201
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Silk JS, Davis S, McMakin DL, Dahl RE, Forbes EE. Why do anxious children become depressed teenagers? The role of social evaluative threat and reward processing. Psychol Med 2012; 42:2095-107. [PMID: 22340187 PMCID: PMC3360132 DOI: 10.1017/s0033291712000207] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Depression is a leading cause of worldwide disability. Adolescence represents a key developmental window in which rates of this disorder increase markedly. Children with an anxiety disorder show a particular risk of developing depression during adolescence. METHOD We present and review evidence for a developmental model that considers the intersection of two vulnerabilities relevant to the trajectory from anxiety to depression: difficulties in response to potential social evaluation and changes in reward processing at puberty. RESULTS Evidence suggests that these vulnerabilities (a) have been associated with depression, (b) are likely to be problematic in many, but not all, anxious youth, and (c) may be exacerbated by maturational processes that occur around pubertal development in ways that can create a negative spiral into a depressive disorder. CONCLUSIONS We discuss the possibility that early intervention strategies targeting key aspects of these vulnerabilities could alter the trajectory away from depression for many anxious youth.
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Affiliation(s)
- J S Silk
- University of Pittsburgh, Department of Psychiatry, Western Psychiatric Institute and Clinic, Pittsburgh, PA 15213, USA.
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202
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Keener MT, Fournier JC, Mullin BC, Kronhaus D, Perlman SB, LaBarbara E, Almeida JC, Phillips ML. Dissociable patterns of medial prefrontal and amygdala activity to face identity versus emotion in bipolar disorder. Psychol Med 2012; 42:1913-1924. [PMID: 22273442 PMCID: PMC3685204 DOI: 10.1017/s0033291711002935] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Individuals with bipolar disorder demonstrate abnormal social function. Neuroimaging studies in bipolar disorder have shown functional abnormalities in neural circuitry supporting face emotion processing, but have not examined face identity processing, a key component of social function. We aimed to elucidate functional abnormalities in neural circuitry supporting face emotion and face identity processing in bipolar disorder. METHOD Twenty-seven individuals with bipolar disorder I currently euthymic and 27 healthy controls participated in an implicit face processing, block-design paradigm. Participants labeled color flashes that were superimposed on dynamically changing background faces comprising morphs either from neutral to prototypical emotion (happy, sad, angry and fearful) or from one identity to another identity depicting a neutral face. Whole-brain and amygdala region-of-interest (ROI) activities were compared between groups. RESULTS There was no significant between-group difference looking across both emerging face emotion and identity. During processing of all emerging emotions, euthymic individuals with bipolar disorder showed significantly greater amygdala activity. During facial identity and also happy face processing, euthymic individuals with bipolar disorder showed significantly greater amygdala and medial prefrontal cortical activity compared with controls. CONCLUSIONS This is the first study to examine neural circuitry supporting face identity and face emotion processing in bipolar disorder. Our findings of abnormally elevated activity in amygdala and medial prefrontal cortex (mPFC) during face identity and happy face emotion processing suggest functional abnormalities in key regions previously implicated in social processing. This may be of future importance toward examining the abnormal self-related processing, grandiosity and social dysfunction seen in bipolar disorder.
