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Mestre-Bach G, Potenza MN. Potential Biological Markers and Treatment Implications for Binge Eating Disorder and Behavioral Addictions. Nutrients 2023; 15:827. [PMID: 36839185 PMCID: PMC9962023 DOI: 10.3390/nu15040827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 01/28/2023] [Accepted: 02/04/2023] [Indexed: 02/08/2023] Open
Abstract
The reward system is highly relevant to behavioral addictions such as gambling disorder (GD), internet gaming disorder (IGD), and food addiction/binge eating disorder (FA/BED). Among other brain regions, the ventral striatum (VS) has been implicated in reward processing. The main objective of the present state-of-the-art review was to explore in depth the specific role of the VS in GD, IGD and FA/BED, understanding it as a possible biomarker of these conditions. Studies analyzing brain changes following interventions for these disorders, and especially those that had explored possible treatment-related changes in VS, are discussed. More evidence is needed on how existing treatments (both pharmacological and psychobehavioral) for behavioral addictions affect the activation of the VS and related circuitry.
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Affiliation(s)
- Gemma Mestre-Bach
- Facultad de Ciencias de la Salud, Universidad Internacional de La Rioja, 26006 Logroño, Spain
| | - Marc N. Potenza
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT 06510, USA
- Connecticut Mental Health Center, New Haven, CT 06519, USA
- Connecticut Council on Problem Gambling, Wethersfield, CT 06109, USA
- Wu Tsai Institute, Yale University, New Haven, CT 06510, USA
- Yale Child Study Center, School of Medicine, Yale University, New Haven, CT 06510, USA
- Department of Neuroscience, School of Medicine, Yale University, New Haven, CT 06510, USA
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Liu X, Zheng Y, Niculescu M, Liang Q, Yang A, Dong G, Gao Z, Lin P, Liu Y, Chen L, Xu D. The involvement of spontaneous brain activity in natural recovery from internet gaming disorder: A resting-state fMRI study. Front Psychiatry 2023; 14:1093784. [PMID: 36896348 PMCID: PMC9990821 DOI: 10.3389/fpsyt.2023.1093784] [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: 11/09/2022] [Accepted: 02/01/2023] [Indexed: 02/23/2023] Open
Abstract
OBJECTIVE Internet gaming disorder (IGD) can seriously impair an individual's physical and mental health. However, unlike the majority of those suffering from substance addiction, individuals with IGD may recover without any professional intervention. Understanding the brain mechanisms of natural recovery from IGD may provide new insight into how to prevent addiction and implement more targeted interventions. METHODS Sixty individuals with IGD were scanned by using a resting-state fMRI to assess brain region changes associated with IGD. After 1 year, 19 individuals with IGD no longer met the IGD criteria and were considered recovered (RE-IGD), 23 individuals still met the IGD criteria (PER-IGD), and 18 individuals left the study. The brain activity in resting state between 19 RE-IGD individuals and 23 PER-IGD individuals was compared by using regional homogeneity (ReHo). Additionally, brain structure and cue-craving functional MRIs were collected to further support the results in the resting-state. RESULTS The resting-state fMRI results revealed that activity in brain regions responsible for reward and inhibitory control [including the orbitofrontal cortex (OFC), the precuneus and the dorsolateral prefrontal cortex (DLPFC)] was decreased in the PER-IGD individuals compared to RE-IGD individuals. In addition, significant positive correlations were found between mean ReHo values in the precuneus and self-reported craving scores for gaming, whether among the PER-IGD individuals or the RE-IGD individuals. Furthermore, we found similar results in that brain structure and cue-craving differences exist between the PER-IGD individuals and RE-IGD individuals, specifically in the brain regions associated with reward processing and inhibitory control (including the DLPFC, anterior cingulate gyrus, insula, OFC, precuneus, and superior frontal gyrus). CONCLUSION These findings indicate that the brain regions responsible for reward processing and inhibitory control are different in PER-IGD individuals, which may have consequences on natural recovery. Our present study provides neuroimaging evidence that spontaneous brain activity may influence natural recovery from IGD.
