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Triola M, Cobo J, González-Rodríguez A, Nieto L, Ochoa S, Usall J, García-Ribera C, Baños I, González B, Solanilla A, Massons C, Ruiz I, Ruiz AI, Oliva JC, Pousa E. Impact of Delusions and Hallucinations on Clinical Insight Dimensions in Schizophrenia Spectrum Disorders. Psychopathology 2024:1-10. [PMID: 38442692 DOI: 10.1159/000536360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 01/07/2024] [Indexed: 03/07/2024]
Abstract
INTRODUCTION Insight in psychosis has been conceptualized as a continuous, dynamic, and multidimensional phenomenon. This study aims to determine the impact of delusions and hallucinations in different dimensions of clinical insight in schizophrenia spectrum disorders. METHODS Cross-sectional multicenter study including 516 patients (336 men) diagnosed with schizophrenia spectrum disorders. Based on dichotomized scores of Positive and Negative Syndrome Scale (PANSS) items P1 (delusions) and P3 (hallucinations), patients were assigned to four groups according to current clear presence of delusions (scores 4 or above 4 in PANSS item P1) and/or hallucinations (scores 4 or above 4 in PANNS item P3). Insight was assessed using the three main dimensions of the Scale of Unawareness of Mental Disorder (SUMD). RESULTS Around 40% of patients showed unawareness of illness; 30% unawareness of the need for treatment; and 45% unawareness of the social consequences of the disorder. Patients with current clear presence of delusions had higher overall lack of awareness, regardless of current clear presence of hallucinations. Similarly, the clear presence of delusions showed a greater predictive value on insight than the presence of hallucinations, although the implication of both in the prediction was modest. CONCLUSIONS Our results confirm that lack of insight is highly prevalent in schizophrenia spectrum disorders, particularly when patients experience delusions. This study adds insight-related data to the growing symptom-based research, where specific types of psychotic experiences such as hallucinations and delusions could form different psychopathological patterns, linking the phenomenology of delusions to a lack of clinical insight.
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Affiliation(s)
- Maria Triola
- Mental Health Department, Corporació Sanitària Parc Taulí - CIBERSAM - ISCIII - I3PT - CREA, Sabadell, Spain
| | - Jesus Cobo
- Mental Health Department, Corporació Sanitària Parc Taulí - CIBERSAM - ISCIII - I3PT - CREA, Sabadell, Spain
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Alexandre González-Rodríguez
- Department of Mental Health, Mutua Terrassa University Hospìtal, Terrassa, Spain
- University of Barcelona, CIBERSAM, Barcelona, Spain
| | - Lourdes Nieto
- Department of Research, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico D.F., Mexico
| | - Susana Ochoa
- Research and Development Unit, Parc Sanitari San Joan de Dèu, MERITT Group, Institut de Recerca Sant Joan de Déu - CIBERSAM - ISCIII, Sant Boi de Llobregat, Barcelona, Spain
| | - Judith Usall
- Research and Development Unit, Parc Sanitari San Joan de Dèu, MERITT Group, Institut de Recerca Sant Joan de Déu - CIBERSAM - ISCIII, Sant Boi de Llobregat, Barcelona, Spain
| | - Carles García-Ribera
- Department of Psychiatry, Hospital de La Santa Creu i Sant Pau, Institut d'Investigació Biomèdica-Sant Pau, IIB-Sant Pau, CIBERSAM, Barcelona, Spain
| | - Iris Baños
- Research and Development Unit, Parc Sanitari San Joan de Dèu, MERITT Group, Institut de Recerca Sant Joan de Déu - CIBERSAM - ISCIII, Sant Boi de Llobregat, Barcelona, Spain
| | - Beatriz González
- Mental Health Department, Hospital Benito Menni, Sant Boi de Llobregat, Barcelona, Spain
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
| | - Ariadna Solanilla
- Mental Health Department, Corporació Sanitària Parc Taulí - CIBERSAM - ISCIII - I3PT - CREA, Sabadell, Spain
| | - Carmina Massons