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Affiliation(s)
- M T Keener
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
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203
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Overlapping prefrontal systems involved in cognitive and emotional processing in euthymic bipolar disorder and following sleep deprivation: a review of functional neuroimaging studies. Clin Psychol Rev 2012; 32:650-63. [PMID: 22926687 DOI: 10.1016/j.cpr.2012.07.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Revised: 07/11/2012] [Accepted: 07/30/2012] [Indexed: 12/11/2022]
Abstract
Prefrontal cortex (PFC) mediated cognitive and emotional processing deficits in bipolar disorder lead to functional limitations even during periods of mood stability. Alterations of sleep and circadian functioning are well-documented in bipolar disorder, but there is little research directly examining the mechanistic role of sleep and/or circadian rhythms in the observed cognitive and emotional processing deficits. We systematically review the cognitive and emotional processing deficits reliant upon PFC functioning of euthymic patients with bipolar disorder and in healthy individuals deprived of sleep. The evidence from two parallel lines of investigation suggests that sleep and circadian rhythms may be involved in the cognitive and emotional processing deficits seen in bipolar disorder through overlapping neurobiological systems. We discuss current models of bipolar highlighting the PFC-limbic connections and discuss inclusion of sleep-related mechanisms. Sleep and circadian dysfunction is a core feature of bipolar disorder and models of neurobiological abnormalities should incorporate chronobiological measures. Further research into the role of sleep and circadian rhythms in cognition and emotional processing in bipolar disorder is warranted.
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204
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Clasen PC, Wells TT, Ellis AJ, Beevers CG. Attentional biases and the persistence of sad mood in major depressive disorder. JOURNAL OF ABNORMAL PSYCHOLOGY 2012; 122:74-85. [PMID: 22867117 DOI: 10.1037/a0029211] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study examined whether attentional biases for emotional information are associated with impaired mood recovery following a sad mood induction among individuals with and without major depressive disorder (MDD). Attentional biases were assessed with an exogenous cuing task using emotional facial expressions as cues among adults with (n = 48) and without (n = 224) current MDD. Mood reactivity and recovery were measured following a sad mood induction. Mood reactivity strongly predicted mood recovery; however, this relationship was moderated by attentional biases for negative emotional stimuli. Biases for sad and fear stimuli were associated with diminished mood recovery following mood induction across the sample. However, biases for sad stimuli were associated with significantly greater impairments in mood recovery among individuals with MDD than healthy controls. Furthermore, within the MDD group, impaired mood recovery was positively associated with depression severity. These results suggest that attentional biases maintain depression, in part, by facilitating the persistence of sad mood.
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Affiliation(s)
- Peter C Clasen
- Department of Psychology, University of Texas at Austin, Austin, TX 78712-0187, USA.
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205
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Vizueta N, Rudie JD, Townsend JD, Torrisi S, Moody TD, Bookheimer SY, Altshuler LL. Regional fMRI hypoactivation and altered functional connectivity during emotion processing in nonmedicated depressed patients with bipolar II disorder. Am J Psychiatry 2012; 169:831-40. [PMID: 22773540 PMCID: PMC3740182 DOI: 10.1176/appi.ajp.2012.11030349] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Although the amygdala and ventrolateral prefrontal cortex have been implicated in the pathophysiology of bipolar I disorder, the neural mechanisms underlying bipolar II disorder remain unknown. The authors examined neural activity in response to negative emotional faces during an emotion perception task that reliably activates emotion regulatory regions. METHOD Twenty-one nonmedicated depressed bipolar II patients and 21 healthy comparison subjects underwent functional MRI (fMRI) while performing an emotional face-matching task. Within- and between-group whole-brain fMRI activation and seed-based connectivity analyses were conducted. RESULTS In depressed bipolar II patients, random-effects between-group fMRI analyses revealed a significant reduction in activation in several regions, including the left and right ventrolateral prefrontal cortices (Brodmann's area [BA] 47) and the right amygdala, a priori regions of interest. Additionally, bipolar patients exhibited significantly reduced negative functional connectivity between the right amygdala and the right orbitofrontal cortex (BA 10) as well as the right dorsolateral prefrontal cortex (BA 46) relative to healthy comparison subjects. CONCLUSIONS These findings suggest that bipolar II depression is characterized by reduced regional orbitofrontal and limbic activation and altered connectivity in a fronto-temporal circuit implicated in working memory and emotional learning. While the amygdala hypoactivation observed in bipolar II depression is opposite to the direction seen in bipolar I mania and may therefore be state dependent, the observed orbitofrontal cortex hypoactivation is consistent with findings in bipolar I depression, mania, and euthymia, suggesting a physiologic trait marker of the disorder.
