Resting-state functional connectivity and cognitive performance in aging adults with cognitive decline: A data-driven multivariate pattern analysis.

BACKGROUND: Cognitive impairments occur on a continuous spectrum in multiple cognitive domains showing individual variability of the deteriorating patterns; however, often, cognitive domains are studied separately. METHODS: The present study investigated aging individual variations of cognitive abilities and related resting-state functional connectivity (rsFC) using data-driven approach. Cognitive and neuroimaging data were obtained from 62 elderly outpatients with cognitive decline. Principal component analysis (PCA) was conducted on the cognitive data to determine patterns of cognitive performance, then data-driven whole-brain connectome multivariate pattern analysis (MVPA) was applied on the neuroimaging data to discover neural regions associated with the cognitive characteristic. RESULTS: The first component (PC1) delineated an overall decline in all domains of cognition, and the second component (PC2) represented a compensatory relationship within basic cognitive functions. MVPA indicated rsFC of the cerebellum lobule VIII and insula with the default-mode network, frontoparietal network, and salience network inversely correlated with PC1 scores. Additionally, PC2 score was related to rsFC patterns with temporal pole and occipital cortex. CONCLUSIONS: The featured primary cognitive characteristic depicted the importance of the cerebellum and insula connectivity patterns in of the general cognitive decline. The findings also discovered a secondary characteristic that communicated impaired interactions within the basic cognitive function, which was independent from the impairment severity.

Differences in the modulation of functional connectivity by self-talk tasks between people with low and high life satisfaction.

Self-respect is a practical way to promote life satisfaction through gratifying basic psychological needs, whereas self-criticism is associated with life dissatisfaction. The goal of the present study was to investigate the effect of two positive and negative self-talks on the functional connectome with respect to life satisfaction and its relationships with basic psychological needs. Forty-eight individuals with low life satisfaction (LLS, n â€‹= â€‹24) and with high life satisfaction (HLS, n â€‹= â€‹24) were scanned using functional magnetic resonance imaging at a baseline state and during and after self-respect or self-criticism tasks. Functional connectivity analysis was conducted to identify the modulatory effects of the tasks on the self-referential, default mode, and reward-motivation networks. We found that self-respect changed only the connection between the posterior cingulate cortex (PCC) and frontoparietal network, whereas self-criticism changed almost all of the connections examined. The group x condition interaction effect of self-respect was identified only in connection between the PCC and left ventrolateral prefrontal cortex, while that of self-criticism was observed in various connections based on the ventromedial prefrontal cortex and nucleus accumbens. In respect to basic psychological needs, functional connectivity after self-criticism was significant in predicting the needs of autonomy and relatedness only in the LLS group, whereas functional connectivity after self-respect could predict the needs of autonomy and competence only in the HLS group. Overall, self-criticism produces more noticeable negative changes in the brain than the positive changes of self-respect. Individuals with low life satisfaction may be more vulnerable to be negatively affected not only by self-criticism but also self-respect than individuals with high life satisfaction. The satisfaction of basic psychological needs can play a mediating role in the effects of self-talk tasks differently concerning life satisfaction.

The parental brain: A neural framework for study of teaching in humans and other animals.

Parenting, conceptualized as a specific form of teaching, may inform mentalistic, culture-based, and functional definitions. Combined brain-imaging, hormone-measurement, and cognitive-behavioral analyses indicate the importance of mentalization circuits. These circuits appear to function according to culture, and cross animal species. Further, these approaches shed light on sex differences through work on fathers as well as mothers, are affected by psychopathology, and may be amenable to treatment in ways that may be applied to optimize teaching.

Influence of first-person and third-person perspectives on neural mechanisms of professional pride.

