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Elvsåshagen T, Westlye LT, Bøen E, Hol PK, Andreassen OA, Boye B, Malt UF. Bipolar II disorder is associated with thinning of prefrontal and temporal cortices involved in affect regulation. Bipolar Disord 2013; 15:855-64. [PMID: 23980618 DOI: 10.1111/bdi.12117] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 05/20/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The neurobiological substrate of bipolar II disorder (BD-II) remains largely unknown. A few previous studies have found evidence for cerebral cortical thinning in mixed samples of BD-II and bipolar I disorder patients; however, no study of cortical thickness or surface area has been limited to BD-II. In the present study, we compared magnetic resonance imaging (MRI)-based indices of cortical thickness and surface area between individuals with BD-II and healthy controls. METHODS Thirty-six individuals with a DSM-IV diagnosis of BD-II and 42 controls underwent 3T MRI. Comparisons of thickness and relative surface areal expansion across the cerebral cortical mantle were performed using Freesurfer. RESULTS Individuals with BD-II showed significant thinning in two prefrontal clusters primarily comprising the left subgenual anterior cingulate cortex, left perigenual ventromedial prefrontal cortex (PFC), bilateral dorsomedial PFC, and bilateral dorsolateral PFC (p < 0.0002 for both clusters, cluster size corrected) and in a left temporal cluster involving the superior, middle, and inferior temporal gyrus (p = 0.006, cluster size corrected). No group differences in cortical surface area were found. No significant effect of medication, mood state, illness duration, or family history of bipolar disorders on cortical thinning was observed. CONCLUSIONS These results indicate that BD-II is associated with thinning of prefrontal and temporal cortices implicated in the expression and regulation of negative and positive affect. Longitudinal studies are needed to clarify whether cortical thinning is a stable trait of BD-II, an illness effect that might progress during the course of the disease, or a combination of the two.
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Affiliation(s)
- Torbjørn Elvsåshagen
- Department of Psychosomatic Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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52
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Ambrosi E, Rossi-Espagnet MC, Kotzalidis GD, Comparelli A, Del Casale A, Carducci F, Romano A, Manfredi G, Tatarelli R, Bozzao A, Girardi P. Structural brain alterations in bipolar disorder II: a combined voxel-based morphometry (VBM) and diffusion tensor imaging (DTI) study. J Affect Disord 2013; 150:610-5. [PMID: 23489395 DOI: 10.1016/j.jad.2013.02.023] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2012] [Revised: 02/13/2013] [Accepted: 02/13/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND Brain structural changes have been described in bipolar disorder (BP), but usually studies focused on both I and II subtypes indiscriminately and investigated changes in either brain volume or white matter (WM) integrity. We used combined voxel-based morphometry (VBM) and diffusion tensor imaging (DTI) analysis to track changes in the grey matter (GM) and WM in the brains of patients affected by BPII, as compared to healthy controls. METHODS Using VBM and DTI, we scanned 20 DSM-IV-TR BPII patients in their euthymic phase and 21 healthy, age- and gender-matched volunteers with no psychiatric history. RESULTS VBM showed decreases in GM of BPII patients, compared to controls, which were diffuse in nature and most prominent in the right middle frontal gyrus and in the right superior temporal gurus. DTI showed significant and widespread FA reduction in BPII patients in all major WM tracts, including cortico-cortical association tracts. LIMITATIONS The small sample size limits the generalisability of our findings. CONCLUSIONS Reduced GM volumes and WM integrity changes in BPII patients are not prominent like those previously reported in bipolar disorder type-I and involve cortical structures and their related association tracts.
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Affiliation(s)
- Elisa Ambrosi
- Neurosciences, Mental Health, and Sensory Organs (NESMOS) Department, Sapienza University, School of Medicine and Psychology, Unit of Psychiatry, Sant'Andrea Hospital, Via di Grottarossa 1035-1039, Rome 00189, Italy.
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53
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Anderson D, Ardekani BA, Burdick KE, Robinson DG, John M, Malhotra AK, Szeszko PR. Overlapping and distinct gray and white matter abnormalities in schizophrenia and bipolar I disorder. Bipolar Disord 2013; 15:680-93. [PMID: 23796123 PMCID: PMC3762889 DOI: 10.1111/bdi.12096] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Accepted: 01/13/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Schizophrenia and bipolar disorder may share common neurobiological mechanisms, but few studies have directly compared gray and white matter structure in these disorders. We used diffusion-weighted magnetic resonance imaging and a region of interest based analysis to identify overlapping and distinct gray and white matter abnormalities in 35 patients with schizophrenia and 20 patients with bipolar I disorder in comparison to 56 healthy volunteers. METHODS We examined fractional anisotropy within the white matter and mean diffusivity within the gray matter in 42 regions of interest defined on a probabilistic atlas following non-linear registration of the images to atlas space. RESULTS Patients with schizophrenia had significantly lower fractional anisotropy in temporal (superior temporal and parahippocampal) and occipital (superior and middle occipital) white matter compared to patients with bipolar disorder and healthy volunteers. By contrast, both patient groups demonstrated significantly higher mean diffusivity in frontal (inferior frontal and lateral orbitofrontal) and temporal (superior temporal and parahippocampal) gray matter compared to healthy volunteers, but did not differ from each other. CONCLUSIONS Our study implicates overlapping gray matter frontal and temporal lobe structural alterations in the neurobiology of schizophrenia and bipolar I disorder, but suggests that temporal and occipital lobe white matter deficits may be an additional risk factor for schizophrenia. Our findings may have relevance for future diagnostic classification systems and the identification of susceptibility genes for these disorders.