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Affiliation(s)
- Xiaoyue Liu
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Yawen Zheng
- Lishui Second Affiliated Hospital of Wenzhou Medical University, Lishui, China
| | - Michelle Niculescu
- Department of Social Sciences, Chatham University, Pittsburgh, PA, United States
| | - Qi Liang
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Ai Yang
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Guangheng Dong
- Centers for Cognition and Brain Disorders, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Zhonghui Gao
- The Affiliated Xiangshan Hospital of Wenzhou Medical University, Ningbo, China
| | - Ping Lin
- The Affiliated Xiangshan Hospital of Wenzhou Medical University, Ningbo, China
| | - Yanlong Liu
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Li Chen
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Danjun Xu
- The Affiliated Xiangshan Hospital of Wenzhou Medical University, Ningbo, China
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Improvement of Impulsivity and Decision Making by Transcranial Direct Current Stimulation of the Dorsolateral Prefrontal Cortex in a Patient with Gambling Disorder. J Gambl Stud 2022; 38:627-634. [PMID: 34213750 PMCID: PMC9120079 DOI: 10.1007/s10899-021-10050-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2021] [Indexed: 01/10/2023]
Abstract
Gambling disorder (GD) is a form of behavioral addiction. In recent years, it has been suggested that the application of transcranial Direct Current Stimulation (tDCS) to the dorsolateral prefrontal cortex (DLPFC), which plays a key role in top-down inhibitory control and impulsivity, may represent a new therapeutic approach for treating addictions. Here we investigated the effectiveness of a novel low dose tDCS protocol (i.e. six sessions of right anodal/left cathodal tDCS for 20 min, with a current intensity of 1 mA) applied to DLPFC in a patient with GD. To evaluate the effect of the proposed intervention, cognitive, psychological and behavioural evaluations were performed at different time points, pre and post intervention. The results showed improvement of impulsivity, decision making, and cognitive functioning after tDCS intervention. Findings of the present study suggest that low doses of right anodal/left cathodal tDCS to DLPFC may effectively improve gambling behaviour. They also suggest to carefully evaluate the effects of this tDCS polarity on the patient's emotional state. The current protocol warrants further investigation in large groups of patients, as it may provide relevant insights into the design of effective, low dose treatments of gambling disorder.
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Bilateral transcranial direct current stimulation attenuated symptoms of alcohol use disorder: A systematic review and meta-analysis. Prog Neuropsychopharmacol Biol Psychiatry 2021; 108:110160. [PMID: 33147505 DOI: 10.1016/j.pnpbp.2020.110160] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/27/2020] [Accepted: 10/28/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Alcohol use disorder is one of the common substance use disorders leading to mental and health problems. Despite the potential positive effects of transcranial direct current stimulation (tDCS) on symptoms of various substance use disorder, how specific tDCS protocols effectively influence on individuals with alcohol use disorder is still controversial. This systematic review and meta-analysis investigated beneficial effects of tDCS on symptoms of alcohol use disorder. METHOD Eighteen total studies met our inclusion criteria, and we used 25 total comparisons from the qualified studies for the data synthesis. We estimated effect sizes by quantifying changes in alcohol craving and consumption between active tDCS protocol and sham groups. In addition, three moderator variable analyses determined whether tDCS effects on symptoms of alcohol use disorder were different based on (a) bilateral versus unilateral tDCS protocols, (b) specific targeted regions, and (c) multiple sessions versus single session of tDCS protocols. RESULTS Random-effects model meta-analysis revealed small positive tDCS effects on alcohol craving and consumption. Specifically, bilateral tDCS protocols significantly reduced alcohol craving, and further anodal tDCS on right dorsolateral prefrontal cortex (DLPFC) and cathodal tDCS on left DLPFC revealed significant positive effects. The multiple sessions of tDCS protocols showed better effects on reducing alcohol craving. CONCLUSIONS The current findings suggested that bilateral tDCS protocols including anodal tDCS on right DLPFC and cathodal tDCS on left DLPFC with multiple sessions may effectively improve tDCS effects on symptoms of alcohol use disorder.
