Pub Date : 2024-06-03DOI: 10.1017/S0033291724001302
Eirini Zoupou, Tyler M Moore, Monica E Calkins, Raquel E Gur, Ruben C Gur, J Cobb Scott
Background: Neurocognitive dysfunction is a transdiagnostic finding in psychopathology, but relationships among cognitive domains and general and specific psychopathology dimensions remain unclear. This study aimed to examine associations between cognition and psychopathology dimensions in a large youth cohort.
Method: The sample (N = 9350; age 8-21 years) was drawn from the Philadelphia Neurodevelopmental Cohort. Data from structured clinical interviews were modeled using bifactor confirmatory factor analysis (CFA), resulting in an overall psychopathology ('p') factor score and six orthogonal psychopathology dimensions: dysphoria/distress, obsessive-compulsive, behavioral/externalizing, attention-deficit/hyperactivity, phobias, and psychosis. Neurocognitive data were aggregated using correlated-traits CFA into five factors: executive functioning, memory, complex cognition, social cognition, and sensorimotor speed. We examined relationships among specific and general psychopathology dimensions and neurocognitive factors.
Results: The final model showed both overall and specific associations between cognitive functioning and psychopathology, with acceptable fit (CFI = 0.91; TLI = 0.90; RMSEA = 0.024; SRMR = 0.054). Overall psychopathology and most psychopathology dimensions were negatively associated with neurocognitive functioning (phobias [p < 0.0005], behavioral/externalizing [p < 0.0005], attention-deficit/hyperactivity [p < 0.0005], psychosis [p < 0.0005 to p < 0.05]), except for dysphoria/distress and obsessive-compulsive symptoms, which were positively associated with complex cognition (p < 0.05 and p < 0.01, respectively).
Conclusion: By modeling a broad range of cognitive and psychopathology domains in a large, diverse sample of youth, we found aspects of neurocognitive functioning shared across clinical phenotypes, as well as domain-specific patterns. Findings support transdiagnostic examination of cognitive performance to parse variability in the link between neurocognitive functioning and clinical phenotypes.
{"title":"Domain-specific associations between psychopathology and neurocognitive functioning.","authors":"Eirini Zoupou, Tyler M Moore, Monica E Calkins, Raquel E Gur, Ruben C Gur, J Cobb Scott","doi":"10.1017/S0033291724001302","DOIUrl":"https://doi.org/10.1017/S0033291724001302","url":null,"abstract":"<p><strong>Background: </strong>Neurocognitive dysfunction is a transdiagnostic finding in psychopathology, but relationships among cognitive domains and general and specific psychopathology dimensions remain unclear. This study aimed to examine associations between cognition and psychopathology dimensions in a large youth cohort.</p><p><strong>Method: </strong>The sample (<i>N</i> = 9350; age 8-21 years) was drawn from the Philadelphia Neurodevelopmental Cohort. Data from structured clinical interviews were modeled using bifactor confirmatory factor analysis (CFA), resulting in an overall psychopathology ('p') factor score and six orthogonal psychopathology dimensions: dysphoria/distress, obsessive-compulsive, behavioral/externalizing, attention-deficit/hyperactivity, phobias, and psychosis. Neurocognitive data were aggregated using correlated-traits CFA into five factors: executive functioning, memory, complex cognition, social cognition, and sensorimotor speed. We examined relationships among specific and general psychopathology dimensions and neurocognitive factors.</p><p><strong>Results: </strong>The final model showed both overall and specific associations between cognitive functioning and psychopathology, with acceptable fit (CFI = 0.91; TLI = 0.90; RMSEA = 0.024; SRMR = 0.054). Overall psychopathology and most psychopathology dimensions were negatively associated with neurocognitive functioning (phobias [<i>p</i> < 0.0005], behavioral/externalizing [<i>p</i> < 0.0005], attention-deficit/hyperactivity [<i>p</i> < 0.0005], psychosis [<i>p</i> < 0.0005 to <i>p</i> < 0.05]), except for dysphoria/distress and obsessive-compulsive symptoms, which were positively associated with complex cognition (<i>p</i> < 0.05 and <i>p</i> < 0.01, respectively).</p><p><strong>Conclusion: </strong>By modeling a broad range of cognitive and psychopathology domains in a large, diverse sample of youth, we found aspects of neurocognitive functioning shared across clinical phenotypes, as well as domain-specific patterns. Findings support transdiagnostic examination of cognitive performance to parse variability in the link between neurocognitive functioning and clinical phenotypes.</p>","PeriodicalId":20891,"journal":{"name":"Psychological Medicine","volume":null,"pages":null},"PeriodicalIF":6.9,"publicationDate":"2024-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141200616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-03DOI: 10.1017/S0033291724001326
Huai-Hsuan Tseng, Cheng Ying Wu, Hui Hua Chang, Tsung-Hua Lu, Wei Hung Chang, Chia-Fen Hsu, Ren-Yi Lin, Ding-Ruey Yeh, Fu-Zen Shaw, Yen Kuang Yang, Po See Chen
Background: Persistent cognitive deficits and functional impairments are associated with bipolar disorder (BD), even during the euthymic phase. The dysfunction of default mode network (DMN) is critical for self-referential and emotional mental processes and is implicated in BD. The current study aims to explore the balance of excitatory and inhibitory neurotransmitters, i.e. glutamate and γ-aminobutyric acid (GABA), in hubs of the DMN during the euthymic patients with BD (euBD).
