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Yang Z, Xiao S, Su T, Gong J, Qi Z, Chen G, Chen P, Tang G, Fu S, Yan H, Huang L, Wang Y. A multimodal meta-analysis of regional functional and structural brain abnormalities in obsessive-compulsive disorder. Eur Arch Psychiatry Clin Neurosci 2024; 274:165-180. [PMID: 37000246 DOI: 10.1007/s00406-023-01594-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 03/14/2023] [Indexed: 04/01/2023]
Abstract
Numerous neuroimaging studies of resting-state functional imaging and voxel-based morphometry (VBM) have revealed abnormalities in specific brain regions in obsessive-compulsive disorder (OCD), but results have been inconsistent. We conducted a whole-brain voxel-wise meta-analysis on resting-state functional imaging and VBM studies that investigated differences of functional activity and gray matter volume (GMV) between patients with OCD and healthy controls (HCs) using seed-based d mapping (SDM) software. A total of 41 independent studies (51 datasets) for resting-state functional imaging and 42 studies (46 datasets) for VBM were included by a systematic literature search. Overall, patients with OCD displayed increased spontaneous functional activity in the bilateral inferior frontal gyrus (IFG) (extending to the bilateral insula) and bilateral medial prefrontal cortex/anterior cingulate cortex (mPFC/ACC), as well as decreased spontaneous functional activity in the bilateral paracentral lobule, bilateral cerebellum, left caudate nucleus, left inferior parietal gyri, and right precuneus cortex. For the VBM meta-analysis, patients with OCD displayed increased GMV in the bilateral thalamus (extending to the bilateral cerebellum), right striatum, and decreased GMV in the bilateral mPFC/ACC and left IFG (extending to the left insula). The conjunction analyses found that the bilateral mPFC/ACC, left IFG (extending to the left insula) showed decreased GMV with increased intrinsic function in OCD patients compared to HCs. This meta-analysis demonstrated that OCD exhibits abnormalities in both function and structure in the bilateral mPFC/ACC, insula, and IFG. A few regions exhibited only functional or only structural abnormalities in OCD, such as the default mode network, striatum, sensorimotor areas, and cerebellum. It may provide useful insights for understanding the underlying pathophysiology of OCD and developing more targeted and efficacious treatment and intervention strategies.
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Affiliation(s)
- Zibin Yang
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
- Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, 510630, China
| | - Shu Xiao
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
- Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, 510630, China
| | - Ting Su
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
- Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, 510630, China
| | - Jiayin Gong
- Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, 510630, China
- Department of Radiology, Six Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510655, China
| | - Zhangzhang Qi
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
- Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, 510630, China
| | - Guanmao Chen
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
- Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, 510630, China
| | - Pan Chen
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
- Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, 510630, China
| | - Guixian Tang
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
- Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, 510630, China
| | - SiYing Fu
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
- Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, 510630, China
| | - Hong Yan
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
- Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, 510630, China
| | - Li Huang
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
- Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, 510630, China
| | - Ying Wang
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China.
- Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, 510630, China.
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Lefebvre A, Traut N, Pedoux A, Maruani A, Beggiato A, Elmaleh M, Germanaud D, Amestoy A, Ly-Le Moal M, Chatham C, Murtagh L, Bouvard M, Alisson M, Leboyer M, Bourgeron T, Toro R, Dumas G, Moreau C, Delorme R. Exploring the multidimensional nature of repetitive and restricted behaviors and interests (RRBI) in autism: neuroanatomical correlates and clinical implications. Mol Autism 2023; 14:45. [PMID: 38012709 PMCID: PMC10680239 DOI: 10.1186/s13229-023-00576-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 11/06/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Repetitive and restricted behaviors and interests (RRBI) are core symptoms of autism with a complex entity and are commonly categorized into 'motor-driven' and 'cognitively driven'. RRBI symptomatology depends on the individual's clinical environment limiting the understanding of RRBI physiology, particularly their associated neuroanatomical structures. The complex RRBI heterogeneity needs to explore the whole RRBI spectrum by integrating the clinical context [autistic individuals, their relatives and typical developing (TD) individuals]. We hypothesized that different RRBI dimensions would emerge by exploring the whole spectrum of RRBI and that these dimensions are associated with neuroanatomical signatures-involving cortical and subcortical areas. METHOD A sample of 792 individuals composed of 267 autistic subjects, their 370 first-degree relatives and 155 TD individuals was enrolled in the study. We assessed the whole patterns of RRBI in each individual by using the Repetitive Behavior Scale-Revised and the Yale-Brown Obsessive Compulsive Scale. We estimated brain volumes using MRI scanner for a subsample of the subjects (n = 152, 42 ASD, 89 relatives and 13 TD). We first investigated the dimensionality of RRBI by performing a principal component analysis on all items of these scales and included all the sampling population. We then explored the relationship between RRBI-derived factors with brain volumes using linear regression models. RESULTS We identified 3 main factors (with 30.3% of the RRBI cumulative variance): Factor 1 (FA1, 12.7%) reflected mainly the 'motor-driven' RRBI symptoms; Factor 2 and 3 (respectively, 8.8% and 7.9%) gathered mainly Y-BOCS related items and represented the 'cognitively driven' RRBI symptoms. These three factors were significantly associated with the right/left putamen volumes but with opposite effects: FA1 was negatively associated with an increased volume of the right/left putamen conversely to FA2 and FA3 (all uncorrected p < 0.05). FA1 was negatively associated with the left amygdala (uncorrected p < 0.05), and FA2 was positively associated with the left parietal structure (uncorrected p = 0.001). CONCLUSION Our results suggested 3 coherent RRBI dimensions involving the putamen commonly and other structures according to the RRBI dimension. The exploration of the putamen's integrative role in RSBI needs to be strengthened in further studies.
