Abstract Self-transcendence, the reorientation of experience away from the self toward others, nature, or broader meaning, is a fundamental dimension of human psychology, yet its causal neural architecture remains poorly understood. Here we applied lesion network mapping to 88 neurosurgical patients with pre- and post-operative assessments of trait self-transcendence to identify the distributed brain network whose disruption alters this capacity. The resulting network showed significant spatial correspondence with the default mode network and, at a finer parcellation level, with frontoparietal control subnetworks. Leave-one-out analyses identified posterior midline regions as the most stable correlates of increased self-transcendence following brain lesions. Independent validation against fMRI meta-analyses of self-referential processing, compassion, and ketamine administration, alongside a neuromodulation target previously shown to modulate the sense of self, converged on a consistent model. These findings provide causal evidence for a network architecture in which posterior midline hubs constrain, and brainstem and anterior midline regions facilitate, self-transcendent experience.

Identifying the anatomy of circuits causal of psychosis could inform treatment targets for schizophrenia. We identified 155 published case reports of brain lesions that caused new-onset psychosis. We mapped connectivity of these lesions using a normative human fMRI connectome. Lesions causing psychosis mapped to a common brain circuit defined by functional connectivity to the posterior subiculum of the hippocampus. This circuit was consistent both across individual symptoms of psychosis (delusions, hallucinations, and thought disorders), and when excluding lesions that touched the hippocampus. In an independent observational study (n=181), lesions connected to this circuit were preferentially associated with psychotic symptoms. A location in the rostromedial prefrontal cortex with high connectivity to this psychosis circuit was identified as a potential target for transcranial magnetic stimulation. Based on these results, we conclude that lesions that cause psychosis have common functional connections to the posterior subiculum of the hippocampus.

The triggers that induce scrupulosity-related distress can vary, depending on an individual’s religious/moral worldview. Accounting for cultural context surrounding one’s obsessions could improve the sensitivity of tests for scrupulosity. With cultural context in mind, we designed the Religious Distress Task (RDT) to elicit negative emotions in members of the Church of Jesus Christ of Latter-day Saints (LDS) with scrupulosity. This study evaluated the factor structure, test-retest reliability, and internal consistency of the RDT in three samples of LDS individuals (N1 = 392, N2 = 607, and N3 = 40 scrupulous and 34 control). Across samples, between 59% and 68% of participants identified as female, while 90% to 100% identified as white, and 88% to 93% identified as non-Hispanic or Latino. An EFA was performed in sample 1 and a CFA in sample 2. The EFA revealed a two-factor structure (factor 1: l = .59 - .77; factor 2: l = .54 - .91). The CFA supported these findings (factor 1: l = .53 - .86; factor 2: l = .74 - .88). All samples demonstrated adequate test-retest reliability and internal consistency (r = .77 - .90; a = .86 - .96). Accounting for cultural and religious background when designing measures of scrupulosity may improve their psychometric properties.

This study examined the relationships between maladaptive perfectionism, scrupulosity, self-compassion, psychological well-being, and suicidal ideation among members of The Church of Jesus Christ of Latter-day Saints (LDS). Recruitment involved 104 LDS adult individuals who completed measures related to maladaptive perfectionism, scrupulosity, self-compassion, psychological well-being, and suicidal ideation. Maladaptive perfectionism and scrupulosity were positively correlated with depression, anxiety, stress, and suicidal ideation. Maladaptive perfectionism and scrupulosity were positively linked to suicidal ideation. Findings also showed that self-compassion had a significant moderate negative direct effect on suicidal ideation, as well as a significant indirect effect between maladaptive perfectionism and suicidal ideation. Clinical implications for addressing maladaptive perfectionism, scrupulosity, self-compassion, psychological well-being, and suicidal ideation among this religious population are discussed.

To begin expanding on previous lesion network mapping of delusions.

To identify the brain regions and networks involved in lesion induced cerebral achromatopsia.

To identify brain regions and networks underlying acquired-brain-injury-induced chronic insomnia.