Method: Thirty-four euBD and 55 healthy controls (HC) were recruited to the study. Using proton magnetic resonance spectroscopy (1H-MRS), glutamate (with PRESS sequence) and GABA levels (with MEGAPRESS sequence) were measured in the medial prefrontal cortex/anterior cingulate cortex (mPFC/ACC) and the posterior cingulate gyrus (PCC). Measured concentrations of excitatory glutamate/glutamine (Glx) and inhibitory GABA were used to calculate the excitatory/inhibitory (E/I) ratio. Executive and attentional functions were respectively assessed using the Wisconsin card-sorting test and continuous performance test.
Results: euBD performed worse on attentional function than controls (p = 0.001). Compared to controls, euBD had higher E/I ratios in the PCC (p = 0.023), mainly driven by a higher Glx level in the PCC of euBD (p = 0.002). Only in the BD group, a marginally significant negative association between the mPFC E/I ratio (Glx/GABA) and executive function was observed (p = 0.068).
Conclusions: Disturbed E/I balance, particularly elevated Glx/GABA ratio in PCC is observed in euBD. The E/I balance in hubs of DMN may serve as potential biomarkers for euBD, which may also contribute to their poorer executive function.
{"title":"Posterior cingulate and medial prefrontal excitation-inhibition balance in euthymic bipolar disorder.","authors":"Huai-Hsuan Tseng, Cheng Ying Wu, Hui Hua Chang, Tsung-Hua Lu, Wei Hung Chang, Chia-Fen Hsu, Ren-Yi Lin, Ding-Ruey Yeh, Fu-Zen Shaw, Yen Kuang Yang, Po See Chen","doi":"10.1017/S0033291724001326","DOIUrl":"https://doi.org/10.1017/S0033291724001326","url":null,"abstract":"<p><strong>Background: </strong>Persistent cognitive deficits and functional impairments are associated with bipolar disorder (BD), even during the euthymic phase. The dysfunction of default mode network (DMN) is critical for self-referential and emotional mental processes and is implicated in BD. The current study aims to explore the balance of excitatory and inhibitory neurotransmitters, i.e. glutamate and <i>γ</i>-aminobutyric acid (GABA), in hubs of the DMN during the euthymic patients with BD (euBD).</p><p><strong>Method: </strong>Thirty-four euBD and 55 healthy controls (HC) were recruited to the study. Using proton magnetic resonance spectroscopy (<sup>1</sup>H-MRS), glutamate (with PRESS sequence) and GABA levels (with MEGAPRESS sequence) were measured in the medial prefrontal cortex/anterior cingulate cortex (mPFC/ACC) and the posterior cingulate gyrus (PCC). Measured concentrations of excitatory glutamate/glutamine (Glx) and inhibitory GABA were used to calculate the excitatory/inhibitory (<i>E</i>/<i>I</i>) ratio. Executive and attentional functions were respectively assessed using the Wisconsin card-sorting test and continuous performance test.</p><p><strong>Results: </strong>euBD performed worse on attentional function than controls (<i>p</i> = 0.001). Compared to controls, euBD had higher <i>E</i>/<i>I</i> ratios in the PCC (<i>p</i> = 0.023), mainly driven by a higher Glx level in the PCC of euBD (<i>p</i> = 0.002). Only in the BD group, a marginally significant negative association between the mPFC <i>E</i>/<i>I</i> ratio (Glx/GABA) and executive function was observed (<i>p</i> = 0.068).</p><p><strong>Conclusions: </strong>Disturbed E/I balance, particularly elevated Glx/GABA ratio in PCC is observed in euBD. The <i>E</i>/<i>I</i> balance in hubs of DMN may serve as potential biomarkers for euBD, which may also contribute to their poorer executive function.</p>","PeriodicalId":20891,"journal":{"name":"Psychological Medicine","volume":null,"pages":null},"PeriodicalIF":6.9,"publicationDate":"2024-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141200574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-03DOI: 10.1017/S0033291724001405
Charles Heriot-Maitland, Til Wykes, Emmanuelle Peters
Background: Shame is experienced as a threat to social self, and so activates threat-protective responses. There is evidence that shame has trauma-like characteristics, suggesting it can be understood within the same conceptual framework as trauma and dissociation. Evidence for causal links among trauma, dissociation, and psychosis thus warrant the investigation of how shame may influence causal mechanisms for psychosis symptoms.
Methods: This study tested the interaction between dissociation and shame, specifically external shame (feeling shamed by others), in predicting psychotic-like experiences (PLEs) six months later in a general population sample (N = 314). It also tested if social safeness moderates these effects. A longitudinal, online questionnaire design tested a moderation model (dissociation-shame) and a moderated moderation model (adding social safeness), using multiple regressions with bootstrap procedures.
Results: Although there was no direct effect of dissociation on PLEs six months later, there was a significant interaction effect with shame, controlling for PLEs at baseline. There were complex patterns in the directions of effects: For high-shame-scorers, higher dissociation predicted higher PLE scores, but for low-shame-scorers, higher dissociation predicted lower PLE scores. Social safeness was found to significantly moderate these interaction effects, which were unexpectedly more pronounced in the context of higher social safeness.
Conclusions: The results demonstrate evidence for an interaction between dissociation and shame on its impact on PLEs, which manifests particularly for those experiencing higher social safeness. This suggests a potential role of social mechanisms in both the etiology and treatment of psychosis, which warrants further testing in clinical populations.
