{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T15:41:55Z","timestamp":1787240515753,"version":"build-2736575974"},"reference-count":79,"publisher":"Springer Science and Business Media LLC","issue":"7","license":[{"start":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T00:00:00Z","timestamp":1773878400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T00:00:00Z","timestamp":1773878400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100000025","name":"U.S. Department of Health & Human Services | NIH | National Institute of Mental Health","doi-asserted-by":"publisher","award":["R01MH100041"],"award-info":[{"award-number":["R01MH100041"]}],"id":[{"id":"10.13039\/100000025","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000025","name":"U.S. Department of Health & Human Services | NIH | National Institute of Mental Health","doi-asserted-by":"publisher","award":["R37MH100041"],"award-info":[{"award-number":["R37MH100041"]}],"id":[{"id":"10.13039\/100000025","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Mol Psychiatry"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Mania\/hypomania is pathognomonic of bipolar disorder (BD), yet early identification remains challenging. Impulsivity is a key feature of mania\/hypomania and of externalizing disorders that may predispose to BD, but neural markers of impulsivity-related risk remain unknown. This study aimed to identify reward expectancy (RE)-related neural correlates of impulsivity facets, test moderation by current affective\/anxiety symptoms, and determine whether such markers differentiate BD and\/or externalizing disorders from low impulsivity individuals. Two independent BD-risk samples aged 18\u201330 years, including individuals with prior externalizing disorder diagnoses but not BD, were recruited; a euthymic BD group was also recruited. Impulsivity facets were assessed via Behavioral Activation System (BAS) and UPPS-P scales. Whole-brain regressions identified neural correlates of impulsivity facets during RE. Linear models tested replication and current affective\/anxiety symptom moderation. ANCOVA compared neural activity among BD, externalizing, and non-BD\/externalizing impulsivity tertile groups. Whole-brain regressions revealed a positive association between BAS Fun Seeking and pre-supplementary motor area (pre-SMA) activity (\n                    <jats:italic>p<\/jats:italic>\n                    <jats:sub>FWE<\/jats:sub>\n                    \u2009=\u20090.003,\n                    <jats:italic>k<\/jats:italic>\n                    \u2009=\u2009167), which replicated when depressive symptoms were covaried (discovery:\n                    <jats:italic>\u03b2<\/jats:italic>\n                    \u2009=\u20092.73,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001; replication:\n                    <jats:italic>\u03b2<\/jats:italic>\n                    \u2009=\u20090.88,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.036; combined:\n                    <jats:italic>\u03b2<\/jats:italic>\n                    \u2009=\u20091.49,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001). A significant pre-SMA \u00d7 depression interaction (\n                    <jats:italic>\u03b2<\/jats:italic>\n                    \u2009=\u2009\u20130.08,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.037) indicated depressive symptoms attenuated the pre-SMA-Fun Seeking association. Group comparisons revealed greater pre-SMA activity in high-Fun Seeking (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001) and externalizing disorder groups (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.039) versus low-Fun Seeking, with similar trends observed in BD once individuals taking medications, particularly benzodiazepines (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.012), were excluded. Pre-SMA hyperactivity during RE is a robust neural correlate of BAS Fun Seeking, moderated by depression severity. This pattern represents a trait-linked neural marker of impulsivity associated with vulnerability to BD and externalizing disorders, informing early risk identification and intervention.\n                  <\/jats:p>","DOI":"10.1038\/s41380-026-03528-0","type":"journal-article","created":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T13:56:12Z","timestamp":1773928572000},"page":"4113-4123","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Elevated pre-supplementary motor area activity during reward expectancy: An impulsivity-related neural marker of vulnerability to bipolar and externalizing disorders"],"prefix":"10.1038","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-8958-1330","authenticated-orcid":false,"given":"Robert","family":"Raeder","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manan","family":"Arora","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3857-1226","authenticated-orcid":false,"given":"Michele","family":"Bertocci","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henry W.","family":"Chase","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander