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Leypoldt M, Wiegand A, Munk M, Drohm S, Fallgatter AJ, Nieratschker V, Kreifelts B. Alterations in cerebral resting state functional connectivity associated with social anxiety disorder and early life adversities. Transl Psychiatry 2025; 15:80. [PMID: 40082409 PMCID: PMC11906641 DOI: 10.1038/s41398-025-03301-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 01/20/2025] [Accepted: 02/25/2025] [Indexed: 03/16/2025] Open
Abstract
Social Anxiety Disorder (SAD) involves fear of negative evaluation and social avoidance, impacting quality of life. Early life adversities (ELA) are recognized as risk factors for SAD. Previous research indicated inconsistent alterations in resting state functional connectivity (RSFC) in SAD, particularly in the prefrontal cortex and precuneus. This study investigated the interaction between SAD and ELA at the RSFC level. Functional magnetic resonance imaging (fMRI) was conducted on 120 participants (aged 19-48). Four groups were formed: low/ high ELA controls (n = 49, n = 22) and low/ high ELA SAD participants (n = 30, n = 19). Seed-based correlation analyses (SCA) and multi-voxel pattern analysis (MVPA) were applied. A network in which ELA moderates the neural correlates of SAD during the resting state was identified, involving key nodes like the subgenual anterior cingulate cortex, left middle frontal gyrus, and an area in the calcarine fissure/precuneus. Five distinct interaction patterns of SAD and ELA were observed, showcasing opposite RSFC patterns in individuals with SAD based on ELA experience. Results remained significant when controlled for general anxiety and depression measures. Emotional aspects of ELA played a significant role in these interactions. These findings stress the necessity of considering primarily emotional ELA as covariate in neuroimaging studies investigating SAD and potentially also other psychiatric disorders, addressing inconsistencies in prior research. The left middle frontal gyrus emerges as a link in the SAD-ELA interaction during resting state and anxiety-relevant stimulation. Longitudinal studies, starting from childhood, are needed to understand ELA's impact on brain function and to identify potential neuromarkers for SAD predisposition post-ELA exposure.
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Affiliation(s)
- Melina Leypoldt
- Department of Psychiatry and Psychotherapy, Tuebingen Center for Mental Health (TüCMH), Tuebingen, Germany
| | - Ariane Wiegand
- Department of Psychiatry and Psychotherapy, Tuebingen Center for Mental Health (TüCMH), Tuebingen, Germany
- Max Planck Fellow Group for Precision Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany
| | - Matthias Munk
- Department of Psychiatry and Psychotherapy, Tuebingen Center for Mental Health (TüCMH), Tuebingen, Germany
| | - Sanja Drohm
- Department of Psychiatry and Psychotherapy, Tuebingen Center for Mental Health (TüCMH), Tuebingen, Germany
| | - Andreas J Fallgatter
- Department of Psychiatry and Psychotherapy, Tuebingen Center for Mental Health (TüCMH), Tuebingen, Germany
- German Center for Mental Health (DZPG), partner site Tuebingen, Tuebingen, Germany
| | - Vanessa Nieratschker
- Department of Psychiatry and Psychotherapy, Tuebingen Center for Mental Health (TüCMH), Tuebingen, Germany
- German Center for Mental Health (DZPG), partner site Tuebingen, Tuebingen, Germany
| | - Benjamin Kreifelts
- Department of Psychiatry and Psychotherapy, Tuebingen Center for Mental Health (TüCMH), Tuebingen, Germany.
