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Chen YH, Stone-Howell B, Edgar JC, Huang M, Wootton C, Hunter MA, Lu BY, Sadek JR, Miller GA, Cañive JM. Frontal slow-wave activity as a predictor of negative symptoms, cognition and functional capacity in schizophrenia. Br J Psychiatry 2016; 208:160-7. [PMID: 26206861 PMCID: PMC4837382 DOI: 10.1192/bjp.bp.114.156075] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 11/04/2014] [Accepted: 11/08/2014] [Indexed: 12/30/2022]
Abstract
BACKGROUND Increased temporal and frontal slow-wave delta (1-4 Hz) and theta (4-7 Hz) activities are the most consistent resting-state neural abnormalities reported in schizophrenia. The frontal lobe is associated with negative symptoms and cognitive abilities such as attention, with negative symptoms and impaired attention associated with poor functional capacity. AIMS To establish whether frontal dysfunction, as indexed by slowing, would be associated with functional impairments. METHOD Eyes-closed magnetoencephalography data were collected in 41 participants with schizophrenia and 37 healthy controls, and frequency-domain source imaging localised delta and theta activity. RESULTS Elevated delta and theta activity in right frontal and right temporoparietal regions was observed in the schizophrenia v. CONTROL GROUP In schizophrenia, right-frontal delta activity was uniquely associated with negative but not positive symptoms. In the full sample, increased right-frontal delta activity predicted poorer attention and functional capacity. CONCLUSIONS Our findings suggest that treatment-associated decreases in slow-wave activity could be accompanied by improved functional outcome and thus better prognosis.
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Affiliation(s)
- Yu-Han Chen
- Yu-Han Chen, PhD, The Children's Hospital of Philadelphia and University of Pennsylvania, Department of Radiology, Philadelphia; Breannan Stone-Howell, MS, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, and The University of New Mexico School of Medicine, Department of Psychiatry, Albuquerque, New Mexico; J. Christopher Edgar, PhD, The Children's Hospital of Philadelphia and University of Pennsylvania, Department of Radiology, Philadelphia; Mingxiong Huang, PhD, University of California, San Diego, Department of Radiology, and San Diego VA Healthcare System, Department of Radiology, San Diego, California; Cassandra Wootton, BS, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, and The University of New Mexico School of Medicine, Department of Psychiatry, Albuquerque, New Mexico; Michael A. Hunter, BS, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, The University of New Mexico School of Medicine, Department of Psychiatry and Department of Psychology, Albuquerque, New Mexico; Brett Y. Lu, MD, PhD, The University of Hawaii at Manoa, Department of Psychiatry, Honolulu, Hawaii; Joseph R. Sadek, PhD, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, New Mexico; Gregory A. Miller, PhD, University of California, Los Angeles, Department of Psychology, Los Angeles, California; José M. Canĩve, MD, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, and The University of New Mexico School of Medicine, Department of Psychiatry, Albuquerque, New Mexico, USA
| | - Breannan Stone-Howell
- Yu-Han Chen, PhD, The Children's Hospital of Philadelphia and University of Pennsylvania, Department of Radiology, Philadelphia; Breannan Stone-Howell, MS, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, and The University of New Mexico School of Medicine, Department of Psychiatry, Albuquerque, New Mexico; J. Christopher Edgar, PhD, The Children's Hospital of Philadelphia and University of Pennsylvania, Department of Radiology, Philadelphia; Mingxiong Huang, PhD, University of California, San Diego, Department of Radiology, and San Diego VA Healthcare System, Department of Radiology, San Diego, California; Cassandra Wootton, BS, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, and The University of New Mexico School of Medicine, Department of Psychiatry, Albuquerque, New Mexico; Michael A. Hunter, BS, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, The University of New Mexico School of Medicine, Department of Psychiatry and Department of Psychology, Albuquerque, New Mexico; Brett Y. Lu, MD, PhD, The University of Hawaii at Manoa, Department of Psychiatry, Honolulu, Hawaii; Joseph R. Sadek, PhD, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, New Mexico; Gregory A. Miller, PhD, University of California, Los Angeles, Department of Psychology, Los Angeles, California; José M. Canĩve, MD, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, and The University of New Mexico School of Medicine, Department of Psychiatry, Albuquerque, New Mexico, USA