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Affiliation(s)
- Nathalie Vizueta
- David Geffen School of Medicine , University of California, Los Angeles, CA, USA.
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206
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Garrett A, Reiss A, Howe M, Kelley R, Singh M, Adleman N, Karchemskiy A, Chang K. Abnormal amygdala and prefrontal cortex activation to facial expressions in pediatric bipolar disorder. J Am Acad Child Adolesc Psychiatry 2012; 51:821-31. [PMID: 22840553 PMCID: PMC3408885 DOI: 10.1016/j.jaac.2012.06.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Revised: 05/21/2012] [Accepted: 06/01/2012] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Previous functional magnetic resonance imaging (fMRI) studies in pediatric bipolar disorder (BD) have reported greater amygdala and less dorsolateral prefrontal cortex (DLPFC) activation to facial expressions compared to healthy controls. The current study investigates whether these differences are associated with the early or late phase of activation, suggesting different temporal characteristics of brain responses. METHOD A total of 20 euthymic adolescents with familial BD (14 male) and 21 healthy control subjects (13 male) underwent fMRI scanning during presentation of happy, sad, and neutral facial expressions. Whole-brain voxelwise analyses were conducted in SPM5, using a three-way analysis of variance (ANOVA) with factors group (BD and healthy control [HC]), facial expression (happy, sad, and neutral versus scrambled), and phase (early and late, corresponding to the first and second half of each block of faces). RESULTS There were no significant group differences in task performance, age, gender, or IQ. Significant activation from the main effect of group included greater DLPFC activation in the HC group, and greater amygdala/hippocampal activation in the BD group. The interaction of Group × Phase identified clusters in the superior temporal sulcus/insula and visual cortex, where activation increased from the early to late phase of the block for the BD but not the HC group. CONCLUSIONS These findings are consistent with previous studies that suggest deficient prefrontal cortex regulation of heightened amygdala response to emotional stimuli in pediatric BD. Increasing activation over time in superior temporal and visual cortices suggests difficulty processing or disengaging attention from emotional faces in BD.
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Affiliation(s)
- Amy Garrett
- Center for Interdisciplinary Brain Sciences Research and the Pediatric Bipolar Disorders Program at Stanford University
| | - Allan Reiss
- Center for Interdisciplinary Brain Sciences Research at Stanford University
| | - Meghan Howe
- Pediatric Bipolar Disorders Program at Stanford University
| | - Ryan Kelley
- Center for Interdisciplinary Brain Sciences Research and the Pediatric Bipolar Disorders Program at Stanford University
| | - Manpreet Singh
- Pediatric Bipolar Disorders Program at Stanford University
| | | | - Asya Karchemskiy
- Center for Interdisciplinary Brain Sciences Research at Stanford University
| | - Kiki Chang
- Pediatric Bipolar Disorders Program at Stanford University
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207
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Liu CH, Li F, Li SF, Wang YJ, Tie CL, Wu HY, Zhou Z, Zhang D, Dong J, Yang Z, Wang CY. Abnormal baseline brain activity in bipolar depression: a resting state functional magnetic resonance imaging study. Psychiatry Res 2012; 203:175-9. [PMID: 23017873 DOI: 10.1016/j.pscychresns.2012.02.007] [Citation(s) in RCA: 101] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Revised: 10/13/2011] [Accepted: 02/12/2012] [Indexed: 01/09/2023]
Abstract
We examined resting state brain activity in the depressive phase of bipolar disorder (BD) by measuring the amplitude of low-frequency fluctuations (ALFF) in the functional magnetic resonance imaging (fMRI) signal. Unlike functional connectivity, the ALFF approach reflects local properties in specific regions and provides direct information about impaired foci. Groups of 26 patients with BD depression and 26 gender-, age-, and education-matched healthy subjects participated in fMRI scans. We examined group differences in ALFF findings as well as correlations between clinical measurements and ALFF in the regions showing significant group differences. Our results showed that patients with BD depression had significantly increased ALFF in the left insula, the right caudate nucleus, the temporal gyrus, the bilateral inferior frontal gyrus, and the posterior lobe of the cerebellum. They also had decreased ALFF in the left postcentral gyrus, the left parahippocampal gyrus, and the cerebellum. Moderate negative correlations were found between the Hamilton Depression Rating Scale score and ALFF in the left insular cortex in the patient group. These results support a model of BD that involves dysfunction in the prefrontal-limbic networks and associated striatal systems. We also demonstrated the feasibility of ALFF as a technique to investigate persistent cerebral dysfunction in BD.