Professional pride, including self-reflection and attitude toward one's own occupational group, induces individuals to behave in socially appropriate ways, and uniforms can encourage wearers to have this pride. This study was to elucidate the working pattern of professional pride by exploring neural responses when wearing uniforms and being conscious of a third-person's perspective. Twenty healthy adults who had an occupation requiring uniforms were scanned using functional MRI with a self-evaluation task consisting of 2 [uniform versus casual wear] × 2 [first-person perspective versus third-person perspective] conditions. The neural effects of clothing and perspective were analyzed and post-hoc tests were followed. The interaction effect was displayed in the bilateral dorsomedial prefrontal cortex, where uniform led to higher activity in third-person perspective than in first-person perspective, whereas casual wear led to the opposite pattern, suggesting this region may be involved in the awareness of third-person's perspective to uniform-wearing. The right dorsomedial prefrontal cortex showed functional connectivity with the right posterior superior temporal sulcus in uniform-third-person perspective compared to uniform-first-person perspective, suggesting this connection may work for processing information from third-person perspective in a uniform-wearing state. Professional pride may prioritize social information processing in third-person perspective rather than self-referential processing in first-person perspective.

Neural substrates of marriage on self-parents processing and the association with a parents-oriented perspective shift in a collectivistic culture.

Relationship with parents is a special bond that shapes self-other representations and have an impact on adult-child's marriage, especially in the early stages of marriage. This study sought to investigate the neural mechanisms underlying self-parents processing as well as their relationship with marriage. Seventy-eight premarital Korean participants were scanned in functional MRI while evaluating traits of the self and parents. Then, 21 of them returned after being married to engage in the identical task three years later. The precuneus and temporoparietal junction were identified to activate stronger for parents than self at both marital statuses. The dorsal anterior cingulate cortex, posterior cingulate cortex, parietal operculum, and caudate activated more for self than parents before marriage, but their activities changed during marriage. The activation increase of the parietal operculum between marital statuses in the parents condition was negatively correlated with the level of marital dissatisfaction, and this association only appeared among participants with a child. Self-parents processing may recruit brain regions involved in autobiographical memory and self-other distinction, and marriage has an impact on the way individuals process rewards and multimodal sensory information during this processing. Marriage may lead to changes in brain function that affect the processing of emotions toward parents and a more parents-oriented perspective shift in collectivistic societies.

Relationship between body mass index and risk of delirium in an intensive care unit.

OBJECTIVE: Delirium in the intensive care unit (ICU) is a common and critical condition that leads to poor prognosis in older patients, but the association between body mass index (BMI) and the incidence of delirium remains unclear. METHODS: We retrospectively analyzed 5,622 patients admitted to the ICU of a tertiary referral hospital between 2013 and 2022. We collected sociodemographic data, vital signs, laboratory results, and delirium scale scores. We subdivided the patients into four categories: underweight (<18.5 kg/m2), normal weight (18.5-22.9 kg/m2), overweight (23-24.9 kg/m2), and obese (>25 kg/m2). The primary outcome was the incidence of delirium according to the BMI categories. We performed multivariable logistic regression analysis, adjusted for sex, age, past smoking and alcohol history, benzodiazepine use, and laboratory abnormalities. RESULTS: Among the 5,622 patients in the ICU (mean age, 72.9 years; male, 60.1%; mean BMI, 24.2 kg/m2), the incidence of delirium was 19.0% (1,069 patients). The mean modified incidence of delirium was higher among underweight patients (odds ratio [OR]=1.51, confidence interval [CI]=1.07-2.12, p = 0.02) than among normal-weight patients. Overweight and obese status were not independently associated with delirium (OR=0.90, CI=0.70-1.17, p = 0.43; OR= 0.97; CI=0.77-1.21, p = 0.78, respectively). The area under the receiver-operating characteristic curve of the multivariable logistic regression model was 0.71 (95% CI=0.69-0.73). CONCLUSIONS: Underweight status is an independent risk factor for delirium in the ICU. Additional caution is required when evaluating underweight patients for delirium. Obese or overweight status are not associated with delirium, providing evidence for the obesity paradox.

The Relationship between Delirium and Statin Use According to Disease Severity in Patients in the Intensive Care Unit.

