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We aimed to assess cognitive and cortical thickness deficits and their relationship to TR in schizophrenia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>We recruited patients with schizophrenia (<jats:italic>n\u2009=<\/jats:italic>\u2009127), including patients at treatment initiation (<jats:italic>n\u2009=<\/jats:italic>\u200945), treatment\u2010responsive patients (<jats:italic>n\u2009=<\/jats:italic>\u200940) and TR patients (<jats:italic>n\u2009=<\/jats:italic>\u200942), and healthy controls (<jats:italic>n\u2009=<\/jats:italic>\u200983). Clinical symptoms, neurocognitive function, and structural images were assessed. We performed group comparisons, and explored association of cortical thickness and cognition with TR.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The TR patients showed significantly more severe clinical symptoms and cognitive impairment relative to the treatment\u2010responsive group. Compared to healthy controls, 56 of 68 brain regions showed significantly reduced cortical thickness in patients with schizophrenia. Reductions in five regions were significantly associated with TR (reduction in TR relative to treatment\u2010responsive patients), i.e. in the right caudal middle frontal gyrus, superior frontal cortex, fusiform gyrus, pars opercularis of the inferior frontal cortex, and supramarginal cortex. Cognition deficits were also significantly correlated with cortical thickness in these five regions in patients with schizophrenia. Cortical thickness of the right caudal middle frontal gyrus, superior frontal cortex and pars opercularis of the inferior frontal cortex also significantly mediated effects of cognitive deficits on TR.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Treatment resistance in schizophrenia was associated with reduced thickness in the right caudal middle frontal gyrus, superior frontal cortex, fusiform gyrus, pars opercularis of the inferior frontal cortex, and supramarginal cortex. Cortical abnormalities further mediate cognitive deficits known to be associated with TR.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pcn.13486","type":"journal-article","created":{"date-parts":[[2022,10,3]],"date-time":"2022-10-03T04:29:53Z","timestamp":1664771393000},"page":"12-19","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Association of cortical thickness and cognition with schizophrenia treatment resistance"],"prefix":"10.1111","volume":"77","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1028-6754","authenticated-orcid":false,"given":"Fengmei","family":"Fan","sequence":"first","affiliation":[{"name":"Beijing Huilongguan Hospital Peking University Huilongguan Clinical Medical School  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junchao","family":"Huang","sequence":"additional","affiliation":[{"name":"Beijing Huilongguan Hospital Peking University Huilongguan Clinical Medical School  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuping","family":"Tan","sequence":"additional","affiliation":[{"name":"Beijing Huilongguan Hospital Peking University Huilongguan Clinical Medical School  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiren","family":"Wang","sequence":"additional","affiliation":[{"name":"Beijing Huilongguan Hospital Peking University Huilongguan Clinical Medical School  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanli","family":"Li","sequence":"additional","affiliation":[{"name":"Beijing Huilongguan Hospital Peking University Huilongguan Clinical Medical School  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Song","family":"Chen","sequence":"additional","affiliation":[{"name":"Beijing Huilongguan Hospital Peking University Huilongguan Clinical Medical School  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Li","sequence":"additional","affiliation":[{"name":"Beijing Huilongguan Hospital Peking University Huilongguan Clinical Medical School  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie","family":"Hare","sequence":"additional","affiliation":[{"name":"Maryland Psychiatric Research Center, Department of Psychiatry University of Maryland School of Medicine  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoming","family":"Du","sequence":"additional","affiliation":[{"name":"Maryland Psychiatric Research Center, Department of Psychiatry University of Maryland School of Medicine  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fude","family":"Yang","sequence":"additional","affiliation":[{"name":"Beijing Huilongguan Hospital Peking University Huilongguan Clinical Medical School  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Baopeng","family":"Tian","sequence":"additional","affiliation":[{"name":"Beijing Huilongguan Hospital Peking University Huilongguan Clinical Medical School  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Kochunov","sequence":"additional","affiliation":[{"name":"Maryland Psychiatric Research Center, Department of Psychiatry University of Maryland School of Medicine  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yunlong","family":"Tan","sequence":"additional","affiliation":[{"name":"Beijing Huilongguan Hospital Peking University Huilongguan Clinical Medical School  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L. 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