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Affiliation(s)
- Aline Lefebvre
- Fondation Vallée, GHT Paris Sud, Hospital of Child and Adolescent Psychiatry, Gentilly, France.
- UMR 3571 CNRS, Human Genetics and Cognitive Functions, Institut Pasteur, Paris, France.
- UNIACT Neurospin - INSERM UMR 1129, CEA, Saclay, France.
- Department of Adult Psychiatry, Henri Mondor and Albert Chenevier Hospital, Créteil, France.
- Faculty of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, France.
| | - Nicolas Traut
- Unité de Neuroanatomie Appliquée et Théorique, Institut Pasteur, Paris, France
| | - Amandine Pedoux
- Department of Child and Adolescent Psychiatry, Robert Debré Hospital, APHP, Paris, France
| | - Anna Maruani
- UMR 3571 CNRS, Human Genetics and Cognitive Functions, Institut Pasteur, Paris, France
- Department of Child and Adolescent Psychiatry, Robert Debré Hospital, APHP, Paris, France
| | - Anita Beggiato
- UMR 3571 CNRS, Human Genetics and Cognitive Functions, Institut Pasteur, Paris, France
- Department of Child and Adolescent Psychiatry, Robert Debré Hospital, APHP, Paris, France
| | - Monique Elmaleh
- Department of Pediatric Radiology, Robert-Debré Hospital, APHP, Paris, France
| | - David Germanaud
- UNIACT Neurospin - INSERM UMR 1129, CEA, Saclay, France
- Department of Clinical Genetics, Robert Debré Hospital, APHP, Paris, France
- Center for Research and Interdisciplinarity (CRI), Université Paris Cité, Paris, France
| | - Anouck Amestoy
- Autism Expert Center, Charles Perrens Hospital, Bordeaux, France
- Fondation FondaMental, French National Science Foundation, Créteil, France
| | | | - Christopher Chatham
- Roche Pharma Research and Early Development, Neuroscience and Rare Diseases, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Lorraine Murtagh
- Roche Pharma Research and Early Development, Neuroscience and Rare Diseases, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Manuel Bouvard
- Autism Expert Center, Charles Perrens Hospital, Bordeaux, France
- Fondation FondaMental, French National Science Foundation, Créteil, France
| | - Marianne Alisson
- Department of Pediatric Radiology, Robert-Debré Hospital, APHP, Paris, France
| | - Marion Leboyer
- Fondation FondaMental, French National Science Foundation, Créteil, France
- Institut National de la Santé et de la Recherche Médicale (INSERM), U955, Institut Mondor de Recherche Biomédicale, Psychiatrie Translationnelle, Créteil, France
| | - Thomas Bourgeron
- UMR 3571 CNRS, Human Genetics and Cognitive Functions, Institut Pasteur, Paris, France
- Université Paris Cité, Paris, France
| | - Roberto Toro
- Unité de Neuroanatomie Appliquée et Théorique, Institut Pasteur, Paris, France
| | - Guillaume Dumas
- Department of Psychiatry, Université de Montreal, CHU Ste Justine Hospital, Montreal, QC, Canada
| | - Clara Moreau
- UMR 3571 CNRS, Human Genetics and Cognitive Functions, Institut Pasteur, Paris, France
- Imaging Genetics Center, Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Richard Delorme
- Fondation Vallée, GHT Paris Sud, Hospital of Child and Adolescent Psychiatry, Gentilly, France
- UMR 3571 CNRS, Human Genetics and Cognitive Functions, Institut Pasteur, Paris, France
- Fondation FondaMental, French National Science Foundation, Créteil, France
- Université Paris Cité, Paris, France
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Mendelian randomization analyses support causal relationships between brain imaging-derived phenotypes and risk of psychiatric disorders. Nat Neurosci 2022; 25:1519-1527. [PMID: 36216997 DOI: 10.1038/s41593-022-01174-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 08/29/2022] [Indexed: 01/13/2023]
Abstract
Observational studies have reported the correlations between brain imaging-derived phenotypes (IDPs) and psychiatric disorders; however, whether the relationships are causal is uncertain. We conducted bidirectional two-sample Mendelian randomization (MR) analyses to explore the causalities between 587 reliable IDPs (N = 33,224 individuals) and 10 psychiatric disorders (N = 9,725 to 161,405). We identified nine IDPs for which there was evidence of a causal influence on risk of schizophrenia, anorexia nervosa and bipolar disorder. For example, 1 s.d. increase in the orientation dispersion index of the forceps major was associated with 32% lower odds of schizophrenia risk. Reverse MR indicated that only genetically predicted schizophrenia was positively associated with two IDPs, the cortical surface area and the volume of the right pars orbitalis. We established the BrainMR database ( http://www.bigc.online/BrainMR/ ) to share our results. Our findings provide potential strategies for the prediction and intervention for psychiatric disorder risk at the brain-imaging level.