| | - J Christopher Edgar
- Yu-Han Chen, PhD, The Children's Hospital of Philadelphia and University of Pennsylvania, Department of Radiology, Philadelphia; Breannan Stone-Howell, MS, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, and The University of New Mexico School of Medicine, Department of Psychiatry, Albuquerque, New Mexico; J. Christopher Edgar, PhD, The Children's Hospital of Philadelphia and University of Pennsylvania, Department of Radiology, Philadelphia; Mingxiong Huang, PhD, University of California, San Diego, Department of Radiology, and San Diego VA Healthcare System, Department of Radiology, San Diego, California; Cassandra Wootton, BS, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, and The University of New Mexico School of Medicine, Department of Psychiatry, Albuquerque, New Mexico; Michael A. Hunter, BS, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, The University of New Mexico School of Medicine, Department of Psychiatry and Department of Psychology, Albuquerque, New Mexico; Brett Y. Lu, MD, PhD, The University of Hawaii at Manoa, Department of Psychiatry, Honolulu, Hawaii; Joseph R. Sadek, PhD, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, New Mexico; Gregory A. Miller, PhD, University of California, Los Angeles, Department of Psychology, Los Angeles, California; José M. Canĩve, MD, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, and The University of New Mexico School of Medicine, Department of Psychiatry, Albuquerque, New Mexico, USA
| | - Mingxiong Huang
- Yu-Han Chen, PhD, The Children's Hospital of Philadelphia and University of Pennsylvania, Department of Radiology, Philadelphia; Breannan Stone-Howell, MS, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, and The University of New Mexico School of Medicine, Department of Psychiatry, Albuquerque, New Mexico; J. Christopher Edgar, PhD, The Children's Hospital of Philadelphia and University of Pennsylvania, Department of Radiology, Philadelphia; Mingxiong Huang, PhD, University of California, San Diego, Department of Radiology, and San Diego VA Healthcare System, Department of Radiology, San Diego, California; Cassandra Wootton, BS, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, and The University of New Mexico School of Medicine, Department of Psychiatry, Albuquerque, New Mexico; Michael A. Hunter, BS, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, The University of New Mexico School of Medicine, Department of Psychiatry and Department of Psychology, Albuquerque, New Mexico; Brett Y. Lu, MD, PhD, The University of Hawaii at Manoa, Department of Psychiatry, Honolulu, Hawaii; Joseph R. Sadek, PhD, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, New Mexico; Gregory A. Miller, PhD, University of California, Los Angeles, Department of Psychology, Los Angeles, California; José M. Canĩve, MD, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, and The University of New Mexico School of Medicine, Department of Psychiatry, Albuquerque, New Mexico, USA
| | - Cassandra Wootton
- Yu-Han Chen, PhD, The Children's Hospital of Philadelphia and University of Pennsylvania, Department of Radiology, Philadelphia; Breannan Stone-Howell, MS, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, and The University of New Mexico School of Medicine, Department of Psychiatry, Albuquerque, New Mexico; J. Christopher Edgar, PhD, The Children's Hospital of Philadelphia and University of Pennsylvania, Department of Radiology, Philadelphia; Mingxiong Huang, PhD, University of California, San Diego, Department of Radiology, and San Diego VA Healthcare System, Department of Radiology, San Diego, California; Cassandra Wootton, BS, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, and The University of New Mexico School of Medicine, Department of Psychiatry, Albuquerque, New Mexico; Michael A. Hunter, BS, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, The University of New Mexico School of Medicine, Department of Psychiatry and Department of Psychology, Albuquerque, New Mexico; Brett Y. Lu, MD, PhD, The University of Hawaii at Manoa, Department of Psychiatry, Honolulu, Hawaii; Joseph R. Sadek, PhD, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, New Mexico; Gregory A. Miller, PhD, University of California, Los Angeles, Department of Psychology, Los Angeles, California; José M. Canĩve, MD, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, and The University of New Mexico School of Medicine, Department of Psychiatry, Albuquerque, New Mexico, USA