- Mental Health Department, Corporació Sanitària Parc Taulí - CIBERSAM - ISCIII - I3PT - CREA, Sabadell, Spain
| | - Isabel Ruiz
- Department of Health and Clinical Psychology, Research Unit, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Ada I Ruiz
- Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Barcelona, Spain
| | | | - Esther Pousa
- Department of Psychiatry, Hospital de La Santa Creu i Sant Pau, Institut d'Investigació Biomèdica-Sant Pau, IIB-Sant Pau, CIBERSAM, Barcelona, Spain
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Lamsma J, Raine A, Kia SM, Cahn W, Arold D, Banaj N, Barone A, Brosch K, Brouwer R, Brunetti A, Calhoun VD, Chew QH, Choi S, Chung YC, Ciccarelli M, Cobia D, Cocozza S, Dannlowski U, Dazzan P, de Bartolomeis A, Di Forti M, Dumais A, Edmond JT, Ehrlich S, Evermann U, Flinkenflügel K, Georgiadis F, Glahn DC, Goltermann J, Green MJ, Grotegerd D, Guerrero-Pedraza A, Ha M, Hong EL, Hulshoff Pol H, Iasevoli F, Kaiser S, Kaleda V, Karuk A, Kim M, Kircher T, Kirschner M, Kochunov P, Kwon JS, Lebedeva I, Lencer R, Marques TR, Meinert S, Murray R, Nenadić I, Nguyen D, Pearlson G, Piras F, Pomarol-Clotet E, Pontillo G, Potvin S, Preda A, Quidé Y, Rodrigue A, Rootes-Murdy K, Salvador R, Skoch A, Sim K, Spalletta G, Spaniel F, Stein F, Thomas-Odenthal F, Tikàsz A, Tomecek D, Tomyshev A, Tranfa M, Tsogt U, Turner JA, van Erp TGM, van Haren NEM, van Os J, Vecchio D, Wang L, Wroblewski A, Nickl-Jockschat T. Structural brain abnormalities and aggressive behaviour in schizophrenia: Mega-analysis of data from 2095 patients and 2861 healthy controls via the ENIGMA consortium. medRxiv 2024:2024.02.04.24302268. [PMID: 38370846 PMCID: PMC10871467 DOI: 10.1101/2024.02.04.24302268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
Background Schizophrenia is associated with an increased risk of aggressive behaviour, which may partly be explained by illness-related changes in brain structure. However, previous studies have been limited by group-level analyses, small and selective samples of inpatients and long time lags between exposure and outcome. Methods This cross-sectional study pooled data from 20 sites participating in the international ENIGMA-Schizophrenia Working Group. Sites acquired T1-weighted and diffusion-weighted magnetic resonance imaging scans in a total of 2095 patients with schizophrenia and 2861 healthy controls. Measures of grey matter volume and white matter microstructural integrity were extracted from the scans using harmonised protocols. For each measure, normative modelling was used to calculate how much patients deviated (in z-scores) from healthy controls at the individual level. Ordinal regression models were used to estimate the associations of these deviations with concurrent aggressive behaviour (as odds ratios [ORs] with 99% confidence intervals [CIs]). Mediation analyses were performed for positive symptoms (i.e., delusions, hallucinations and disorganised thinking), impulse control and illness insight. Aggression and potential mediators were assessed with the Positive and Negative Syndrome Scale, Scale for the Assessment of Positive Symptoms or Brief Psychiatric Rating Scale. Results Aggressive behaviour was significantly associated with reductions in total cortical volume (OR [99% CI] = 0.88 [0.78, 0.98], p = .003) and global white matter integrity (OR [99% CI] = 0.72 [0.59, 0.88], p = 3.50 × 10-5) and additional reductions in dorsolateral prefrontal cortex volume (OR [99% CI] = 0.85 [0.74, 0.97], p =.002), inferior parietal lobule volume (OR [99% CI] = 0.76 [0.66, 0.87], p = 2.20 × 10-7) and internal capsule integrity (OR [99% CI] = 0.76 [0.63, 0.92], p = 2.90 × 10-4). Except for inferior parietal lobule volume, these associations were largely mediated by increased severity of positive symptoms and reduced impulse control. Conclusions This study provides evidence that the co-occurrence of positive symptoms, poor impulse control and aggressive behaviour in schizophrenia has a neurobiological basis, which may inform the development of therapeutic interventions.