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Affiliation(s)
- Chun-Hong Liu
- Department of Radiology, Capital Medical University, Beijing, China
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208
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Dichter GS, Damiano CA, Allen JA. Reward circuitry dysfunction in psychiatric and neurodevelopmental disorders and genetic syndromes: animal models and clinical findings. J Neurodev Disord 2012; 4:19. [PMID: 22958744 PMCID: PMC3464940 DOI: 10.1186/1866-1955-4-19] [Citation(s) in RCA: 199] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Accepted: 05/02/2012] [Indexed: 02/07/2023] Open
Abstract
This review summarizes evidence of dysregulated reward circuitry function in a range of neurodevelopmental and psychiatric disorders and genetic syndromes. First, the contribution of identifying a core mechanistic process across disparate disorders to disease classification is discussed, followed by a review of the neurobiology of reward circuitry. We next consider preclinical animal models and clinical evidence of reward-pathway dysfunction in a range of disorders, including psychiatric disorders (i.e., substance-use disorders, affective disorders, eating disorders, and obsessive compulsive disorders), neurodevelopmental disorders (i.e., schizophrenia, attention-deficit/hyperactivity disorder, autism spectrum disorders, Tourette's syndrome, conduct disorder/oppositional defiant disorder), and genetic syndromes (i.e., Fragile X syndrome, Prader-Willi syndrome, Williams syndrome, Angelman syndrome, and Rett syndrome). We also provide brief overviews of effective psychopharmacologic agents that have an effect on the dopamine system in these disorders. This review concludes with methodological considerations for future research designed to more clearly probe reward-circuitry dysfunction, with the ultimate goal of improved intervention strategies.
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Affiliation(s)
- Gabriel S Dichter
- Carolina Institute for Developmental Disabilities, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
- Department of Psychology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Psychiatry, University of North Carolina School of Medicine, CB# 7255, 101 Manning Drive, Chapel Hill, NC, 275997255, USA
| | - Cara A Damiano
- Department of Psychology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - John A Allen
- Neuroscience Research Unit Pfizer Global Research and Development, Groton, CT 06340, USA
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209
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Mindfulness-based stress reduction, mindfulness-based cognitive therapy, and Zen meditation for depression, anxiety, pain, and psychological distress. J Psychiatr Pract 2012; 18:233-52. [PMID: 22805898 DOI: 10.1097/01.pra.0000416014.53215.86] [Citation(s) in RCA: 141] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Mindfulness has been described as a practice of learning to focus attention on moment-bymoment experience with an attitude of curiosity, openness, and acceptance. Mindfulness practices have become increasingly popular as complementary therapeutic strategies for a variety of medical and psychiatric conditions. This paper provides an overview of three mindfulness interventions that have demonstrated effectiveness for psychiatric symptoms and/or pain. The goal of this review is to provide a synopsis that practicing clinicians can use as a clinical reference concerning Zen meditation, mindfulness-based stress reduction (MBSR), and mindfulness-based cognitive therapy (MBCT). All three approaches originated from Buddhist spiritual practices, but only Zen is an actual Buddhist tradition. MBSR and MBCT are secular, clinically based methods that employ manuals and standardized techniques. Studies indicate that MBSR and MBCT have broad-spectrum antidepressant and antianxiety effects and decrease general psychological distress. MBCT is strongly recommended as an adjunctive treatment for unipolar depression. The evidence suggests that both MBSR and MBCT have efficacy as adjunctive interventions for anxiety symptoms. MBSR is beneficial for general psychological health and stress management in those with medical and psychiatric illness as well as in healthy individuals. Finally, MBSR and Zen meditation have a role in pain management.
