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Comparative Neuropsychiatry: White Matter Abnormalities in Children and Adolescents with Schizophrenia, Bipolar Affective Disorder, and Obsessive-Compulsive Disorder

Published online by Cambridge University Press:  15 April 2020

T. White ,
C. Langen ,
M. Schmidt ,
M. Hough  and
A. James
T. White*
Affiliation:
Department of Child and Adolescent Psychiatry, Erasmus Medical Centre – Sophia, Rotterdam, The Netherlands Department of Radiology, Erasmus Medical Centre – Sophia, Rotterdam, The Netherlands
C. Langen
Affiliation:
Department of Child and Adolescent Psychiatry, Erasmus Medical Centre – Sophia, Rotterdam, The Netherlands Department of Radiology, Erasmus Medical Centre – Sophia, Rotterdam, The Netherlands
M. Schmidt
Affiliation:
Department of Child and Adolescent Psychiatry, Erasmus Medical Centre – Sophia, Rotterdam, The Netherlands
M. Hough
Affiliation:
Department of Psychiatry, Oxford University, Oxford, United Kingdom
A. James
Affiliation:
Department of Psychiatry, Oxford University, Oxford, United Kingdom Highfield Adolescent Unit, Warneford Hospital, Oxford, United Kingdom
*
*Corresponding author. Department of Child and Adolescent Psychiatry, Erasmus MC – Sophia, kamer SP-2869, Postbus 2060, 3000 CB Rotterdam, The Netherlands. E-mail address:t.white@erasmusmc.nl (T. White).
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Abstract

Background:

There is considerable evidence that white matter abnormalities play a key role in the pathogenesis of a number of major psychiatric disorders, including schizophrenia, bipolar affective disorder, and obsessive-compulsive disorder. Few studies, however, have compared white matter abnormalities early in the course of the illness.

Methods:

A total of 102 children and adolescents participated in the study, including 43 with early-onset schizophrenia, 13 with early-onset bipolar affective disorder, 17 with obsessive-compulsive disorder, and 29 healthy controls. Diffusion tensor imaging scans were obtained on all children and the images were assessed for the presence of non-spatially overlapping regions of white matter differences, a novel algorithm known as the pothole approach.

Results:

Patients with early-onset schizophrenia and early-onset bipolar affective disorder had a significantly greater number of white matter potholes compared to controls, but the total number of potholes did not differ between the two groups. The volumes of the potholes were significantly larger in patients with early-onset bipolar affective disorder compared to the early-onset schizophrenia group. Children and adolescents with obsessive-compulsive disorder showed no differences in the total number of white matter potholes compared to controls.

Conclusions:

White matter abnormalities in early-onset schizophrenia and bipolar affective disorder are more global in nature, whereas children and adolescents with obsessive-compulsive disorder do not show widespread differences in FA.

Keywords

Diffusion tensor imagingPotholesEarly-onset schizophreniaChildrenAdolescents
Type
Original article
Information
European Psychiatry , Volume 30 , Issue 2 , February 2015 , pp. 205 - 213
Copyright
Copyright © Elsevier Masson SAS 2014