S.","family":"Skeba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Genna","family":"Bebko","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haris A.","family":"Aslam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simona","family":"Graur","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Osasumwen","family":"Benjamin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiming","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richelle","family":"Stiffler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4958-1291","authenticated-orcid":false,"given":"Mary L.","family":"Phillips","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,19]]},"reference":[{"key":"3528_CR1","volume-title":"Manic-Depressive Illness: Bipolar Disorders and Recurrent Depression","author":"FK Goodwin","year":"2007","unstructured":"Goodwin FK, Jamison KR, Ghaemi SN. Manic-Depressive Illness: Bipolar Disorders and Recurrent Depression. 2nd ed. Oxford University Press; 2007.","edition":"2nd ed."},{"key":"3528_CR2","doi-asserted-by":"publisher","first-page":"241","DOI":"10.1001\/archgenpsychiatry.2011.12","volume":"68","author":"KR Merikangas","year":"2011","unstructured":"Merikangas KR, Jin R, He JP, Kessler RC, Lee S, Sampson NA, et al. Prevalence and correlates of bipolar spectrum disorder in the world mental health survey initiative. Arch Gen Psychiatry. 2011;68:241 https:\/\/doi.org\/10.1001\/archgenpsychiatry.2011.12","journal-title":"Arch Gen Psychiatry"},{"key":"3528_CR3","doi-asserted-by":"publisher","first-page":"1663","DOI":"10.1016\/S0140-6736(13)60989-7","volume":"381","author":"ML Phillips","year":"2013","unstructured":"Phillips ML, Kupfer DJ. Bipolar disorder diagnosis: challenges and future directions. Lancet. 2013;381:1663\u201371. https:\/\/doi.org\/10.1016\/S0140-6736(13)60989-7","journal-title":"Lancet"},{"key":"3528_CR4","first-page":"57","volume":"3","author":"T Singh","year":"2006","unstructured":"Singh T, Rajput M. Misdiagnosis of bipolar disorder. Psychiatry Edgmont Pa Townsh. 2006;3:57\u201363.","journal-title":"Psychiatry Edgmont Pa Townsh"},{"key":"3528_CR5","doi-asserted-by":"publisher","first-page":"324","DOI":"10.1111\/j.1399-5618.2007.00487.x","volume":"9","author":"CU Correll","year":"2007","unstructured":"Correll CU, Penzner JB, Lencz T, Auther A, Smith CW, Malhotra AK, et al. Early identification and high\u2010risk strategies for bipolar disorder. Bipolar Disord. 2007;9:324\u201338. https:\/\/doi.org\/10.1111\/j.1399-5618.2007.00487.x","journal-title":"Bipolar Disord"},{"key":"3528_CR6","doi-asserted-by":"publisher","unstructured":"American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fifth Edition. American Psychiatric Association; Washington, DC; 2013. https:\/\/doi.org\/10.1176\/appi.books.9780890425596.","DOI":"10.1176\/appi.books.9780890425596"},{"key":"3528_CR7","doi-asserted-by":"publisher","first-page":"313","DOI":"10.1016\/j.euroneuro.2006.10.002","volume":"17","author":"P Najt","year":"2007","unstructured":"Najt P, Perez J, Sanches M, Peluso M, Glahn D, Soares J. Impulsivity and bipolar disorder. Eur Neuropsychopharmacol. 2007;17:313\u201320. https:\/\/doi.org\/10.1016\/j.euroneuro.2006.10.002","journal-title":"Eur Neuropsychopharmacol"},{"key":"3528_CR8","doi-asserted-by":"publisher","first-page":"1783","DOI":"10.1176\/appi.ajp.158.11.1783","volume":"158","author":"FG Moeller","year":"2001","unstructured":"Moeller FG, Barratt ES, Dougherty DM, Schmitz JM, Swann AC. Psychiatric aspects of impulsivity. Am J Psychiatry. 2001;158:1783\u201393. https:\/\/doi.org\/10.1176\/appi.ajp.158.11.1783","journal-title":"Am J Psychiatry"},{"key":"3528_CR9","doi-asserted-by":"publisher","first-page":"2141","DOI":"10.1017\/S0033291720003086","volume":"50","author":"A Ram\u00edrez-Mart\u00edn","year":"2020","unstructured":"Ram\u00edrez-Mart\u00edn A, Ramos-Mart\u00edn J, Mayoral-Cleries F, Moreno-K\u00fcstner B, Guzman-Parra J. Impulsivity, decision-making and risk-taking behaviour in bipolar disorder: a systematic review and meta-analysis. Psychol Med. 2020;50:2141\u201353. https:\/\/doi.org\/10.1017\/S0033291720003086","journal-title":"Psychol Med"},{"key":"3528_CR10","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1111\/j.1399-5618.2010.00806.x","volume":"12","author":"SM Strakowski","year":"2010","unstructured":"Strakowski SM, Fleck DE, DelBello MP, Adler CM, Shear PK, Kotwal R, et al. Impulsivity across the course of bipolar disorder. Bipolar Disord. 2010;12:285\u201397. https:\/\/doi.org\/10.1111\/j.1399-5618.2010.00806.x","journal-title":"Bipolar Disord"},{"key":"3528_CR11","doi-asserted-by":"publisher","first-page":"1479","DOI":"10.1016\/j.comppsych.2014.05.010","volume":"55","author":"S Saddichha","year":"2014","unstructured":"Saddichha S, Schuetz C. Is impulsivity in remitted bipolar disorder a stable trait? A meta-analytic review. Compr Psychiatry. 2014;55:1479\u201384. https:\/\/doi.org\/10.1016\/j.comppsych.2014.05.010","journal-title":"Compr Psychiatry"},{"key":"3528_CR12","doi-asserted-by":"publisher","first-page":"876","DOI":"10.1177\/0004867418783062","volume":"52","author":"J Rote","year":"2018","unstructured":"Rote J, Dingelstadt AML, Aigner A, Bauer M, Fiebig J, K\u00f6nig B, et al. Impulsivity predicts illness severity in long-term course of bipolar disorder: A prospective approach. Aust N Z J Psychiatry. 