{"title":"Social influences on the relationship between dissociation and psychotic-like experiences.","authors":"Charles Heriot-Maitland, Til Wykes, Emmanuelle Peters","doi":"10.1017/S0033291724001405","DOIUrl":"https://doi.org/10.1017/S0033291724001405","url":null,"abstract":"<p><strong>Background: </strong>Shame is experienced as a threat to social self, and so activates threat-protective responses. There is evidence that shame has trauma-like characteristics, suggesting it can be understood within the same conceptual framework as trauma and dissociation. Evidence for causal links among trauma, dissociation, and psychosis thus warrant the investigation of how shame may influence causal mechanisms for psychosis symptoms.</p><p><strong>Methods: </strong>This study tested the interaction between dissociation and shame, specifically external shame (feeling shamed by others), in predicting psychotic-like experiences (PLEs) six months later in a general population sample (<i>N</i> = 314). It also tested if social safeness moderates these effects. A longitudinal, online questionnaire design tested a moderation model (dissociation-shame) and a moderated moderation model (adding social safeness), using multiple regressions with bootstrap procedures.</p><p><strong>Results: </strong>Although there was no direct effect of dissociation on PLEs six months later, there was a significant interaction effect with shame, controlling for PLEs at baseline. There were complex patterns in the directions of effects: For high-shame-scorers, higher dissociation predicted higher PLE scores, but for low-shame-scorers, higher dissociation predicted lower PLE scores. Social safeness was found to significantly moderate these interaction effects, which were unexpectedly more pronounced in the context of higher social safeness.</p><p><strong>Conclusions: </strong>The results demonstrate evidence for an interaction between dissociation and shame on its impact on PLEs, which manifests particularly for those experiencing higher social safeness. This suggests a potential role of social mechanisms in both the etiology and treatment of psychosis, which warrants further testing in clinical populations.</p>","PeriodicalId":20891,"journal":{"name":"Psychological Medicine","volume":null,"pages":null},"PeriodicalIF":6.9,"publicationDate":"2024-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141200577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-03DOI: 10.1017/S0033291724001338
Rory Sheehan, Jennifer Leng, Hannah Woods, R Asaad Baksh
Background: Attention deficit hyperactivity disorder (ADHD) is increasingly diagnosed in adults. People with intellectual disability have higher rates of ADHD yet there is little evidence on the presentation and pharmacological treatment of ADHD in this population or how this differs from the general population.
Methods: Retrospective cohort study using data from electronic health records. Adults with intellectual disability newly diagnosed with ADHD between 2007 and 2022 were matched to adults with ADHD without intellectual disability and their clinical features and treatments were compared.
Results: A total of 159 adults with ADHD and intellectual disability and 648 adults with ADHD without intellectual disability formed the dataset. Adults with intellectual disability had higher rates of psychiatric co-morbidity and spent more time under mental health services than those without intellectual disability. They were more likely to have recorded agitation, aggression, hostility, and mood instability, and less likely to have poor concentration recorded in the 12 months prior to the diagnosis of ADHD. Following diagnosis, people with intellectual disability were significantly less likely to be prescribed any medication for ADHD than controls without intellectual disability (adjusted odds ratio 0.60, 95% confidence interval 0.38-0.91), and were less likely to be prescribed stimulants (27.7% v 46.0%, p < 0.001).
Conclusions: The presence of behaviors that challenge in adults with intellectual disability may indicate co-occurring ADHD. Further work to define the safety and efficacy of medication for ADHD in adults with intellectual disability is needed to understand differences in prescription rates and to avoid inequities in care outcomes.
{"title":"Diagnosis and pharmacological management of attention deficit hyperactivity disorder in adults with and without intellectual disability: cohort study using electronic health records.","authors":"Rory Sheehan, Jennifer Leng, Hannah Woods, R Asaad Baksh","doi":"10.1017/S0033291724001338","DOIUrl":"https://doi.org/10.1017/S0033291724001338","url":null,"abstract":"<p><strong>Background: </strong>Attention deficit hyperactivity disorder (ADHD) is increasingly diagnosed in adults. People with intellectual disability have higher rates of ADHD yet there is little evidence on the presentation and pharmacological treatment of ADHD in this population or how this differs from the general population.</p><p><strong>Methods: </strong>Retrospective cohort study using data from electronic health records. Adults with intellectual disability newly diagnosed with ADHD between 2007 and 2022 were matched to adults with ADHD without intellectual disability and their clinical features and treatments were compared.</p><p><strong>Results: </strong>A total of 159 adults with ADHD and intellectual disability and 648 adults with ADHD without intellectual disability formed the dataset. Adults with intellectual disability had higher rates of psychiatric co-morbidity and spent more time under mental health services than those without intellectual disability. They were more likely to have recorded agitation, aggression, hostility, and mood instability, and less likely to have poor concentration recorded in the 12 months prior to the diagnosis of ADHD. Following diagnosis, people with intellectual disability were significantly less likely to be prescribed any medication for ADHD than controls without intellectual disability (adjusted odds ratio 0.60, 95% confidence interval 0.38-0.91), and were less likely to be prescribed stimulants (27.7% <i>v</i> 46.0%, <i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>The presence of behaviors that challenge in adults with intellectual disability may indicate co-occurring ADHD. Further work to define the safety and efficacy of medication for ADHD in adults with intellectual disability is needed to understand differences in prescription rates and to avoid inequities in care outcomes.</p>","PeriodicalId":20891,"journal":{"name":"Psychological Medicine","volume":null,"pages":null},"PeriodicalIF":6.9,"publicationDate":"2024-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141200612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01Epub Date: 2023-12-04DOI: 10.1017/S003329172300346X
Aino Saarinen, Jarmo Hietala, Leo-Pekka Lyytikäinen, Binisha Hamal Mishra, Elina Sormunen, Veikka Lavonius, Mika Kähönen, Olli Raitakari, Terho Lehtimäki, Liisa Keltikangas-Järvinen
Background: We investigated (a) whether polygenic risk for schizophrenia predicts different trajectories of social development among those who have not developed psychoses and (b) whether possible associations are PRSSCZ-specific or evident also for any polygenic risk for mental disorders, e.g. for major depression.