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210
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Rao NP. Pathogenetic and therapeutic perspectives on neurocognitive models in psychiatry: A synthesis of behavioral, brain imaging, and biological studies. Indian J Psychiatry 2012; 54:217-22. [PMID: 23226843 PMCID: PMC3512356 DOI: 10.4103/0019-5545.102410] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Neurocognitive assessments are useful to determine the locus of insult as well as functional capacities of patients on treatment. In psychiatry, neurocognitive assessment is useful in the identification of brain lesions, evaluation of cognitive deterioration over time, and advancement of theories regarding the neuroanatomical localization of symptoms. Neurocognitive models provide a bridging link between brain pathology and phenomenology. They provide a useful framework to understand the pathogenesis of psychiatric disorders, bringing together isolated findings in behavioral, neuroimaging, and other neurobiological studies. This review will discuss neurocognitive model of three disorders - schizophrenia, bipolar disorder, and obsessive compulsive disorder - by incorporating findings from neurocognitive, neuroimaging, and other biological studies.
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Affiliation(s)
- Naren P. Rao
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
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211
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Bertocci MA, Bebko GM, Mullin BC, Langenecker SA, Ladouceur CD, Almeida JRC, Phillips ML. Abnormal anterior cingulate cortical activity during emotional n-back task performance distinguishes bipolar from unipolar depressed females. Psychol Med 2012; 42:1417-1428. [PMID: 22099606 PMCID: PMC3601380 DOI: 10.1017/s003329171100242x] [Citation(s) in RCA: 100] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Depression in the context of bipolar disorder (BDd) is often misdiagnosed as unipolar disorder depression (UDd) leading to poor clinical outcomes for many bipolar sufferers. We examined neural circuitry supporting emotion regulation in females with either BDd or UDd as a first stage toward identifying biomarkers that may differentiate BDd from UDd. METHOD Fifty-seven females aged 18-45 years participated in this study: 23 with UDd, 18 with bipolar disorder type I depression (BDId) and 16 healthy females. During 3-T functional magnetic resonance imaging (fMRI), the participants performed an emotional face n-back (EFNBACK) task, that is an n-back task with high (2-back) and low (0-back) memory load conditions flanked by two positive, negative or neutral face distracters. This paradigm examines executive control with emotional distracters-emotion regulation. RESULTS High memory load with neutral face distracters elicited greater bilateral and left dorsal anterior midcingulate cortex (dAMCC) activity in UDd than in healthy and BDId females respectively, and greater bilateral putamen activity in both depressed groups versus healthy females. High memory load with happy face distracters elicited greater left putamen activity in UDd than in healthy females. Psychotropic medication was associated with greater putamen activity to these contrasts in UDd females. CONCLUSIONS During high memory load with neutral face distracters, elevated dAMCC activity in UDd suggests abnormal recruitment of attentional control circuitry to maintain task performance, whereas elevated putamen activity unrelated to psychotropic medication in BDId females may suggest an attentional bias toward ambiguous neutral face distracters. Differential patterns of functional abnormalities in neural circuitry supporting attentional control during emotion regulation, especially in the dAMCC, is a promising neuroimaging measure to distinguish UDd from BDId in females.