Objective: The aim of this study was to investigate the association between the use of statins and the occurrence of delirium in a large cohort of patients in the intensive care unit (ICU), considering disease severity and statin properties. Methods: We obtained clinical and demographical information from 3,604 patients admitted to the ICU from January 2013 to April 2020. This included information on daily statin use and delirium state, as assessed by the Confusion Assessment Method for ICU. We used inverse probability of treatment weighting and categorized the patients into four groups based on the Acute Physiology and Chronic Health Evaluation II score (group 1: 0-10 - mild; group 2: 11-20 - mild to moderate; group 3: 21-30 - moderate to severe; group 4: > 30 - severe). We analyzed the association between the use of statin and the occurrence of delirium in each group, while taking into account the properties of statins. Results: Comparisons between statin and non-statin patient groups revealed that only in group 2, patients who were administered statin showed significantly higher occurrence of delirium (p = 0.004, odds ratio [OR] = 1.58) compared to the patients who did not receive statin. Regardless of whether statins were lipophilic (p = 0.036, OR = 1.47) or hydrophilic (p = 0.032, OR = 1.84), the occurrence of delirium was higher only in patients from group 2. Conclusion: The use of statins may be associated with the increases in the risk of delirium occurrence in patients with mild to moderate disease severity, irrespective of statin properties.

Differential relationship of observer-rated and self-rated depression and anxiety scales with heart rate variability features.

Heart rate variability (HRV) is a known psychophysiological marker for diverse psychiatric symptoms. In this study, we aimed to explore the potential for clinical use of HRV by investigating the interrelationship between HRV indices and clinical measures mainly used to assess depressive and anxious symptoms. Participants who reported depressive and anxious symptoms were designated into the following groups: group 1, clinician-rated and self-rated depression; group 2, only self-rated depression; group 3, clinician-rated and self-rated anxiety; group 4, only self-rated anxiety. Statistical comparisons were performed between these groups to investigate the association between HRV and clinical measures. As a result, HRV variables showed significant correlations only with the clinician-rated assessments. Moreover, both time and frequency domain HRV indices were significantly different between groups 1 and 2, but groups 3 and 4 showed significant differences only in frequency domain HRV indices. Our study showed that HRV is an objective indicator for depressive or anxious symptoms. Additionally, it is considered a potential indicator for predicting the severity or state of depressive symptoms rather than of anxious symptoms. This study will contribute to increasing the diagnostic utility of discriminating those symptoms based on HRV in the future.

Association and interaction between clinician-rated measures of depression and anxiety with heart rate variability in elderly patients with psychiatric disorders.

Background: Older adults are vulnerable to comorbid depression and anxiety symptoms; however, these conditions are widely underrecognized and often untreated. Understanding their combined manifestation using objective measurements, such as clinician-rated scales and heart rate variability (HRV), can help refine the diagnosis and select a treatment strategy for geriatric patients. Methods: This study included patients over 65 years who were mainly diagnosed with either category of depressive or anxiety disorders from the psychiatric outpatient clinic in a university hospital. A total of 114 patients met eligibility with a completed collection of electrocardiograms, the Hamilton Depression Rating Scale (HDRS; clinician-rated depression), and the Hamilton Anxiety Scale (HAS; clinician-rated anxiety) to assess the severity of symptoms. Both main and interaction effects between HDRS and HAS on HRV parameters were examined. Results: Significant interaction effects between clinician-rated depression and anxiety (HDRS × HAS) on HRV reduction in frequency parameters (i.e., nuLF, nuHF, LF/HF ratio) were found, which consistently indicated autonomic nervous system dysregulation. Findings imply that HRV could reflect synergistic effects of comorbid depressive and anxiety symptoms, perhaps due to the amplification of individual symptoms in geriatric patients. Conclusions: The results imply that using objective measurements can improve diagnostic accuracy, particularly in geriatric patients with comorbid status, and the normalization of the autonomic nervous system might be a candidate target for prevention and treatment.