Methods: Participants came from the population-based Young Finns Study (n = 2377). We calculated a polygenic risk score for schizophrenia (PRSSCZ) and for major depression (PRSDEP). Diagnoses of psychotic disorders were derived from the hospital care register. Social development from adolescence to middle age was measured by (a) perceived social support from friends, family, and a close other, (b) perceived sociability, and (c) family structure (partnership status, number of children, age of first-time parenthood).
Results: Among those without manifest psychoses, high PRSSCZ predicted lower experienced support from friends (B = -0.04, p = 0.009-0.035) and family (B = -0.04, p = 0.009-0.035) especially after early adulthood, and also lower perceived sociability (B = -0.05, p = 0.010-0.026). PRSSCZ was not related to family structure. PRSDEP did not predict any domain of social development.
Conclusions: Individuals at high PRSSCZ (not converted to psychosis) seem to experience a lower preference to be with others over being alone. Individuals with high (v. low) PRSSCZ seem to have a similar family structure in terms of partnership status or number of children but, nevertheless, they experience less support from their family. Among those not converted to psychosis in a typical age period, high PRSSCZ may predict a 'later risk phase' and reduced functional resilience when approaching middle age.
背景:我们调查了(a)精神分裂症的多基因风险是否预测了未患精神病者的不同社会发展轨迹;(b)可能的关联是prsscz特异性的还是与精神障碍(如重度抑郁症)的多基因风险明显相关。方法:参与者来自以人群为基础的芬兰青年研究(n = 2377)。我们计算了精神分裂症(PRSSCZ)和重度抑郁症(PRSDEP)的多基因风险评分。精神障碍的诊断来自医院护理登记。从青春期到中年的社会发展是通过以下几个方面来衡量的:(a)感知到的来自朋友、家人和亲密他人的社会支持,(b)感知到的社交能力,以及(c)家庭结构(伴侣关系状况、子女数量、首次为人父母的年龄)。结果:在无明显精神障碍的被试中,高PRSSCZ对成年早期的朋友(B = -0.04, p = 0.009-0.035)和家庭(B = -0.04, p = 0.009-0.035)的支持体验较低,对社交能力的感知也较低(B = -0.05, p = 0.010-0.026)。PRSSCZ与家庭结构无关。PRSDEP没有预测任何社会发展领域。结论:高PRSSCZ的个体(未转化为精神病)似乎更倾向于与他人在一起而不是独处。高(或低)PRSSCZ的个体在伴侣关系状态或子女数量方面似乎具有相似的家庭结构,但他们从家庭获得的支持较少。在那些没有在典型年龄阶段转化为精神病的人中,高PRSSCZ可能预示着“后期风险阶段”,并且在接近中年时功能恢复能力降低。
{"title":"Polygenic risk for schizophrenia predicting social trajectories in a general population sample.","authors":"Aino Saarinen, Jarmo Hietala, Leo-Pekka Lyytikäinen, Binisha Hamal Mishra, Elina Sormunen, Veikka Lavonius, Mika Kähönen, Olli Raitakari, Terho Lehtimäki, Liisa Keltikangas-Järvinen","doi":"10.1017/S003329172300346X","DOIUrl":"10.1017/S003329172300346X","url":null,"abstract":"<p><strong>Background: </strong>We investigated (a) whether polygenic risk for schizophrenia predicts different trajectories of social development among those who have not developed psychoses and (b) whether possible associations are PRS<sub>SCZ</sub>-specific or evident also for any polygenic risk for mental disorders, e.g. for major depression.</p><p><strong>Methods: </strong>Participants came from the population-based Young Finns Study (<i>n</i> = 2377). We calculated a polygenic risk score for schizophrenia (PRS<sub>SCZ</sub>) and for major depression (PRS<sub>DEP</sub>). Diagnoses of psychotic disorders were derived from the hospital care register. Social development from adolescence to middle age was measured by (a) perceived social support from friends, family, and a close other, (b) perceived sociability, and (c) family structure (partnership status, number of children, age of first-time parenthood).</p><p><strong>Results: </strong>Among those without manifest psychoses, high PRS<sub>SCZ</sub> predicted lower experienced support from friends (<i>B</i> = -0.04, <i>p</i> = 0.009-0.035) and family (<i>B</i> = -0.04, <i>p</i> = 0.009-0.035) especially after early adulthood, and also lower perceived sociability (<i>B</i> = -0.05, <i>p</i> = 0.010-0.026). PRS<sub>SCZ</sub> was not related to family structure. PRS<sub>DEP</sub> did not predict any domain of social development.</p><p><strong>Conclusions: </strong>Individuals at high PRS<sub>SCZ</sub> (not converted to psychosis) seem to experience a lower preference to be with others over being alone. Individuals with high (<i>v.</i> low) PRS<sub>SCZ</sub> seem to have a similar family structure in terms of partnership status or number of children but, nevertheless, they experience less support from their family. Among those not converted to psychosis in a typical age period, high PRS<sub>SCZ</sub> may predict a 'later risk phase' and reduced functional resilience when approaching middle age.</p>","PeriodicalId":20891,"journal":{"name":"Psychological Medicine","volume":null,"pages":null},"PeriodicalIF":6.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138478469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01Epub Date: 2023-12-22DOI: 10.1017/S0033291723003549
Malte Zopfs, Miroslava Jindrová, Guy Gurevitch, Jackob N Keynan, Talma Hendler, Sarah Baumeister, Pascal-M Aggensteiner, Sven Cornelisse, Daniel Brandeis, Christian Schmahl, Christian Paret
Background: The modulation of brain circuits of emotion is a promising pathway to treat borderline personality disorder (BPD). Precise and scalable approaches have yet to be established. Two studies investigating the amygdala-related electrical fingerprint (Amyg-EFP) in BPD are presented: one study addressing the deep-brain correlates of Amyg-EFP, and a second study investigating neurofeedback (NF) as a means to improve brain self-regulation.