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Affiliation(s)
- Dana Anderson
- The Feinstein Institute for Medical Research, North Shore-LIJ Health System, Manhasset, NY,The Zucker Hillside Hospital, North Shore-LIJ Health System, Glen Oaks, NY
| | - Babak A. Ardekani
- The Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY
| | - Katherine E. Burdick
- Departments of Psychiatry and Neuroscience, Mount Sinai School of Medicine, NY, NY
| | - Delbert G. Robinson
- The Feinstein Institute for Medical Research, North Shore-LIJ Health System, Manhasset, NY,The Zucker Hillside Hospital, North Shore-LIJ Health System, Glen Oaks, NY,Hofstra North Shore – LIJ School of Medicine, Departments of Psychiatry and Molecular Medicine, Hempstead, NY, USA
| | - Majnu John
- The Feinstein Institute for Medical Research, North Shore-LIJ Health System, Manhasset, NY,The Zucker Hillside Hospital, North Shore-LIJ Health System, Glen Oaks, NY
| | - Anil K. Malhotra
- The Feinstein Institute for Medical Research, North Shore-LIJ Health System, Manhasset, NY,The Zucker Hillside Hospital, North Shore-LIJ Health System, Glen Oaks, NY,Hofstra North Shore – LIJ School of Medicine, Departments of Psychiatry and Molecular Medicine, Hempstead, NY, USA
| | - Philip R. Szeszko
- The Feinstein Institute for Medical Research, North Shore-LIJ Health System, Manhasset, NY,The Zucker Hillside Hospital, North Shore-LIJ Health System, Glen Oaks, NY,Hofstra North Shore – LIJ School of Medicine, Departments of Psychiatry and Molecular Medicine, Hempstead, NY, USA
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54
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Rossi R, Pievani M, Lorenzi M, Boccardi M, Beneduce R, Bignotti S, Borsci G, Cotelli M, Giannakopoulos P, Magni LR, Rillosi L, Rosini S, Rossi G, Frisoni GB. Structural brain features of borderline personality and bipolar disorders. Psychiatry Res 2013; 213:83-91. [PMID: 23146251 DOI: 10.1016/j.pscychresns.2012.07.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Revised: 07/04/2012] [Accepted: 07/06/2012] [Indexed: 12/11/2022]
Abstract
A potential overlap between bipolar disorder (BD) and borderline personality disorder (BPD) has been recently proposed. We aimed to assess similarities and differences of brain structural features in BD and BPD. Structural magnetic resonance imaging (MRI) was performed in 26 inpatients with BPD, 14 with BD, and 40 age-and sex-matched healthycontrols (HC). Voxel-based morphometry analysis with Statistical Parametric Mapping (SPM) was used to localize and quantify gray (GM) and white matter (WM) abnormalities in BD and BPD compared to HC and to identify those specifically affected in each patient group. Region of interest (ROI)-based analyses were also performed for confirmation. GM density changes in BD are significantly more diffuse and severe than in BPD, as demonstrated in both SPM- and ROI-based analyses. The topography of GM alterations showed some regions of overlap, but each disorder had specific regions of abnormality (involving both cortical and subcortical structures in BD, confined mainly to fronto-limbic regions in BPD). WM density changes were less pronounced in both conditions and involved completely different regions. Although BPD and BD show a considerable overlap of GM changes, the topography of alterations is more consistent with the separate conditions hypothesis and with the vulnerability of separate neural systems.
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Affiliation(s)
- Roberta Rossi
- Unit of Psychiatry, IRCCS San Giovanni di Dio-Fatebenefratelli, via Pilastroni 4, I-25125, Brescia, Italy.
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55
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Yip SW, Chandler RA, Rogers RD, Mackay CE, Goodwin GM. White matter alterations in antipsychotic- and mood stabilizer-naïve individuals with bipolar II/NOS disorder. NEUROIMAGE-CLINICAL 2013; 3:271-8. [PMID: 24273712 PMCID: PMC3814955 DOI: 10.1016/j.nicl.2013.08.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 07/30/2013] [Accepted: 08/04/2013] [Indexed: 01/16/2023]
Abstract
Structural magnetic resonance imaging (MRI) studies using voxel-based morphometry (VBM) and tract-based spatial statistics (TBSS) have been inconsistent in demonstrating impairments in gray matter (GM) and white matter (WM) structures in bipolar disorder (BD). This may be a consequence of significant confounding effects of medication, illness history and selection of controls in existing studies. Study of bipolar II or not-otherwise-specified (BD II/NOS) disorder provides a solution to these confounds and a bridge to unipolar cases across the affective spectrum. Thirty-eight euthymic, antipsychotic- and mood stabilizer-naïve young adults (mean age = 20.9 years) with BD II/NOS and 37 age-, cognitive ability- and gender-matched healthy controls (HCs) underwent MRI. Voxel-wise and regional gray matter volume comparisons were conducted using voxel-based morphometry (VBM). Tract-based spatial statistics (TBSS) were used to assess whole-brain WM, as indexed using fractional anisotropy (FA), mean diffusivity (MD), parallel and perpendicular diffusion values. No between-group differences were observed for whole-brain VBM comparisons. By contrast, in comparison to HCs, participants with BD II/NOS had significant widespread reductions in FA and increased MD and perpendicular diffusion values in virtually all the major cortical white matter tracts. These data suggest pathophysiological involvement of WM microstructures - but not GM macrostructures - in high functioning BD II/NOS patients at an early age and before significant clinical adversity has been recorded. We propose that white matter development is a valid candidate target for understanding genetic and environmental antecedents to bipolar disorder and mood disorder more generally.
