Objective: The interpretability of results in psychiatric neuroimaging is significantly limited by an overreliance on correlational relationships. Purely correlational studies cannot alone determine whether behavior-imaging relationships are causal to illness, functionally compensatory processes, or purely epiphenomena. Negative symptoms (e.g., anhedonia, amotivation, and expressive deficits) are refractory to current medications and are among the foremost causes of disability in schizophrenia. The authors used a two-step approach in identifying and then empirically testing a brain network model of schizophrenia symptoms.
Methods: In the first cohort (N=44), a data-driven resting-state functional connectivity analysis was used to identify a network with connectivity that corresponds to negative symptom severity. In the second cohort (N=11), this network connectivity was modulated with 5 days of twice-daily transcranial magnetic stimulation (TMS) to the cerebellar midline.
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The participant will model how the cerebellar-prefrontal network is associated with negative symptoms of schizophrenia.
This program is designed for all psychiatrists in clinical practice, residents in Graduate Medical Education programs, medical students interested in psychiatry, and other physicians who wish to advance their current knowledge of clinical medicine.
Duration: 1 hour
Begin Date: July 1, 2019
End Date: June 30, 2021
In order to earn CME credit, subscribers should read through the material presented in the article. After reading the article, complete the quiz and submit your evaluation and study hours (up to 1 AMA PRA Category 1 Credit™). A score of 60% or higher is required to receive credit.
The American Psychiatric Association (APA) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
The APA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Title: Cerebellar-Prefrontal Network Connectivity and Negative Symptoms in Schizophrenia
Authors: Roscoe O. Brady, Jr., M.D., Ph.D., Irene Gonsalvez, M.D., Ivy Lee, B.S., Dost Öngür, M.D., Ph.D., Larry J. Seidman, Ph.D., Jeremy D. Schmahmann, M.D., Shaun M. Eack, Ph.D., Matcheri S. Keshavan, M.D., Alvaro Pascual-Leone, M.D., Ph.D., Mark A. Halko, Ph.D.
Affiliations: Department of Psychiatry, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston (R.O.B., I.L., L.J.S., M.S.K.); Schizophrenia and Bipolar Disorders Program, McLean Hospital, Belmont, Mass. (R.O.B., D.Ö.); Harvard Medical School, Boston (R.O.B., D.Ö.); St. Elizabeth’s Medical Center, Boston (I.G.); Department of Neurology, Ataxia Unit, Cognitive Behavioral Neurology Unit, and Laboratory for Neuroanatomy and Cerebellar Neurobiology, Massachusetts General Hospital and Harvard Medical School, Boston (J.D.S.); Department of Psychiatry and the School of Social Work, University of Pittsburgh (S.M.E.); Berenson-Allen Center for Noninvasive Brain Stimulation and Division for Cognitive Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston (A.P.-L., M.A.H.).
Disclosures: Dr. Öngür has served on the scientific advisory board for Neurocrine. Dr. Schmahmann serves on the scientific advisory board for Cadent; he serves as a consultant for Biogen, Biohaven, and Pfizer; and he holds a license with the General Hospital Corporation for the Brief Ataxia Rating Scale and the Cerebellar Cognitive Affective/Schmahmann Syndrome Scale. Dr. Pascual-Leone serves on the scientific advisory boards for Neosync, Neuroelectrics, Neuronix, Nexstim, and Starlab Neuroscience, and he is listed as an inventor on several issued and pending patents for the real-time integration of transcranial magnetic stimulation with EEG and MRI. The other authors report no financial relationships with commercial interests.
Discussion of unapproved or investigational use of products*: No.
*APA policy requires disclosure by CME authors of unapproved or investigational use of products discussed in CME programs. Off-label use of medications by individual physicians is permitted and common. Decisions about off-label use can be guided by scientific literature and clinical experience.
Ned H. Kalin, M.D. (Editor-in-Chief, AJP); Carolyn Rodriguez, M.D., Ph.D. (Deputy Editor, AJP); Michael D. Roy (Editorial Director, AJP); Michael A. Pogachar (Online Content Manager, Journals). Dr. Kalin has served as a consultant to the Board of Scientific Advisors, the Pritzker Neuropsychiatric Disorders Research Consortium, and the Skyland Trail Advisory Board and as Councilor, Society of Biological Psychiatry. Dr. Rodriguez has served as a consultant to Allergan, Blackthorn, Epiodyne, and Rugen. Mr. Roy and Mr. Pogachar report no financial relationships with commercial interests.
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