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References

Adler, C.M., Adams, J., DelBello, M.P., Holland, S.K., Schmithorst, V., Levine, A., et al.Evidence of white matter pathology in bipolar disorder adolescents experiencing their first episode of mania: a diffusion tensor imaging study. Am J Psychiatry 2006;163 (2):322–324.CrossRefGoogle ScholarPubMed
American Psychiatric Association. Diagnostic statistical manual for mental disorders, 4th ed., text revisionWashington, DC, USA: American Psychiatric Association; 1994.Google Scholar
Anderson, D., Ardekani, B.A., Burdick, K.E., Robinson, D.G., John, M., Malhotra, A.K., et al.Overlapping and distinct gray and white matter abnormalities in schizophrenia and bipolar I disorder. Bipolar Disord 2013;15 (6):680–693.CrossRefGoogle ScholarPubMed
Andersson, J., Jenkinson, M., Smith, S.Non-linear optimisation: FMRIB technical report TR07JA1 2007, http://www.fmrib.ox.ac.uk/analysis/techrep.Google Scholar
Andersson, J., Jenkinson, M., Smith, S.Non-linear registration, aka Spatial normalisation: FMRIB technical report TR07JA2 2007, http://www.fmrib.ox.ac.uk/analysis/techrep.Google Scholar
Andreasen, N.C.. Linking mind and brain in the study of mental illnesses: a project for a scientific psychopathology. Science 1997;275 (5306):1586–1593.CrossRefGoogle Scholar
Andreasen, N.C., Endicott, J., Spitzer, R.L., Winokur, G.. The family history method using diagnostic criteria. Reliability and validity. Arch Gen Psychiatry 1977;34 (10):1229–1235.CrossRefGoogle ScholarPubMed
Arango, C., Fraguas, D., Parellada, M.Differential neurodevelopmental trajectories in patients with early-onset bipolar and schizophrenia disorders. Schizophr Bull 2013.Google ScholarPubMed
Asarnow, R.F., Nuechterlein, K.H., Fogelson, D., Subotnik, K.L., Payne, D.A., Russell, A.T., et al.Schizophrenia and schizophrenia-spectrum personality disorders in the first-degree relatives of children with schizophrenia: the UCLA family study. Arch Gen Psychiatry 2001;58 (6):581–588.CrossRefGoogle ScholarPubMed
Ashtari, M., Cottone, J., Ardekani, B.A., Cervellione, K., Szeszko, P.R., Wu, J., et al.Disruption of white matter integrity in the inferior longitudinal fasciculus in adolescents with schizophrenia as revealed by fiber tractography. Arch Gen Psychiatry 2007;64 (11):1270–1280.CrossRefGoogle ScholarPubMed
Baker, J.T., Holmes, A.J., Masters, G.A., Yeo, B.T., Krienen, F., Buckner, R.L., et al.Disruption of cortical association networks in schizophrenia and psychotic bipolar disorder. JAMA Psychiatry 2014;71 (2):109–118.CrossRefGoogle ScholarPubMed
Barnea-Goraly, N., Chang, K.D., Karchemskiy, A., Howe, M.E., Reiss, A.L.. Limbic and corpus callosum aberrations in adolescents with bipolar disorder: a tract-based spatial statistics analysis. Biol Psychiatry 2009;66 (3):238–244.CrossRefGoogle ScholarPubMed
Basser, P.J., Jones, D.K.. Diffusion tensor MRI: theory, experimental design and data analysis – a technical review. NMR Biomed 2002;15 (7–8):456–467.CrossRefGoogle ScholarPubMed
Bishop, J.R., Pavuluri, M.N.. Review of risperidone for the treatment of pediatric and adolescent bipolar disorder and schizophrenia. Neuropsychiatr Dis Treat 2008;4 (1):55–68.Google Scholar
Citrome, L.. A review of aripiprazole in the treatment of patients with schizophrenia or bipolar I disorder. Neuropsychiatr Dis Treat 2006;2 (4):427–443.CrossRefGoogle ScholarPubMed
Craddock, N., O’Donovan, M.C., Owen, M.J.. Psychosis genetics: modeling the relationship between schizophrenia, bipolar disorder, and mixed (or “schizoaffective”) psychoses. Schizophr Bull 2009;35 (3):482–490.CrossRefGoogle ScholarPubMed