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Vaidya N, Marquand AF, Nees F, Siehl S, Schumann G. The impact of psychosocial adversity on brain and behaviour: an overview of existing knowledge and directions for future research. Mol Psychiatry 2024; 29:3245-3267. [PMID: 38658773 PMCID: PMC11449794 DOI: 10.1038/s41380-024-02556-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 04/03/2024] [Accepted: 04/08/2024] [Indexed: 04/26/2024]
Abstract
Environmental experiences play a critical role in shaping the structure and function of the brain. Its plasticity in response to different external stimuli has been the focus of research efforts for decades. In this review, we explore the effects of adversity on brain's structure and function and its implications for brain development, adaptation, and the emergence of mental health disorders. We are focusing on adverse events that emerge from the immediate surroundings of an individual, i.e., microenvironment. They include childhood maltreatment, peer victimisation, social isolation, affective loss, domestic conflict, and poverty. We also take into consideration exposure to environmental toxins. Converging evidence suggests that different types of adversity may share common underlying mechanisms while also exhibiting unique pathways. However, they are often studied in isolation, limiting our understanding of their combined effects and the interconnected nature of their impact. The integration of large, deep-phenotyping datasets and collaborative efforts can provide sufficient power to analyse high dimensional environmental profiles and advance the systematic mapping of neuronal mechanisms. This review provides a background for future research, highlighting the importance of understanding the cumulative impact of various adversities, through data-driven approaches and integrative multimodal analysis techniques.
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Affiliation(s)
- Nilakshi Vaidya
- Centre for Population Neuroscience and Stratified Medicine (PONS), Department of Psychiatry and Clinical Neuroscience, Charité Universitätsmedizin Berlin, Berlin, Germany.
| | - Andre F Marquand
- Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Frauke Nees
- Institute of Medical Psychology and Medical Sociology, University Medical Center Schleswig Holstein, Kiel University, Kiel, Germany
| | - Sebastian Siehl
- Institute of Medical Psychology and Medical Sociology, University Medical Center Schleswig Holstein, Kiel University, Kiel, Germany
| | - Gunter Schumann
- Centre for Population Neuroscience and Stratified Medicine (PONS), Department of Psychiatry and Clinical Neuroscience, Charité Universitätsmedizin Berlin, Berlin, Germany
- Centre for Population Neuroscience and Stratified Medicine (PONS), Institute for Science and Technology of Brain-Inspired Intelligence (ISTBI), Fudan University, Shanghai, China
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Liu W, Heij J, Liu S, Liebrand L, Caan M, van der Zwaag W, Veltman DJ, Lu L, Aghajani M, van Wingen G. Hippocampal, thalamic, and amygdala subfield morphology in major depressive disorder: an ultra-high resolution MRI study at 7-Tesla. Eur Arch Psychiatry Clin Neurosci 2024:10.1007/s00406-024-01874-0. [PMID: 39217211 DOI: 10.1007/s00406-024-01874-0] [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: 03/25/2024] [Accepted: 08/13/2024] [Indexed: 09/04/2024]
Abstract
Morphological changes in the hippocampal, thalamic, and amygdala subfields have been suggested to form part of the pathophysiology of major depressive disorder (MDD). However, the use of conventional MRI scanners and acquisition techniques has prevented in-depth examinations at the subfield level, precluding a fine-grained understanding of these subfields and their involvement in MDD pathophysiology. We uniquely employed ultra-high field MRI at 7.0 Tesla to map hippocampal, thalamic, and amygdala subfields in MDD. Fifty-six MDD patients and 14 healthy controls (HCs) were enrolled in the final analysis. FreeSurfer protocols were used to segment hippocampal, thalamic, and amygdala subfields. Bayesian analysis was then implemented to assess differences between groups and relations with clinical features. While no effect was found for MDD diagnosis (i.e., case-control comparison), clinical characteristics of MDD patients were associated with subfield volumes of the hippocampus, thalamus, and amygdala. Specifically, the severity of depressive symptoms, insomnia, and childhood trauma in MDD patients related to lower thalamic subfield volumes. In addition, MDD patients with typical MDD versus those with atypical MDD showed lower hippocampal, thalamic, and amygdala subfield volumes. MDD patients with recurrent MDD versus those with first-episode MDD also showed lower thalamic subfield volumes. These findings allow uniquely fine-grained insights into hippocampal, thalamic, and amygdala subfield morphology in MDD, linking some of them to the clinical manifestation of MDD.
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Affiliation(s)
- Weijian Liu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University, HuayuanBei Road 51, Beijing, 100191, China.
- Department of Psychiatry, UMC Location University of Amsterdam, Meibergdreef 5, 1100 DD, Amsterdam, the Netherlands.