OBJECTIVE:To create an open source, web-based platform for aggregating, viewing, and analyzing published case reports of brain lesions. BACKGROUND:Given the recent surge of methodological innovation using human brain lesion data, our objective is to create an open source, web-based platform for aggregating, viewing, and analyzing published case reports containing both brain imaging and clinical evaluation of the patient. DESIGN/METHODS:LesionBank.org provides a user-friendly platform for curated brain lesion reports, allowing search, visualization, and retrieval of lesion images and metadata. The application leverages the Django web-framework and a Postgres database to process user requests and handle the user interface. The application is deployed on a DigitalOcean droplet, and imaging data is stored in an S3-compatible DigitalOcean object space. Currently, the collection includes 163 lesion ROIs and associated lesion network maps that were found from previous published case reports. RESULTS:LesionBank.org has been launched with a viewer and search capabilities based on both textual search of case reports and image-based search of published brain lesion images. To date, the LesionBank.org platform has been used to successfully reproduce primary findings from an already-published study on amnesia (Ferguson, 2019). Additionally, LesionBank.org has been used to support training of several dozen undergraduate research assistants to identify brain lesion case reports of interest, create digital lesion tracings from published, catalog metadata, and relate brain lesions to their underlying functional connectivity. CONCLUSIONS:Science: LesionBank, an open source platform for brain lesion case reports, is able to reproduce brain lesion mapping results from published literature. Education: LesionBank is able to power an asynchronous undergraduate semester research course on clinical neuroscience. Disclosure: Mr. Turner has nothing to disclose. Mr. Suvarna has nothing to disclose. Ms. Chen has nothing to disclose. Mr. Baughan has nothing to disclose. Ms. Bunnell has nothing to disclose. Dr. Howard has received intellectual property interests from a discovery or technology relating to health care. Dr. Howard has a non-compensated relationship as a Founder with KiTH Solutions that is relevant to AAN interests or activities. Dr. Schaper has nothing to disclose. Dr. Ferguson has nothing to disclose. Prof. Nielsen has nothing to disclose.

In patients of tertiary-level mental healthcare facilities, symptoms of insomnia are prevalent in 78.2% of the population. Additionally, among those who suffer from acquired brain injury, few symptoms are as generally pervasive as that of primary insomnia. Meta-analyses of insomnia patients with fMRI data have failed to identify consistently affected brain regions. Individual studies have suggested several brain regions are involved in insomnia, including the anterior cingulum and orbitofrontal cortex. However, few regions have consistently been implicated in the pathophysiology of insomnia. Moreover, little is known regarding the collective brain networks involving insomnia.

Religious fundamentalism is a globally relevant and growing phenomenon. This study examined the interaction between religious fundamentalism and intrinsic religiosity, as it relates to spiritual well-being and social connectedness. These phenomena were explored among Muslims living in Iran, where a fundamentalist orientation is prevalent. Religious fundamentalism interacted with intrinsic religiosity to increase global spiritual well-being, which in turn was associated with greater identification with one's community, country, and all of humanity. These results indicate an adaptive function of religious fundamentalism, one that deepens spirituality and interconnectedness. These positive benefits may help explain the growing phenomena of fundamentalism, and the strength by which fundamentalists adhere to their doctrine. Furthermore, these findings provide a more holistic view of fundamentalism, as the literature predominantly examines the negative consequences of fundamentalism. A multifaceted understanding of religious fundamentalism necessitates an awareness of when it is detrimental and when it is beneficial.