Cui, L., Chen, Z., Deng, W., Huang, X., Li, M., Ma, X., et al.Assessment of white matter abnormalities in paranoid schizophrenia and bipolar mania patients. Psychiatry Res 2011;194 (3):347–353.CrossRefGoogle ScholarPubMed
Fontenelle, L.F., Harrison, B.J., Yucel, M., Pujol, J., Fujiwara, H., Pantelis, C.. Is there evidence of brain white matter abnormalities in obsessive-compulsive disorder?: a narrative review. Top Magn Reson Imaging 2009;20 (5):291–298.CrossRefGoogle ScholarPubMed
Frazier, J.A., McClellan, J., Findling, R.L., Vitiello, B., Anderson, R., Zablotsky, B., et al.Treatment of early-onset schizophrenia-spectrum disorders (TEOSS): demographic and clinical characteristics. J Am Acad Child Adolesc Psychiatry 2007;46 (8):979–988.CrossRefGoogle ScholarPubMed
Friston, K.J., Frith, C.D.. Schizophrenia: a disconnection syndrome?. Clin Neurosci 1995;3 (2):89–97.Google ScholarPubMed
Frye, R.E., Hasan, K., Malmberg, B., Desouza, L., Swank, P., Smith, K., et al.Superior longitudinal fasciculus and cognitive dysfunction in adolescents born preterm and at term. Dev Med Child Neurol 2010;52 (8):760–766.CrossRefGoogle ScholarPubMed
Inoue, Y., Nakajima, S., Fukuda, T., Nemoto, Y., Shakudo, M., Murata, R., et al.Magnetic resonance images of tuberous sclerosis. Further observations and clinical correlations. Neuroradiology 1988;30 (5):379–384.CrossRefGoogle ScholarPubMed
Ivleva, E.I., Morris, D.W., Moates, A.F., Suppes, T., Thaker, G.K., Tamminga, C.A.. Genetics and intermediate phenotypes of the schizophrenia – bipolar disorder boundary. Neurosci Biobehav Rev 2010;34 (6):897–921.CrossRefGoogle ScholarPubMed
James, A., Hough, M., James, S., Winmill, L., Burge, L., Nijhawan, S., et al.Greater white and grey matter changes associated with early cannabis use in adolescent-onset schizophrenia (AOS). Schizophr Res 2011;128 (1–3):91–97.CrossRefGoogle Scholar
James, A., Hough, M., James, S., Burge, L., Winmill, L., Nijhawan, S., et al.Structural brain and neuropsychometric changes associated with pediatric bipolar disorder with psychosis. Bipolar Disord 2011;13 (1):16–27.CrossRefGoogle ScholarPubMed
Jayarajan, R.N., Venkatasubramanian, G., Viswanath, B., Janardhan Reddy, Y.C., Srinath, S., Vasudev, M.K., et al.White matter abnormalities in children and adolescents with obsessive-compulsive disorder: a diffusion tensor imaging study. Depress Anxiety 2012;29 (9):780–788.CrossRefGoogle ScholarPubMed
Jung, H.H., Kim, C.H., Chang, J.H., Park, Y.G., Chung, S.S., Chang, J.W.. Bilateral anterior cingulotomy for refractory obsessive-compulsive disorder: long-term follow-up results. Stereotact Funct Neurosurg 2006;84 (4):184–189.CrossRefGoogle ScholarPubMed
Kafantaris, V., Kingsley, P., Ardekani, B., Saito, E., Lencz, T., Lim, K., et al.Lower orbital frontal white matter integrity in adolescents with bipolar I disorder. J Am Acad Child Adolesc Psychiatry 2009;48 (1):79–86.CrossRefGoogle ScholarPubMed
Karlsgodt, K.H., van Erp, T.G., Poldrack, R.A., Bearden, C.E., Nuechterlein, K.H., Cannon, T.D.. Diffusion tensor imaging of the superior longitudinal fasciculus and working memory in recent-onset schizophrenia. Biol Psychiatry 2008;63 (5):512–518.CrossRefGoogle ScholarPubMed
Kaufman, J., Birmaher, B., Brent, D., Rao, U., Flynn, C., Moreci, P., et al.Schedule for affective disorders and schizophrenia for school-age children-present and lifetime version (K-SADS-PL): initial reliability and validity data. J Am Acad Child Adolesc Psychiatry 1997;36 (7):980–988.CrossRefGoogle ScholarPubMed
Kay, S.R., Opler, L.A., Lindenmayer, J.P.. The Positive and Negative Syndrome Scale (PANSS): rationale and standardisation. Br J Psychiatry Suppl 1989;7 :59–67.CrossRefGoogle Scholar
