OBJECTIVES: Ambivalence of self-image is considered to be important in patients with schizophrenia since impairment of self-referential processing and increment in ambivalence are illness-related symptoms. This study aimed to evaluate quantitative and qualitative properties of ambivalence of self-image in patients with schizophrenia. METHODS: Twenty patients with schizophrenia and 20 normal controls performed a set of 'self-image reflection task' and then the level of ambivalence towards actual and ideal self-image were numerically scored. Ambivalence scores were compared between groups and correlation analyses with psychometric scales were done in each group. RESULTS: Patients with schizophrenia had higher level of ambivalence towards both actual and ideal self-image (p<0.001). Normal controls showed significant correlations with the scales representing level of self-concept clarity (r=-0.480, p=0.033), depression (r=0.479, p=0.033), and self-esteem (r=-0.555, p=0.011 ; R=-0.600, p=0.005) while the patients did not. CONCLUSION: Ambivalence towards one's self-image is more intense in patients with schizophrenia. This symptom may be considered to exist as an independent symptom in schizophrenia.
Depression ; Humans ; Psychometrics ; Schizophrenia* ; Weights and Measures

PURPOSE: The purpose of this study was to setup a concuurent transcranial magnetic stimulation (TMS)-functional MRI (fMRI) system for understanding causality of the functional brain network. MATERIALS AND METHODS: We manufactured a TMS coil holder using nonmagnetic polyether ether ketone (PEEK). We simulated magnetic field distributions in the MR scanner according to TMS coil positions and angles. To minimize image distortions caused by TMS application, we controlled fMRI acquisition and TMS sequences to trigger TMS during inter-volume intervals. RESULTS: Simulation showed that the magnetic field below the center of the coil was dramatically decreased with distance. Through the MR phantom study, we confirmed that TMS application around inter-volume acquisition time = 100 miliseconds reduced imaging distortion. Finally, the applicability of the concurrent TMS-fMRI was tested in preliminary studies with a healthy subject conducting a motor task within TMS-fMRI and passive motor movement induced by TMS in fMRI. CONCLUSION: In this study, we confirmed that the developed system allows use of TMS inside an fMRI system, which would contribute to the research of brain activation changes and causality in brain connectivity.
Brain ; Ether, Ethyl ; Magnetic Fields ; Magnetic Resonance Imaging ; Transcranial Magnetic Stimulation

Objective: Little has been explored about a reflection towards self-image in schizophrenia, though it can be related to heterogeneous symptoms of the illness. We identified the neural basis of ambivalence towards ideal self-image in patients with schizophrenia. Methods: 20 patients with schizophrenia and 20 healthy controls underwent functional MRI while the self-image reflection tasks of determining whether to agree with sentences describing their actual or ideal self-image that contained one of the adjective pairs with opposite valence. The interaction between the group and ideal ambivalence score was examined, and group differences in functional connectivity related to ambivalence towards ideal self-image were further studied. Results: The interaction of group-by-ideal ambivalence score was shown in the dorsal anterior cingulate cortex and dorsolateral prefrontal cortex, where activities were positively correlated with the level of ideal self-image ambivalence in patients, but not in controls. Task-related decrease in functional connectivity was shown between the orbitofrontal cortex and cerebellum in patients. Conclusion The process of reflecting on ambivalent ideal self-image in schizophrenia may be related to aberrant prefrontal activity and connectivity. Abnormality in the prefrontal regions that take part in cognitive conflict monitoring and value judgment may underlie the pathophysiology of increased ambivalence towards ideal self-image.