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Besiroglu L, Zalesky A, Kasal MI, Dikmeer N, Bilge A, Durmaz E, Polat S, Gelal F, Zorlu N. Cortical thickness and surface area in patients with obsessive compulsive disorder and their unaffected siblings. Brain Imaging Behav 2022; 16:1946-1953. [PMID: 35867324 DOI: 10.1007/s11682-022-00660-7] [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: 11/04/2020] [Revised: 02/07/2022] [Accepted: 03/07/2022] [Indexed: 11/02/2022]
Abstract
Little is known about the underlying neurobiological mechanisms in patients with obsessive-compulsive disorder (OCD). We aimed to examine cortical thickness and surface area in individuals with OCD and their unaffected siblings, comparing them to healthy controls. 30 patients with OCD, 21 unaffected siblings (SIB) and 30 controls underwent structural magnetic resonance imaging. Structural images were analyzed using the FreeSurfer software package (version 6.0). Compared to healthy controls, both OCD and SIB groups showed significantly lower cortical thickness in the right anterior insula. Surface areas of the superior frontal gyrus, paracentral gyrus and precuneus of the right hemisphere were also reduced in OCD patients compared to controls. There were no significant differences in cortical thickness and surface area between the OCD and SIB groups. We did not detect any significant differences in subcortical volumes between groups. Lower cortical thickness in the right anterior insula in both OCD patients and unaffected siblings may represent a potential structural endophenotype for OCD.
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Affiliation(s)
- Lutfullah Besiroglu
- Department of Psychiatry, Ataturk Education and Research Hospital, Katip Celebi University, Izmir, Turkey
| | - Andrew Zalesky
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, The University of Melbourne and Melbourne Health, Carlton South, VIC, Australia.,Department of Biomedical Engineering, The University of Melbourne, 3010, Melbourne, Australia
| | - Meltem I Kasal
- Department of Psychiatry, Ataturk Education and Research Hospital, Katip Celebi University, Izmir, Turkey
| | - Nur Dikmeer
- Department of Psychiatry, Ataturk Education and Research Hospital, Katip Celebi University, Izmir, Turkey
| | - Aslıhan Bilge
- Department of Psychiatry, Ataturk Education and Research Hospital, Katip Celebi University, Izmir, Turkey
| | - Ercan Durmaz
- Department of Psychiatry, Ataturk Education and Research Hospital, Katip Celebi University, Izmir, Turkey
| | - Serap Polat
- Department of Psychiatry, Ataturk Education and Research Hospital, Katip Celebi University, Izmir, Turkey
| | - Fazil Gelal
- Department of Radiodiagnostics, Ataturk Education and Research Hospital, Katip Celebi University, Izmir, Turkey
| | - Nabi Zorlu
- Department of Psychiatry, Ataturk Education and Research Hospital, Katip Celebi University, Izmir, Turkey.
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Koch K, Rodriguez-Manrique D, Rus-Oswald OG, Gürsel DA, Berberich G, Kunz M, Zimmer C. Homogeneous grey matter patterns in patients with obsessive-compulsive disorder. NEUROIMAGE-CLINICAL 2021; 31:102727. [PMID: 34146774 PMCID: PMC8220095 DOI: 10.1016/j.nicl.2021.102727] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/19/2021] [Accepted: 06/09/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Changes in grey matter volume have frequently been reported in patients with obsessive-compulsive disorder (OCD). Most studies performed whole brain or region-of-interest based analyses whereas grey matter volume based on structural covariance networks has barely been investigated up to now. Therefore, the present study investigated grey matter volume within structural covariance networks in a sample of 228 participants (n = 117 OCD patients, n = 111 healthy controls). METHODS First, an independent component analysis (ICA) was performed on all subjects' preprocessed T1 images to derive covariance-dependent morphometric networks. Then, grey matter volume from each of the ICA-derived morphometric networks was extracted and compared between the groups. In addition, we performed logistic regressions and receiver operating characteristic (ROC) analyses to investigate whether network-related grey matter volume could serve as a characteristic that allows to differentiate patients from healthy volunteers. Moreover, we assessed grey matter pattern organization by correlating grey matter volume in all networks across all participants. Finally, we explored a potential association between grey matter volume or whole-brain grey matter pattern organization and clinical characteristics in terms of symptom severity and duration of illness. RESULTS There were only subtle group differences in network-related grey matter volume. Network-related grey matter volume had moreover a very poor discrimination performance. We found, however, significant group differences with regard to grey matter pattern organization. When correlating grey matter volume in all networks across all participants, patients showed a significantly higher homogeneity across all networks and a significantly lower heterogeneity, as assessed by the coefficient of variation across all networks as well as in several single networks. There was no association with clinical characteristics. CONCLUSION The findings of the present study suggest that the pathological mechanisms of OCD reduce interindividual grey matter variability. We assume that common characteristics associated with the disorder may lead to a more uniform, disorder-specific morphometry.