- Amsterdam Neuroscience, Amsterdam, the Netherlands.
| | - Jurjen Heij
- Spinoza Centre for Neuroimaging, KNAW, Amsterdam, the Netherlands
- Department of Computational Cognitive Neuroscience and Neuroimaging, Netherlands Institute for Neuroscience, Amsterdam, Netherlands
| | - Shu Liu
- Key Laboratory of Genetic Evolution & Animal Models, National Research Facility for Phenotypic & Genetic Analysis of Model Animals (Primate Facility), National Resource Center for Non-Human Primates, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, China
| | - Luka Liebrand
- Amsterdam Neuroscience, Amsterdam, the Netherlands
- Department of Radiation Oncology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Matthan Caan
- Amsterdam Neuroscience, Amsterdam, the Netherlands
- Department of Biomedical Engineering & Physics, UMC Location University of Amsterdam, Amsterdam, the Netherlands
| | - Wietske van der Zwaag
- Spinoza Centre for Neuroimaging, KNAW, Amsterdam, the Netherlands
- Department of Computational Cognitive Neuroscience and Neuroimaging, Netherlands Institute for Neuroscience, Amsterdam, Netherlands
| | - Dick J Veltman
- Department of Psychiatry, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Lin Lu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University, HuayuanBei Road 51, Beijing, 100191, China.
- Peking-Tsinghua Centre for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China.
- National Institute On Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China.
| | - Moji Aghajani
- Department of Psychiatry, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Institute of Education and Child Studies, Section Forensic Family and Youth Care, Leiden University, Leiden, the Netherlands
| | - Guido van Wingen
- Department of Psychiatry, UMC Location University of Amsterdam, Meibergdreef 5, 1100 DD, Amsterdam, the Netherlands.
- Amsterdam Neuroscience, Amsterdam, the Netherlands.
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Zhang M, Wu C, Lu S, Wang Y, Ma R, Du Y, Wang S, Fang J. Regional brain activity and connectivity associated with childhood trauma in drug-naive patients with obsessive-compulsive disorder. Sci Rep 2024; 14:18111. [PMID: 39103500 PMCID: PMC11300583 DOI: 10.1038/s41598-024-69122-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 07/31/2024] [Indexed: 08/07/2024] Open
Abstract
Obsessive-compulsive disorder (OCD) is characterized by intrusive thoughts and repetitive, compulsive behaviors, with childhood trauma recognized as a contributing factor to its pathophysiology. This study aimed to delineate brain functional aberrations in OCD patients and explore the association between these abnormalities and childhood trauma, to gain insights into the neural underpinnings of OCD. Forty-eight drug-naive OCD patients and forty-two healthy controls (HC) underwent resting-state functional magnetic resonance imaging and clinical assessments, including the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and Childhood Trauma Questionnaire-Short Form (CTQ-SF). Compared to HCs, OCD patients exhibited significantly decreased amplitude of low-frequency fluctuations (ALFF) in the right cerebellum, decreased regional homogeneity (ReHo) in the right cerebellum and right superior occipital lobes (FWE-corrected p < 0.05), which negatively correlated with Y-BOCS scores (p < 0.05). Furthermore, cerebellar ALFF negatively correlated with the CTQ emotional abuse subscale (r = - 0.514, p < 0.01). Mediation analysis revealed that cerebellar ALFF mediated the relationship between CTQ-emotional abuse and Y-BOCS (good model fit: R2 = 0.231, MSE = 14.311, F = 5.721, p < 0.01; direct effect, c' = 0.153, indirect effect, a*b = 0.191). Findings indicated abnormal spontaneous and regional cerebellar activity in OCD, suggesting childhood trauma impacts OCD symptoms through cerebellar neural remodeling, highlighting its importance for clinical treatment selection.