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Affiliation(s)
- Sarah W Yip
- Department of Psychiatry, University of Oxford, Oxford OX3 7JX, United Kingdom
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56
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Cabranes JA, Ancín I, Santos JL, Sánchez-Morla E, García-Jiménez MA, Rodríguez-Moya L, Fernández C, Barabash A. P50 sensory gating is a trait marker of the bipolar spectrum. Eur Neuropsychopharmacol 2013; 23:721-7. [PMID: 22770636 DOI: 10.1016/j.euroneuro.2012.06.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Revised: 06/12/2012] [Accepted: 06/12/2012] [Indexed: 02/03/2023]
Abstract
UNLABELLED Sensory gating deficit, assessed by a paired auditory stimulus paradigm (P50), has been reported as a stable marker of schizophrenia. The aim of this study was to explore if this neurophysiological disturbance also fulfilled stability criteria in the bipolar disorder (BD) spectrum bipolar, as state independence is one of the main points to be considered as a potential endophenotype of the illness. The P50 evoked potential was studied in 95 healthy controls and 126 bipolar euthymic patients. Euthymia was established according to Van Gorp's criteria. Bipolar I and II subtypes were analyzed separately. The influence of a lifetime history of psychoses was also evaluated in the clinical sample. P50 gating was deficitary in all the subsamples of patients relative to healthy comparison subjects. Bipolar I patients with and without a history of psychosis showed higher P50 ratios than the other subgroups of patients, although these differences were not significant. P50 alterations were mainly due to a deficit in the inhibition of the second wave (test wave or S2) amplitude. CONCLUSIONS The findings suggest that this inhibitory deficit can be considered characteristic of the illness and that the intensity of the gating abnormality varies according to the severity of BD.
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Affiliation(s)
- José A Cabranes
- Institute of Psychiatry and Mental Health, Hospital Clínico San Carlos, Madrid, Spain
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57
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Ha TH, Kim JS, Chang JS, Oh SH, Her JY, Cho HS, Park TS, Shin SY, Ha K. Verbal and Visual Memory Impairments in Bipolar I and II Disorder. Psychiatry Investig 2012; 9:339-46. [PMID: 23251197 PMCID: PMC3521109 DOI: 10.4306/pi.2012.9.4.339] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2012] [Revised: 10/07/2012] [Accepted: 10/07/2012] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE To compare verbal and visual memory performances between patients with bipolar I disorder (BD I) and patients with bipolar II disorder (BD II) and to determine whether memory deficits were mediated by impaired organizational strategies. METHODS Performances on the Korean-California Verbal Learning Test (K-CVLT) and the Rey-Osterrieth Complex Figure Test (ROCF) in 37 patients with BD I, 46 patients with BD II and 42 healthy subjects were compared. Mediating effects of impaired organization strategies on poor delayed recall was tested by comparing direct and mediated models using multiple regression analysis. RESULTS Both patients groups recalled fewer words and figure components and showed lower Semantic Clustering compared to controls. Verbal memory impairment was partly mediated by difficulties in Semantic Clustering in both subtypes, whereas the mediating effect of Organization deficit on the visual memory impairment was present only in BD I. In all mediated models, group differences in delayed recall remained significant. CONCLUSION Our findings suggest that memory impairment may be one of the fundamental cognitive deficits in bipolar disorders and that executive dysfunctions can exert an additional influence on memory impairments.
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Affiliation(s)
- Tae Hyon Ha
- Mood Disorders Clinic & Clinical Affective Neuroscience Laboratory, Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Ji Sun Kim
- Mood Disorders Clinic & Clinical Affective Neuroscience Laboratory, Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jae Seung Chang
- Mood Disorders Clinic & Clinical Affective Neuroscience Laboratory, Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Sung Hee Oh
- Mood Disorders Clinic & Clinical Affective Neuroscience Laboratory, Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Ju Young Her
- Mood Disorders Clinic & Clinical Affective Neuroscience Laboratory, Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hyun Sang Cho
- Department of Psychiatry, Severance Mental Health Hospital, Gwangju, Republic of Korea
| | - Tae Sung Park
- Department of Statistics, Seoul National University, Seoul, Republic of Korea
| | - Soon Young Shin
- Institute of Biomedical Science and Technology, Konkuk University Hospital, Seoul, Republic of Korea
| | - Kyooseob Ha
- Mood Disorders Clinic & Clinical Affective Neuroscience Laboratory, Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Psychiatry, Seoul National University College of Medicine and Institute for Human Behavioral Medicine, Seoul, Republic of Korea
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58
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Liu CH, Ma X, Li F, Wang YJ, Tie CL, Li SF, Chen TL, Fan TT, Zhang Y, Dong J, Yao L, Wu X, Wang CY. Regional homogeneity within the default mode network in bipolar depression: a resting-state functional magnetic resonance imaging study. PLoS One 2012; 7:e48181. [PMID: 23133615 PMCID: PMC3487908 DOI: 10.1371/journal.pone.0048181] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Accepted: 09/26/2012] [Indexed: 01/29/2023] Open
Abstract
Aim We sought to use a regional homogeneity (ReHo) approach as an index in resting-state functional magnetic resonance imaging (fMRI) to investigate the features of spontaneous brain activity within the default mode network (DMN) in patients suffering from bipolar depression (BD). Methods Twenty-six patients with BD and 26 gender-, age-, and education-matched healthy subjects participated in the resting-state fMRI scans. We compared the differences in ReHo between the two groups within the DMN and investigated the relationships between sex, age, years of education, disease duration, the Hamilton Rating Scale for Depression (HAMD) total score, and ReHo in regions with significant group differences. Results Our results revealed that bipolar depressed patients had increased ReHo in the left medial frontal gyrus and left inferior parietal lobe compared to healthy controls. No correlations were found between regional ReHo values and sex, age, and clinical features within the BD group. Conclusions Our findings indicate that abnormal brain activity is mainly distributed within prefrontal-limbic circuits, which are believed to be involved in the pathophysiological mechanisms underlying bipolar depression.