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Affiliation(s)
- Kathrin Koch
- Department of Neuroradiology & TUM-Neuroimaging Center (TUM-NIC), Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675 Munich, Germany; Graduate School of Systemic Neurosciences GSN, Ludwig-Maximilians-Universität, Biocenter, Groβhaderner Strasse 2, 82152 Munich, Germany.
| | - Daniela Rodriguez-Manrique
- Department of Neuroradiology & TUM-Neuroimaging Center (TUM-NIC), Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675 Munich, Germany; Graduate School of Systemic Neurosciences GSN, Ludwig-Maximilians-Universität, Biocenter, Groβhaderner Strasse 2, 82152 Munich, Germany
| | | | - Deniz A Gürsel
- Department of Neuroradiology & TUM-Neuroimaging Center (TUM-NIC), Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675 Munich, Germany
| | - Götz Berberich
- Windach Institute and Hospital of Neurobehavioural Research and Therapy (WINTR), Schützenstr. 100, 86949 Windach, Germany
| | - Miriam Kunz
- Department of Medical Psychology, University of Augsburg, 86156 Augsburg, Germany
| | - Claus Zimmer
- Department of Neuroradiology & TUM-Neuroimaging Center (TUM-NIC), Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675 Munich, Germany
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Ye Q, Zhang Z, Sun W, Fan Q, Li Y. Disrupted functional connectivity of precuneus subregions in obsessive-compulsive disorder. NEUROIMAGE-CLINICAL 2021; 31:102720. [PMID: 34146773 PMCID: PMC8220401 DOI: 10.1016/j.nicl.2021.102720] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 04/15/2021] [Accepted: 06/04/2021] [Indexed: 12/12/2022]
Abstract
Obsessive-compulsive disorder (OCD) is a chronic and disablingpsychiatric disorder with high lifetime prevalence, yet the underlying pathogenesis remains not fully understood. Increasing neuroimaging evidence has shown that the disrupted activity of brain functional hubs might contribute to the pathophysiology of OCD. Precuneus is an important brain hub which showed structural and functional abnormalities in OCD patients. However, the functional heterogeneity of the precuneus subregion has not been considered and its relation to OCD symptomatology remains to be elucidated. In this paper, a total of 73 unmedicated OCD patients and 79 matched healthy subjects were recruited and the heterogeneous functional connectivities (FCs) of the precuneus subregions were investigated using resting-state functional magnetic resonance imaging. The FC-based subdivision of the precuneus was performed using the K-means clustering algorithm, which led to a tripartite functional parcellation of precuneus. For each subregion, the distinct connectivity pattern with the whole brain was shown, using both voxel-wise and module-wise analysis, respectively. Decreased FC between dorsal posterior precuneus and vermis (corrected p<0.01) was shown in the patient group, which was negatively correlated with patient compulsions score (ρ = - 0.393, p = 0.001), indicating its contribution to the compulsive behavior inhibition of OCD. Our work might provide new insights into the understanding of precuneus subregion function and the importance of dorsal precuneus-cerebellum functional connectivity in OCD pathophysiology.
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Affiliation(s)
- Qianqian Ye
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200030, PR China
| | - Zongfeng Zhang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, PR China; Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 200030, PR China
| | - Wanqing Sun
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200030, PR China
| | - Qing Fan
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, PR China; Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 200030, PR China.
| | - Yao Li
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200030, PR China.
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Yu S, Feng F, Zhang Q, Shen Z, Wang Z, Hu Y, Gong L. Gray matter hypertrophy in primary insomnia: a surface-based morphometric study. Brain Imaging Behav 2021; 14:1309-1317. [PMID: 30511119 DOI: 10.1007/s11682-018-9992-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Studies have explored brain structural abnormalities in patients with primary insomnia (PI). However, most of them are based on volumetric measures, in a specific region of interest, and have small sample sizes. Here, we investigated changes in cortical morphology (thickness and volume) in PI using an advanced surface-based morphometric method. Sixty-seven patients with PI and 55 matched healthy controls were recruited for this study and underwent a structural magnetic resonance imaging scan. The reconstructed cortical surface was processed by Freesurfer 6.0. A general linear model was used to explore group differences in surface-based morphometric features. Furthermore, the association between these cortical features and clinical characteristics were assessed in the PI group. Compared to controls, PI patients showed cortical thickening in the left orbital frontal cortex (OFC), right rostral anterior cingulate cortex (rACC), left middle cingulate cortex (MCC), bilateral insula, left superior parietal lobule (SPL), and right fusiform area (FFA), and showed increased cortical volume in the left OFC, right rACC, bilateral rostral middle frontal gyrus, and right FFA. Cortical thickness in the right OFC and FFA was positively correlated with the severity of insomnia in the PI group, suggesting a right-lateralized relationship. This study was the first to explore multiple-scale cortical morphometric changes in a relatively large sample of PI patients. Our results suggest that hypertrophic cortical morphology may underlie the neuropathology of primary insomnia.