| | - Michael A Hunter
- Yu-Han Chen, PhD, The Children's Hospital of Philadelphia and University of Pennsylvania, Department of Radiology, Philadelphia; Breannan Stone-Howell, MS, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, and The University of New Mexico School of Medicine, Department of Psychiatry, Albuquerque, New Mexico; J. Christopher Edgar, PhD, The Children's Hospital of Philadelphia and University of Pennsylvania, Department of Radiology, Philadelphia; Mingxiong Huang, PhD, University of California, San Diego, Department of Radiology, and San Diego VA Healthcare System, Department of Radiology, San Diego, California; Cassandra Wootton, BS, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, and The University of New Mexico School of Medicine, Department of Psychiatry, Albuquerque, New Mexico; Michael A. Hunter, BS, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, The University of New Mexico School of Medicine, Department of Psychiatry and Department of Psychology, Albuquerque, New Mexico; Brett Y. Lu, MD, PhD, The University of Hawaii at Manoa, Department of Psychiatry, Honolulu, Hawaii; Joseph R. Sadek, PhD, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, New Mexico; Gregory A. Miller, PhD, University of California, Los Angeles, Department of Psychology, Los Angeles, California; José M. Canĩve, MD, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, and The University of New Mexico School of Medicine, Department of Psychiatry, Albuquerque, New Mexico, USA
| | - Brett Y Lu
- Yu-Han Chen, PhD, The Children's Hospital of Philadelphia and University of Pennsylvania, Department of Radiology, Philadelphia; Breannan Stone-Howell, MS, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, and The University of New Mexico School of Medicine, Department of Psychiatry, Albuquerque, New Mexico; J. Christopher Edgar, PhD, The Children's Hospital of Philadelphia and University of Pennsylvania, Department of Radiology, Philadelphia; Mingxiong Huang, PhD, University of California, San Diego, Department of Radiology, and San Diego VA Healthcare System, Department of Radiology, San Diego, California; Cassandra Wootton, BS, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, and The University of New Mexico School of Medicine, Department of Psychiatry, Albuquerque, New Mexico; Michael A. Hunter, BS, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, The University of New Mexico School of Medicine, Department of Psychiatry and Department of Psychology, Albuquerque, New Mexico; Brett Y. Lu, MD, PhD, The University of Hawaii at Manoa, Department of Psychiatry, Honolulu, Hawaii; Joseph R. Sadek, PhD, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, New Mexico; Gregory A. Miller, PhD, University of California, Los Angeles, Department of Psychology, Los Angeles, California; José M. Canĩve, MD, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, and The University of New Mexico School of Medicine, Department of Psychiatry, Albuquerque, New Mexico, USA
| | - Joseph R Sadek
- Yu-Han Chen, PhD, The Children's Hospital of Philadelphia and University of Pennsylvania, Department of Radiology, Philadelphia; Breannan Stone-Howell, MS, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, and The University of New Mexico School of Medicine, Department of Psychiatry, Albuquerque, New Mexico; J. Christopher Edgar, PhD, The Children's Hospital of Philadelphia and University of Pennsylvania, Department of Radiology, Philadelphia; Mingxiong Huang, PhD, University of California, San Diego, Department of Radiology, and San Diego VA Healthcare System, Department of Radiology, San Diego, California; Cassandra Wootton, BS, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, and The University of New Mexico School of Medicine, Department of Psychiatry, Albuquerque, New Mexico; Michael A. Hunter, BS, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, The University of New Mexico School of Medicine, Department of Psychiatry and Department of Psychology, Albuquerque, New Mexico; Brett Y. Lu, MD, PhD, The University of Hawaii at Manoa, Department of Psychiatry, Honolulu, Hawaii; Joseph R. Sadek, PhD, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, New Mexico; Gregory A. Miller, PhD, University of California, Los Angeles, Department of Psychology, Los Angeles, California; José M. Canĩve, MD, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, and The University of New Mexico School of Medicine, Department of Psychiatry, Albuquerque, New Mexico, USA
