine group differences in grey matter volumes across the whole brain.
RESULTS The three participant groups were comparable in age [F(2,57) = 0.34, P = 0.71] and the patient groups did not differ in age at illness onset [t(38) = 0.87, P = 0.39]. Insight- and Insight+ patient groups also did not differ in symptoms on the Positive and Negative Syndromes scale (PANSS): Positive symptoms [t(38) = 0.58, P = 0.57], negative symptoms [t(38) = 0.61, P = 0.55], general psychopathology [t(38) = 1.30, P = 0.20] and total PANSS scores [t(38) = 0.21, P = 0.84]. The two patient groups, as expected, varied significantly in the level of BIS-assessed insight [t(38) = 12.11, P < 0.001]. MRI results revealed lower fronto-temporal, parahippocampal, occipital and cerebellar grey matter volumes in Insight- patients, relative to Insight+ patients and healthy controls (for all clusters, family-wise error corrected P < 0.05). Insight+ patient and healthy controls did not differ significantly (P > 0.20) from each other.
CONCLUSION Our findings demonstrate a clear association between poor clinical insight and smaller fronto-temporal, occipital and cerebellar grey matter volumes in stable long-term schizophrenia patients.
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Alústiza I, Radua J, Albajes-Eizagirre A, Domínguez M, Aubá E, Ortuño F. Meta-Analysis of Functional Neuroimaging and Cognitive Control Studies in Schizophrenia: Preliminary Elucidation of a Core Dysfunctional Timing Network. Front Psychol 2016; 7:192. [PMID: 26925013 PMCID: PMC4756542 DOI: 10.3389/fpsyg.2016.00192] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 01/31/2016] [Indexed: 12/04/2022] Open
Abstract
Timing and other cognitive processes demanding cognitive control become interlinked when there is an increase in the level of difficulty or effort required. Both functions are interrelated and share neuroanatomical bases. A previous meta-analysis of neuroimaging studies found that people with schizophrenia had significantly lower activation, relative to normal controls, of most right hemisphere regions of the time circuit. This finding suggests that a pattern of disconnectivity of this circuit, particularly in the supplementary motor area, is a trait of this mental disease. We hypothesize that a dysfunctional temporal/cognitive control network underlies both cognitive and psychiatric symptoms of schizophrenia and that timing dysfunction is at the root of the cognitive deficits observed. The goal of our study was to look, in schizophrenia patients, for brain structures activated both by execution of cognitive tasks requiring increased effort and by performance of time perception tasks. We conducted a signed differential mapping (SDM) meta-analysis of functional neuroimaging studies in schizophrenia patients assessing the brain response to increasing levels of cognitive difficulty. Then, we performed a multimodal meta-analysis to identify common brain regions in the findings of that SDM meta-analysis and our previously-published activation likelihood estimate (ALE) meta-analysis of neuroimaging of time perception in schizophrenia patients. The current study supports the hypothesis that there exists an overlap between neural structures engaged by both timing tasks and non-temporal cognitive tasks of escalating difficulty in schizophrenia. The implication is that a deficit in timing can be considered as a trait marker of the schizophrenia cognitive profile.
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Affiliation(s)
- Irene Alústiza
- Department of Psychiatry and Clinical Psychology, Clínica Universidad de NavarraPamplona, Spain; Instituto de Investigación Sanitaria de NavarraNavarra, Spain
| | - Joaquim Radua
- Department of Psychosis Studies, Institute of Psychiatry, Kings CollegeLondon, UK; FIDMAG Germanes Hospitalaries Hospital Sant RafaelBarcelona, Spain; Centro de Investigación Biomédicaen Redde Salud MentalBarcelona, Spain
| | - Anton Albajes-Eizagirre
- FIDMAG Germanes Hospitalaries Hospital Sant RafaelBarcelona, Spain; Centro de Investigación Biomédicaen Redde Salud MentalBarcelona, Spain
| | - Manuel Domínguez
- Department of Psychiatry and Clinical Psychology, Clínica Universidad de NavarraPamplona, Spain; Instituto de Investigación Sanitaria de NavarraNavarra, Spain
| | - Enrique Aubá
- Department of Psychiatry and Clinical Psychology, Clínica Universidad de NavarraPamplona, Spain; Instituto de Investigación Sanitaria de NavarraNavarra, Spain
| | - Felipe Ortuño
- Department of Psychiatry and Clinical Psychology, Clínica Universidad de NavarraPamplona, Spain; Instituto de Investigación Sanitaria de NavarraNavarra, Spain
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Sapara A, ffytche DH, Cooke MA, Williams SC, Kumari V. Is it me? Verbal self-monitoring neural network and clinical insight in schizophrenia. Psychiatry Res 2015; 234:328-35. [PMID: 26549744 PMCID: PMC4834462 DOI: 10.1016/j.pscychresns.2015.10.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Revised: 09/30/2015] [Accepted: 10/01/2015] [Indexed: 01/12/2023]
Abstract
Self-monitoring, defined as the ability to distinguish between self-generated stimuli from other-generated ones, is known to be impaired in schizophrenia. This impairment has been theorised as the basis for many of the core psychotic symptoms, in particular, poor clinical insight. This study aimed to investigate verbal self-monitoring related neural substrates of preserved and poor clinical insight in schizophrenia. It involved 40 stable schizophrenia outpatients, 20 with preserved and 20 with poor insight, and 20 healthy participants. All participants underwent functional magnetic resonance imaging with brain coverage covering key areas in the self-monitoring network during a verbal self-monitoring task. Healthy participants showed higher performance accuracy and greater thalamic activity than both preserved and poor insight patient groups. Preserved insight patients showed higher activity in the putamen extending into the caudate, insula and inferior frontal gyrus, compared to poor insight patients, and in the anterior cingulate and medial frontal gyrus, compared to healthy participants. Poor insight patients did not show greater activity in any brain area compared to preserved insight patients or healthy participants. Future studies may pursue therapeutic avenues, such as meta-cognitive therapies to promote self-monitoring or targeted stimulation of relevant brain areas, as means of enhancing insight in schizophrenia.