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Affiliation(s)
- Chun-Hong Liu
- Department of Radiology, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Beijing Key Lab of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Xin Ma
- Beijing Key Lab of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Center of the Treatment in Depressive Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Feng Li
- Beijing Key Lab of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Yong-Jun Wang
- Beijing Key Lab of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Chang-Le Tie
- Beijing Key Lab of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Su-Fang Li
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
| | - Tao-Lin Chen
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
| | - Ting-ting Fan
- College of Information Science and Technology, Beijing Normal University, Beijing, China
| | - Yu Zhang
- Department of Radiology, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Jie Dong
- Department of Radiology, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Li Yao
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
- College of Information Science and Technology, Beijing Normal University, Beijing, China
| | - Xia Wu
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
- College of Information Science and Technology, Beijing Normal University, Beijing, China
- * E-mail: (CYW); (XW)
| | - Chuan-Yue Wang
- Beijing Key Lab of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Brain Major Disorders - State Key Lab Incubation Base, Capital Medical University, Beijing, China
- Beijing Neuroscience Disciplines, Capital Medical University, Beijing, China
- * E-mail: (CYW); (XW)
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59
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Gray matter volume in schizophrenia and bipolar disorder with psychotic features. Schizophr Res 2012; 138:177-82. [PMID: 22445668 PMCID: PMC3372612 DOI: 10.1016/j.schres.2012.03.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Revised: 02/29/2012] [Accepted: 03/02/2012] [Indexed: 01/09/2023]
Abstract
There is growing evidence that schizophrenia (SZ) and bipolar disorder (BD) overlap significantly in risk factors, neurobiological features, clinical presentations, and outcomes. SZ is characterized by well documented gray matter (GM) abnormalities in multiple frontal, temporal and subcortical structures. Recent voxel-based morphometry (VBM) studies and meta-analyses in BD also report GM reductions in overlapping, albeit less widespread, brain regions. Psychosis, a hallmark of SZ, is also experienced by a significant proportion of BD patients and there is evidence that psychotic BD may be characterized by specific clinical and pathophysiological features. However, there are few studies comparing GM between SZ and psychotic BD. In this study we compared GM volumes in a sample of 58 SZ patients, 28 BD patients experiencing psychotic symptoms and 43 healthy controls using whole-brain voxel-based morphometry. SZ patients had GM reductions in multiple frontal and temporal regions compared to healthy controls and in the subgenual cortex compared to psychotic BD patients. GM volume was increased in the right posterior cerebellum in SZ patients compared to controls. However, psychotic BD patients did not show significant GM deficits compared to healthy controls or SZ patients. We conclude that GM abnormality as measured by VBM analysis is less pronounced in psychotic BD compared to SZ. This may be due to disease-specific factors or medications used more commonly in BD.
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60
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Hafeman DM, Chang KD, Garrett AS, Sanders EM, Phillips ML. Effects of medication on neuroimaging findings in bipolar disorder: an updated review. Bipolar Disord 2012; 14:375-410. [PMID: 22631621 DOI: 10.1111/j.1399-5618.2012.01023.x] [Citation(s) in RCA: 258] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Neuroimaging is an important tool for better understanding the neurobiological underpinnings of bipolar disorder (BD). However, potential study participants are often receiving psychotropic medications which can possibly confound imaging data. To better interpret the results of neuroimaging studies in BD, it is important to understand the impact of medications on structural magnetic resonance imaging (sMRI), functional MRI (fMRI), and diffusion tensor imaging (DTI). METHODS To better understand the impact of medications on imaging data, we conducted a literature review and searched MEDLINE for papers that included the key words bipolar disorder and fMRI, sMRI, or DTI. The search was limited to papers that assessed medication effects and had not been included in a previous review by Phillips et al. (Medication effects in neuroimaging studies of bipolar disorder. Am J Psychiatry 2008; 165: 313-320). This search yielded 74 sMRI studies, 46 fMRI studies, and 15 DTI studies. RESULTS Medication appeared to influence many sMRI studies, but had limited impact on fMRI and DTI findings. From the structural studies, the most robust finding (20/45 studies) was that lithium was associated with increased volumes in areas important for mood regulation, while antipsychotic agents and anticonvulsants were generally not. Regarding secondary analysis of the medication effects of fMRI and DTI studies, few showed significant effects of medication, although rigorous analyses were typically not possible when the majority of subjects were medicated. Medication effects were more frequently observed in longitudinal studies designed to assess the impact of particular medications on the blood oxygen level-dependent (BOLD) signal. With a few exceptions, the observed effects were normalizing, meaning that the medicated individuals with BD were more similar than their unmedicated counterparts to healthy subjects. CONCLUSIONS The effects of psychotropic medications, when present, are predominantly normalizing and thus do not seem to provide an alternative explanation for differences in volume, white matter tracts, or BOLD signal between BD participants and healthy subjects. However, the normalizing effects of medication could obfuscate differences between BD and healthy subjects, and thus might lead to type II errors.
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Affiliation(s)
- Danella M Hafeman
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
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61
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Abstract
Cognitive changes are documented in bipolar disorder (BP). Cortical volume loss, especially in prefrontal regions, has also been reported, but associations between cognition and cortical abnormalities have not been fully documented. This study explores associations between cognitive performance and cortical parameters (area, thickness and volume) of the fronto-temporal cortex in 36 BP patients (25 BPI and 11 BPII). T1-weighted volumetric MRI images were obtained using a 1.5 Tesla scanner. Cortical parameters were measured using surface-based morphometry and their associations with estimated premorbid, current IQ, visual memory, and executive function explored. Premorbid IQ was associated with frontal cortical area and volume, but no such associations were present for current cognitive performance. Cortical parameters were not different in BPI and BPII patients, but the association between current IQ and temporal cortical area was stronger in BPII patients. The pattern of cortico-cognitive associations in BPI and BPII patients merits further consideration.