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Affiliation(s)
- M A Bertocci
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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212
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Tu PC, Chen LF, Hsieh JC, Bai YM, Li CT, Su TP. Regional cortical thinning in patients with major depressive disorder: a surface-based morphometry study. Psychiatry Res 2012; 202:206-13. [PMID: 22521631 DOI: 10.1016/j.pscychresns.2011.07.011] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2011] [Revised: 06/02/2011] [Accepted: 07/11/2011] [Indexed: 12/18/2022]
Abstract
This study uses surfaced-based morphometry to investigate cortical thinning and its functional correlates in patients with major depressive disorder (MDD). Subjects with MDD (N=36) and healthy control subjects (N=36) were enrolled in the study. Each subject received T1 structural magnetic resonance imaging (MRI), clinical evaluations, and neuropsychological examinations of executive functions with the Color Trail Test (CTT) and the Wisconsin Card Sorting Test (WCST). This study used an automated surface-based method (FreeSurfer) to measure cortical thickness and to generate the thickness maps for each subject. Statistical comparisons were performed using a general linear model. Compared with healthy controls, subjects with MDD showed the largest area of cortical thinning in the prefrontal cortex. This study also noted smaller areas of cortical thinning in the bilateral inferior parietal cortex, left middle temporal gyrus, left entorhinal cortex, left lingual cortex, and right postcentral gyrus. Regression analysis demonstrated cortical thinning in several frontoparietal regions, predicting worse executive performance measured by CTT 2, though the patterns of cortical thickness/executive performance correlation differed in healthy controls and MDD subjects. In conclusion, the results provide further evidence for the significant role of a prefrontal structural deficit and an aberrant structural/functional relationship in patients with MDD.
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Affiliation(s)
- Pei-Chi Tu
- Institute of Neuroscience, School of Life Science, National Yang-Ming University, Taipei 112, Taiwan
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213
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Dannlowski U, Kugel H, Huber F, Stuhrmann A, Redlich R, Grotegerd D, Dohm K, Sehlmeyer C, Konrad C, Baune BT, Arolt V, Heindel W, Zwitserlood P, Suslow T. Childhood maltreatment is associated with an automatic negative emotion processing bias in the amygdala. Hum Brain Mapp 2012; 34:2899-909. [PMID: 22696400 DOI: 10.1002/hbm.22112] [Citation(s) in RCA: 176] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Revised: 03/21/2012] [Accepted: 04/03/2012] [Indexed: 12/29/2022] Open
Abstract
UNLABELLED Major depression has been repeatedly associated with amygdala hyper-responsiveness to negative (but not positive) facial expressions at early, automatic stages of emotion processing using subliminally presented stimuli. However, it is not clear whether this "limbic bias" is a correlate of depression or represents a vulnerability marker preceding the onset of the disease. Because childhood maltreatment is a potent risk factor for the development of major depression in later life, we explored whether childhood maltreatment is associated with amygdalar emotion processing bias in maltreated but healthy subjects. Amygdala responsiveness to subliminally presented sad and happy faces was measured by means of fMRI at 3 T in N = 150 healthy subjects carefully screened for psychiatric disorders. Childhood maltreatment was assessed by the 25-item childhood trauma questionnaire (CTQ). A strong association of CTQ-scores with amygdala responsiveness to sad, but not happy facial expressions emerged. This result was further qualified by an interaction of emotional valence and CTQ-scores and was not confounded by trait anxiety, current depression level, age, gender, intelligence, education level, and more recent stressful life-events. Childhood maltreatment is apparently associated with detectable changes in amygdala function during early stages of emotion processing which resemble findings described in major depression. Limbic hyper-responsiveness to negative facial cues could be a consequence of the experience of maltreatment during childhood increasing the risk of depression in later life. LIMITATION the present association of limbic bias and maltreatment was demonstrated in the absence of psychopathological abnormalities, thereby limiting strong conclusions.