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Affiliation(s)
- Siyi Yu
- Department of Acupuncture & Tuina, Chengdu University of Traditional Chinese Medicine, No. 37 Shierqiao Road, Chengdu, 610075, Sichuan, China
| | - Fen Feng
- Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, Sichuan, China
| | - Qi Zhang
- Department of Acupuncture & Tuina, Chengdu University of Traditional Chinese Medicine, No. 37 Shierqiao Road, Chengdu, 610075, Sichuan, China
| | - Zhifu Shen
- Department of Acupuncture & Tuina, Chengdu University of Traditional Chinese Medicine, No. 37 Shierqiao Road, Chengdu, 610075, Sichuan, China
| | - Zhengyan Wang
- Department of Pain Management, Sichuan Integrative Medicine Hospital, Chengdu, 610041, Sichuan, China
| | - Youping Hu
- Department of Acupuncture & Tuina, Chengdu University of Traditional Chinese Medicine, No. 37 Shierqiao Road, Chengdu, 610075, Sichuan, China.
| | - Liang Gong
- Department of Neurology, Chengdu Second People's Hospital, No. 10 Qingyunnan Road, Chengdu, 610017, Sichuan, China. .,Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, 210009, Jiangsu, China.
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8
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Zhang L, Hu X, Lu L, Li B, Hu X, Bu X, Li H, Tang S, Gao Y, Yang Y, Sweeney JA, Gong Q, Huang X. Anatomic alterations across amygdala subnuclei in medication-free patients with obsessive-compulsive disorder. J Psychiatry Neurosci 2020; 45:334-343. [PMID: 32293840 PMCID: PMC7850150 DOI: 10.1503/jpn.190114] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The amygdala has been implicated in obsessive-compulsive disorder (OCD), a common, disabling illness. However, the regional distribution of anatomic alterations in this structure and their association with the symptoms of OCD remains to be established. METHODS We collected high-resolution 3D T1-weighted images from 81 untreated patients with OCD and no lifetime history of comorbid psychotic, affective or anxiety disorders, and from 95 age- and sex-matched healthy controls. We extracted the volume of the central nucleus of the amygdala (CeA) and the basolateral complex of the amygdala (BLA) and compared them across groups using FreeSurfer 6.0. In exploratory analyses, we evaluated other subnuclei, including the cortical medial nuclei, the anterior amygdaloid area, and the corticoamygdaloid transition area. RESULTS Patients with OCD had reduced amygdala volume bilaterally compared with healthy controls (left, p = 0.034; right, p = 0.002). Volume reductions were greater in the CeA (left: -11.9%, p = 0.002; right: -13.3%, p < 0.001) than in the BLA (left lateral nucleus: -3.3%, p = 0.029; right lateral nucleus: -3.9%, p = 0.018; right basal nucleus: -4.1%, p = 0.017; left accessory basal nucleus: -6.5%, p = 0.001; right accessory basal nucleus: -9.3%, p < 0.001). Volume reductions in the CeA were associated with illness duration. Exploratory analysis revealed smaller medial (left: -15.4%, p < 0.001, η2 = 0.101) and cortical (left: -9.1%, p = 0.001, η2 = 0.058; right: -15.4%, p < 0.001, η2 = 0.175) nuclei in patients with OCD compared with healthy controls. LIMITATIONS Although the strict exclusion criteria used in the study helped us to identify OCD-specific alterations, they may have limited generalizability to the broader OCD population. CONCLUSION Our results provide a comprehensive anatomic profile of alterations in the amygdala subnuclei in untreated patients with OCD and highlight a distinctive pattern of volume reductions across subnuclei in OCD. Based on the functional properties of the amygdala subnuclei established from preclinical research, CeA impairment may contribute to behavioural inflexibility, and BLA disruption may be responsible for altered fear conditioning and the affective components of OCD.