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Affiliation(s)
- Jelle Lamsma
- Department of Criminology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Adrian Raine
- Department of Criminology, University of Pennsylvania, Philadelphia, USA
- Department of Psychology, University of Pennsylvania, Philadelphia, USA
- Department of Psychiatry, University of Pennsylvania, Philadelphia, USA
| | - Seyed M. Kia
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Cognitive Science and Artificial Intelligence, Tilburg University, Tilburg, the Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands
| | - Wiepke Cahn
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Dominic Arold
- Division of Psychological and Social Medicine and Developmental Neurosciences, TU Dresden, Germany
| | - Nerisa Banaj
- Laboratory of Neuropsychiatry, Santa Lucia Foundation IRCCS, Rome, Italy
| | - Annarita Barone
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
| | - Katharina Brosch
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, USA
| | - Rachel Brouwer
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Complex Trait Genetics, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Arturo Brunetti
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Vince D. Calhoun
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science, Georgia State University, Georgia Institute of Technology and Emory University, Atlanta, USA
| | - Qian H. Chew
- Department of Research, Institute of Mental Health, Singapore
| | - Sunah Choi
- Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, South Korea
| | - Young-Chul Chung
- Department of Psychiatry, Jeonbuk National University, Jeonju, South Korea
- Department of Psychiatry, Jeonbuk National University Hospital, Jeonju, South Korea
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea
| | - Mariateresa Ciccarelli
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
| | - Derin Cobia
- Department of Psychology and Neuroscience Center, Brigham Young University, Provo, USA
| | - Sirio Cocozza
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Udo Dannlowski
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Paola Dazzan
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Andrea de Bartolomeis
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
| | - Marta Di Forti
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Alexandre Dumais
- Department of Psychiatry and Addictology, University of Montreal, Montreal, Canada
- Institut Philippe-Pinel, Montreal, Canada
| | - Jesse T. Edmond
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science, Georgia State University, Georgia Institute of Technology and Emory University, Atlanta, USA
- Department of Psychology, Georgia State University, Atlanta, USA
| | - Stefan Ehrlich
- Division of Psychological and Social Medicine and Developmental Neurosciences, TU Dresden, Germany
- Department of Child and Adolescent Psychiatry and Psychotherapy, TU Dresden, Germany
| | - Ulrika Evermann
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Kira Flinkenflügel
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Foivos Georgiadis
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zürich, Switzerland
| | - David C. Glahn
- Department of Psychiatry, Harvard Medical School, Harvard, USA
- Olin Neuropsychiatry Research Center, Institute of Living, Hartford, USA
| | - Janik Goltermann
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Melissa J. Green
- Neuroscience Research Australia, Randwick, Australia
- School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - Dominik Grotegerd
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | | | - Minji Ha
- Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, South Korea
| | - Elliot L. Hong
- Department of Psychiatry and Behavioral Science, UTHealth Houston, Houston, USA
| | - Hilleke Hulshoff Pol
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Psychology, Utrecht University, Utrecht, the Netherlands
| | - Felice Iasevoli
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
| | - Stefan Kaiser
- Department of Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Vasily Kaleda
- Department of Youth Psychiatry, Mental Health Research Center, Moscow, Russia
| | - Andriana Karuk
- FIDMAG Germanes Hospitalaries Research Foundation, Barcelona, Spain
| | - Minah Kim
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, South Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, South Korea
| | - Tilo Kircher
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Matthias Kirschner
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zürich, Switzerland
- Department of Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
- Montreal Neurological Institute-Hospital, McGill University, Montreal, Canada
| | - Peter Kochunov
- Department of Psychiatry and Behavioral Science, UTHealth Houston, Houston, USA
| | - Jun Soo Kwon
- Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, South Korea
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, South Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, South Korea
| | - Irina Lebedeva
- Laboratory of Neuroimaging and Multimodal Analysis, Mental Health Research Center, Moscow, Russia
| | - Rebekka Lencer
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
- Department of Psychiatry and Psychotherapy, University of Lübeck, Germany
| | - Tiago R. Marques
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- MRC London Institute of Medical Sciences, Imperial College London, London, UK
- Institute of Clinical Sciences, Imperial College London, London, UK
| | - Susanne Meinert
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
- Institute for Translational Neuroscience, University of Münster, Münster, Germany
| | - Robin Murray
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Igor Nenadić
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Dana Nguyen
- Department of Psychiatry and Human Behavior, University of California Irvine, Irvine, USA
| | - Godfrey Pearlson
- Olin Neuropsychiatry Research Center, Institute of Living, Hartford, USA
| | - Fabrizio Piras
- Laboratory of Neuropsychiatry, Santa Lucia Foundation IRCCS, Rome, Italy
| | - Edith Pomarol-Clotet
- FIDMAG Germanes Hospitalaries Research Foundation, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Carlos III Health Institute, Barcelona, Spain
| | - Giuseppe Pontillo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
- Department of Electrical Engineering and Information Technology, University of Naples Federico II, Naples, Italy
| | - Stéphane Potvin
- Department of Psychiatry and Addictology, University of Montreal, Montreal, Canada
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
| | - Adrian Preda