Methods: Study 1 combined electroencephalography (EEG) and simultaneous functional magnetic resonance imaging to investigate the replicability of Amyg-EFP-related brain activation found in the reference dataset (N = 24 healthy subjects, 8 female; re-analysis of published data) in the replication dataset (N = 16 female individuals with BPD). In the replication dataset, we additionally explored how the Amyg-EFP would map to neural circuits defined by the research domain criteria. Study 2 investigated a 10-session Amyg-EFP NF training in parallel to a 12-weeks residential dialectical behavior therapy (DBT) program. Fifteen patients with BPD completed the training, N = 15 matched patients served as DBT-only controls.
Results: Study 1 replicated previous findings and showed significant amygdala blood oxygenation level dependent activation in a whole-brain regression analysis with the Amyg-EFP. Neurocircuitry activation (negative affect, salience, and cognitive control) was correlated with the Amyg-EFP signal. Study 2 showed Amyg-EFP modulation with NF training, but patients received reversed feedback for technical reasons, which limited interpretation of results.
Conclusions: Recorded via scalp EEG, the Amyg-EFP picks up brain activation of high relevance for emotion. Administering Amyg-EFP NF in addition to standardized BPD treatment was shown to be feasible. Clinical utility remains to be investigated.
{"title":"Amygdala-related electrical fingerprint is modulated with neurofeedback training and correlates with deep-brain activation: proof-of-concept in borderline personality disorder.","authors":"Malte Zopfs, Miroslava Jindrová, Guy Gurevitch, Jackob N Keynan, Talma Hendler, Sarah Baumeister, Pascal-M Aggensteiner, Sven Cornelisse, Daniel Brandeis, Christian Schmahl, Christian Paret","doi":"10.1017/S0033291723003549","DOIUrl":"10.1017/S0033291723003549","url":null,"abstract":"<p><strong>Background: </strong>The modulation of brain circuits of emotion is a promising pathway to treat borderline personality disorder (BPD). Precise and scalable approaches have yet to be established. Two studies investigating the amygdala-related electrical fingerprint (Amyg-EFP) in BPD are presented: one study addressing the deep-brain correlates of Amyg-EFP, and a second study investigating neurofeedback (NF) as a means to improve brain self-regulation.</p><p><strong>Methods: </strong>Study 1 combined electroencephalography (EEG) and simultaneous functional magnetic resonance imaging to investigate the replicability of Amyg-EFP-related brain activation found in the reference dataset (<i>N</i> = 24 healthy subjects, 8 female; re-analysis of published data) in the replication dataset (<i>N</i> = 16 female individuals with BPD). In the replication dataset, we additionally explored how the Amyg-EFP would map to neural circuits defined by the research domain criteria. Study 2 investigated a 10-session Amyg-EFP NF training in parallel to a 12-weeks residential dialectical behavior therapy (DBT) program. Fifteen patients with BPD completed the training, <i>N</i> = 15 matched patients served as DBT-only controls.</p><p><strong>Results: </strong>Study 1 replicated previous findings and showed significant amygdala blood oxygenation level dependent activation in a whole-brain regression analysis with the Amyg-EFP. Neurocircuitry activation (negative affect, salience, and cognitive control) was correlated with the Amyg-EFP signal. Study 2 showed Amyg-EFP modulation with NF training, but patients received reversed feedback for technical reasons, which limited interpretation of results.</p><p><strong>Conclusions: </strong>Recorded via scalp EEG, the Amyg-EFP picks up brain activation of high relevance for emotion. Administering Amyg-EFP NF in addition to standardized BPD treatment was shown to be feasible. Clinical utility remains to be investigated.</p>","PeriodicalId":20891,"journal":{"name":"Psychological Medicine","volume":null,"pages":null},"PeriodicalIF":6.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138831299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01Epub Date: 2024-01-04DOI: 10.1017/S0033291723003720
Clare C Beatty, Kelly Gair, Joy Anatala, Daniel N Klein, Greg Hajcak, Brady D Nelson
Background: Adolescence is a key developmental period for the emergence of psychopathology. Reward-related brain activity increases across adolescence and has been identified as a potential neurobiological mechanism of risk for different forms of psychopathology. The reward positivity (RewP) is an event-related potential component that indexes reward system activation and has been associated with both concurrent and family history of psychopathology. However, it is unclear whether the RewP is also associated with higher-order psychopathology subfactors and whether this relationship is present across different types of reward.
Methods: In a sample of 193 adolescent females and a biological parent, the present study examined the association between adolescent and parental psychopathology subfactors and adolescent RewP to monetary and social reward.
Results: Results indicated that the adolescent and parental distress subfactors were negatively associated with the adolescent domain-general RewP. The adolescent and parental positive mood subfactors were negatively associated with the adolescent domain-general and domain-specific monetary RewP, respectively. Conversely, the adolescent and parental fear/obsessions subfactors were positively associated with the adolescent domain-general RewP. The associations between parental and adolescent psychopathology subfactors and the adolescent RewP were independent of each other.
Conclusions: The RewP in adolescent females is associated with both concurrent and parental psychopathology symptoms, suggesting that it indexes both severity and risk for higher-order subfactors.