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Affiliation(s)
- Manxue Zhang
- Mental Health Center, Ningxia Medical University General Hospital, Yinchuan, China
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
| | - Chujun Wu
- Mental Health Center, Ningxia Medical University General Hospital, Yinchuan, China
| | - Shihao Lu
- Mental Health Center, Ningxia Medical University General Hospital, Yinchuan, China
| | - Yanrong Wang
- Mental Health Center, Ningxia Medical University General Hospital, Yinchuan, China
| | - Rui Ma
- Mental Health Center, Ningxia Medical University General Hospital, Yinchuan, China
| | - Yunyun Du
- Mental Health Center, Ningxia Medical University General Hospital, Yinchuan, China
| | - Shaoxia Wang
- Mental Health Center, Ningxia Medical University General Hospital, Yinchuan, China
| | - Jianqun Fang
- Institute of Medical Sciences, General Hospital of Ningxia Medical University, Yinchuan, 750004, Ningxia, China.
- Mental Health Center, Ningxia Medical University General Hospital, Yinchuan, China.
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Zheng Y, Wu Y, Liu Y, Li D, Liang X, Chen Y, Zhang H, Guo Y, Lu R, Wang J, Qiu S. Abnormal dynamic functional connectivity of thalamic subregions in patients with first-episode, drug-naïve major depressive disorder. Front Psychiatry 2023; 14:1152332. [PMID: 37234210 PMCID: PMC10206063 DOI: 10.3389/fpsyt.2023.1152332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 04/24/2023] [Indexed: 05/27/2023] Open
Abstract
Background Recent studies have shown that major depressive disorder (MDD) is associated with altered intrinsic functional connectivity (FC) of the thalamus; however, investigations of these alterations at a finer time scale and the level of thalamic subregions are still lacking. Methods We collected resting-state functional MRI data from 100 treatment-naïve, first-episode MDD patients and 99 age-, gender- and education-matched healthy controls (HCs). Seed-based whole-brain sliding window-based dFC analyses were performed for 16 thalamic subregions. Between-group differences in the mean and variance of dFC were determined using threshold-free cluster enhancement algorithm. For significant alterations, there relationships with clinical and neuropsychological variables were further examined via bivariate and multivariate correlation analyses. Results Of all thalamic subregions, only the left sensory thalamus (Stha) showed altered variance of dFC in the patients characterized by increases with the left inferior parietal lobule, left superior frontal gyrus, left inferior temporal gyrus, and left precuneus, and decreases with multiple frontal, temporal, parietal, and subcortical regions. These alterations accounted for, to a great extent, clinical, and neuropsychological characteristics of the patients as revealed by the multivariate correlation analysis. In addition, the bivariate correlation analysis revealed a positive correlation between the variance of dFC between the left Stha and right inferior temporal gurus/fusiform and childhood trauma questionnaires scores (r = 0.562, P < 0.001). Conclusion These findings suggest that the left Stha is the most vulnerable thalamic subregion to MDD, whose dFC alterations may serve as potential biomarkers for the diagnosis of the disease.
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Affiliation(s)
- Yanting Zheng
- Department of Radiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Yujie Wu
- Department of Clinical Psychology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Yujie Liu
- Department of Radiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
- Department of Radiology, Guangzhou First People’s Hospital, Guangzhou, Guangdong, China
| | - Danian Li
- Cerebropathy Center, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Xinyu Liang
- The First School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Yaoping Chen
- The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Hanyue Zhang
- Department of Radiology, Guangzhou First People’s Hospital, Guangzhou, Guangdong, China
| | - Yan Guo
- The First School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Ruoxi Lu
- The First School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Jinhui Wang
- Institute for Brain Research and Rehabilitation, South China Normal University, Guangzhou, China
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, Guangzhou, China
- Center for Studies of Psychological Application, South China Normal University, Guangzhou, China
- Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China
| | - Shijun Qiu
- Department of Radiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
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Liu J, Cao L, Li H, Gao Y, Bu X, Liang K, Bao W, Zhang S, Qiu H, Li X, Hu X, Lu L, Zhang L, Hu X, Huang X, Gong Q. Abnormal resting-state functional connectivity in patients with obsessive-compulsive disorder: A systematic review and meta-analysis. Neurosci Biobehav Rev 2022; 135:104574. [DOI: 10.1016/j.neubiorev.2022.104574] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 12/12/2021] [Accepted: 02/07/2022] [Indexed: 12/31/2022]