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Affiliation(s)
- Udo Dannlowski
- Department of Psychiatry, University of Münster, Germany; Department of Psychiatry, University of Marburg, Germany
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Abstract
OBJECTIVES Bipolar disorder (BP) is characterized by a dysfunction of mood, alternating between states of mania/hypomania and depression. Thus, the primary abnormality appears to be an inability to regulate emotion, the result of which is emotional extremes. The purpose of this paper is to review the current functional magnetic resonance imaging (fMRI) literature on adult patients with BP using emotion processing or regulation paradigms. METHODS A search was conducted on PubMed using the keywords: bipolar disorder, fMRI, mania, bipolar depression, bipolar euthymia, emotion, and amygdala. Only those studies that were conducted in adult patients using an emotion activation task were included in the final review. RESULTS Using tasks that assess neural functioning during emotion processing and emotion regulation, many fMRI studies have examined BP subjects during mania and euthymia. Fewer fMRI studies have been conducted during depression, and fewer still have included the same subjects in multiple mood states. Despite these limitations, these studies have demonstrated specific abnormalities in frontal-limbic regions. Using a variety of paradigms, investigators have specifically evaluated the amygdala (a structure within the limbic system known to be critical for emotion) and the prefrontal cortex (PFC) (a region known to have a regulatory function over the limbic system). CONCLUSIONS These investigations reveal that amygdala activation varies as a function of mood state, while the PFC remains persistently hypoactivated across mood states. Emotional dysregulation and lability in mania and depression may reflect disruption of a frontal-limbic functional neuroanatomical network.
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Affiliation(s)
- Jennifer Townsend
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA 90095-7057, USA
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215
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Henry C, Phillips M, Leibenluft E, M'Bailara K, Houenou J, Leboyer M. Emotional dysfunction as a marker of bipolar disorders. Front Biosci (Elite Ed) 2012; 4:2622-30. [PMID: 22652673 PMCID: PMC3927326 DOI: 10.2741/e578] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Assessment of emotional reactivity, defined as rapid emotional responses to salient environmental events, has been neglected in mood disorders. This article reviews data showing the relevance of using emotional reactivity to better characterize bipolar mood episodes. METHOD We reviewed clinical data on emotional reactivity during all phases of bipolar disorders (euthymic, manic, mixed and depressive states) and brain-imaging, neurochemical, genetic studies related to emotional reactivity disturbances. RESULT Euthymic bipolar patients show mild abnormalities (hypersensitivity to emotional stimuli and higher arousability) in comparison to controls. Both manic and mixed states are characterized by a significant increase in emotional reactivity. Furthermore, emotional reactivity may discriminate between two types of bipolar depression, the first being characterized by emotional hypo-reactivity and global behavioral inhibition, the second by emotional hyper-reactivity. Brain-imaging studies can help to identify the underlying mechanisms involved in disturbances of emotional reactivity. CONCLUSION Emotional reactivity can be used to refine more homogeneous pathophysiological subtypes of mood episodes. Future research should explore possible correlations between biomarkers, response to treatments and these clinical phenotypes.
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Affiliation(s)
- Chantal Henry
- INSERM, U955, IMRB, departement de Genetique, Creteil, F-94000, France.