{"title":"Neural response to monetary and social rewards and familial risk for psychopathology in adolescent females.","authors":"Clare C Beatty, Kelly Gair, Joy Anatala, Daniel N Klein, Greg Hajcak, Brady D Nelson","doi":"10.1017/S0033291723003720","DOIUrl":"10.1017/S0033291723003720","url":null,"abstract":"<p><strong>Background: </strong>Adolescence is a key developmental period for the emergence of psychopathology. Reward-related brain activity increases across adolescence and has been identified as a potential neurobiological mechanism of risk for different forms of psychopathology. The reward positivity (RewP) is an event-related potential component that indexes reward system activation and has been associated with both concurrent and family history of psychopathology. However, it is unclear whether the RewP is also associated with higher-order psychopathology subfactors and whether this relationship is present across different types of reward.</p><p><strong>Methods: </strong>In a sample of 193 adolescent females and a biological parent, the present study examined the association between adolescent and parental psychopathology subfactors and adolescent RewP to monetary and social reward.</p><p><strong>Results: </strong>Results indicated that the adolescent and parental distress subfactors were negatively associated with the adolescent domain-general RewP. The adolescent and parental positive mood subfactors were negatively associated with the adolescent domain-general and domain-specific monetary RewP, respectively. Conversely, the adolescent and parental fear/obsessions subfactors were positively associated with the adolescent domain-general RewP. The associations between parental and adolescent psychopathology subfactors and the adolescent RewP were independent of each other.</p><p><strong>Conclusions: </strong>The RewP in adolescent females is associated with both concurrent and parental psychopathology symptoms, suggesting that it indexes both severity and risk for higher-order subfactors.</p>","PeriodicalId":20891,"journal":{"name":"Psychological Medicine","volume":null,"pages":null},"PeriodicalIF":6.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139088077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01Epub Date: 2024-01-29DOI: 10.1017/S0033291723003793
Hafsah A Tauseef, Katja M Schmalenberger, Jordan C Barone, Jaclyn M Ross, Jessica R Peters, Susan S Girdler, Tory A Eisenlohr-Moul
Background: A minority of naturally cycling individuals experience clinically significant affective changes across the menstrual cycle. However, few studies have examined cognitive and behavioral constructs that may maintain or worsen these changes. Several small studies link rumination with premenstrual negative affect, with authors concluding that a tendency to ruminate amplifies and perpetuates hormone-sensitive affective symptoms. Replication in larger samples is needed to confirm the validity of rumination as a treatment target.
Method: 190 cycling individuals (M = 30.82 years; 61.1% Caucasian) were recruited for moderate perceived stress, a risk factor for cyclical symptoms. They completed the Rumination Response Scale at baseline, then reported daily affective and physical symptoms across 1-6 cycles. Multilevel growth models tested trait rumination as a predictor of baseline levels, luteal increases, and follicular decreases in symptoms.
Results: The degree of affective cyclicity was normally distributed across a substantial range, supporting feasibility of hypothesis tests and validating the concept of dimensional hormone sensitivity. Contrary to prediction, higher brooding did not predict levels or cyclical changes of any symptom. In a subsample selected for luteal increases in negative affect, brooding predicted higher baseline negative affect but still did not predict affective cyclicity.
Conclusions: An individual's trait-like propensity to engage in rumination may not be a valid treatment target in premenstrual mood disorders. State-like changes in rumination should still be further explored, and well-powered prospective studies should explore other cognitive and behavioral factors to inform development of targeted psychological treatments for patients with cyclical affective symptoms.
{"title":"Is trait rumination associated with affective reactivity to the menstrual cycle? A prospective analysis.","authors":"Hafsah A Tauseef, Katja M Schmalenberger, Jordan C Barone, Jaclyn M Ross, Jessica R Peters, Susan S Girdler, Tory A Eisenlohr-Moul","doi":"10.1017/S0033291723003793","DOIUrl":"10.1017/S0033291723003793","url":null,"abstract":"<p><strong>Background: </strong>A minority of naturally cycling individuals experience clinically significant affective changes across the menstrual cycle. However, few studies have examined cognitive and behavioral constructs that may maintain or worsen these changes. Several small studies link rumination with premenstrual negative affect, with authors concluding that a tendency to ruminate amplifies and perpetuates hormone-sensitive affective symptoms. Replication in larger samples is needed to confirm the validity of rumination as a treatment target.</p><p><strong>Method: </strong>190 cycling individuals (<i>M</i> = 30.82 years; 61.1% Caucasian) were recruited for moderate perceived stress, a risk factor for cyclical symptoms. They completed the Rumination Response Scale at baseline, then reported daily affective and physical symptoms across 1-6 cycles. Multilevel growth models tested trait rumination as a predictor of baseline levels, luteal increases, and follicular decreases in symptoms.</p><p><strong>Results: </strong>The degree of affective cyclicity was normally distributed across a substantial range, supporting feasibility of hypothesis tests and validating the concept of dimensional hormone sensitivity. Contrary to prediction, higher brooding did not predict levels or cyclical changes of any symptom. In a subsample selected for luteal increases in negative affect, brooding predicted higher baseline negative affect but still did not predict affective cyclicity.</p><p><strong>Conclusions: </strong>An individual's trait-like propensity to engage in rumination may not be a valid treatment target in premenstrual mood disorders. State-like changes in rumination should still be further explored, and well-powered prospective studies should explore other cognitive and behavioral factors to inform development of targeted psychological treatments for patients with cyclical affective symptoms.</p>","PeriodicalId":20891,"journal":{"name":"Psychological Medicine","volume":null,"pages":null},"PeriodicalIF":6.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11132929/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139571281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01Epub Date: 2023-11-29DOI: 10.1017/S0033291723003471
Anne Alkema, Mattia Marchi, Jeroen A J van der Zaag, Daniëlle van der Sluis, Varun Warrier, Roel A Ophoff, René S Kahn, Wiepke Cahn, Jacqueline G F M Hovens, Harriëtte Riese, Floortje Scheepers, Brenda W J H Penninx, Charlotte Cecil, Albertine J Oldehinkel, Christiaan H Vinkers, Marco P M Boks
Background: Childhood maltreatment (CM) is a strong risk factor for psychiatric disorders but serves in its current definitions as an umbrella for various fundamentally different childhood experiences. As first step toward a more refined analysis of the impact of CM, our objective is to revisit the relation of abuse and neglect, major subtypes of CM, with symptoms across disorders.