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Selvaraj S, Arnone D, Job D, Stanfield A, Farrow TF, Nugent AC, Scherk H, Gruber O, Chen X, Sachdev PS, Dickstein DP, Malhi GS, Ha TH, Ha K, Phillips ML, McIntosh AM. Grey matter differences in bipolar disorder: a meta-analysis of voxel-based morphometry studies. Bipolar Disord 2012; 14:135-45. [PMID: 22420589 DOI: 10.1111/j.1399-5618.2012.01000.x] [Citation(s) in RCA: 219] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Several neuroimaging studies have reported structural brain differences in bipolar disorder using automated methods. While these studies have several advantages over those using region of interest techniques, no study has yet estimated a summary effect size or tested for between-study heterogeneity. We sought to address this issue using meta-analytic techniques applied for the first time in bipolar disorder at the level of the individual voxel. METHODS A systematic review identified 16 voxel-based morphometry (VBM) studies comparing individuals with bipolar disorder with unaffected controls, of which eight were included in the meta-analysis. In order to take account of heterogeneity, summary effect sizes were computed using a random-effects model with appropriate correction for multiple testing. RESULTS Compared with controls, subjects with bipolar disorder had reduced grey matter in a single cluster encompassing the right ventral prefrontal cortex, insula, temporal cortex, and claustrum. Study heterogeneity was widespread throughout the brain; though the significant cluster of grey matter reduction remained once these extraneous voxels had been removed. We found no evidence of publication bias (Eggers p = 0.63). CONCLUSIONS Bipolar disorder is consistently associated with reductions in right prefrontal and temporal lobe grey matter. Reductions elsewhere may be obscured by clinical and methodological heterogeneity.
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Affiliation(s)
- Sudhakar Selvaraj
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK.
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63
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Torres I, Solé B, Vieta E, Martinez-Aran A. Neurocognitive impairment in the bipolar spectrum. ACTA ACUST UNITED AC 2012. [DOI: 10.2217/npy.12.3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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64
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Bora E, Fornito A, Yücel M, Pantelis C. The effects of gender on grey matter abnormalities in major psychoses: a comparative voxelwise meta-analysis of schizophrenia and bipolar disorder. Psychol Med 2012; 42:295-307. [PMID: 21835091 DOI: 10.1017/s0033291711001450] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Recent evidence from genetic and familial studies revitalized the debate concerning the validity of the distinction between schizophrenia and bipolar disorder. Comparing brain imaging findings is an important avenue to examine similarities and differences and, therefore, the validity of the distinction between these conditions. However, in contrast to bipolar disorder, most patient samples in studies of schizophrenia are predominantly male. This a limiting factor for comparing schizophrenia and bipolar disorder since male gender is associated with more severe neurodevelopmental abnormalities, negative symptoms and cognitive deficits in schizophrenia. METHOD We used a coordinate-based meta-analysis technique to compare grey matter (GM) abnormalities in male-dominated schizophrenia, gender-balanced schizophrenia and bipolar disorder samples based on published voxel-based morphometry (VBM) studies. In total, 72 English-language, peer reviewed articles published prior to January 2011 were included. All reports used VBM for comparing schizophrenia or bipolar disorder with controls and reported whole-brain analyses in standard stereotactic space. RESULTS GM reductions were more extensive in male-dominated schizophrenia compared to gender-balanced bipolar disorder and schizophrenia. In gender-balanced samples, GM reductions were less severe. Compared to controls, GM reductions were restricted to dorsal anterior cingulate cortex (ACC) and dorsolateral prefrontal cortex in schizophrenia and ACC and bilateral fronto-insular cortex in bipolar disorder. CONCLUSIONS When gender is controlled, GM abnormalities in bipolar disorder and schizophrenia are mostly restricted to regions that have a role in emotional and cognitive aspects of salience respectively. Dorsomedial and dorsolateral prefrontal cortex were the only regions that showed greater GM reductions in schizophrenia compared to bipolar disorder.
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Affiliation(s)
- E Bora
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, VIC, Australia
| | - A Fornito
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, VIC, Australia
| | - M Yücel
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, VIC, Australia
| | - C Pantelis
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, VIC, Australia
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Bipolar disorder: clinical perspectives and implications with cognitive dysfunction and dementia. DEPRESSION RESEARCH AND TREATMENT 2012; 2012:275957. [PMID: 22685638 PMCID: PMC3368175 DOI: 10.1155/2012/275957] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Revised: 03/13/2012] [Accepted: 03/27/2012] [Indexed: 01/28/2023]
Abstract
Introduction. Cognitive dysfunction as a core feature in the course of bipolar affective disorder (BPD) is a current subject of debate and represents an important source of psychosocial and functional burden. Objectives. To stand out the connection and clinical implications between cognitive dysfunction, dementia, and BPD. Methods. A nonsystematic review of all English language PubMed articles published between 1995 and 2011 using the terms "bipolar disorder," "cognitive dysfunction," and "dementia". Discussion. As a manifestation of an affective trait or stage, both in the acute phases and in remission, the domains affected include attention, executive function, and verbal memory. The likely evolution or overlap with the behavioural symptoms of an organic dementia allows it to be considered as a dementia specific to BPD. This is named by some authors, as BPD type VI, but others consider it a form of frontotemporal dementia. It is still not known if this process is neurodevelopmental or neurodegenerative in nature, or both simultaneously. The assessment should consider the iatrogenic effects of medication, the affective symptoms, and a neurocognitive evaluation. Conclusion. More specific neuropsychological tests and functional imaging studies are needed and will assume an important role in the near future for diagnosis and treatment.
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66
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Similarities and differences of white matter connectivity and water diffusivity in bipolar I and II disorder. Neurosci Lett 2011; 505:150-4. [DOI: 10.1016/j.neulet.2011.10.009] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Revised: 08/30/2011] [Accepted: 10/04/2011] [Indexed: 11/23/2022]
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Abstract
There is considerable debate over whether bipolar and related disorders that share common signs and symptoms, but are currently defined as distinct clinical entities in DSM-IV and ICD-10, may be better characterized as falling within a more broadly defined "bipolar spectrum". With a spectrum view in mind, the possibility of broadening the diagnosis of bipolar disorder has been proposed. This paper discusses some of the rationale for an expanded diagnostic scheme from both clinical and research perspectives in light of potential drawbacks. The ultimate goal of broadening the diagnosis of bipolar disorder is to help identify a common etiopathogenesis for these conditions to better guide treatment. To help achieve this goal, bipolar researchers have increasingly expanded their patient populations to identify objective biological or endophenotypic markers that transcend phenomenological observation. Although this approach has and will likely continue to produce beneficial results, the upcoming DSM-IV and ICD-10 revisions will place increasing scrutiny on psychiatry's diagnostic classification systems and pressure to re-evaluate our conceptions of bipolar disorder. However, until research findings can provide consistent and converging evidence as to the validity of a broader diagnostic conception, clinical expansion to a dimensional bipolar spectrum should be considered with caution.