2018;52:876\u201386. https:\/\/doi.org\/10.1177\/0004867418783062","journal-title":"Aust N Z J Psychiatry"},{"key":"3528_CR13","doi-asserted-by":"publisher","first-page":"491","DOI":"10.1016\/j.jad.2011.10.044","volume":"136","author":"E Jim\u00e9nez","year":"2012","unstructured":"Jim\u00e9nez E, Arias B, Castellv\u00ed P, Goikolea JM, Rosa AR, Fa\u00f1an\u00e1s L, et al. Impulsivity and functional impairment in bipolar disorder. J Affect Disord. 2012;136:491\u20137. https:\/\/doi.org\/10.1016\/j.jad.2011.10.044","journal-title":"J Affect Disord"},{"key":"3528_CR14","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1016\/j.jad.2009.12.016","volume":"125","author":"M Di Nicola","year":"2010","unstructured":"Di Nicola M, Tedeschi D, Mazza M, Martinotti G, Harnic D, Catalano V, et al. Behavioural addictions in bipolar disorder patients: Role of impulsivity and personality dimensions. J Affect Disord. 2010;125:82\u201388. https:\/\/doi.org\/10.1016\/j.jad.2009.12.016","journal-title":"J Affect Disord"},{"key":"3528_CR15","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1111\/j.1399-5618.2011.00900.x","volume":"13","author":"AC Swann","year":"2011","unstructured":"Swann AC, Lijffijt M, Lane SD, Kjome KL, Steinberg JL, Moeller FG. Criminal conviction, impulsivity, and course of illness in bipolar disorder: Bipolar disorder and conviction history. Bipolar Disord. 2011;13:173\u201381. https:\/\/doi.org\/10.1111\/j.1399-5618.2011.00900.x","journal-title":"Bipolar Disord"},{"key":"3528_CR16","doi-asserted-by":"publisher","first-page":"1680","DOI":"10.1176\/appi.ajp.162.9.1680","volume":"162","author":"AC Swann","year":"2005","unstructured":"Swann AC, Dougherty DM, Pazzaglia PJ, Pham M, Steinberg JL, Moeller FG. Increased impulsivity associated with severity of suicide attempt history in patients with bipolar disorder. Am J Psychiatry. 2005;162:1680\u20137. https:\/\/doi.org\/10.1176\/appi.ajp.162.9.1680","journal-title":"Am J Psychiatry"},{"key":"3528_CR17","doi-asserted-by":"publisher","first-page":"555","DOI":"10.1192\/bjp.2018.111","volume":"213","author":"SM Meier","year":"2018","unstructured":"Meier SM, Pavlova B, Dalsgaard S, Nordentoft M, Mors O, Mortensen PB, et al. Attention-deficit hyperactivity disorder and anxiety disorders as precursors of bipolar disorder onset in adulthood. Br J Psychiatry. 2018;213:555\u201360. https:\/\/doi.org\/10.1192\/bjp.2018.111","journal-title":"Br J Psychiatry"},{"key":"3528_CR18","doi-asserted-by":"publisher","first-page":"454","DOI":"10.1037\/abn0000258","volume":"126","author":"R Kotov","year":"2017","unstructured":"Kotov R, Krueger RF, Watson D, Achenbach TM, Althoff RR, Bagby RM, et al. The Hierarchical Taxonomy of Psychopathology (HiTOP): A dimensional alternative to traditional nosologies. J Abnorm Psychol. 2017;126:454\u201377. https:\/\/doi.org\/10.1037\/abn0000258","journal-title":"J Abnorm Psychol"},{"key":"3528_CR19","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1097\/NMD.0000000000000235","volume":"203","author":"D Hidalgo-Mazzei","year":"2015","unstructured":"Hidalgo-Mazzei D, Walsh E, Rosenstein L, Zimmerman M. Comorbid bipolar disorder and borderline personality disorder and substance use disorder. J Nerv Ment Dis. 2015;203:54\u201357. https:\/\/doi.org\/10.1097\/NMD.0000000000000235","journal-title":"J Nerv Ment Dis"},{"key":"3528_CR20","doi-asserted-by":"publisher","first-page":"180","DOI":"10.1177\/026988119901300211","volume":"13","author":"J Evenden","year":"1999","unstructured":"Evenden J. Impulsivity: a discussion of clinical and experimental findings. J Psychopharmacol (Oxf). 1999;13:180\u201392. https:\/\/doi.org\/10.1177\/026988119901300211","journal-title":"J Psychopharmacol (Oxf)"},{"key":"3528_CR21","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1037\/0022-3514.67.2.319","volume":"67","author":"CS Carver","year":"1994","unstructured":"Carver CS, White TL. Behavioral inhibition, behavioral activation, and affective responses to impending reward and punishment: The BIS\/BAS Scales. J Pers Soc Psychol. 1994;67:319\u201333. https:\/\/doi.org\/10.1037\/0022-3514.67.2.319","journal-title":"J Pers Soc Psychol"},{"key":"3528_CR22","doi-asserted-by":"publisher","first-page":"669","DOI":"10.1016\/S0191-8869(00)00064-7","volume":"30","author":"SP Whiteside","year":"2001","unstructured":"Whiteside SP, Lynam DR. The Five Factor Model and impulsivity: using a structural model of personality to understand impulsivity. Personal Individ Differ. 2001;30:669\u201389. https:\/\/doi.org\/10.1016\/S0191-8869(00)00064-7","journal-title":"Personal Individ Differ"},{"key":"3528_CR23","doi-asserted-by":"publisher","first-page":"158","DOI":"10.1038\/nrn.2017.8","volume":"18","author":"JW Dalley","year":"2017","unstructured":"Dalley JW, Robbins TW. Fractionating impulsivity: Neuropsychiatric implications. Nat Rev Neurosci. 