Methods: Three longitudinal studies of major depressive disorder (MDD, N = 1240), bipolar disorder (BD, N = 1339), and schizophrenia (SCZ, N = 577), each including controls (N = 881), were analyzed. Multivariate regression models were used to examine the relation between exposure to abuse, neglect, or their combination to the odds for MDD, BD, SCZ, and symptoms across disorders. Bidirectional Mendelian randomization (MR) was used to probe causality, using genetic instruments of abuse and neglect derived from UK Biobank data (N = 143 473).
Results: Abuse was the stronger risk factor for SCZ (OR 3.51, 95% CI 2.17-5.67) and neglect for BD (OR 2.69, 95% CI 2.09-3.46). Combined CM was related to increased risk exceeding additive effects of abuse and neglect for MDD (RERI = 1.4) and BD (RERI = 1.1). Across disorders, abuse was associated with hallucinations (OR 2.16, 95% CI 1.55-3.01) and suicide attempts (OR 2.16, 95% CI 1.55-3.01) whereas neglect was associated with agitation (OR 1.24, 95% CI 1.02-1.51) and reduced need for sleep (OR 1.64, 95% CI 1.08-2.48). MR analyses were consistent with a bidirectional causal effect of abuse with SCZ (IVWforward = 0.13, 95% CI 0.01-0.24).
Conclusions: Childhood abuse and neglect are associated with different risks to psychiatric symptoms and disorders. Unraveling the origin of these differences may advance understanding of disease etiology and ultimately facilitate development of improved personalized treatment strategies.
背景:童年虐待(CM)是精神疾病的一个强大的危险因素,但在其目前的定义中,它是各种根本不同的童年经历的保护伞。作为对CM影响进行更细致分析的第一步,我们的目标是重新审视虐待和忽视(CM的主要亚型)与各种障碍症状的关系。方法:对重度抑郁症(MDD, N = 1240)、双相情感障碍(BD, N = 1339)和精神分裂症(SCZ, N = 577) 3项纵向研究进行分析,各纳入对照组(N = 881)。使用多变量回归模型来检查暴露于虐待、忽视或其组合与MDD、BD、SCZ的几率和跨障碍症状之间的关系。双向孟德尔随机化(MR)被用于探索因果关系,使用来自UK Biobank数据的滥用和忽视遗传工具(N = 143 473)。结果:滥用是SCZ更强的危险因素(OR 3.51, 95% CI 2.17-5.67),忽视BD (OR 2.69, 95% CI 2.09-3.46)。合并CM与滥用和忽视MDD (rei = 1.4)和BD (rei = 1.1)的风险增加相关。在所有障碍中,滥用与幻觉(OR 2.16, 95% CI 1.55-3.01)和自杀企图(OR 2.16, 95% CI 1.55-3.01)相关,而忽视与躁动(OR 1.24, 95% CI 1.02-1.51)和睡眠需求减少(OR 1.64, 95% CI 1.08-2.48)相关。MR分析与滥用与SCZ的双向因果效应一致(IVWforward = 0.13, 95% CI 0.01-0.24)。结论:儿童虐待和忽视与精神症状和障碍的不同风险相关。揭示这些差异的起源可能会促进对疾病病因学的理解,并最终促进改进的个性化治疗策略的发展。
{"title":"Childhood abuse <i>v.</i> neglect and risk for major psychiatric disorders.","authors":"Anne Alkema, Mattia Marchi, Jeroen A J van der Zaag, Daniëlle van der Sluis, Varun Warrier, Roel A Ophoff, René S Kahn, Wiepke Cahn, Jacqueline G F M Hovens, Harriëtte Riese, Floortje Scheepers, Brenda W J H Penninx, Charlotte Cecil, Albertine J Oldehinkel, Christiaan H Vinkers, Marco P M Boks","doi":"10.1017/S0033291723003471","DOIUrl":"10.1017/S0033291723003471","url":null,"abstract":"<p><strong>Background: </strong>Childhood maltreatment (CM) is a strong risk factor for psychiatric disorders but serves in its current definitions as an umbrella for various fundamentally different childhood experiences. As first step toward a more refined analysis of the impact of CM, our objective is to revisit the relation of abuse and neglect, major subtypes of CM, with symptoms across disorders.</p><p><strong>Methods: </strong>Three longitudinal studies of major depressive disorder (MDD, <i>N</i> = 1240), bipolar disorder (BD, <i>N</i> = 1339), and schizophrenia (SCZ, <i>N</i> = 577), each including controls (<i>N</i> = 881), were analyzed. Multivariate regression models were used to examine the relation between exposure to abuse, neglect, or their combination to the odds for MDD, BD, SCZ, and symptoms across disorders. Bidirectional Mendelian randomization (MR) was used to probe causality, using genetic instruments of abuse and neglect derived from UK Biobank data (<i>N</i> = 143 473).</p><p><strong>Results: </strong>Abuse was the stronger risk factor for SCZ (OR 3.51, 95% CI 2.17-5.67) and neglect for BD (OR 2.69, 95% CI 2.09-3.46). Combined CM was related to increased risk exceeding additive effects of abuse and neglect for MDD (RERI = 1.4) and BD (RERI = 1.1). Across disorders, abuse was associated with hallucinations (OR 2.16, 95% CI 1.55-3.01) and suicide attempts (OR 2.16, 95% CI 1.55-3.01) whereas neglect was associated with agitation (OR 1.24, 95% CI 1.02-1.51) and reduced need for sleep (OR 1.64, 95% CI 1.08-2.48). MR analyses were consistent with a bidirectional causal effect of abuse with SCZ (IVW<sub>forward</sub> = 0.13, 95% CI 0.01-0.24).</p><p><strong>Conclusions: </strong>Childhood abuse and neglect are associated with different risks to psychiatric symptoms and disorders. Unraveling the origin of these differences may advance understanding of disease etiology and ultimately facilitate development of improved personalized treatment strategies.</p>","PeriodicalId":20891,"journal":{"name":"Psychological Medicine","volume":null,"pages":null},"PeriodicalIF":6.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138452305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01Epub Date: 2024-03-18DOI: 10.1017/S0033291723002581
Joanna H Hong, Julia S Nakamura, Sakshi S Sahakari, William J Chopik, Koichiro Shiba, Tyler J VanderWeele, Eric S Kim
Background: A large and accumulating body of evidence shows that loneliness is detrimental for various health and well-being outcomes. However, less is known about potentially modifiable factors that lead to decreased loneliness.