Kendi, M., Kendi, A.T., Lehericy, S., Ducros, M., Lim, K.O., Ugurbil, K., et al.Structural and diffusion tensor imaging of the fornix in childhood- and adolescent-onset schizophrenia. J Am Acad Child Adolesc Psychiatry 2008;47 (7):826–832.CrossRefGoogle ScholarPubMed
Koch, K., Wagner, G., Schachtzabel, C., Schultz, C.C., Straube, T., Gullmar, D., et al.White matter structure and symptom dimensions in obsessive-compulsive disorder. J Psychiatr Res 2012;46 (2):264–270.CrossRefGoogle ScholarPubMed
Kotlicka-Antczak, M., Gmitrowicz, A., Sobow, T.M., Rabe-Jablonska, J.. Obstetric complications and Apgar score in early-onset schizophrenic patients with prominent positive and prominent negative symptoms. J Psychiatr Res 2001;35 (4):249–257.CrossRefGoogle ScholarPubMed
Kubicki, M., Westin, C.F., McCarley, R.W., Shenton, M.E.. The application of DTI to investigate white matter abnormalities in schizophrenia. Ann N Y Acad Sci 2005;1064 :134–148.CrossRefGoogle Scholar
Kumra, S., Ashtari, M., McMeniman, M., Vogel, J., Augustin, R., Becker, D.E., et al.Reduced frontal white matter integrity in early-onset schizophrenia: a preliminary study. Biol Psychiatry 2004;55 (12):1138–1145.CrossRefGoogle ScholarPubMed
Kumra, S., Ashtari, M., Cervellione, K.L., Henderson, I., Kester, H., Roofeh, D., et al.White matter abnormalities in early-onset schizophrenia: a voxel-based diffusion tensor imaging study. J Am Acad Child Adolesc Psychiatry 2005;44 (9):934–941.CrossRefGoogle ScholarPubMed
Kyriakopoulos, M., Frangou, S.. Recent diffusion tensor imaging findings in early stages of schizophrenia. Curr Opin Psychiatry 2009;22 (2):168–176.CrossRefGoogle ScholarPubMed
Kyriakopoulos, M., Vyas, N.S., Barker, G.J., Chitnis, X.A., Frangou, S.. A diffusion tensor imaging study of white matter in early-onset schizophrenia. Biol Psychiatry 2008;63 (5):519–523.CrossRefGoogle ScholarPubMed
Kyriakopoulos, M., Perez-Iglesias, R., Woolley, J.B., Kanaan, R.A., Vyas, N.S., Barker, G.J., et al.Effect of age at onset of schizophrenia on white matter abnormalities. Br J Psychiatry 2009;195 (4):346–353.CrossRefGoogle ScholarPubMed
Li, J., Kale Edmiston, E., Chen, K., Tang, Y., Ouyang, X., Jiang, Y., et al.A comparative diffusion tensor imaging study of corpus callosum subregion integrity in bipolar disorder and schizophrenia. Psychiatry Res 2014;221 (1):58–62.CrossRefGoogle Scholar
Lu, L.H., Zhou, X.J., Keedy, S.K., Reilly, J.L., Sweeney, J.A.. White matter microstructure in untreated first episode bipolar disorder with psychosis: comparison with schizophrenia. Bipolar Disord 2011;13 (7–8):604–613.CrossRefGoogle ScholarPubMed
Makki, M.I., Chugani, D.C., Janisse, J., Chugani, H.T.. Characteristics of abnormal diffusivity in normal-appearing white matter investigated with diffusion tensor MR imaging in tuberous sclerosis complex. AJNR Am J Neuroradiol 2007;28 (9):1662–1667.CrossRefGoogle ScholarPubMed
Marlinge, E., Bellivier, F., Houenou, J.. White matter alterations in bipolar disorder: potential for drug discovery and development. Bipolar Disord 2014;16 (2):97–112.CrossRefGoogle ScholarPubMed
Mesulam, M.M.. A cortical network for directed attention and unilateral neglect. Ann Neurol 1981;10 (4):309–325.CrossRefGoogle ScholarPubMed
Mori, S., Oishi, K., Jiang, H., Jiang, L., Li, X., Akhter, K., et al.Stereotaxic white matter atlas based on diffusion tensor imaging in an ICBM template. Neuroimage 2008;40 (2):570–582.CrossRefGoogle Scholar
Nieto, R.G., Castellanos, F.X.. A meta-analysis of neuropsychological functioning in patients with early-onset schizophrenia and pediatric bipolar disorder. J Clin Child Adolesc Psychol 2011;40 (2):266–280.CrossRefGoogle ScholarPubMed