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Affiliation(s)
- STEPHEN M. STRAKOWSKI
- Division of Bipolar Disorders Research, Department
of Psychiatry, University of Cincinnati College of Medicine, 231 Albert Sabin
Way, Cincinnati, OH 45267-0559, USA
| | - DAVID E. FLECK
- Division of Bipolar Disorders Research, Department
of Psychiatry, University of Cincinnati College of Medicine, 231 Albert Sabin
Way, Cincinnati, OH 45267-0559, USA
| | - MARIO MAJ
- Department of Psychiatry, University of Naples
SUN, Naples, Italy
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Molina V, Galindo G, Cortés B, de Herrera AGS, Ledo A, Sanz J, Montes C, Hernández-Tamames JA. Different gray matter patterns in chronic schizophrenia and chronic bipolar disorder patients identified using voxel-based morphometry. Eur Arch Psychiatry Clin Neurosci 2011; 261:313-22. [PMID: 21188405 DOI: 10.1007/s00406-010-0183-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2010] [Accepted: 12/15/2010] [Indexed: 10/18/2022]
Abstract
Gray matter (GM) volume deficits have been described in patients with schizophrenia (Sz) and bipolar disorder (BD), but to date, few studies have directly compared GM volumes between these syndromes with methods allowing for whole-brain comparisons. We have used structural magnetic resonance imaging (MRI) and voxel-based morphometry (VBM) to compare GM volumes between 38 Sz and 19 BD chronic patients. We also included 24 healthy controls. The results revealed a widespread cortical (dorsolateral and medial prefrontal and precentral) and cerebellar deficit as well as GM deficits in putamen and thalamus in Sz when compared to BD patients. Besides, a subcortical GM deficit was shown by Sz and BD groups when compared to the healthy controls, although a putaminal reduction was only evident in the Sz patients. In this comparison, the BD patients showed a limited cortical and subcortical GM deficit. These results support a partly different pattern of GM deficits associated to chronic Sz and chronic BD, with some degree of overlapping.
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Affiliation(s)
- Vicente Molina
- Department of Psychiatry, Hospital Universitario de Salamanca, Paseo de San Vicente, Spain.
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69
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Neuroimaging-based markers of bipolar disorder: evidence from two meta-analyses. J Affect Disord 2011; 132:344-55. [PMID: 21470688 DOI: 10.1016/j.jad.2011.03.016] [Citation(s) in RCA: 168] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2010] [Revised: 02/14/2011] [Accepted: 03/03/2011] [Indexed: 12/26/2022]
Abstract
BACKGROUND Bipolar disorder (BD) is often misdiagnosed or tardily detected, leading to inadequate treatment and devastating consequences. The identification of objective biomarkers, such as functional and structural brain abnormalities of BD might improve diagnosis and help elucidate its pathophysiology. METHODS To identify neurobiological markers of BD, two meta-analyses, one of functional neuroimaging studies related to emotional processing and a second of structural whole-brain neuroimaging studies in BD were conducted in the present study. Conducting a literature search on studies published up to September 2009 we identified 28 studies that were eligible for the meta-analyses: 13 functional magnetic resonance imaging studies, related to emotional processing and 15 structural imaging studies using whole-brain voxel-based morphometry. Only studies comparing patients with bipolar disorder to healthy controls were considered. Data were extracted or converted to a single anatomical reference (Talairach space). The activation likelihood estimation technique was used to assess the voxel-wise correspondence of results between studies. RESULTS In patients with BD, decreased activation and diminution of gray matter were identified in a cortical-cognitive brain network that has been associated with the regulation of emotions. By contrast, patients with BD exhibited increased activation in ventral limbic brain regions that mediate the experience of emotions and generation of emotional responses. The present study provides evidence for functional and anatomical alterations in BD in brain networks associated with the experience and regulation of emotions. CONCLUSIONS These alterations support previously proposed neurobiological models of BD and might represent valid neurobiological markers of the disorder. The specificity of these results to unipolar depression remains to be explored.
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70
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Wang F, Kalmar JH, Womer FY, Edmiston EE, Chepenik LG, Chen R, Spencer L, Blumberg HP. Olfactocentric paralimbic cortex morphology in adolescents with bipolar disorder. Brain 2011; 134:2005-12. [PMID: 21666263 PMCID: PMC3122371 DOI: 10.1093/brain/awr124] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2010] [Revised: 04/13/2011] [Accepted: 04/16/2011] [Indexed: 01/21/2023] Open
Abstract
The olfactocentric paralimbic cortex plays a critical role in the regulation of emotional and neurovegetative functions that are disrupted in core features of bipolar disorder. Adolescence is thought to be a critical period in both the maturation of the olfactocentric paralimbic cortex and in the emergence of bipolar disorder pathology. Together, these factors implicate a central role for the olfactocentric paralimbic cortex in the development of bipolar disorder and suggest that abnormalities in this cortex may be expressed by adolescence in the disorder. We tested the hypothesis that differences in olfactocentric paralimbic cortex structure are a morphological feature in adolescents with bipolar disorder. Subjects included 118 adolescents (41 with bipolar disorder and 77 healthy controls). Cortical grey matter volume differences between adolescents with and without bipolar disorder were assessed with voxel-based morphometry analyses of high-resolution structural magnetic resonance imaging scans. Compared with healthy comparison adolescents, adolescents with bipolar disorder demonstrated significant volume decreases in olfactocentric paralimbic regions, including orbitofrontal, insular and temporopolar cortices. Findings in these regions survived small volume correction (P < 0.05, corrected). Volume decreases in adolescents with bipolar disorder were also noted in inferior prefrontal and superior temporal gyri and cerebellum. The findings suggest that abnormalities in the morphology of the olfactocentric paralimbic cortex may contribute to the bipolar disorder phenotype that emerges in adolescence. The morphological development of the olfactocentric paralimbic cortex has received little study. The importance of these cortices in emotional and social development, and support for a central role for these cortices in the development of bipolar disorder, suggest that study of the development of these cortices in health and in bipolar disorder is critically needed.