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Pettorruso M, Miuli A, Di Natale C, Montemitro C, Zoratto F, De Risio L, d'Andrea G, Dannon PN, Martinotti G, di Giannantonio M. Non-invasive brain stimulation targets and approaches to modulate gambling-related decisions: A systematic review. Addict Behav 2021; 112:106657. [PMID: 32987305 DOI: 10.1016/j.addbeh.2020.106657] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 08/23/2020] [Accepted: 09/10/2020] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Despite intense neuroscience research on the neurobiological underpinnings of Gambling Disorder (GD) and gambling-related decision-making, effective treatments targeting these dysfunctions are still lacking. Non Invasive Brain Stimulation (NIBS) techniques, such as transcranial Direct Current Stimulation (tDCS) and Transcranial Magnetic Stimulation (TMS), selectively modulate activity of brain circuits and have the potential to reverse alterations sustaining GD symptoms. Therefore, the aim of this systematic review was to determine the impact of different NIBS interventions on gambling-related decision processes. METHODS We conducted a comprehensive and translational search in three online databases (MEDLINE via PubMed, Scopus, Web of Science), in accordance with the PRISMA guidelines. We included studies applying neuromodulation (TMS, tDCS) techniques in GD patients or assessing gambling-related decision-making in healthy subjects. In addition, we explored the potential impact of NIBS in drug-induced GD (e.g., Parkinson's Disease). RESULTS Twenty-seven studies have been included. We summarized results to detect the impact of different targets and stimulation/inhibition protocols in terms of gambling-related decision-making. The majority of both tDCS and TMS studies targeted the dorsolateral prefrontal cortex. Although heterogeneous in protocols and parameters, results from tDCS and TMS studies converge in indicating that the stimulation (instead of inhibition) of prefrontal regions could be beneficial to contrast dysfunctional gambling-related decision processes. CONCLUSION NIBS interventions show promise to be further tested in controlled clinical settings for the treatment of behavioral addictions. Further studies are also necessary to investigate connectivity changes and laterality issues (unilateral versus bilateral; left versus right) of NIBS application in GD.
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Zucchella C, Mantovani E, Federico A, Lugoboni F, Tamburin S. Non-invasive Brain Stimulation for Gambling Disorder: A Systematic Review. Front Neurosci 2020; 14:729. [PMID: 33013280 PMCID: PMC7461832 DOI: 10.3389/fnins.2020.00729] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 06/18/2020] [Indexed: 12/18/2022] Open
Abstract
Background: Gambling disorder (GD) is the most common behavioral addiction and shares pathophysiological and clinical features with substance use disorders (SUDs). Effective therapeutic interventions for GD are lacking. Non-invasive brain stimulation (NIBS) may represent a promising treatment option for GD. Objective: This systematic review aimed to provide a comprehensive and structured overview of studies applying NIBS techniques to GD and problem gambling. Methods: A literature search using Pubmed, Web of Science, and Science Direct was conducted from databases inception to December 19, 2019, for studies assessing the effects of repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (t-DCS) on subjects with GD or problem gambling. Studies using NIBS techniques on healthy subjects and those without therapeutic goals but only aiming to assess basic neurophysiology measures were excluded. Results: A total of 269 articles were title and abstract screened, 13 full texts were assessed, and 11 were included, of which six were controlled and five were uncontrolled. Most studies showed a reduction of gambling behavior, craving for gambling, and gambling-related symptoms. NIBS effects on psychiatric symptoms were less consistent. A decrease of the behavioral activation related to gambling was also reported. Some studies reported modulation of behavioral measures (i.e., impulsivity, cognitive and attentional control, decision making, cognitive flexibility). Studies were not consistent in terms of NIBS protocol, site of stimulation, clinical and surrogate outcome measures, and duration of treatment and follow-up. Sample size was small in most studies. Conclusions: The clinical and methodological heterogeneity of the included studies prevented us from drawing any firm conclusion on the efficacy of NIBS interventions for GD. Further methodologically sound, robust, and well-powered studies are needed.