Did It Change Your Mind? Neural Substrates of Purchase Intention Change and Product Information.

Price and customer ratings are perhaps the two most important pieces of information consumers rely on when shopping online. This study aimed to elucidate the neural mechanism by which the introduction of these two types of information influences the purchase intention of potential consumers for hedonic products. Participants performed a lip-care product shopping task during functional magnetic resonance imaging, in which they re-disclosed purchase intentions referring to the information of price or rating provided about the products that they had previously disclosed their purchase intentions without any information. Data from 38 young female participants were analyzed to identify the underlying neural regions associated with the intention change and product information. The bilateral frontopolar cortex, bilateral dorsal anterior cingulate cortex (dACC), and left insula activated higher for the unchanged than changed intention condition. The right dACC and bilateral insula also activated more toward the price than the rating condition, whereas the medial prefrontal cortex and bilateral temporoparietal junction responded in the opposite direction. These results seem to reflect the shift to exploratory decision-making strategies and increased salience in maintaining purchase intentions despite referring to provided information and to highlight the involvement of social cognition-related regions in reference to customer ratings rather than price.

Delirium and Anxiety Outcomes Related to Visiting Policy Changes in the Intensive Care Unit During the COVID-19 Pandemic.

Objective: To evaluate the effect of intensive care unit (ICU) visit on the incidence of delirium, delirium subtype, and anxiety level in ICU patients. Methods: Trained psychiatrists and nurses evaluated ICU patients for delirium, delirium subtypes, and anxiety. Propensity score matching (PSM) was used to retrospectively analyze the data. Then, we compared the differences in the incidence of delirium, delirium subtypes, and anxiety level before and after the ICU visit ban. Logistic regression was conducted to identify the risk factors for delirium subtypes and high anxiety levels. Results: After PSM, there was no statistically significant difference in the incidence of delirium between the non-visiting and restrictive visiting groups (non-visiting 27.4% versus restrictive visiting 30.9%, p = 0.162). The proportion of hyperactive and mixed subtypes was higher in the non-visiting than in the restrictive visiting group (non-visiting 35.3 and 30.1% versus restrictive visiting 27.7 and 20.1%, p = 0.002). The anxiety level was higher in the non-visiting than in the restrictive visiting group (state-trait anxiety inventory score: non-visiting 53.46 ± 4.58 versus restrictive visiting 52.22 ± 6.50, p = 0.009). Patients who stayed in the ICU during the visit ban were more likely to have hyperactive (p = 0.005) and mixed subtype (p = 0.001) than those who did not. Moreover, patients who stayed in the ICU during the visit ban were more likely to experience high anxiety levels than those who did not (p < 0.001). Conclusion: Prohibition of ICU visits during COVID-19 pandemic did not affect the incidence of delirium during COVID-19 but could change the delirium subtype and raise anxiety level. Moreover, visiting prohibition was a risk factor for non-hypoactive delirium subtype and high anxiety levels. Therefore, ICU visits are important in dealing with delirium subtypes and anxiety in ICU patients.

Potential Usefulness of Blood Urea Nitrogen to Creatinine Ratio in the Prediction and Early Detection of Delirium Motor Subtype in the Intensive Care Unit.

Prediction and early detection of delirium can improve patient outcomes. A high blood urea nitrogen to creatinine ratio (BCR), which reflects dehydration, has been reported as a risk factor for delirium. Additionally, BCR represents skeletal muscle loss in intensive care unit (ICU) patients, which can have critical implications for clinical outcomes. We investigated whether BCR could be used to predict the occurrence and motor subtype of delirium in ICU patients through a retrospective cohort study that included 7167 patients (50 years or older) admitted to the ICU. Patients were assessed daily using the Richmond Agitation-Sedation Scale and the Confusion Assessment Method for ICU and categorized according to the delirium subtype. Participants were split into 10 groups according to BCR at ICU admission and the prevalence of each delirium subtype was compared. Multivariable logistic regression was then used for analysis. A higher BCR at ICU admission was associated with the development of hypoactive delirium. Moreover, BCR > 24.9 was associated with higher rates of hypoactive delirium. Our findings showed that a high BCR at ICU admission was associated with the development of hypoactive delirium, which suggested that BCR could be a potential biomarker for hypoactive delirium in ICU patients.