| | - Gregory A Miller
- Yu-Han Chen, PhD, The Children's Hospital of Philadelphia and University of Pennsylvania, Department of Radiology, Philadelphia; Breannan Stone-Howell, MS, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, and The University of New Mexico School of Medicine, Department of Psychiatry, Albuquerque, New Mexico; J. Christopher Edgar, PhD, The Children's Hospital of Philadelphia and University of Pennsylvania, Department of Radiology, Philadelphia; Mingxiong Huang, PhD, University of California, San Diego, Department of Radiology, and San Diego VA Healthcare System, Department of Radiology, San Diego, California; Cassandra Wootton, BS, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, and The University of New Mexico School of Medicine, Department of Psychiatry, Albuquerque, New Mexico; Michael A. Hunter, BS, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, The University of New Mexico School of Medicine, Department of Psychiatry and Department of Psychology, Albuquerque, New Mexico; Brett Y. Lu, MD, PhD, The University of Hawaii at Manoa, Department of Psychiatry, Honolulu, Hawaii; Joseph R. Sadek, PhD, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, New Mexico; Gregory A. Miller, PhD, University of California, Los Angeles, Department of Psychology, Los Angeles, California; José M. Canĩve, MD, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, and The University of New Mexico School of Medicine, Department of Psychiatry, Albuquerque, New Mexico, USA
| | - José M Cañive
- Yu-Han Chen, PhD, The Children's Hospital of Philadelphia and University of Pennsylvania, Department of Radiology, Philadelphia; Breannan Stone-Howell, MS, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, and The University of New Mexico School of Medicine, Department of Psychiatry, Albuquerque, New Mexico; J. Christopher Edgar, PhD, The Children's Hospital of Philadelphia and University of Pennsylvania, Department of Radiology, Philadelphia; Mingxiong Huang, PhD, University of California, San Diego, Department of Radiology, and San Diego VA Healthcare System, Department of Radiology, San Diego, California; Cassandra Wootton, BS, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, and The University of New Mexico School of Medicine, Department of Psychiatry, Albuquerque, New Mexico; Michael A. Hunter, BS, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, The University of New Mexico School of Medicine, Department of Psychiatry and Department of Psychology, Albuquerque, New Mexico; Brett Y. Lu, MD, PhD, The University of Hawaii at Manoa, Department of Psychiatry, Honolulu, Hawaii; Joseph R. Sadek, PhD, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, New Mexico; Gregory A. Miller, PhD, University of California, Los Angeles, Department of Psychology, Los Angeles, California; José M. Canĩve, MD, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, and The University of New Mexico School of Medicine, Department of Psychiatry, Albuquerque, New Mexico, USA
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9
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Huang MX, Nichols S, Baker DG, Robb A, Angeles A, Yurgil KA, Drake A, Levy M, Song T, McLay R, Theilmann RJ, Diwakar M, Risbrough VB, Ji Z, Huang CW, Chang DG, Harrington DL, Muzzatti L, Canive JM, Christopher Edgar J, Chen YH, Lee RR. Single-subject-based whole-brain MEG slow-wave imaging approach for detecting abnormality in patients with mild traumatic brain injury. NEUROIMAGE-CLINICAL 2014; 5:109-19. [PMID: 25009772 PMCID: PMC4087185 DOI: 10.1016/j.nicl.2014.06.004] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Revised: 06/10/2014] [Accepted: 06/11/2014] [Indexed: 01/13/2023]
Abstract