2017;18:158\u201371. https:\/\/doi.org\/10.1038\/nrn.2017.8","journal-title":"Nat Rev Neurosci"},{"key":"3528_CR24","doi-asserted-by":"publisher","first-page":"243","DOI":"10.1146\/annurev-clinpsy-032511-143148","volume":"8","author":"SL Johnson","year":"2012","unstructured":"Johnson SL, Edge MD, Holmes MK, Carver CS. The Behavioral Activation System and Mania. Annu Rev Clin Psychol. 2012;8:243\u201367. https:\/\/doi.org\/10.1146\/annurev-clinpsy-032511-143148","journal-title":"Annu Rev Clin Psychol"},{"key":"3528_CR25","doi-asserted-by":"publisher","first-page":"339","DOI":"10.1037\/a0025877","volume":"121","author":"LB Alloy","year":"2012","unstructured":"Alloy LB, Bender RE, Whitehouse WG, Wagner CA, Liu RT, Grant DA, et al. High Behavioral Approach System (BAS) sensitivity, reward responsiveness, and goal-striving predict first onset of bipolar spectrum disorders: A prospective behavioral high-risk design. J Abnorm Psychol. 2012;121:339\u201351. https:\/\/doi.org\/10.1037\/a0025877","journal-title":"J Abnorm Psychol"},{"key":"3528_CR26","doi-asserted-by":"publisher","first-page":"310","DOI":"10.1111\/j.1399-5618.2007.00547.x","volume":"10","author":"LB Alloy","year":"2008","unstructured":"Alloy LB, Abramson LY, Walshaw PD, Cogswell A, Grandin LD, Hughes ME, et al. Behavioral Approach System and Behavioral Inhibition System sensitivities and bipolar spectrum disorders: prospective prediction of bipolar mood episodes. Bipolar Disord. 2008;10:310\u201322. https:\/\/doi.org\/10.1111\/j.1399-5618.2007.00547.x","journal-title":"Bipolar Disord"},{"key":"3528_CR27","doi-asserted-by":"publisher","first-page":"1148","DOI":"10.1001\/jamapsychiatry.2014.1031","volume":"71","author":"MK Singh","year":"2014","unstructured":"Singh MK, Kelley RG, Howe ME, Reiss AL, Gotlib IH, Chang KD. Reward processing in healthy offspring of parents with bipolar disorder. JAMA Psychiatry. 2014;71:1148. https:\/\/doi.org\/10.1001\/jamapsychiatry.2014.1031","journal-title":"JAMA Psychiatry"},{"key":"3528_CR28","doi-asserted-by":"publisher","first-page":"74","DOI":"10.1016\/j.brat.2014.08.011","volume":"62","author":"R Nusslock","year":"2014","unstructured":"Nusslock R, Young CB, Damme KSF. Elevated reward-related neural activation as a unique biological marker of bipolar disorder: Assessment and treatment implications. Behav Res Ther. 2014;62:74\u201387. https:\/\/doi.org\/10.1016\/j.brat.2014.08.011","journal-title":"Behav Res Ther"},{"key":"3528_CR29","doi-asserted-by":"publisher","first-page":"726","DOI":"10.1016\/j.bpsc.2019.04.005","volume":"4","author":"L De Oliveira","year":"2019","unstructured":"De Oliveira L, Portugal LCL, Pereira M, Chase HW, Bertocci M, Stiffler R, et al. Predicting bipolar disorder risk factors in distressed young adults from patterns of brain activation to reward: A machine learning approach. Biol Psychiatry Cogn Neurosci Neuroimaging. 2019;4:726\u201333. https:\/\/doi.org\/10.1016\/j.bpsc.2019.04.005","journal-title":"Biol Psychiatry Cogn Neurosci Neuroimaging"},{"key":"3528_CR30","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1038\/npp.2009.129","volume":"35","author":"SN Haber","year":"2010","unstructured":"Haber SN, Knutson B. The reward circuit: linking primate anatomy and human imaging. Neuropsychopharmacology. 2010;35:4\u201326. https:\/\/doi.org\/10.1038\/npp.2009.129","journal-title":"Neuropsychopharmacology"},{"key":"3528_CR31","doi-asserted-by":"publisher","first-page":"1054","DOI":"10.1016\/j.neuron.2011.05.014","volume":"70","author":"MFS Rushworth","year":"2011","unstructured":"Rushworth MFS, Noonan MP, Boorman ED, Walton ME, Behrens TE. Frontal cortex and reward-guided learning and decision-making. Neuron. 2011;70:1054\u201369. https:\/\/doi.org\/10.1016\/j.neuron.2011.05.014","journal-title":"Neuron"},{"key":"3528_CR32","doi-asserted-by":"publisher","first-page":"666","DOI":"10.1038\/mp.2017.16","volume":"22","author":"AH Ashok","year":"2017","unstructured":"Ashok AH, Marques TR, Jauhar S, Nour MM, Goodwin GM, Young AH, et al. The dopamine hypothesis of bipolar affective disorder: the state of the art and implications for treatment. Mol Psychiatry. 2017;22:666\u201379. https:\/\/doi.org\/10.1038\/mp.2017.16","journal-title":"Mol Psychiatry"},{"key":"3528_CR33","doi-asserted-by":"publisher","unstructured":"Arora M, Chase H, Bertocci MA, Skeba AS, Eckstrand K, Bebko G et al. Left ventrolateral prefrontal cortical activity during reward expectancy and mania risk. JAMA Psychiatry. Published online January 2, 2025. https:\/\/doi.org\/10.1001\/jamapsychiatry.2024.4216","DOI":"10.1001\/jamapsychiatry.2024.4216"},{"key":"3528_CR34","doi-asserted-by":"publisher","first-page":"e1096","DOI":"10.1038\/tp.2017.60","volume":"7","author":"HW Chase","year":"2017","unstructured":"Chase HW, Fournier JC, Bertocci MA, Greenberg T, Aslam H, Stiffler R, et al. A pathway linking reward circuitry, impulsive sensation-seeking and risky decision-making in young adults: identifying neural markers for new interventions. Transl Psychiatry. 2017;7:e1096\u2013e1096. https:\/\/doi.org\/10.1038\/tp.2017.60","journal-title":"Transl Psychiatry"},{"key":"3528_CR35","doi-asserted-by":"publisher","first-page":"325","DOI":"10.1016\/j.jad.2022.08.081","volume":"319","author":"EK Edmiston","year":"2022","unstructured":"Edmiston EK, Fournier JC, Chase HW, Aslam HA, Lockovich J, Graur S, et al. Left ventrolateral prefrontal cortical activity during reward expectancy predicts mania risk up to one year post scan. J Affect Disord. 