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Affiliation(s)
- Adegboyega Sapara
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Dominic H. ffytche
- Department of Old Age Psychiatry and Department of Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Michael A. Cooke
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Steven C.R. Williams
- Department of Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Veena Kumari
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, UK.
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15
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Devi S, Rao NP, Badamath S, Chandrashekhar CR, Janardhan Reddy YC. Prevalence and clinical correlates of obsessive-compulsive disorder in schizophrenia. Compr Psychiatry 2015; 56:141-8. [PMID: 25308405 DOI: 10.1016/j.comppsych.2014.09.015] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 09/15/2014] [Accepted: 09/16/2014] [Indexed: 10/24/2022] Open
Abstract
Obsessive compulsive symptoms frequently occur in a substantial proportion of patients with schizophrenia. The term schizoobsessive has been proposed to delineate this subgroup of schizophrenia patients who present with obsessive-compulsive symptoms/disorder. However, whether this co-occurrence is more than just co-morbidity and represents a distinct subgroup remains controversial. A striking variation is noted across studies examining prevalence of obsessive-compulsive symptoms/disorder in schizophrenia patients and their impact on clinical profile of schizophrenia. Hence, in this study, we examined the prevalence of obsessive-compulsive symptoms/disorder in a large sample of consecutively hospitalized schizophrenia patients and compared the clinical and functional characteristics of schizophrenia patients with and without obsessive-compulsive symptoms/disorder. We evaluated 200 consecutive subjects with the DSM-IV diagnosis of schizophrenia using the Structured Clinical Interview for DSM-IV Axis I disorders, Positive and Negative Syndrome Scale, Yale-Brown Obsessive-Compulsive Scale, Brown Assessment of Beliefs Scale, Clinical Global Impression-Severity scale, Global Assessment of Functioning Scale, Family Interview for Genetic Studies and World Health Organization Quality of Life scale. The prevalence of obsessive-compulsive symptoms in patients with schizophrenia was 24% (n=48); 37 of them had obsessive-compulsive disorder (OCD) and 11 had obsessive-compulsive symptoms not amounting to a clinical diagnosis of OCD (OCS). Schizophrenia patients with OCS/OCD had an earlier age at onset of schizophrenia symptoms, lower positive symptoms score, higher co-morbidity with Axis II disorders, higher occurrence of OCD in family and better quality of life. Findings of the study indicate a higher prevalence of OCS/OCD in schizophrenia. Schizophrenia patients with and without OCS/OCD have comparable clinical profile with few exceptions. High rates of OCD in first degree relatives suggest possible genetic contributions and differences in neurobiology. Finally, evidence to consider schizoobsessive as a distinct diagnostic entity is inconclusive and warrants further studies.
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Affiliation(s)
- Sugnyani Devi
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Naren P Rao
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India; Centre for Neuroscience, Indian Institute of Science, Bangalore, India
| | - Suresh Badamath
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - C R Chandrashekhar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Y C Janardhan Reddy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India.
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Zhou Y, Wang Z, Zuo XN, Zhang H, Wang Y, Jiang T, Liu Z. Hyper-coupling between working memory task-evoked activations and amplitude of spontaneous fluctuations in first-episode schizophrenia. Schizophr Res 2014; 159:80-9. [PMID: 25132644 DOI: 10.1016/j.schres.2014.07.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 04/16/2014] [Accepted: 07/20/2014] [Indexed: 12/15/2022]
Abstract
Working memory (WM) deficit is an important component of impaired cognition in schizophrenia. However, between-studies inconsistencies as to the specific functional substrate imply that inter-individual variability (IIV) in the WM performance is associated with IIV in brain activity in schizophrenia. To examine the neural substrate of this WM IIV, we studied whether the neural mechanisms that underlie individual differences in WM capacity are the same in schizophrenia patients and healthy people. We correlated the IIV of the task-evoked brain activity and task performance during an n-back WM task with the IIV of the moment-to-moment variability in intrinsic resting-state activity, as measured by the amplitude of low-frequency fluctuations (ALFFs) and further compared this relationship between 17 patients with first-episode schizophrenia (FES) and 18 healthy controls. Between-group comparisons of the correlation patterns indicated aberrant ALFF-WM activation correlations and ALFF-WM performance correlations in the FES patients, but no significant changes were detected in any single measurement of these three characteristics. Specifically, we found increased positive ALFF-WM activation correlations in the bilateral lateral prefrontal cortices, posterior parietal cortices and fusiform gyri in the FES patients. We also observed significant increases in positive ALFF-WM performance correlations in the bilateral ventromedial prefrontal cortices in the FES patients. This hyper-coupling between the ALFF and fMRI measures during a WM task may indicate that it was difficult for the patients to detach themselves from one state to transition to another and suggests that the inefficient cortical function in schizophrenia stems from the intrinsic functional architecture of the brain.
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Affiliation(s)
- Yuan Zhou
- Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China; Magnetic Resonance Imaging Research Center, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China
| | - Zheng Wang
- Institute of Mental Health, Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Xi-Nian Zuo
- Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China; Magnetic Resonance Imaging Research Center, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China
| | - Huiran Zhang
- Institute of Mental Health, Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Yun Wang
- Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China
| | - Tianzi Jiang
- Brainnetome Center, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China; National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China
| | - Zhening Liu
- Institute of Mental Health, Second Xiangya Hospital, Central South University, Changsha 410011, China.
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