- Department of Psychiatry and Human Behavior, University of California Irvine, Irvine, USA
| | - Yann Quidé
- Neuroscience Research Australia, Randwick, Australia
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Amanda Rodrigue
- Department of Psychiatry, Harvard Medical School, Harvard, USA
| | - Kelly Rootes-Murdy
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science, Georgia State University, Georgia Institute of Technology and Emory University, Atlanta, USA
- Department of Psychology, Georgia State University, Atlanta, USA
| | - Raymond Salvador
- FIDMAG Germanes Hospitalaries Research Foundation, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Carlos III Health Institute, Barcelona, Spain
| | - Antonin Skoch
- National Institute of Mental Health, Klecany, Czech Republic
| | - Kang Sim
- Department of Research, Institute of Mental Health, Singapore
| | | | - Filip Spaniel
- National Institute of Mental Health, Klecany, Czech Republic
| | - Frederike Stein
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | | | - Andràs Tikàsz
- Department of Psychiatry and Addictology, University of Montreal, Montreal, Canada
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
| | - David Tomecek
- National Institute of Mental Health, Klecany, Czech Republic
- Institute of Computer Science, Czech Academy of Sciences, Prague, Czech Republic
- Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic
| | - Alexander Tomyshev
- Laboratory of Neuroimaging and Multimodal Analysis, Mental Health Research Center, Moscow, Russia
| | - Mario Tranfa
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Uyanga Tsogt
- Department of Psychiatry, Jeonbuk National University, Jeonju, South Korea
| | - Jessica A. Turner
- Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center, Columbus, USA
| | - Theo G. M. van Erp
- Department of Psychiatry and Human Behavior, University of California Irvine, Irvine, USA
- Center for the Neurobiology of Learning and Memory, University of California Irvine, Irvine, USA
| | - Neeltje E. M. van Haren
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus MC Sophia, Rotterdam, the Netherlands
| | - Jim van Os
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Department of Psychiatry and Neuropsychology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Daniela Vecchio
- Laboratory of Neuropsychiatry, Santa Lucia Foundation IRCCS, Rome, Italy
| | - Lei Wang
- Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center, Columbus, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, USA
| | - Adrian Wroblewski
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Thomas Nickl-Jockschat
- Department of Psychiatry, University of Iowa, Iowa City, USA
- Iowa Neuroscience Institute, University of Iowa, Iowa City, USA
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Xu L, Zhu T, Tang Y, Tang X, Qian Z, Wei Y, Cui H, Hu Y, Zhang D, Wang Y, Zhu J, Li H, Liu X, Zhang T, Hong X, Wang J. Impaired insight and error-monitoring deficits among outpatients with attenuated psychosis syndrome and first-episode psychosis. J Psychiatr Res 2024; 170:33-41. [PMID: 38101208 DOI: 10.1016/j.jpsychires.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 11/23/2023] [Accepted: 12/06/2023] [Indexed: 12/17/2023]
Abstract
We aimed to determine the relationship between electrophysiological signatures of error monitoring and clinical insight among outpatients with attenuated psychosis syndrome (APS) and first-episode psychosis (FEP). Error-related negativity (ERN), error positivity (Pe), and correct response negativity (CRN) were recorded during a modified flanker task for patients with FEP (n = 32), APS individuals (n = 58), and healthy controls (HC, n = 49). Clinical insight was measured using the Schedule of Assessment of Insight (SAI) and included awareness of illness (SAI-illness), relabeling of specific symptoms (SAI-symptoms), and treatment compliance (SAI-treatment). Compared with HC, patients with FEP showed smaller ERN (p < 0.001) and Pe (p = 0.011) amplitudes and individuals with APS showed smaller ERN amplitude (p = 0.009). No significant difference in CRN amplitude was observed among the groups. A smaller negative amplitude of ERN correlated with a lower score on SAI-symptoms (b = -0.032, 95% CI: 0.062 to -0.002, p = 0.035) and a decreased total score of SAI (b = -0.096, 95% CI: 0.182 to -0.010, p = 0.029). This links were adjusted for age, education, and diagnosis (a dummy variable with FEP = 1 and APS = 0), and was independent of positive symptoms. SAI-illness was predominantly influenced by diagnosis, whereas SAI-treatment was additionally affected by disorganized communications. Neither Pe nor CRN amplitude exhibited an association with clinical insight. Unconscious error detection, as indicated by ERN, may aid individuals at the preliminary stage of psychosis in recognizing the unusual symptoms.
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Affiliation(s)
- LiHua Xu
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, PR China
| | - TianYuan Zhu
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, PR China
| | - YingYing Tang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, PR China
| | - XiaoChen Tang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, PR China
| | - ZhenYing Qian
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, PR China
| | - YanYan Wei
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, PR China
| | - HuiRu Cui
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, PR China
| | - YeGang Hu
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, PR China
| | - Dan Zhang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, PR China
| | - YingChan Wang
- Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, PR China
| | - JunJuan Zhu
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, PR China
| | - Hui Li
- Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, PR China
| | - XiaoHua Liu
- Department of Early Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, PR China
| | - TianHong Zhang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, PR China; Shanghai Intelligent Psychological Evaluation and Intervention Engineering Technology Research Center, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, PR China.
| | - XiangFei Hong
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, PR China.
| | - JiJun Wang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, PR China; CAS Center for Excellence in Brain Science and Intelligence Technology (CEBSIT), Chinese Academy of Science, Shanghai, 201203, PR China; Institute of Psychology and Behavioral Science, Shanghai Jiao Tong University, Shanghai, 200030, PR China.
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