2022;319:325\u20138. https:\/\/doi.org\/10.1016\/j.jad.2022.08.081","journal-title":"J Affect Disord"},{"key":"3528_CR36","doi-asserted-by":"publisher","first-page":"249","DOI":"10.1111\/j.1399-5618.2012.01012.x","volume":"14","author":"R Nusslock","year":"2012","unstructured":"Nusslock R, Almeida JR, Forbes EE, Versace A, Frank E, Labarbara EJ, et al. Waiting to win: elevated striatal and orbitofrontal cortical activity during reward anticipation in euthymic bipolar disorder adults. Bipolar Disord. 2012;14:249\u201360. https:\/\/doi.org\/10.1111\/j.1399-5618.2012.01012.x","journal-title":"Bipolar Disord"},{"key":"3528_CR37","doi-asserted-by":"publisher","first-page":"533","DOI":"10.1176\/appi.ajp.2012.12020169","volume":"170","author":"X Caseras","year":"2013","unstructured":"Caseras X, Lawrence NS, Murphy K, Wise RG, Phillips ML. Ventral Striatum Activity in Response to Reward: Differences Between Bipolar I and II Disorders. Am J Psychiatry. 2013;170:533\u201341. https:\/\/doi.org\/10.1176\/appi.ajp.2012.12020169","journal-title":"Am J Psychiatry"},{"key":"3528_CR38","doi-asserted-by":"publisher","first-page":"389","DOI":"10.1016\/j.tics.2004.07.006","volume":"8","author":"R Davidson","year":"2004","unstructured":"Davidson R, Shackman A, Maxwell J. Asymmetries in face and brain related to emotion. Trends Cogn Sci. 2004;8:389\u201391. https:\/\/doi.org\/10.1016\/j.tics.2004.07.006","journal-title":"Trends Cogn Sci"},{"key":"3528_CR39","doi-asserted-by":"publisher","first-page":"e36036","DOI":"10.1371\/journal.pone.0036036","volume":"7","author":"G Brookshire","year":"2012","unstructured":"Brookshire G, Casasanto D. Motivation and motor control: Hemispheric specialization for approach motivation reverses with handedness. PLoS ONE. 2012;7:e36036 https:\/\/doi.org\/10.1371\/journal.pone.0036036.","journal-title":"PLoS ONE"},{"key":"3528_CR40","doi-asserted-by":"publisher","first-page":"610","DOI":"10.1037\/0022-3514.82.4.610","volume":"82","author":"E Harmon-Jones","year":"2002","unstructured":"Harmon-Jones E, Abramson LY, Sigelman J, Bohlig A, Hogan ME, Harmon-Jones C. Proneness to hypomania\/mania symptoms or depression symptoms and asymmetrical frontal cortical responses to an anger-evoking event. J Pers Soc Psychol. 2002;82:610\u20138.","journal-title":"J Pers Soc Psychol"},{"key":"3528_CR41","doi-asserted-by":"publisher","first-page":"1343","DOI":"10.1016\/j.neuron.2016.02.014","volume":"89","author":"ED Boorman","year":"2016","unstructured":"Boorman ED, Rajendran VG, O\u2019Reilly JX, Behrens TE. Two anatomically and computationally distinct learning signals predict changes to stimulus-outcome associations in hippocampus. Neuron. 2016;89:1343\u201354. https:\/\/doi.org\/10.1016\/j.neuron.2016.02.014","journal-title":"Neuron"},{"key":"3528_CR42","doi-asserted-by":"publisher","first-page":"e1002137","DOI":"10.1371\/journal.pbio.1002137","volume":"13","author":"SW Lee","year":"2015","unstructured":"Lee SW, O\u2019Doherty JP, Shimojo S. Neural computations mediating one-shot learning in the human brain. PLoS Biol. 2015;13:e1002137 https:\/\/doi.org\/10.1371\/journal.pbio.1002137.","journal-title":"PLoS Biol"},{"key":"3528_CR43","doi-asserted-by":"publisher","first-page":"660","DOI":"10.1016\/j.bpsc.2019.10.012","volume":"5","author":"EK Edmiston","year":"2020","unstructured":"Edmiston EK, Fournier JC, Chase HW, Bertocci MA, Greenberg T, Aslam HA, et al. Assessing relationships among impulsive sensation seeking, reward circuitry activity, and risk for psychopathology: A functional magnetic resonance imaging replication and extension study. Biol Psychiatry Cogn Neurosci Neuroimaging. 2020;5:660\u20138. https:\/\/doi.org\/10.1016\/j.bpsc.2019.10.012","journal-title":"Biol Psychiatry Cogn Neurosci Neuroimaging"},{"key":"3528_CR44","doi-asserted-by":"publisher","first-page":"4094","DOI":"10.1093\/cercor\/bhu123","volume":"25","author":"MA Cyders","year":"2015","unstructured":"Cyders MA, Dzemidzic M, Eiler WJ, Coskunpinar A, Karyadi KA, Kareken DA. Negative urgency mediates the relationship between amygdala and orbitofrontal cortex activation to negative emotional stimuli and general risk-taking. Cereb Cortex. 2015;25:4094\u2013102. https:\/\/doi.org\/10.1093\/cercor\/bhu123","journal-title":"Cereb Cortex"},{"key":"3528_CR45","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1016\/j.neuroimage.2016.02.024","volume":"132","author":"DS Chester","year":"2016","unstructured":"Chester DS, Lynam DR, Milich R, Powell DK, Andersen AH, DeWall CN. How do negative emotions impair self-control? A neural model of negative urgency. Neuroimage. 2016;132:43\u201350. https:\/\/doi.org\/10.1016\/j.neuroimage.2016.02.024","journal-title":"Neuroimage"},{"key":"3528_CR46","doi-asserted-by":"publisher","first-page":"1148","DOI":"10.1016\/j.neuroimage.2009.03.038","volume":"46","author":"T Hahn","year":"2009","unstructured":"Hahn T, Dresler T, Ehlis AC, Plichta MM, Heinzel S, Polak T, et al. Neural response to reward anticipation is modulated by Gray\u2019s impulsivity. Neuroimage. 