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Affiliation(s)
- Lianqing Zhang
- From the Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China (Zhang, Xinyu Hu, Lu, Xiaoxiao Hu, Bu, Li, Tang, Gao, Sweeney, Gong, Huang); the Department of Psychiatry, West China Hospital of Sichuan University, Chengdu, PR China (Li, Yang); the Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, USA (Sweeney); and the Psychoradiology Research Unit of the Chinese Academy of Medical Sciences (2018RU011), West China Hospital of Sichuan University, Chengdu, Sichuan, China (Zhang, Xinyu Hu, Lu, Xiaoxiao Hu, Bu, Li, Tang, Gao, Gong, Huang)
| | - Xinyu Hu
- From the Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China (Zhang, Xinyu Hu, Lu, Xiaoxiao Hu, Bu, Li, Tang, Gao, Sweeney, Gong, Huang); the Department of Psychiatry, West China Hospital of Sichuan University, Chengdu, PR China (Li, Yang); the Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, USA (Sweeney); and the Psychoradiology Research Unit of the Chinese Academy of Medical Sciences (2018RU011), West China Hospital of Sichuan University, Chengdu, Sichuan, China (Zhang, Xinyu Hu, Lu, Xiaoxiao Hu, Bu, Li, Tang, Gao, Gong, Huang)
| | - Lu Lu
- From the Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China (Zhang, Xinyu Hu, Lu, Xiaoxiao Hu, Bu, Li, Tang, Gao, Sweeney, Gong, Huang); the Department of Psychiatry, West China Hospital of Sichuan University, Chengdu, PR China (Li, Yang); the Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, USA (Sweeney); and the Psychoradiology Research Unit of the Chinese Academy of Medical Sciences (2018RU011), West China Hospital of Sichuan University, Chengdu, Sichuan, China (Zhang, Xinyu Hu, Lu, Xiaoxiao Hu, Bu, Li, Tang, Gao, Gong, Huang)
| | - Bin Li
- From the Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China (Zhang, Xinyu Hu, Lu, Xiaoxiao Hu, Bu, Li, Tang, Gao, Sweeney, Gong, Huang); the Department of Psychiatry, West China Hospital of Sichuan University, Chengdu, PR China (Li, Yang); the Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, USA (Sweeney); and the Psychoradiology Research Unit of the Chinese Academy of Medical Sciences (2018RU011), West China Hospital of Sichuan University, Chengdu, Sichuan, China (Zhang, Xinyu Hu, Lu, Xiaoxiao Hu, Bu, Li, Tang, Gao, Gong, Huang)
| | - Xiaoxiao Hu
- From the Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China (Zhang, Xinyu Hu, Lu, Xiaoxiao Hu, Bu, Li, Tang, Gao, Sweeney, Gong, Huang); the Department of Psychiatry, West China Hospital of Sichuan University, Chengdu, PR China (Li, Yang); the Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, USA (Sweeney); and the Psychoradiology Research Unit of the Chinese Academy of Medical Sciences (2018RU011), West China Hospital of Sichuan University, Chengdu, Sichuan, China (Zhang, Xinyu Hu, Lu, Xiaoxiao Hu, Bu, Li, Tang, Gao, Gong, Huang)
| | - Xuan Bu
- From the Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China (Zhang, Xinyu Hu, Lu, Xiaoxiao Hu, Bu, Li, Tang, Gao, Sweeney, Gong, Huang); the Department of Psychiatry, West China Hospital of Sichuan University, Chengdu, PR China (Li, Yang); the Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, USA (Sweeney); and the Psychoradiology Research Unit of the Chinese Academy of Medical Sciences (2018RU011), West China Hospital of Sichuan University, Chengdu, Sichuan, China (Zhang, Xinyu Hu, Lu, Xiaoxiao Hu, Bu, Li, Tang, Gao, Gong, Huang)
| | - Hailong Li
- From the Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China (Zhang, Xinyu Hu, Lu, Xiaoxiao Hu, Bu, Li, Tang, Gao, Sweeney, Gong, Huang); the Department of Psychiatry, West China Hospital of Sichuan University, Chengdu, PR China (Li, Yang); the Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, USA (Sweeney); and the Psychoradiology Research Unit of the Chinese Academy of Medical Sciences (2018RU011), West China Hospital of Sichuan University, Chengdu, Sichuan, China (Zhang, Xinyu Hu, Lu, Xiaoxiao Hu, Bu, Li, Tang, Gao, Gong, Huang)
| | - Shi Tang
- From the Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China (Zhang, Xinyu Hu, Lu, Xiaoxiao Hu, Bu, Li, Tang, Gao, Sweeney, Gong, Huang); the Department of Psychiatry, West China Hospital of Sichuan University, Chengdu, PR China (Li, Yang); the Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, USA (Sweeney); and the Psychoradiology Research Unit of the Chinese Academy of Medical Sciences (2018RU011), West China Hospital of Sichuan University, Chengdu, Sichuan, China (Zhang, Xinyu Hu, Lu, Xiaoxiao Hu, Bu, Li, Tang, Gao, Gong, Huang)
| | - Yingxue Gao
- From the Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China (Zhang, Xinyu Hu, Lu, Xiaoxiao Hu, Bu, Li, Tang, Gao, Sweeney, Gong, Huang); the Department of Psychiatry, West China Hospital of Sichuan University, Chengdu, PR China (Li, Yang); the Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, USA (Sweeney); and the Psychoradiology Research Unit of the Chinese Academy of Medical Sciences (2018RU011), West China Hospital of Sichuan University, Chengdu, Sichuan, China (Zhang, Xinyu Hu, Lu, Xiaoxiao Hu, Bu, Li, Tang, Gao, Gong, Huang)
| | - Yanchun Yang
- From the Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China (Zhang, Xinyu Hu, Lu, Xiaoxiao Hu, Bu, Li, Tang, Gao, Sweeney, Gong, Huang); the Department of Psychiatry, West China Hospital of Sichuan University, Chengdu, PR China (Li, Yang); the Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, USA (Sweeney); and the Psychoradiology Research Unit of the Chinese Academy of Medical Sciences (2018RU011), West China Hospital of Sichuan University, Chengdu, Sichuan, China (Zhang, Xinyu Hu, Lu, Xiaoxiao Hu, Bu, Li, Tang, Gao, Gong, Huang)
| | - John A Sweeney