Traumatic brain injury (TBI) is a leading cause of sustained impairment in military and civilian populations. However, mild TBI (mTBI) can be difficult to detect using conventional MRI or CT. Injured brain tissues in mTBI patients generate abnormal slow-waves (1–4 Hz) that can be measured and localized by resting-state magnetoencephalography (MEG). In this study, we develop a voxel-based whole-brain MEG slow-wave imaging approach for detecting abnormality in patients with mTBI on a single-subject basis. A normative database of resting-state MEG source magnitude images (1–4 Hz) from 79 healthy control subjects was established for all brain voxels. The high-resolution MEG source magnitude images were obtained by our recent Fast-VESTAL method. In 84 mTBI patients with persistent post-concussive symptoms (36 from blasts, and 48 from non-blast causes), our method detected abnormalities at the positive detection rates of 84.5%, 86.1%, and 83.3% for the combined (blast-induced plus with non-blast causes), blast, and non-blast mTBI groups, respectively. We found that prefrontal, posterior parietal, inferior temporal, hippocampus, and cerebella areas were particularly vulnerable to head trauma. The result also showed that MEG slow-wave generation in prefrontal areas positively correlated with personality change, trouble concentrating, affective lability, and depression symptoms. Discussion is provided regarding the neuronal mechanisms of MEG slow-wave generation due to deafferentation caused by axonal injury and/or blockages/limitations of cholinergic transmission in TBI. This study provides an effective way for using MEG slow-wave source imaging to localize affected areas and supports MEG as a tool for assisting the diagnosis of mTBI. A voxel-based whole-brain MEG slow-wave source imaging method for mild TBI. The new approach showed 84.5% positive detection rate in 84 mild TBI patients. The new approach detected loci of injury in mild TBI patients on a single-subject basis. MEG slow-wave source imaging revealed brain areas vulnerable to mild TBI. MEG slow-wave generations correlated with mild TBI symptoms.
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Affiliation(s)
- Ming-Xiong Huang
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA ; Department of Radiology, University of California, San Diego, CA, USA
| | - Sharon Nichols
- Department of Neuroscience, University of California, San Diego, CA, USA
| | - Dewleen G Baker
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA ; Department of Psychiatry, University of California, San Diego, CA, USA ; VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA
| | - Ashley Robb
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA
| | - Annemarie Angeles
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA
| | - Kate A Yurgil
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA
| | | | - Michael Levy
- Rady Children's Hospital San Diego, University of California, San Diego, CA, USA
| | - Tao Song
- Department of Radiology, University of California, San Diego, CA, USA
| | - Robert McLay
- Naval Medical Center San Diego, San Diego, CA, USA
| | | | - Mithun Diwakar
- Department of Radiology, University of California, San Diego, CA, USA
| | - Victoria B Risbrough
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA ; Department of Psychiatry, University of California, San Diego, CA, USA ; VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA
| | - Zhengwei Ji
- Department of Radiology, University of California, San Diego, CA, USA
| | | | - Douglas G Chang
- Department of Orthopaedics, University of California, San Diego, CA, USA
| | - Deborah L Harrington
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA ; Department of Radiology, University of California, San Diego, CA, USA
| | - Laura Muzzatti
- Department of Radiology, University of California, San Diego, CA, USA
| | - Jose M Canive
- Psychiatry Research, New Mexico VA Healthcare System, Albuquerque, NM, USA ; Departments of Psychiatry and Neurosciences, University of New Mexico, Albuquerque, NM, USA
| | - J Christopher Edgar
- The Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA, USA
| | - Yu-Han Chen
- Departments of Psychiatry and Neurosciences, University of New Mexico, Albuquerque, NM, USA ; The Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA, USA
| | - Roland R Lee
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA ; Department of Radiology, University of California, San Diego, CA, USA
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