2009;46:1148\u201353. https:\/\/doi.org\/10.1016\/j.neuroimage.2009.03.038","journal-title":"Neuroimage"},{"key":"3528_CR47","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1016\/j.biopsycho.2016.01.006","volume":"115","author":"LB Neal","year":"2016","unstructured":"Neal LB, Gable PA. Neurophysiological markers of multiple facets of impulsivity. Biol Psychol. 2016;115:64\u201368. https:\/\/doi.org\/10.1016\/j.biopsycho.2016.01.006","journal-title":"Biol Psychol"},{"key":"3528_CR48","doi-asserted-by":"publisher","DOI":"10.1016\/j.neubiorev.2023.105109","volume":"147","author":"CC Chan","year":"2023","unstructured":"Chan CC, Alter S, Hazlett EA, Shafritz KM, Yehuda R, Goodman M, et al. Neural correlates of impulsivity in bipolar disorder: A systematic review and clinical implications. Neurosci Biobehav Rev. 2023;147:105109 https:\/\/doi.org\/10.1016\/j.neubiorev.2023.105109","journal-title":"Neurosci Biobehav Rev"},{"key":"3528_CR49","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1097\/YCO.0000000000000122","volume":"28","author":"AE Whitton","year":"2015","unstructured":"Whitton AE, Treadway MT, Pizzagalli DA. Reward processing dysfunction in major depression, bipolar disorder and schizophrenia. Curr Opin Psychiatry. 2015;28:7\u201312. https:\/\/doi.org\/10.1097\/YCO.0000000000000122","journal-title":"Curr Opin Psychiatry"},{"key":"3528_CR50","doi-asserted-by":"publisher","DOI":"10.1038\/s41398-019-0644-x","volume":"9","author":"TH Ng","year":"2019","unstructured":"Ng TH, Alloy LB, Smith DV. Meta-analysis of reward processing in major depressive disorder reveals distinct abnormalities within the reward circuit. Transl Psychiatry. 2019;9:293 https:\/\/doi.org\/10.1038\/s41398-019-0644-x","journal-title":"Transl Psychiatry"},{"key":"3528_CR51","doi-asserted-by":"publisher","first-page":"2623","DOI":"10.1038\/npp.2015.110","volume":"40","author":"R Redlich","year":"2015","unstructured":"Redlich R, Dohm K, Grotegerd D, Opel N, Zwitserlood P, Heindel W, et al. Reward processing in unipolar and bipolar depression: A functional MRI study. Neuropsychopharmacology. 2015;40:2623\u201331. https:\/\/doi.org\/10.1038\/npp.2015.110","journal-title":"Neuropsychopharmacology"},{"key":"3528_CR52","doi-asserted-by":"publisher","first-page":"780","DOI":"10.1016\/j.bpsc.2022.12.006","volume":"8","author":"R Botvinik-Nezer","year":"2023","unstructured":"Botvinik-Nezer R, Wager TD. Reproducibility in neuroimaging analysis: Challenges and solutions. Biol Psychiatry Cogn Neurosci Neuroimaging. 2023;8:780\u20138. https:\/\/doi.org\/10.1016\/j.bpsc.2022.12.006","journal-title":"Biol Psychiatry Cogn Neurosci Neuroimaging"},{"key":"3528_CR53","unstructured":"First M, Williams J, Karg R, Spitzer RL Structured clinical interview for DSM-5\u2014Research version (SCID-5 for DSM-5, research version; SCID-5-RV). Am Psychiatr Assoc. Published online 2015."},{"key":"3528_CR54","doi-asserted-by":"publisher","first-page":"829","DOI":"10.1176\/appi.ajp.2014.13081008","volume":"171","author":"ML Phillips","year":"2014","unstructured":"Phillips ML, Swartz HA. A critical appraisal of neuroimaging studies of bipolar disorder: Toward a new conceptualization of underlying neural circuitry and a road map for future research. Am J Psychiatry. 2014;171:829\u201343. https:\/\/doi.org\/10.1176\/appi.ajp.2014.13081008","journal-title":"Am J Psychiatry"},{"key":"3528_CR55","doi-asserted-by":"publisher","first-page":"932","DOI":"10.1038\/mp.2017.73","volume":"23","author":"DP Hibar","year":"2018","unstructured":"Hibar DP, Westlye LT, Doan NT, Jahanshad N, Cheung JW, Ching CRK, et al. Cortical abnormalities in bipolar disorder: an MRI analysis of 6503 individuals from the ENIGMA Bipolar Disorder Working Group. Mol Psychiatry. 2018;23:932\u201342. https:\/\/doi.org\/10.1038\/mp.2017.73","journal-title":"Mol Psychiatry"},{"key":"3528_CR56","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1136\/jnnp.23.1.56","volume":"23","author":"M Hamilton","year":"1960","unstructured":"Hamilton M. A RATING SCALE FOR DEPRESSION. J Neurol Neurosurg Psychiatry. 1960;23:56\u201362. https:\/\/doi.org\/10.1136\/jnnp.23.1.56","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"3528_CR57","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1111\/j.2044-8341.1959.tb00467.x","volume":"32","author":"M Hamilton","year":"1959","unstructured":"Hamilton M. THE ASSESSMENT OF ANXIETY STATES BY RATING. Br J Med Psychol. 1959;32:50\u201355. https:\/\/doi.org\/10.1111\/j.2044-8341.1959.tb00467.x","journal-title":"Br J Med Psychol"},{"key":"3528_CR58","doi-asserted-by":"publisher","first-page":"429","DOI":"10.1192\/bjp.133.5.429","volume":"133","author":"RC Young","year":"1978","unstructured":"Young RC, Biggs JT, Ziegler VE, Meyer DA. A rating scale for mania: reliability, validity and sensitivity. Br J Psychiatry. 1978;133:429\u201335. https:\/\/doi.org\/10.1192\/bjp.133.5.429","journal-title":"Br J Psychiatry"},{"key":"3528_CR59","doi-asserted-by":"publisher","first-page":"412","DOI":"10.1016\/j.neuroimage.2013.12.058","volume":"91","author":"CW Woo","year":"2014","unstructured":"Woo CW, Krishnan A, Wager TD. Cluster-extent based thresholding in fMRI analyses: Pitfalls and recommendations. Neuroimage. 