- From the Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China (Zhang, Xinyu Hu, Lu, Xiaoxiao Hu, Bu, Li, Tang, Gao, Sweeney, Gong, Huang); the Department of Psychiatry, West China Hospital of Sichuan University, Chengdu, PR China (Li, Yang); the Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, USA (Sweeney); and the Psychoradiology Research Unit of the Chinese Academy of Medical Sciences (2018RU011), West China Hospital of Sichuan University, Chengdu, Sichuan, China (Zhang, Xinyu Hu, Lu, Xiaoxiao Hu, Bu, Li, Tang, Gao, Gong, Huang)
| | - Qiyong Gong
- From the Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China (Zhang, Xinyu Hu, Lu, Xiaoxiao Hu, Bu, Li, Tang, Gao, Sweeney, Gong, Huang); the Department of Psychiatry, West China Hospital of Sichuan University, Chengdu, PR China (Li, Yang); the Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, USA (Sweeney); and the Psychoradiology Research Unit of the Chinese Academy of Medical Sciences (2018RU011), West China Hospital of Sichuan University, Chengdu, Sichuan, China (Zhang, Xinyu Hu, Lu, Xiaoxiao Hu, Bu, Li, Tang, Gao, Gong, Huang)
| | - Xiaoqi Huang
- From the Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China (Zhang, Xinyu Hu, Lu, Xiaoxiao Hu, Bu, Li, Tang, Gao, Sweeney, Gong, Huang); the Department of Psychiatry, West China Hospital of Sichuan University, Chengdu, PR China (Li, Yang); the Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, USA (Sweeney); and the Psychoradiology Research Unit of the Chinese Academy of Medical Sciences (2018RU011), West China Hospital of Sichuan University, Chengdu, Sichuan, China (Zhang, Xinyu Hu, Lu, Xiaoxiao Hu, Bu, Li, Tang, Gao, Gong, Huang)
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Wagner G, Köhler S, Peikert G, de la Cruz F, Reess TJ, Rus OG, Schultz CC, Koch K, Bär KJ. Checking and washing rituals are reflected in altered cortical thickness in obsessive-compulsive disorder. Cortex 2019; 117:147-156. [DOI: 10.1016/j.cortex.2019.03.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 12/13/2018] [Accepted: 03/18/2019] [Indexed: 10/27/2022]
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10
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Sun Y, Wang X, Wang Y, Dong H, Lu J, Scheininger T, Ewers M, Jessen F, Zuo XN, Han Y. Anxiety correlates with cortical surface area in subjective cognitive decline: APOE ε4 carriers versus APOE ε4 non-carriers. ALZHEIMERS RESEARCH & THERAPY 2019; 11:50. [PMID: 31159873 PMCID: PMC6547570 DOI: 10.1186/s13195-019-0505-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 05/16/2019] [Indexed: 12/31/2022]
Abstract
Background Subjective cognitive decline (SCD) is characterized by self-reported cognitive deficits without measurable cognitive impairment. It has been suggested that individuals with SCD exhibited brain structural alterations in widespread cortical thinning or gray matter loss in the medial temporal and frontotemporal regions. Apolipoprotein E (APOE) ε4 allele is thought to be a genetic marker associated with risk of SCD. Neuropsychiatric symptoms may provide insight in detecting higher-risk elders for early Alzheimer’s disease as well. Therefore, we aim to explore the characteristics of brain morphology in SCD and to determine whether it is influenced by APOE ε4 as well as neuropsychiatric symptoms in SCD. Methods A total of 138 cognitively normal older individuals from the SILCODE cohort underwent a clinical interview, neuropsychological assessments, a blood test, and MRI. A two-sample t-test was used to examine the cortex volume and bilateral cortical surface area alterations between SCD (n = 65) and controls (n = 73). A general linear model analysis was used to test for both main and interaction effects of clinical phenotype (SCD vs. controls) and APOE on global and regional cortex volume and bilateral cortical surface area and thickness. A multiple linear regression analysis was conducted to determine the effects of the APOE genotype on the relationships between morphometric features and neuropsychiatric symptoms in SCD. Results Compared with controls, individuals with SCD showed decreased total cortical volumes and cortical surface area. SCD APOE ε4 carriers showed additive reduction in the right cortical surface area. The evaluation scores of anxiety symptoms were negatively associated with the right cortical surface area in SCD APOE 4 non-carriers. Conclusions Individuals with SCD had an altered cortical surface area, and APOE genotype and anxiety symptoms are modified factors on the cortical surface area decrease in SCD. Trial registration ClinicalTrials.gov (Identifier: NCT03370744). Registered 15 March 2017. Electronic supplementary material The online version of this article (10.1186/s13195-019-0505-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yu Sun
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Xiaoni Wang
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Yinshan Wang
- CAS Key Laboratory of Behavioral Science and Research Center for Lifespan Development of Mind and Brain (CLIMB), Institute of Psychology, Beijing, China
| | - Haoming Dong
- CAS Key Laboratory of Behavioral Science and Research Center for Lifespan Development of Mind and Brain (CLIMB), Institute of Psychology, Beijing, China
| | - Jie Lu
- Department of Radiology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Tohar Scheininger
- Center for the Developing Brain, Child Mind Institute, New York, USA
| | - Michael Ewers
- Institute for Stroke and Dementia Research (ISD), Ludwig-Maximilians-Universität (LMU), Munich, Germany
| | - Frank Jessen
- Department of Psychiatry, Medical Faculty, University of Cologne, Cologne, Germany
| | - Xi-Nian Zuo
- CAS Key Laboratory of Behavioral Science and Research Center for Lifespan Development of Mind and Brain (CLIMB), Institute of Psychology, Beijing, China
| | - Ying Han
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China. .,National Clinical Research Center for Geriatric Disorders, Beijing, China. .,Beijing Institute of Geriatrics, Beijing, China. .,Center of Alzheimer's Disease, Beijing Institute for Brain Disorders, Beijing, China.