Objective: To test whether lesions related to epilepsy map to a common brain network. Background: Focal epilepsy is commonly caused by brain lesions, but it remains unclear why some lesion locations result in epilepsy while others do not. One possibility is that some brain regions or networks are more vulnerable than others. Identifying the brain regions or networks related to epilepsy could inform prognosis and guide interventions. Design/Methods: Lesion locations from patients with ischemic stroke-related epilepsy (n = 76) and control lesions (n = 625) were mapped to a common brain atlas. Traditional lesion mapping methods were used to test for associations between epilepsy and lesion location. Next, we computed the brain network functionally connected to each lesion location using human brain connectome data (n = 1000). Network connections associated with epilepsy were identified. Generalizability to other lesion types was assessed using independent datasets of four different lesion etiologies (n = 772) and a leave-one-dataset-out analysis. These connections were then used to generate a brain network map that best encompasses lesion locations related to epilepsy. Finally, we tested whether thalamic deep brain stimulation sites that improve seizure control were connected to this same network (n = 30). Results: We found that lesions associated with epilepsy occurred in multiple heterogenous locations spanning different lobes and vascular territories. However, these heterogenous lesion locations were part of a common brain network defined by functional connectivity to the basal ganglia and cerebellum (Vmax = 6.8, P < 0.001). Functional connectivity to these regions was associated with the risk of epilepsy across different lesion types (χ2 = 205.3, P < 0.001) and with therapeutic response to thalamic deep brain stimulation (r = 0.63, P < 0.005). Conclusions: Lesion locations related to epilepsy map to a common brain network defined by functional connectivity to the basal ganglia and cerebellum. Disclosure: Dr. Schaper has nothing to disclose. Dr. Nordberg has nothing to disclose. The institution of Dr. Cohen has received research support from NIH. The institution of Dr. Cohen has received research support from Simons Foundation. Mr. Lin has nothing to disclose. The institution of Mr. Hsu has received research support from Walter L. Copeland Fund of the Pittsburgh Foundation. Dr. Horn has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Boston Scientific. Dr. Ferguson has nothing to disclose. Dr. Siddiqi has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for Magnus Medical. Dr. Siddiqi has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Brainsway Ltd. Dr. Siddiqi has stock in Brainsway Ltd. Dr. Siddiqi has stock in Magnus Medical. Dr. Siddiqi has received intellectual property interests from a discovery or technology relating to health care. Mr. Drew has nothing to disclose. Louis Soussand has nothing to disclose. Dr. Winkler has received research support from National Institutes of Health. Dr. Simó has nothing to disclose. Jordi Bruna has nothing to disclose. Prof. RHEIMS has nothing to disclose. Prof. GUENOT has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Dixi Medical. Dr. Bucci has nothing to disclose. Dr. Nummenmaa has nothing to disclose. Dr. Staals has nothing to disclose. Dr. Colon has received personal compensation in the range of $500-$4,999 for serving as a Consultant for DEKRA. Dr. Colon has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Livanova. Dr. Colon has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Medtronic. Dr. Colon has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for De Baar. Dr. Colon has received personal compensation in the range of $0-$499 for serving as an Expert Witness for Rechtbank Zwolle. The institution of Dr. Colon has received research support from Zon/MW ZiN. Miss Ackermans has nothing to disclose. Dr. Bubrick has received personal compensation in the range of $500-$4,999 for serving as a Consultant for UniQure. Dr. Peters has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Neurelis. Dr. Peters has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Neurelis. Dr. Peters has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Neurelis. Dr. Wu has received stock or an ownership interest from Microsoft. Dr. Wu has received stock or an ownership interest from Disney. Dr. Wu has received stock or an ownership interest from Con Edison. Dr. Wu has received stock or an ownership interest from Cisco. The institution of Dr. Wu has received research support from NIH. The institution of Dr. Wu has received research support from AHA. The institution of Dr. Wu has received research support from Same You. The institution of Dr. Wu has received research support from Football Players Health Study. Dr. Wu has received intellectual property interests from a discovery or technology relating to health care. Dr. Wu has received intellectual property interests from a discovery or technology relating to health care. Dr. Wu has received intellectual property interests from a discovery or technology relating to health care. Dr. Wu has received personal compensation in the range of $500-$4,999 for serving as a grant reviewer with NIH. Dr. Rost has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Stroke - AHA/ASA Journal. The institution of Dr. Rost has received research support from NIH. Dr. Rost has received publishing royalties from a publication relating to health care. Dr. Grafman has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Elsevier. The institution of Dr. Grafman has received research support from NIH. The institution of Dr. Grafman has received research support from Templeton Foundation. Dr. Blumenfeld has nothing to disclose. Yasin Temel has nothing to disclose. Rob Rouhl has nothing to disclose. The institution of Juho Joutsa has received research support from Finnish Medical Foundation. The institution of Juho Joutsa has received research support from Sigrid Juselius Foundation. The institution of Juho Joutsa has received research support from Instrumentarium Research Foundation. The institution of Juho Joutsa has received research support from Turku University Hospital. Dr. Fox has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Wiley.