2014;91:412\u20139. https:\/\/doi.org\/10.1016\/j.neuroimage.2013.12.058","journal-title":"Neuroimage"},{"key":"3528_CR60","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1002\/hbm.460020402","volume":"2","author":"KJ Friston","year":"1994","unstructured":"Friston KJ, Holmes AP, Worsley KJ, Poline J\u2010P, Frith CD, Frackowiak RSJ. Statistical parametric maps in functional imaging: A general linear approach. Hum Brain Mapp. 1994;2:189\u2013210. https:\/\/doi.org\/10.1002\/hbm.460020402","journal-title":"Hum Brain Mapp"},{"key":"3528_CR61","doi-asserted-by":"publisher","first-page":"1959","DOI":"10.1016\/S0028-3932(03)00077-0","volume":"41","author":"NR Horn","year":"2003","unstructured":"Horn NR, Dolan M, Elliott R, Deakin JFW, Woodruff PWR. Response inhibition and impulsivity: an fMRI study. Neuropsychologia. 2003;41:1959\u201366. https:\/\/doi.org\/10.1016\/S0028-3932(03)00077-0","journal-title":"Neuropsychologia"},{"key":"3528_CR62","doi-asserted-by":"publisher","first-page":"856","DOI":"10.1038\/nrn2478","volume":"9","author":"P Nachev","year":"2008","unstructured":"Nachev P, Kennard C, Husain M. Functional role of the supplementary and pre-supplementary motor areas. Nat Rev Neurosci. 2008;9:856\u201369. https:\/\/doi.org\/10.1038\/nrn2478","journal-title":"Nat Rev Neurosci"},{"key":"3528_CR63","doi-asserted-by":"publisher","first-page":"875","DOI":"10.1016\/j.biopsych.2023.06.002","volume":"94","author":"D Huang","year":"2023","unstructured":"Huang D, Ma YY. Increased excitability of layer 2 cortical pyramidal neurons in the supplementary motor cortex underlies high cocaine-seeking behaviors. Biol Psychiatry. 2023;94:875\u201387. https:\/\/doi.org\/10.1016\/j.biopsych.2023.06.002","journal-title":"Biol Psychiatry"},{"key":"3528_CR64","doi-asserted-by":"publisher","first-page":"1414","DOI":"10.1523\/JNEUROSCI.1287-22.2023","volume":"43","author":"A Lohse","year":"2023","unstructured":"Lohse A, L\u00f8kkegaard A, Siebner HR, Meder D. Linking impulsivity to activity levels in pre-supplementary motor area during sequential gambling. J Neurosci. 2023;43:1414\u201321. https:\/\/doi.org\/10.1523\/JNEUROSCI.1287-22.2023","journal-title":"J Neurosci"},{"key":"3528_CR65","doi-asserted-by":"publisher","DOI":"10.1016\/j.heliyon.2017.e00335","volume":"3","author":"T Ishida","year":"2017","unstructured":"Ishida T, Donishi T, Iwatani J, Yamada S, Takahashi S, Ukai S, et al. Interhemispheric disconnectivity in the sensorimotor network in bipolar disorder revealed by functional connectivity and diffusion tensor imaging analysis. Heliyon. 2017;3:e00335 https:\/\/doi.org\/10.1016\/j.heliyon.2017.e00335","journal-title":"Heliyon"},{"key":"3528_CR66","doi-asserted-by":"publisher","first-page":"1149","DOI":"10.1111\/j.1469-7610.2012.02568.x","volume":"53","author":"NE Adleman","year":"2012","unstructured":"Adleman NE, Fromm SJ, Razdan V, Kayser R, Dickstein DP, Brotman MA, et al. Cross\u2010sectional and longitudinal abnormalities in brain structure in children with severe mood dysregulation or bipolar disorder. J Child Psychol Psychiatry. 2012;53:1149\u201356. https:\/\/doi.org\/10.1111\/j.1469-7610.2012.02568.x","journal-title":"J Child Psychol Psychiatry"},{"key":"3528_CR67","doi-asserted-by":"publisher","first-page":"430","DOI":"10.1016\/j.jad.2024.01.131","volume":"351","author":"Y Xia","year":"2024","unstructured":"Xia Y, Wang X, You W, Hua L, Dai Z, Tang H, et al. Impulsivity and neural correlates of response inhibition in bipolar disorder and their unaffected relatives: A MEG study. J Affect Disord. 2024;351:430\u201341. https:\/\/doi.org\/10.1016\/j.jad.2024.01.131","journal-title":"J Affect Disord"},{"key":"3528_CR68","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuroimage.2024.120838","volume":"299","author":"G Vural","year":"2024","unstructured":"Vural G, Katruss N, Soutschek A. Pre-supplementary motor area strengthens reward sensitivity in intertemporal choice. Neuroimage. 2024;299:120838 https:\/\/doi.org\/10.1016\/j.neuroimage.2024.120838","journal-title":"Neuroimage"},{"key":"3528_CR69","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1016\/j.brs.2024.02.002","volume":"17","author":"A Mayeli","year":"2024","unstructured":"Mayeli A, Wang Y, Graur S, Ghane M, Keihani A, Kim A, et al. Effects of theta burst stimulation on reward processing and decision-making in bipolar disorder: A pilot study. Brain Stimulat. 2024;17:163\u20135. https:\/\/doi.org\/10.1016\/j.brs.2024.02.002","journal-title":"Brain Stimulat"},{"key":"3528_CR70","doi-asserted-by":"publisher","unstructured":"Pallanti S, Di Ponzio M, Levola J, Lioumis, P, Paunio, T, Ki\u010di\u0107, D et al. Treatment of behavioral addictions and substance use disorders: A focus on the effects of theta-burst stimulation over the Pre-SMA. Int J Ment Health Addict. Published online March 19, 2024. https:\/\/doi.org\/10.1007\/s11469-024-01261-9","DOI":"10.1007\/s11469-024-01261-9"},{"key":"3528_CR71","doi-asserted-by":"publisher","first-page":"1990","DOI":"10.3390\/diagnostics14171990","volume":"14","author":"A Alahmadi","year":"2024","unstructured":"Alahmadi A. Functional connectivity profiles of ten sub-regions within the premotor and supplementary motor areas: Insights into neurophysiological integration. Diagnostics. 