Oldfield, R.C.. The assessment and analysis of handedness: the Edinburgh inventory. Neuropsychologia 1971;9 (1):97–113.CrossRefGoogle ScholarPubMed
Ozcelik-Eroglu, E., Ertugrul, A., Oguz, K.K., Has, A.C., Karahan, S., Yazici, M.K.. Effect of clozapine on white matter integrity in patients with schizophrenia: a diffusion tensor imaging study. Psychiatry Res 2014;223 (3):226–235.CrossRefGoogle ScholarPubMed
Peters, B.D., Szeszko, P.R., Radua, J., Ikuta, T., Gruner, P., DeRosse, P., et al.White matter development in adolescence: diffusion tensor imaging and meta-analytic results. Schizophr Bull 2012;38 (6):1308–1317.CrossRefGoogle ScholarPubMed
Pierpaoli, C., Basser, P.J.. Toward a quantitative assessment of diffusion anisotropy. Magn Reson Med 1996;36 (6):893–906.CrossRefGoogle Scholar
Potash, J.B., Bienvenu, O.J.. Neuropsychiatric disorders: shared genetics of bipolar disorder and schizophrenia. Nat Rev Neurol 2009;5 (6):299–300.CrossRefGoogle Scholar
Purcell, R., Maruff, P., Kyrios, M., Pantelis, C.. Cognitive deficits in obsessive-compulsive disorder on tests of frontal-striatal function. Biol Psychiatry 1998;43 (5):348–357.CrossRefGoogle ScholarPubMed
Rapoport, J.L., Gogtay, N.. Childhood onset schizophrenia: support for a progressive neurodevelopmental disorder. Int J Dev Neurosci 2011;29 (3):251–258.CrossRefGoogle ScholarPubMed
Rich, B.A., Fromm, S.J., Berghorst, L.H., Dickstein, D.P., Brotman, M.A., Pine, D.S., et al.Neural connectivity in children with bipolar disorder: impairment in the face emotion processing circuit. J Child Psychol Psychiatry 2008;49 (1):88–96.CrossRefGoogle ScholarPubMed
Rueckert, D., Sonoda, L.I., Hayes, C., Hill, D.L., Leach, M.O., Hawkes, D.J.. Nonrigid registration using free-form deformations: application to breast MR images. IEEE Trans Med Imaging 1999;18 (8):712–721.CrossRefGoogle ScholarPubMed
Samartzis, L., Dima, D., Fusar-Poli, P., Kyriakopoulos, M.. White matter alterations in early stages of schizophrenia: a systematic review of diffusion tensor imaging studies. J Neuroimaging 2014;24 (2):101–110.CrossRefGoogle ScholarPubMed
Savadjiev, P., Whitford, T.J., Hough, M.E., Clemm von Hohenberg, C., Bouix, S., Westin, C.F., et al.Sexually dimorphic white matter geometry abnormalities in adolescent-onset schizophrenia. Cereb Cortex 2014;24 (5):1389–1396.CrossRefGoogle ScholarPubMed
Shin, N.Y., Lee, T.Y., Kim, E., Kwon, J.S.Cognitive functioning in obsessive-compulsive disorder: a meta-analysis. Psychol Med 2013 1–10.Google ScholarPubMed
Silk, T., Chen, J., Seal, M., Vance, A.. White matter abnormalities in pediatric obsessive-compulsive disorder. Psychiatry Res 2013;213 (2):154–160.CrossRefGoogle ScholarPubMed
Skudlarski, P., Schretlen, D.J., Thaker, G.K., Stevens, M.C., Keshavan, M.S., Sweeney, J.A., et al.Diffusion tensor imaging white matter endophenotypes in patients with schizophrenia or psychotic bipolar disorder and their relatives. Am J Psychiatry 2013;170 (8):886–898.CrossRefGoogle ScholarPubMed
Smith, S.M.. Fast robust automated brain extraction. Hum Brain Mapp 2002;17 (3):143–155.CrossRefGoogle ScholarPubMed
Smith, S.M., Jenkinson, M., Woolrich, M.W., Beckmann, C.F., Behrens, T.E., Johansen-Berg, H., et al.Advances in functional and structural MR image analysis and implementation as FSL. Neuroimage 2004;23 (Suppl. 1):S208–S219.CrossRefGoogle ScholarPubMed
Smith, S.M., Jenkinson, M., Johansen-Berg, H., Rueckert, D., Nichols, T.E., Mackay, C.E., et al.Tract-based spatial statistics: voxelwise analysis of multi-subject diffusion data. Neuroimage 2006;31 (4):1487–1505.CrossRefGoogle ScholarPubMed