Methods: We used data from the Health and Retirement Study to prospectively evaluate a wide array of candidate predictors of subsequent loneliness. Importantly, we examined if changes in 69 physical-, behavioral-, and psychosocial-health factors (from t0;2006/2008 to t1;2010/2012) were associated with subsequent loneliness 4 years later (t2;2014/2016).
Results: Adjusting for a large range of covariates, changes in certain health behaviors (e.g. increased physical activity), physical health factors (e.g. fewer functioning limitations), psychological factors (e.g. increased purpose in life, decreased depression), and social factors (e.g. greater number of close friends) were associated with less subsequent loneliness.
Conclusions: Our findings suggest that subjective ratings of physical and psychological health and perceived social environment (e.g. chronic pain, self-rated health, purpose in life, anxiety, neighborhood cohesion) are more strongly associated with subsequent loneliness. Yet, objective ratings (e.g. specific chronic health conditions, living status) show less evidence of associations with subsequent loneliness. The current study identified potentially modifiable predictors of subsequent loneliness that may be important targets for interventions aimed at reducing loneliness.
背景:大量不断积累的证据表明,孤独不利于各种健康和幸福结果。然而,人们对导致孤独感减少的潜在可改变因素知之甚少:方法:我们利用健康与退休研究(Health and Retirement Study)的数据,前瞻性地评估了一系列候选的后续孤独感预测因素。重要的是,我们研究了69个身体、行为和社会心理健康因素的变化(从t0;2006/2008到t1;2010/2012)是否与4年后(t2;2014/2016)的孤独感有关:结果:在对大量协变量进行调整后,某些健康行为(如增加体育锻炼)、身体健康因素(如减少功能限制)、心理因素(如增加生活目标、减少抑郁)和社会因素(如增加亲密朋友的数量)的变化与随后的孤独感减少有关:我们的研究结果表明,对身体和心理健康的主观评价以及对社会环境的感知(如慢性疼痛、自我健康评价、生活目标、焦虑、邻里凝聚力)与随后的孤独感有更密切的关系。然而,客观评分(如具体的慢性健康状况、生活状况)与后续孤独感相关的证据较少。目前的研究发现了可能可以改变随后孤独感的预测因素,这些预测因素可能是旨在减少孤独感的干预措施的重要目标。
{"title":"The silent epidemic of loneliness: identifying the antecedents of loneliness using a lagged exposure-wide approach.","authors":"Joanna H Hong, Julia S Nakamura, Sakshi S Sahakari, William J Chopik, Koichiro Shiba, Tyler J VanderWeele, Eric S Kim","doi":"10.1017/S0033291723002581","DOIUrl":"10.1017/S0033291723002581","url":null,"abstract":"<p><strong>Background: </strong>A large and accumulating body of evidence shows that loneliness is detrimental for various health and well-being outcomes. However, less is known about potentially modifiable factors that lead to decreased loneliness.</p><p><strong>Methods: </strong>We used data from the Health and Retirement Study to prospectively evaluate a wide array of candidate predictors of subsequent loneliness. Importantly, we examined if changes in 69 physical-, behavioral-, and psychosocial-health factors (from <i>t</i><sub>0</sub>;2006/2008 to <i>t</i><sub>1</sub>;2010/2012) were associated with subsequent loneliness 4 years later (<i>t</i><sub>2</sub>;2014/2016).</p><p><strong>Results: </strong>Adjusting for a large range of covariates, changes in certain health behaviors (e.g. increased physical activity), physical health factors (e.g. fewer functioning limitations), psychological factors (e.g. increased purpose in life, decreased depression), and social factors (e.g. greater number of close friends) were associated with less subsequent loneliness.</p><p><strong>Conclusions: </strong>Our findings suggest that subjective ratings of physical and psychological health and perceived social environment (e.g. chronic pain, self-rated health, purpose in life, anxiety, neighborhood cohesion) are more strongly associated with subsequent loneliness. Yet, objective ratings (e.g. specific chronic health conditions, living status) show less evidence of associations with subsequent loneliness. The current study identified potentially modifiable predictors of subsequent loneliness that may be important targets for interventions aimed at reducing loneliness.</p>","PeriodicalId":20891,"journal":{"name":"Psychological Medicine","volume":null,"pages":null},"PeriodicalIF":6.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140143971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}