2024;14:1990 https:\/\/doi.org\/10.3390\/diagnostics14171990","journal-title":"Diagnostics"},{"key":"3528_CR72","doi-asserted-by":"publisher","first-page":"356","DOI":"10.3389\/fnhum.2018.00356","volume":"12","author":"R Kazemi","year":"2018","unstructured":"Kazemi R, Rostami R, Khomami S, Baghdadi G, Rezaei M, Hata M, et al. Bilateral transcranial magnetic stimulation on DLPFC changes resting state networks and cognitive function in patients with bipolar depression. Front Hum Neurosci. 2018;12:356 https:\/\/doi.org\/10.3389\/fnhum.2018.00356","journal-title":"Front Hum Neurosci"},{"key":"3528_CR73","doi-asserted-by":"publisher","first-page":"78","DOI":"10.3389\/fncir.2019.00078","volume":"13","author":"C Bouarab","year":"2019","unstructured":"Bouarab C, Thompson B, Polter AM. VTA GABA neurons at the interface of stress and reward. Front Neural Circuits. 2019;13:78 https:\/\/doi.org\/10.3389\/fncir.2019.00078","journal-title":"Front Neural Circuits"},{"key":"3528_CR74","doi-asserted-by":"publisher","first-page":"3247","DOI":"10.1152\/jn.1998.80.6.3247","volume":"80","author":"K Shima","year":"1998","unstructured":"Shima K, Tanji J. Both supplementary and presupplementary motor areas are crucial for the temporal organization of multiple movements. J Neurophysiol. 1998;80:3247\u201360. https:\/\/doi.org\/10.1152\/jn.1998.80.6.3247","journal-title":"J Neurophysiol"},{"key":"3528_CR75","doi-asserted-by":"publisher","first-page":"1061","DOI":"10.1001\/archpsyc.57.11.1061","volume":"57","author":"A Guidotti","year":"2000","unstructured":"Guidotti A, Auta J, Davis JM, Di-Giorgi-Gerevini V, Dwivedi Y, et al. Decrease in Reelin and Glutamic Acid Decarboxylase67 (GAD67) expression in schizophrenia and bipolar disorder: A postmortem brain study. Arch Gen Psychiatry. 2000;57:1061 https:\/\/doi.org\/10.1001\/archpsyc.57.11.1061","journal-title":"Arch Gen Psychiatry"},{"key":"3528_CR76","doi-asserted-by":"publisher","first-page":"5213","DOI":"10.1038\/s41380-020-0810-9","volume":"26","author":"X Yu","year":"2021","unstructured":"Yu X, Ba W, Zhao G, Ma Y, Harding EC, Yin L, et al. Dysfunction of ventral tegmental area GABA neurons causes mania-like behavior. Mol Psychiatry. 2021;26:5213\u201328. https:\/\/doi.org\/10.1038\/s41380-020-0810-9","journal-title":"Mol Psychiatry"},{"key":"3528_CR77","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2024.1492126","volume":"15","author":"HJ MacDonald","year":"2024","unstructured":"MacDonald HJ, Kleppe R, Szigetvari PD, Haavik J. The dopamine hypothesis for ADHD: An evaluation of evidence accumulated from human studies and animal models. Front Psychiatry. 2024;15:1492126 https:\/\/doi.org\/10.3389\/fpsyt.2024.1492126","journal-title":"Front Psychiatry"},{"key":"3528_CR78","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuropharm.2024.109897","volume":"249","author":"AS Ferranti","year":"2024","unstructured":"Ferranti AS, Luessen DJ, Niswender CM. Novel pharmacological targets for GABAergic dysfunction in ADHD. Neuropharmacology. 2024;249:109897 https:\/\/doi.org\/10.1016\/j.neuropharm.2024.109897","journal-title":"Neuropharmacology"},{"key":"3528_CR79","doi-asserted-by":"publisher","first-page":"553","DOI":"10.1038\/nrn1430","volume":"5","author":"MA Rogawski","year":"2004","unstructured":"Rogawski MA, L\u00f6scher W. The neurobiology of antiepileptic drugs. Nat Rev Neurosci. 2004;5:553\u201364. https:\/\/doi.org\/10.1038\/nrn1430","journal-title":"Nat Rev Neurosci"}],"container-title":["Molecular Psychiatry"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41380-026-03528-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41380-026-03528-0","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41380-026-03528-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T07:48:20Z","timestamp":1781509700000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41380-026-03528-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,19]]},"references-count":79,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2026,7]]}},"alternative-id":["3528"],"URL":"https:\/\/doi.org\/10.1038\/s41380-026-03528-0","relation":{},"ISSN":["1359-4184","1476-5578"],"issn-type":[{"value":"1359-4184","type":"print"},{"value":"1476-5578","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,19]]},"assertion":[{"value":"21 October 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 February 2026","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 March 2026","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 March 2026","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"All procedures were performed in accordance with the relevant guidelines and regulations. The study protocol was approved by the University of Pittsburgh Human Research Protection Office Institutional Review Board (protocols PRO13060048 and STUDY18110024). All participants provided written informed consent prior to participation.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}