Objective: To determine whether delirium in acute ischemic stroke is localizable to specific neural networks. Background: Delirium is estimated to occur in one-fourth of patients with acute stroke. Despite its associated morbidity and mortality, prediction and pathophysiological understanding of delirium remains challenging. A recent meta-analysis of patients with delirium and stroke found increased risks of delirium in supratentorial, cortical, and anterior circulation strokes, raising the possibility of an underlying neural network for delirium. Design/Methods: We performed a retrospective cohort study of patients admitted to a comprehensive stroke center with acute ischemic stroke from January 2016 to April 2019. Patients were assessed for delirium by trained clinical nursing staff using the Confusion Assessment Method (CAM) framework. Acute stroke lesions from MRI diffusion weighted images (DWI) lesions were automatically segmented using a machine learning algorithm. Lesions were registered to a 2mm Montreal Neurological Institute template (MNI-152). We then used lesion network mapping to identify potential unifying brain networks for delirium in patients with acute stroke. Results: 907 scans from unique patients were analyzed. 274 patients had delirium (30.2%), 47.5% were women (431), and the mean age was 69.6 years old. In comparison to a general stroke cohort, patients with delirium had lesions connected to the right and left inferior frontal gyri and left middle temporal gyrus and left temporo-parietal junction (one-sample t-test, family-wise error p<0.05). Sensitivity analysis showed that delirium was not associated with parietal, occipital, brainstem, and cerebellar lesions. Conclusions: Delirium in stroke localizes to a network connected to frontotemporal regions. These results have implications for prediction of delirium in patients with acute stroke, with the potential for targeting multimodal prevention. Future work will refine their specificity, however, the results suggest that frontotemporal networks may be particularly important for cardinal symptoms of delirium, a disorder of impaired attention and awareness Disclosure: Dr. Rhee has stock in NTAP. Dr. Rhee has stock in TSLA. Dr. Rhee has stock in BABA. Dr. Rhee has stock in ZM. Dr. Rhee has stock in GM. Dr. Rhee has stock in PFF. Dr. Rhee has stock in AMZN. Dr. Rhee has stock in META. Dr. Rhee has stock in GE. Dr. Rhee has received publishing royalties from a publication relating to health care. Dr. Rhee has received personal compensation in the range of $0-$499 for serving as a Director of the Hippocratic Forum with Abigail Adams Institute. Dr. Ferguson has nothing to disclose. Dr. Bonkhoff has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for NeuroImage Clinical (Elsevier). Mr. Patel has nothing to disclose. Dr. Bretzner has nothing to disclose. Dr. Hong has nothing to disclose. Dr. Ryan has nothing to disclose. Dr. Westover has stock in Beacon Biosignals. The institution of Dr. Westover has received research support from NIH. Dr. Westover has received publishing royalties from a publication relating to health care. Dr. Westover has a non-compensated relationship as a cofounder with Beacon Biosignals that is relevant to AAN interests or activities. Dr. Fox has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Wiley. Dr. Rost has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Stroke - AHA/ASA Journal. The institution of Dr. Rost has received research support from NIH. Dr. Rost has received publishing royalties from a publication relating to health care. The institution of Dr. Kimchi has received research support from NIH. The institution of an immediate family member of Dr. Kimchi has received research support from NIH.

Click to increase image sizeClick to decrease image size Disclosure statementNo potential conflict of interest was reported by the author(s).

Human brain imaging has sufficiently advanced to the point of detecting brain circuits that are not only functionally correlated with spirituality and religiosity, but are causally involved in these complex behaviors. Simultaneously, significant progress has been made to identify brain circuits that are causally associated with clinical symptoms. Taken together, a paradigm of "clinical neurospirituality" explores the possibility of strategically integrating patient-centered spiritual practices to treat clinical symptoms on the basis of shared neural substrates.

Introduction: Understanding the relations between lesions and outcomes is a particularly promising avenue to support tailored stroke care. We here employed a novel Bayesian framework integrating lesion location and functional lesion connectivity, i.e., lesion network mapping data, aiming to augment the prediction of stroke severity and the interpretability of lesion-symptom associations in a multi-center cohort of acute ischemic stroke (AIS) patients. Methods: Analyses relied on 1,077 AIS patients of the MRI-GENIE study [age: 64.2(14.7), 38%women]. NIHSS-based stroke severity was modeled via Bayesian linear regression. Structural location and functional connectivity information was represented by ten unique patterns each. We compared the out-of-sample predictive performances of structural vs. structural-functional models in Bayesian model comparisons. In ancillary analyses, we extracted functional connectivity pattern relevant for stroke severity and repeated analyses after stratifying for lesion size (50% of patients with larger lesions). Models were generally adjusted for age, sex, comorbidities and total DWI lesion volume. Results: Model comparison indicated a benefit of the combined structural-functional stroke severity prediction model compared to the structural one (model weights: 82% vs. 18%). This benefit of the combined model became even more apparent in case of patients with large lesions (97% vs. 3%). Positive lesion connectivity to the bilateral ventral attention (VA) and somatomotor networks, as well as temporal default mode network (DMN) predicted higher severity, while positive connectivity to more medial parts of the DMN and the visual network predicted lower severity. Additionally, negative lesion connectivity to the bilateral DMN, somatomotor, dorsal attention, and control networks predicted higher, and negative connectivity to the right control and bilateral VA networks predicted lower severity. Conclusions: Model comparisons indicated a benefit of integrating structural and functional information for the prediction of stroke severity, especially in case of larger lesions. Lesion connectivity data can enhance our understanding of why specific lesion locations can lead to symptoms post-stroke.