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Affiliation(s)
- Chiara Zucchella
- Neurology Unit, Department of Neurosciences, Verona University Hospital, Verona, Italy
| | - Elisa Mantovani
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Angela Federico
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Fabio Lugoboni
- Addiction Medicine Unit, Department of Medicine, Verona University Hospital, Verona, Italy
| | - Stefano Tamburin
- Neurology Unit, Department of Neurosciences, Verona University Hospital, Verona, Italy.,Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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Zhang J, Hu Y, Li H, Zheng H, Xiang M, Wang Z, Dong G. Altered brain activities associated with cue reactivity during forced break in subjects with Internet gaming disorder. Addict Behav 2020; 102:106203. [PMID: 31801104 DOI: 10.1016/j.addbeh.2019.106203] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 06/17/2019] [Accepted: 11/03/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Studies have proven that forced break can elicit strong psychological cravings for addictive behaviors. This phenomenon could create an excellent situation to study the neural underpinnings of addiction. The current study explores brain features during a cue-reactivity task in Internet gaming disorder (IGD) when participants were forced to stop their gaming behaviors. METHODS Forty-nine IGD subjects and forty-nine matched recreational Internet game users (RGU) were asked to complete a cue-reactivity task when their ongoing gaming behaviors were forced to break. We compared their brain responses to gaming cues and tried to find specific features associated with IGD. RESULTS Compared with RGU, the IGD subjects showed decreased activation in the anterior cingulate cortex (ACC), parahippocampal gyrus, and dorsolateral prefrontal cortex (DLPFC). Significant negative correlations were observed between self-reported gaming cravings and the baseline activation level (bate value) of the ACC, DLPFC, and parahippocampal gyrus. CONCLUSIONS IGD subjects were unable to suppress their gaming cravings after unexpectedly forced break. This result could also explain why RGU subjects are able to play online games without developing dependence.
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Gomis-Vicent E, Thoma V, Turner JJD, Hill KP, Pascual-Leone A. Review: Non-Invasive Brain Stimulation in Behavioral Addictions: Insights from Direct Comparisons With Substance Use Disorders. Am J Addict 2019; 28:431-454. [PMID: 31513324 DOI: 10.1111/ajad.12945] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 06/01/2019] [Accepted: 07/27/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Treatment models developed for substance use disorders (SUDs) are often applied to behavioral addictions (BAs), even though the correspondence between these forms of addiction is unclear. This is also the case for noninvasive brain stimulation (NIBS) techniques being investigated as potential treatment interventions for SUDs and BAs. OBJECTIVES to contribute to the development of more effective NIBS protocols for BAs. METHODS Two literature searches using PubMed and Google Scholar were conducted identifying a total of 35 studies. The first search identified 25 studies examining the cognitive and neurophysiological overlap between BAs and SUDs. The second search yielded 10 studies examining the effects of NIBS in BAs. RESULTS Impulsivity and cravings show behavioral and neurophysiologic overlaps between BAs and SUDs, however, other outcomes like working-memory abilities or striatal connectivity, differ between BAs and SUDs. The most-employed NIBS target in BAs was dorsolateral prefrontal cortex (DLPFC), which was associated with a decrease in cravings, and less frequently with a reduction of addiction severity. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE Direct comparisons between BAs and SUDs revealed discrepancies between behavioral and neurophysiological outcomes, but overall, common and distinctive characteristics underlying each disorder. The lack of complete overlap between BAs and SUDs suggests that investigating the cognitive and neurophysiological features of BAs to create individual NIBS protocols that target risk-factors associated specifically with BAs, might be more effective than transferring protocols from SUDs to BAs. Individualizing NIBS protocols to target specific risk-factors associated with each BA might help to improve treatment interventions for BAs. (Am J Addict 2019;00:1-23).