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11
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Hazari N, Narayanaswamy JC, Venkatasubramanian G. Neuroimaging findings in obsessive-compulsive disorder: A narrative review to elucidate neurobiological underpinnings. Indian J Psychiatry 2019; 61:S9-S29. [PMID: 30745673 PMCID: PMC6343409 DOI: 10.4103/psychiatry.indianjpsychiatry_525_18] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Obsessive compulsive disorder (OCD) is a common psychiatric illness and significant research has been ongoing to understand its neurobiological basis. Neuroimaging studies right from the 1980s have revealed significant differences between OCD patients and healthy controls. Initial imaging findings showing hyperactivity in the prefrontal cortex (mainly orbitofrontal cortex), anterior cingulate cortex and caudate nucleus led to the postulation of the cortico-striato-thalamo-cortical (CSTC) model for the neurobiology of OCD. However, in the last two decades emerging evidence suggests the involvement of widespread associative networks, including regions of the parietal cortex, limbic areas (including amygdala) and cerebellum. This narrative review discusses findings from structural [Magnetic Resonance Imaging (MRI), Diffusion Tensor Imaging(DTI)], functional [(functional MRI (fMRI), Single photon emission computed tomography (SPECT), Positron emission tomography (PET), functional near-infrared spectroscopy (fNIRS)], combined structural and functional imaging studies and meta-analyses. Subsequently, we collate these findings to describe the neurobiology of OCD including CSTC circuit, limbic system, parietal cortex, cerebellum, default mode network and salience network. In future, neuroimaging may emerge as a valuable tool for personalised medicine in OCD treatment.
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Affiliation(s)
- Nandita Hazari
- Department of Psychiatry, Vidyasagar Institute of Mental Health and Neurosciences, Delhi, India
| | - Janardhanan C Narayanaswamy
- Department of Psychiatry, OCD Clinic, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Ganesan Venkatasubramanian
- Department of Psychiatry, OCD Clinic, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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12
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Zhou C, Xu J, Ping L, Zhang F, Chen W, Shen Z, Jiang L, Xu X, Cheng Y. Cortical thickness and white matter integrity abnormalities in obsessive-compulsive disorder: A combined multimodal surface-based morphometry and tract-based spatial statistics study. Depress Anxiety 2018; 35:742-751. [PMID: 29734487 DOI: 10.1002/da.22758] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 03/05/2018] [Accepted: 03/12/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Cerebral morphological abnormalities may play a key role in pathogenesis of obsessive-compulsive disorder (OCD). However, few studies have used multimodal imaging strategies to investigate alterations of cortical morphometry and white matter (WM) integrity. This study aimed to evaluate cortical thickness, cortical and subcortical volume, and WM integrity characteristics in OCD patients comprehensively. METHODS We acquired magnetic resonance imaging (MRI) scans from 52 OCD patients and 46 well-matched healthy controls (HCs). Cortical thickness and cortical and subcortical volume were measured using the surface-based morphometry (SBM) approach. We also evaluated fractional anisotropy (FA) and mean diffusivity (MD) derived from diffusion tensor imaging (DTI) using tract-based spatial statistics (TBSS). The disease severity was evaluated by score of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). For those brain regions exhibiting altered structure, correlations between alterations and clinical symptoms severity were analyzed in all patients and medication-naïve patients, respectively. RESULTS Compared with controls, OCD patients exhibited cortical thinning in right posterior cingulate cortex (PCC), as well as significantly decreased FA values in the genu and body of corpus callosum (CC). In medication-naïve patients group, the total Y-BOCS score and obsession score were significantly negative correlated with right PCC cortical thickness. CONCLUSIONS OCD patients demonstrated symptom-related reduced cortical thickness structural alteration of the right PCC, and altered WM integrity in the genu and body of CC. Medication seems could alleviate the alteration of cortical thickness but not WM integrity. Combined multimodal neuroimaging methods may provide a more comprehensive perspective to clarify the pathological mechanism of OCD.
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Affiliation(s)
- Cong Zhou
- Department of Psychiatry, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jian Xu
- Department of Internal Medicine, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Liangliang Ping
- Department of Psychiatry, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Fengrui Zhang
- Department of Medical Imaging, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Wei Chen
- Department of Medical Imaging, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Zonglin Shen
- Department of Psychiatry, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Linling Jiang
- Department of Psychiatry, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xiufeng Xu
- Department of Psychiatry, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yuqi Cheng
- Department of Psychiatry, First Affiliated Hospital of Kunming Medical University, Kunming, China
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