Neural Correlates of Garment Fit and Purchase Intention in the Consumer Decision-Making Process and the Influence of Product Presentation.

In today's competitive e-commerce markets, it is crucial to promote product satisfaction and to quickly identify purchase intention in decision-making consumers. The present investigation examined the relationship between perceived garment fit and purchase intention, together with how product presentation methods (mannequin versus self-model) contribute to decision-making processes of clothing. Thirty-nine female volunteers were scanned using fMRI while performing an online shopping task. In Part 1, univariate analysis was conducted between garment fit and product presentation factors to assess their effects on purchase deliberation. In Part 2, univariate, multivariate pattern, and psychophysiological interaction analyses were carried out to examine the predictive ability of fit evaluation and product presentation on purchase intention. First, garment fit × product presentation interaction effects on purchase deliberation were observed in the frontopolar cortex, superior frontal gyrus, anterior cingulate cortex, and posterior cingulate cortex. Part 2 demonstrated neural signals of the dorsomedial prefrontal cortex, premotor cortex, supplementary motor area, superior parietal lobule, supramarginal gyrus, superior temporal sulcus, fusiform gyrus, and insula to distinguish subsequent purchase intentions. Overall, the findings denote directed exploration, visual and action processing as key neural processes in decision-making that uniquely reflect garment fit and product presentation type during purchase deliberation. Additionally, with respect to the effects of purchase intention on product evaluation, the evidence conveys that mental interactions with products and social cognition are fundamental processes that capture subsequent purchase intention at the product evaluation stage.

Anhedonia Relates to the Altered Global and Local Grey Matter Network Properties in Schizophrenia.

Anhedonia is one of the major negative symptoms in schizophrenia and defined as the loss of hedonic experience to various stimuli in real life. Although structural magnetic resonance imaging has provided a deeper understanding of anhedonia-related abnormalities in schizophrenia, network analysis of the grey matter focusing on this symptom is lacking. In this study, single-subject grey matter networks were constructed in 123 patients with schizophrenia and 160 healthy controls. The small-world property of the grey matter network and its correlations with the level of physical and social anhedonia were evaluated using graph theory analysis. In the global scale whole-brain analysis, the patients showed reduced small-world property of the grey matter network. The local-scale analysis further revealed reduced small-world property in the default mode network, salience/ventral attention network, and visual network. The regional-level analysis showed an altered relationship between the small-world properties and the social anhedonia scale scores in the cerebellar lobule in patients with schizophrenia. These results indicate that anhedonia in schizophrenia may be related to abnormalities in the grey matter network at both the global whole-brain scale and local-regional scale.

Appropriate Number of Treatment Sessions in Virtual Reality-Based Individual Cognitive Behavioral Therapy for Social Anxiety Disorder.

Virtual reality (VR) was introduced to maximize the effect of cognitive behavioral therapy (CBT) by efficiently performing exposure therapy. The purpose of this study was to find out whether VR-based individual CBT with relatively few treatment sessions is effective in improving social anxiety disorder (SAD). This therapy was applied to 115 patients with SAD who were retrospectively classified into 43 patients who completed the nine or 10 sessions normally (normal termination group), 52 patients who finished the sessions early (early termination group), and 20 patients who had extended the sessions (session extension group). The Brief Fear of Negative Evaluation Scale (BFNE) scores tended to decrease in all groups as the session progressed, and the slope of decrease was the steepest in the early termination group and the least steep in the session extension group. Severity of social anxiety in the last session and symptom reduction rate showed no significant group difference. Our findings suggest that short-term VR-based individual CBT of nine to 10 sessions may be effective. When the therapeutic effect is insufficient during this period, the additional benefit may be minimal if the session is simply extended. The improvement in the early termination group suggests that even shorter sessions of five or six can also be effective.