Sugranyes, G., Kyriakopoulos, M., Dima, D., O’Muircheartaigh, J., Corrigall, R., Pendelbury, G., et al.Multimodal analyses identify linked functional and white matter abnormalities within the working memory network in schizophrenia. Schizophr Res 138 22–32012 136–142.CrossRefGoogle Scholar
Sussmann, J.E., Lymer, G.K., McKirdy, J., Moorhead, T.W., Munoz Maniega, S., Job, D., et al.White matter abnormalities in bipolar disorder and schizophrenia detected using diffusion tensor magnetic resonance imaging. Bipolar Disord 2009;11 (1):11–18.CrossRefGoogle ScholarPubMed
Thiebaut de Schotten, M., Urbanski, M., Duffau, H., Volle, E., Levy, R., Dubois, B., et al.Direct evidence for a parietal-frontal pathway subserving spatial awareness in humans. Science 2005;309 (5744):2226–2228.CrossRefGoogle ScholarPubMed
Vederine, F.E., Wessa, M., Leboyer, M., Houenou, J.. A meta-analysis of whole-brain diffusion tensor imaging studies in bipolar disorder. Prog Neuropsychopharmacol Biol Psychiatry 2011;35 (8):1820–1826.CrossRefGoogle ScholarPubMed
Wang, Q., Cheung, C., Deng, W., Li, M., Huang, C., Ma, X., et al.White matter microstructure in previously drug-naive patients with schizophrenia after 6 weeks of treatment. Psychol Med 2013;43 (11):2301–2309.CrossRefGoogle ScholarPubMed
Watts, R., Thomas, A., Filippi, C.G., Nickerson, J.P., Freeman, K.Potholes and molehills: bias in the diagnostic performance of diffusion tensor imaging in concussion. Radiology 2014 131856.Google ScholarPubMed
Wechsler, D.Wechsler Abbreviated Scale of Intelligence. San Antonio, TX, USA: The Psychological Association; 1999.Google Scholar
White, T., Kendi, A.T., Lehericy, S., Kendi, M., Karatekin, C., Guimaraes, A., et al.Disruption of hippocampal connectivity in children and adolescents with schizophrenia – a voxel-based diffusion tensor imaging study. Schizophr Res 2007;90 (1–3):302.CrossRefGoogle ScholarPubMed
White, T., Nelson, M., Lim, K.O.Diffusion tensor imaging in psychiatric disorders. Top Magn Reson Imaging 2008;19 (2):97–109.CrossRefGoogle ScholarPubMed
White, T., Schmidt, M., Karatekin, C.White matter ‘potholes’ in early-onset schizophrenia: a new approach to evaluate white matter microstructure using diffusion tensor imaging. Psychiatry Res 2009;174 (2):110–115.CrossRefGoogle ScholarPubMed
White, T., Ehrlich, S., Ho, B.C., Manoach, D.S., Caprihan, A., Schulz, S.C., et al.Spatial characteristics of white matter abnormalities in schizophrenia. Schizophr Bull 2013;39 (5):1077–1086.CrossRefGoogle Scholar
Yakovlev, P.I., Lecours, A.R.The myelogenetic cycles of regional maturation of the brain. In: Minkowski, A., Regional development of the brain in early life Oxford: Blackwell; 1967. p. 3–70.Google Scholar
Yao, L., Lui, S., Liao, Y., Du, M.Y., Hu, N., Thomas, J.A., et al.White matter deficits in first episode schizophrenia: an activation likelihood estimation meta-analysis. Prog Neuropsychopharmacol Biol Psychiatry 2013;45 :100–106.CrossRefGoogle ScholarPubMed
Young, A.H.Treatment of bipolar disorder with antipsychotic medication: issues shared with schizophrenia. J Clin Psychiatry 68 2Suppl. 62007 24–25.Google ScholarPubMed
Zarei, M., Mataix-Cols, D., Heyman, I., Hough, M., Doherty, J., Burge, L., et al.Changes in gray matter volume and white matter microstructure in adolescents with obsessive-compulsive disorder. Biol Psychiatry 2011;70 (11):1083–1090.CrossRefGoogle ScholarPubMed
Zhang, Q.J., Wang, W.H., Wei, X.P.Long-term efficacy of stereotactic bilateral anterior cingulotomy and bilateral anterior capsulotomy as a treatment for refractory obsessive-compulsive disorder. Stereotact Funct Neurosurg 2013;91 (4):258–261.CrossRefGoogle ScholarPubMed
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