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Affiliation(s)
- Fei Wang
- 1 Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06511, USA
- 2 Veterans Affairs Connecticut Healthcare System, West Haven, CT 06516, USA
| | - Jessica H. Kalmar
- 1 Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06511, USA
| | - Fay Y. Womer
- 1 Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06511, USA
| | - Erin E. Edmiston
- 1 Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06511, USA
| | - Lara G. Chepenik
- 1 Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06511, USA
- 2 Veterans Affairs Connecticut Healthcare System, West Haven, CT 06516, USA
| | - Rachel Chen
- 1 Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06511, USA
| | - Linda Spencer
- 1 Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06511, USA
| | - Hilary P. Blumberg
- 1 Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06511, USA
- 2 Veterans Affairs Connecticut Healthcare System, West Haven, CT 06516, USA
- 3 Child Study Centre, Yale University School of Medicine, New Haven, CT 06510, USA
- 4 Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, CT 06511, USA
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Volume reduction of ventromedial prefrontal cortex in bipolar II patients with rapid cycling: a voxel-based morphometric study. Prog Neuropsychopharmacol Biol Psychiatry 2011; 35:439-45. [PMID: 21115089 DOI: 10.1016/j.pnpbp.2010.11.030] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2010] [Revised: 10/14/2010] [Accepted: 11/20/2010] [Indexed: 11/23/2022]
Abstract
Although rapid cycling (RC), a course specifier of bipolar I or II disorder, is particularly common among bipolar II patients compared with bipolar I patients, the pathophysiological lines of evidence regarding bipolar II with RC are still limited. In this preliminary study with a cross-sectional design, we examined the regional gray matter (GM) volume in 14 bipolar II patients with RC, 17 patients without RC and 84 healthy controls by whole-brain and region-of-interest (ROI) analysis methods, using magnetic resonance imaging with voxel-based morphometry. Whole-brain analysis in this study revealed that the bipolar II patients with RC showed GM volume reductions in the bilateral hemispheres of the medial orbital prefrontal cortex, ventromedial prefrontal cortex, anterior cingulate, insula and parahippocampus, in the left hemisphere of the inferior temporal cortex and cerebellum, and in the brainstem, compared with the healthy controls. Moreover, ROI analysis focusing on the ventral prefrontal cortex, i.e., Brodmann areas 10, 11 and 47, revealed that the bipolar II patients with RC showed GM volume reduction in the ventromedial prefrontal cortex, compared with the patients without RC. The findings of our pilot study suggest that the ventromedial prefrontal cortex is associated with the generation of RC in bipolar II disorder.
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Abstract
OBJECTIVE The clinical distinction between bipolar II disorder (BD II) and bipolar I disorder (BD I) is not clear-cut. Cognitive functioning offers the potential to explore objective markers to help delineate this boundary. To examine this issue, we conducted a quantitative review of the cognitive profile of clinically stable patients with BD II in comparison with both patients with BD I and healthy controls. METHOD Meta-analytical methods were used to compare cognitive functioning of BD II disorder with both BD I disorder and healthy controls. RESULTS Individuals with BD II were less impaired than those with BD I on verbal memory. There were also small but significant difference in visual memory and semantic fluency. There were no significant differences in global cognition or in other cognitive domains. Patients with BD II performed poorer than controls in all cognitive domains. CONCLUSION Our findings suggest that with the exception of memory and semantic fluency, cognitive impairment in BD II is as severe as in BD I. Further studies are needed to investigate whether more severe deficits in BD I are related to neurotoxic effects of severe manic episodes on medial temporal structures or neurobiological differences from the onset of the illness.
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Affiliation(s)
- E Bora
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, Carlton, Vic., Australia. ;
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73
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Li M, Cui L, Deng W, Ma X, Huang C, Jiang L, Wang Y, Collier DA, Gong Q, Li T. Voxel-based morphometric analysis on the volume of gray matter in bipolar I disorder. Psychiatry Res 2011; 191:92-7. [PMID: 21236649 DOI: 10.1016/j.pscychresns.2010.09.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2009] [Revised: 08/29/2010] [Accepted: 09/09/2010] [Indexed: 01/14/2023]
Abstract
A number of previous studies have found that bipolar disorder is associated with abnormalities of brain structure. In this study we used optimized voxel-based morphometry (VBM) to compare gray matter volume between patients with bipolar I disorder and healthy controls. Twenty-four bipolar I patients (15 males and nine females) and 36 healthy controls (21 males and 15 females), who were well matched for age and gender, were scanned using structural magnetic resonance imaging. Gray matter volume was assessed and compared using optimized VBM, and the correlation between duration of illness/number of episodes and regional volumes was analyzed. There was no difference in whole-brain gray matter volume between the two groups. Optimized vVBM showed that subjects with bipolar I disorder had smaller volumes in the left inferior parietal lobule, right superior temporal gyrus, right middle frontal gyrus and left caudate. Only the volume of the right middle frontal gyrus was correlated with duration of illness and number of episodes in patients. These results suggest widespread gray matter defects in bipolar I disorder, which may play an important role in onset of the illness.