Differences in basic psychological needs-related resting-state functional connectivity between individuals with high and low life satisfaction.

Basic psychological needs including autonomy, competence, and relatedness can be affected by the level of life satisfaction. The current research aimed to elucidate differences in the association of these needs and functional connectivity of reward processing and emotion regulation between individuals with high and low life satisfaction. A total of 83 young adults were divided into the high life satisfaction (HLS) and low life satisfaction (LLS) groups and were scanned for 5-min resting-state fMRI. A seed-to-voxel analysis was performed using the seeds of the nucleus accumbens (NAcc), medial orbitofrontal cortex, subgenual anterior cingulate cortex (sgACC), insula, and amygdala. Analysis of covariance was conducted to test differences in the association of basic psychological needs and functional connectivity between the two groups. Connectivity strengths between the NAcc and right ventromedial prefrontal cortex and between the sgACC and left ventromedial prefrontal cortex were higher in the HLS group as the autonomy and relatedness scores increased, respectively, whereas in the LLS group as they decreased. Connectivity strengths between the NAcc and right midcingulate cortex and between the sgACC and left fusiform gyrus were higher in the HLS group as the competence and relatedness scores decreased, respectively, but in the LLS group as they increased. These findings suggest that individuals' perceived life satisfaction affects the relationship between the neural mechanism for reward processing and emotion regulation and basic psychological needs support. Psychological need satisfactions seem to have an emotional impact by acting as a contradictory brain mechanism between individuals with high and low life satisfaction.

Differences in resting-state functional connectivity according to the level of impulsiveness in patients with internet gaming disorder.

BACKGROUND AND AIMS: Impulsiveness is an important factor in the pathophysiology of Internet gaming disorder (IGD), and regional brain functions can be different depending on the level of impulsiveness. This study aimed to demonstrate that different brain mechanisms are involved depending on the level of impulsiveness among patients with IGD. METHODS: Resting-state functional MRI data were obtained from 23 IGD patients with high impulsivity, 27 IGD patients with low impulsivity, and 22 healthy controls, and seed-based functional connectivity was compared among the three groups. The seed regions were the ventromedial prefrontal cortex (vmPFC), dorsolateral prefrontal cortex, nucleus accumbens (NAcc), and amygdala. RESULTS: Connectivity of the vmPFC with the left temporo-parietal junction (TPJ) and NAcc-left insula connectivity were significantly decreased in the patients with high impulsivity, compared with the patients with low impulsivity and healthy controls. On the other hand, amygdala-based connectivity with the left inferior frontal gyrus showed decreases in both patient groups, compared with the healthy controls. CONCLUSION: These findings may suggest a potential relationship between impulsivity and deficits in reward-related social cognition processes in patients with IGD. In particular, certain interventions targeted at vmPFC-TPJ connectivity, found to be impulsivity-specific brain connectivity, are likely to help with addiction recovery among impulsive patients with IGD.

The effects of positive or negative self-talk on the alteration of brain functional connectivity by performing cognitive tasks.

Self-talk can improve cognitive performance, but the underlying mechanism of such improvement has not been investigated. This study aimed to elucidate the effects of self-talks on functional connectivity associated with cognitive performance. We used the short form of Progressive Matrices Test (sRPM) to measure differences in performance improvements between self-respect and self-criticism. Participants were scanned using functional magnetic resonance imaging in the following order: baseline, during-sRPM1, post-sRPM1, self-respect or self-criticism, during-sRPM2, and post-sRPM2. Analysis was conducted to identify the self-talks' modulatory effects on the reward-motivation, default mode, and central-executive networks. Increase in sRPM2 score compared to sRPM1 score was observed only after self-criticism. The self-talk-by-repetition interaction effect was not found for during-sRPM, but found for post-sRPM; decreased nucleus accumbens-based connectivity was shown after self-criticism compared with self-respect. However, the significant correlations between the connectivity change and performance change appeared only in the self-respect group. Our findings showed that positive self-talk and negative self-talk differently modulate brain states concerning cognitive performance. Self-respect may have both positive and negative effects due to enhanced executive functions and inaccurate confidence, respectively, whereas self-criticism may positively affect cognitive performance by inducing a less confident state that increases internal motivation and attention.