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Childhood adversity affects symptomatology via behavioral inhibition in patients with obsessive-compulsive disorder. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-02718-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Associations of parental mental disorders and age with childhood mental disorders: a population-based cohort study with four million offspring. Eur Child Adolesc Psychiatry 2021; 32:825-833. [PMID: 34802066 DOI: 10.1007/s00787-021-01914-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 11/11/2021] [Indexed: 12/13/2022]
Abstract
This Taiwan study examined the associations of parental age and mental disorders with the offspring risks of attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), major depressive disorder (MDD), and bipolar disorder (BD). Children born between January 1991 and December 2004 in Taiwan were enrolled as the birth cohort (n = 4,138,151) and followed up until December 2011. A logistic regression analysis was performed to identify the odds ratio (OR). The advanced age effects were significant in ADHD (range of OR: 1.04 to 1.49) and ASD (range of OR: 1.35 to 2.27). Teenage mothers, teenage fathers, and fathers ≥ 50 years had higher offspring risks of MDD (range of OR: 1.24 to 1.46); and teenage mothers and fathers ≥ 50 years had increased offspring risks of BD (range of OR: 1.23 to 1.87). Both paternal and maternal mental disorders were associated with higher risks of within-disorder transmission for ADHD, ASD, MDD, and BD (range of OR: 2.64 to 30.41). Besides, parents with one of these four mental disorders (ADHD, ASD, MDD, and BD) might have higher risk of cross-disorder transmission to at least one of the other three mental disorders in the offspring (range of OR: 1.35 to 7.15). Parental age and mental disorders had complex and nuanced patterns in association with offspring mental disorders.
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Rakesh D, Kelly C, Vijayakumar N, Zalesky A, Allen NB, Whittle S. Unraveling the Consequences of Childhood Maltreatment: Deviations From Typical Functional Neurodevelopment Mediate the Relationship Between Maltreatment History and Depressive Symptoms. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2020; 6:329-342. [PMID: 33454282 DOI: 10.1016/j.bpsc.2020.09.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/13/2020] [Accepted: 09/27/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Childhood maltreatment is associated with lifelong psychiatric sequelae. However, our understanding of neurobiological mechanisms responsible for this association is limited. Childhood maltreatment may confer risk for psychopathology by altering neurodevelopmental trajectories during childhood and adolescence. Longitudinal research, which is essential for examining this question, has been limited. METHODS We investigated maltreatment-associated alterations in the development of neural circuitry. Associations between cumulative childhood maltreatment (assessed using a dimensional measure of abuse and neglect via the Childhood Trauma Questionnaire) and the longitudinal development of resting-state functional connectivity (rsFC) were examined in 130 community-residing adolescents. Functional magnetic resonance imaging data were acquired at age 16 (T1; mean ± SD age, 16.46 ± 0.52 years; 66 females) and age 19 (T2; mean follow-up period, 2.35 years; n = 90 with functional magnetic resonance imaging data at both time points). RESULTS We found maltreatment to be associated with widespread longitudinal increases in rsFC, primarily between default mode, dorsal attention, and frontoparietal systems. We also found sex-dependent increased maltreatment-associated rsFC in male participants in salience and limbic circuits. Cross-sectional analyses revealed a shift in maltreatment-related rsFC alterations, which were localized to subcortical and sensory circuits at T1 and to frontal circuits at T2. Finally, longitudinal increases in rsFC connectivity mediated the relationship between childhood maltreatment and increased depressive symptoms. CONCLUSIONS To our knowledge, this is the first study to examine longitudinal maltreatment-related alterations in rsFC in adolescents. Our findings shed light on the neurodevelopmental consequences of childhood maltreatment and provide evidence for their role in risk for depression.
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Affiliation(s)
- Divyangana Rakesh
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton, Australia.
| | - Clare Kelly
- Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
| | | | - Andrew Zalesky
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton, Australia; Melbourne School of Engineering, University of Melbourne, Melbourne, Victoria, Australia
| | | | - Sarah Whittle
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton, Australia.
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