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Affiliation(s)
- Mingli Li
- The Department of Psychiatry & Psychiatric Laboratory, West China Hospital, Sichuan University, Sichuan 610041, China
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Yu K, Cheung C, Leung M, Li Q, Chua S, McAlonan G. Are Bipolar Disorder and Schizophrenia Neuroanatomically Distinct? An Anatomical Likelihood Meta-analysis. Front Hum Neurosci 2010; 4:189. [PMID: 21103008 PMCID: PMC2987512 DOI: 10.3389/fnhum.2010.00189] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2010] [Accepted: 09/22/2010] [Indexed: 11/13/2022] Open
Abstract
Objective: There is renewed debate on whether modern diagnostic classification should adopt a dichotomous or dimensional approach to schizophrenia and bipolar disorder. This study synthesizes data from voxel-based studies of schizophrenia and bipolar disorder to estimate the extent to which these conditions have a common neuroanatomical phenotype. Methods: A post-hoc meta-analytic estimation of the extent to which bipolar disorder, schizophrenia, or both conditions contribute to brain gray matter differences compared to controls was achieved using a novel application of the conventional anatomical likelihood estimation (ALE) method. 19 schizophrenia studies (651 patients and 693 controls) were matched as closely as possible to 19 bipolar studies (540 patients and 745 controls). Result: Substantial overlaps in the regions affected by schizophrenia and bipolar disorder included regions in prefrontal cortex, thalamus, left caudate, left medial temporal lobe, and right insula. Bipolar disorder and schizophrenia jointly contributed to clusters in the right hemisphere, but schizophrenia was almost exclusively associated with additional gray matter deficits (left insula and amygdala) in the left hemisphere. Limitation: The current meta-analytic method has a number of constraints. Importantly, only studies identifying differences between controls and patient groups could be included in this analysis. Conclusion: Bipolar disorder shares many of the same brain regions as schizophrenia. However, relative to neurotypical controls, lower gray matter volume in schizophrenia is more extensive and includes the amygdala. This fresh application of ALE accommodates multiple studies in a relatively unbiased comparison. Common biological mechanisms may explain the neuroanatomical overlap between these major disorders, but explaining why brain differences are more extensive in schizophrenia remains challenging.
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Affiliation(s)
- Kevin Yu
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong Pokfulam, Hong Kong
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75
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van der Schot AC, Vonk R, Brouwer RM, van Baal GCM, Brans RGH, van Haren NEM, Schnack HG, Boomsma DI, Nolen WA, Pol HEH, Kahn RS. Genetic and environmental influences on focal brain density in bipolar disorder. Brain 2010; 133:3080-92. [DOI: 10.1093/brain/awq236] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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Bora E, Fornito A, Yücel M, Pantelis C. Voxelwise meta-analysis of gray matter abnormalities in bipolar disorder. Biol Psychiatry 2010; 67:1097-105. [PMID: 20303066 DOI: 10.1016/j.biopsych.2010.01.020] [Citation(s) in RCA: 264] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Revised: 01/12/2010] [Accepted: 01/15/2010] [Indexed: 11/25/2022]
Abstract
BACKGROUND We conducted a meta-analysis of gray matter abnormalities in bipolar disorder (BD) using voxel-based morphometry studies to help clarify the structural abnormalities underpinning this condition. METHODS A systematic review was conducted for voxel-based morphometry studies of patients with BD. Meta-analyses of gray matter differences between BD and control subjects were undertaken using "signed differential mapping," a novel method that, in contrast to previously used techniques, allows inclusion of negative findings and ensures that single studies do not exert undue influence on the results. Meta-regression and subgroup analyses were used to examine the effect of moderator variables on gray matter abnormalities. RESULTS A total of 21 studies comparing gray matter volumes of 660 BD patients and 770 healthy control subjects were included. Gray matter reduction in left rostral anterior cingulate cortex (ACC) and right fronto-insular cortex was associated with BD. Fronto-insular cortex abnormality was not evident in early phases of the illness. In chronic patients, longer duration of illness was associated with increased gray matter in a cluster that included basal ganglia, subgenual ACC, and amygdala. Lithium treatment was associated with enlargement of ACC gray matter volumes, which overlapped with the region where gray matter was reduced in BD. CONCLUSIONS The most robust gray matter reductions in BD occur in anterior limbic regions, which may be related to the executive control and emotional processing abnormalities seen in this patient population. Clinical factors such as illness duration and lithium treatment also impact on case-control comparisons of gray matter volume.
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Affiliation(s)
- Emre Bora
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia.
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77
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Ellison-Wright I, Bullmore E. Anatomy of bipolar disorder and schizophrenia: a meta-analysis. Schizophr Res 2010; 117:1-12. [PMID: 20071149 DOI: 10.1016/j.schres.2009.12.022] [Citation(s) in RCA: 403] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2009] [Revised: 11/27/2009] [Accepted: 12/19/2009] [Indexed: 01/14/2023]
Abstract
BACKGROUND Recent genetic results have indicated that the two major, classically distinct forms of psychosis - schizophrenia and bipolar disorder - may share causative factors in common. However it is not clear to what extent they may also have similar profiles of brain abnormality. We used meta-analytic techniques to generate and compare maps of brain structural abnormality in the large samples of patients with both disorders that have been studied using magnetic resonance imaging. METHOD A systematic search was conducted for voxel-based morphometry studies examining gray matter in patients with schizophrenia or bipolar disorder. The anatomical distribution of the co-ordinates of gray matter differences was meta-analysed using Anatomical Likelihood Estimation. RESULTS Forty-two schizophrenia studies including 2058 patients with schizophrenia and 2131 comparison subjects were compared with fourteen bipolar studies including 366 patients with bipolar disorder and 497 comparison subjects. In schizophrenia, there were extensive gray matter deficits in frontal, temporal, cingulate and insular cortex and thalamus, and increased gray matter in the basal ganglia. In bipolar disorder, gray matter reductions were present in the anterior cingulate and bilateral insula. These substantially overlapped with areas of gray matter reduction in schizophrenia, except for a region of anterior cingulate where gray matter reduction was specific to bipolar disorder. IMPLICATIONS In bipolar disorder studies there were consistent regional gray matter reductions in paralimbic regions (anterior cingulate and insula) implicated in emotional processing. Gray matter reductions in schizophrenia studies were more extensive and involved limbic and neocortical structures as well as the paralimbic regions affected in bipolar disorder.
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