Effectiveness of Self-Guided Virtual Reality-Based Cognitive Behavioral Therapy for Panic Disorder: Randomized Controlled Trial.

BACKGROUND: Virtual reality (VR) is as effective a technique as traditional cognitive behavioral therapy (CBT) and a promising tool for treating panic disorder symptoms because VR exposure can be safer and has better acceptability than in vivo exposure and is more immersive than exposure through imagination. CBT techniques can be delivered more effectively using VR as well. So far, VR has required high-quality devices, but the development of mobile VR technology has improved user availability. At the same time, a well-structured form of VR can be reproduced and used anywhere. This means that VR can be used to provide a self-guided form of treatment and address the high treatment costs of evidence-based therapy and the lack of professional therapists. This study aimed to investigate the potential of self-guided VR as an alternative to high-cost treatment. OBJECTIVE: The main goal of this study was to offer data about the efficacy of a mobile app-based self-led VR CBT in the treatment of panic disorder. METHODS: A total of 54 subjects with panic disorder were enrolled in this study and randomly assigned to either the VR treatment group or waitlist group. The VR treatment was designed to be total 12 sessions for 4 weeks. The VR treatment consists of 4 steps in which patients are gradually exposed to phobic stimuli while learning to cope with panic symptoms in each stage. The effectiveness of treatment was assessed through the Panic Disorder Severity Scale, Hamilton Rating Scale for Depression, Body Sensations Questionnaire, Albany Panic and Phobia Questionnaire, Anxiety Sensitivity Index, State-Trait Anxiety Inventory, Hospital Anxiety and Depression Scale, Korean Inventory of Social Avoidance and Distress Scale, Korean Inventory of Depressive Symptomatology, and Perceived Stress Scale. In addition, physiological changes using heart rate variability were evaluated. RESULTS: In within-group analyses, the VR treatment group exhibited improvements in panic disorder symptoms, anxiety, and depression after 4 weeks, while the waitlist group did not show any significant improvement. Compared to the waitlist group, the VR treatment group showed significantly greater improvements in the Panic Disorder Severity Scale in both completer analysis and intention-to-treat analysis. Heart rate variability in the VR treatment group showed improvement in normalized high frequency from baseline to postassessment with no significant differences in any outcome measure between groups. CONCLUSIONS: The self-guided, mobile app-based VR intervention was effective in the treatment of panic symptoms and restoring the autonomic nervous system demonstrating the validity of the use of VR for self-guided treatment. VR treatment can be a cost-effective therapeutic approach. TRIAL REGISTRATION: ClinicalTrials.gov NCT04985019; https://clinicaltrials.gov/ct2/show/NCT04985019.

The relationship between ambivalence, alexithymia, and salience network dysfunction in schizophrenia.

Ambivalence in schizophrenia is worth investigating its association with salience processing and alexithymia using functional MRI. Twenty-two patients with schizophrenia and 22 healthy controls were scanned during the ambivalence task of matching picture (ambivalent, positive and negative) and word (positive and negative) stimuli, and the Toronto Alexithymia Scale (TAS) was rated. Patients exhibited decreased activity in the anterior cingulate cortex (ACC) and insula compared to controls, and ACC activity in the ambivalent condition was negatively correlated with the TAS score in patients. Ambivalence in schizophrenia may be based on salience network dysfunction, and this disturbance may be related to alexithymia.