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Affiliation(s)
- Elena Gomis-Vicent
- Department of Psychological Sciences, College of Applied Health and Communities, University of East London, London, United Kingdom
| | - Volker Thoma
- Department of Psychological Sciences, College of Applied Health and Communities, University of East London, London, United Kingdom
| | - John J D Turner
- Department of Psychological Sciences, College of Applied Health and Communities, University of East London, London, United Kingdom
| | - Kevin P Hill
- Division of Addiction Psychiatry, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Alvaro Pascual-Leone
- Department of Neurology, Berenson-Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.,Institut Guttmann de Neurorehabilitació, Universitat Autonòma de Barcelona, Badalona, Barcelona, Spain
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Transcranial Direct Current Stimulation Reduces Craving in Substance Use Disorders: A Double-blind, Placebo-Controlled Study. J ECT 2019; 35:207-211. [PMID: 30844881 DOI: 10.1097/yct.0000000000000580] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The use of transcranial direct current stimulation (tDCS) in addiction disorders is still on its rise in comparison with pharmacological and psychotherapeutic strategies that still show low level of evidence. In this study, we aimed to evaluate the efficacy of the anodic tDCS for the short-term treatment of substance craving and other psychiatric symptoms. METHODS In this randomized, double-blind, sham-controlled trial, inclusion criteria included the diagnosis of substance use disorder and/or gambling disorder. The protocol includes 5 consecutive days of active or sham tDCS session. Cathode was placed over the left dorsolateral prefrontal cortex. Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Young Mania Rating Scale, Barratt Impulsiveness Scale, South Oaks Gambling Screen, and visual analog scale (VAS) 1 to 10 for craving were administered at the baseline (T0) and after 5 days of treatment (T1). RESULTS Thirty-four treatment-seeking subjects were randomized to sham (n = 16) and active stimulation (n = 18) groups. A statistically significant reduction of values at T1 was found in all subjects considering VAS (P < 0.001), Hamilton Depression Rating Scale (P < 0.001), Hamilton Anxiety Rating Scale (P < 0.001), and Barratt Impulsiveness Scale 11 (P = 0.032). A significant reduction for VAS craving in favor of the active stimulation (P = 0.011) was found. CONCLUSIONS Our findings reveal a statistically significant rapid reduction of craving in the active tDCS group on the right dorsolateral prefrontal cortex with respect to sham group, confirming the scientific literature trend. Large samples, with maintenance tDCS therapy and long-term follow-up, are required to establish the potential of this noninvasive and easily delivered brain stimulation strategy.
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Dong G, Liu X, Zheng H, Du X, Potenza MN. Brain response features during forced break could predict subsequent recovery in internet gaming disorder: A longitudinal study. J Psychiatr Res 2019; 113:17-26. [PMID: 30878788 DOI: 10.1016/j.jpsychires.2019.03.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 02/12/2019] [Accepted: 03/04/2019] [Indexed: 02/07/2023]
Abstract
Although internet gaming disorder (IGD) is associated with negative health measures, individuals may recover without professional intervention. Exploring neural features associated with natural recovery may provide insights into how best to promote health among people with IGD. Seventy-nine IGD subjects were scanned when they were performing cue-craving tasks before and after gaming was interrupted with a forced break. After one year, 20 individuals no longer met IGD criteria and were considered recovered. We compared brain responses in cue-craving tasks between these 20 recovered IGD subjects and 20 matched IGD subjects still meeting criteria at one year (persistent IGD). Recovered IGD subjects showed lower dorsolateral prefrontal cortex (DLPFC) activation than persistent IGD subjects to gaming cues at both pre- and post-gaming times. Significant group-by-time interactions were found in the bilateral DLPFC and insula, and these involved relatively decreased DLPFC and increased insula activation in the persistent IGD group during the forced break. Relatively decreased DLPFC activity and increased insula activity in response to gaming cues following recent gaming may underlie persistence of gaming. These findings suggest that executive control and interoceptive processing warrant additional study in understanding recovery from IGD.
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Affiliation(s)
- Guangheng Dong
- Center for Cognition and Brain Disorders, Hangzhou Normal University, Hangzhou, Zhejiang Province, PR China.
| | - Xiaoyue Liu
- Wenzhou Medical University, Wenzhou, Zhejiang, PR China
| | - Hui Zheng
- Center for Cognition and Brain Disorders, Hangzhou Normal University, Hangzhou, Zhejiang Province, PR China
| | - Xiaoxia Du
- Department of Physics, Shanghai Key Laboratory of Magnetic Resonance, East China Normal University, Shanghai, PR China
| | - Marc N Potenza
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; Department of Neuroscience, Yale University School of Medicine, New Haven, CT, USA; Department of Child Study Center, Yale University School of Medicine, New Haven, CT, USA; Connecticut Mental Health Center, New Haven, CT, USA
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