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216
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Liu TY, Hsieh JC, Chen YS, Tu PC, Su TP, Chen LF. Different patterns of abnormal gamma oscillatory activity in unipolar and bipolar disorder patients during an implicit emotion task. Neuropsychologia 2012; 50:1514-20. [DOI: 10.1016/j.neuropsychologia.2012.03.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Revised: 03/01/2012] [Accepted: 03/02/2012] [Indexed: 10/28/2022]
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217
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Mourão-Miranda J, Almeida JRC, Hassel S, de Oliveira L, Versace A, Marquand AF, Sato JR, Brammer M, Phillips ML. Pattern recognition analyses of brain activation elicited by happy and neutral faces in unipolar and bipolar depression. Bipolar Disord 2012; 14:451-60. [PMID: 22631624 PMCID: PMC3510302 DOI: 10.1111/j.1399-5618.2012.01019.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVES Recently, pattern recognition approaches have been used to classify patterns of brain activity elicited by sensory or cognitive processes. In the clinical context, these approaches have been mainly applied to classify groups of individuals based on structural magnetic resonance imaging (MRI) data. Only a few studies have applied similar methods to functional MRI (fMRI) data. METHODS We used a novel analytic framework to examine the extent to which unipolar and bipolar depressed individuals differed on discrimination between patterns of neural activity for happy and neutral faces. We used data from 18 currently depressed individuals with bipolar I disorder (BD) and 18 currently depressed individuals with recurrent unipolar depression (UD), matched on depression severity, age, and illness duration, and 18 age- and gender ratio-matched healthy comparison subjects (HC). fMRI data were analyzed using a general linear model and Gaussian process classifiers. RESULTS The accuracy for discriminating between patterns of neural activity for happy versus neutral faces overall was lower in both patient groups relative to HC. The predictive probabilities for intense and mild happy faces were higher in HC than in BD, and for mild happy faces were higher in HC than UD (all p < 0.001). Interestingly, the predictive probability for intense happy faces was significantly higher in UD than BD (p = 0.03). CONCLUSIONS These results indicate that patterns of whole-brain neural activity to intense happy faces were significantly less distinct from those for neutral faces in BD than in either HC or UD. These findings indicate that pattern recognition approaches can be used to identify abnormal brain activity patterns in patient populations and have promising clinical utility as techniques that can help to discriminate between patients with different psychiatric illnesses.
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Affiliation(s)
- Janaina Mourão-Miranda
- Department of Computer Science, Centre for Computational Statistics and Machine Learning, University College London, London, UK.
| | - Jorge RC Almeida
- Department of Psychiatry, University of Pittsburgh School of MedicinePittsburgh, PA, USA
| | - Stefanie Hassel
- Department of Psychiatry, University of Pittsburgh School of MedicinePittsburgh, PA, USA
| | - Leticia de Oliveira
- Department of Neuroimaging, King's College LondonLondon, UK,Instituto Biomédico, Universidade Federal FluminenseRio de Janeiro
| | - Amelia Versace
- Department of Psychiatry, University of Pittsburgh School of MedicinePittsburgh, PA, USA
| | | | - Joao R Sato
- Center of Mathematics, Computation and Cognition, Universidade Federal do ABCSanto André, Brazil
| | - Michael Brammer
- Department of Clinical Neuroscience, Institute of Psychiatry, King’s College LondonLondon
| | - Mary L Phillips
- Department of Psychiatry, University of Pittsburgh School of MedicinePittsburgh, PA, USA,Department of Psychological Medicine, Cardiff UniversityCardiff, UK
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218
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Whalley HC, Papmeyer M, Sprooten E, Lawrie SM, Sussmann JE, McIntosh AM. Review of functional magnetic resonance imaging studies comparing bipolar disorder and schizophrenia. Bipolar Disord 2012; 14:411-31. [PMID: 22631622 DOI: 10.1111/j.1399-5618.2012.01016.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Although bipolar disorder (BD) and schizophrenia (SCZ) have a number of clinical features and certain susceptibility genes in common, they are considered separate disorders, and it is unclear which aspects of pathophysiology are specific to each condition. Here, we examine the functional magnetic resonance imaging (fMRI) literature to determine the evidence for diagnosis-specific patterns of brain activation in the two patient groups. METHOD A systematic search was performed to identify fMRI studies directly comparing BD and SCZ to examine evidence for diagnosis-specific activation patterns. Studies were categorized into (i) those investigating emotion, reward, or memory, (ii) those describing executive function or language tasks, and (iii) those looking at the resting state or default mode networks. Studies reporting estimates of sensitivity and specificity of classification are also summarized, followed by studies reporting associations with symptom severity measures. RESULTS In total, 21 studies were identified including patients (n = 729) and healthy subjects (n = 465). Relative over-activation in the medial temporal lobe and associated structures was found in BD versus SCZ in tasks involving emotion or memory. Evidence of differences between the disorders in prefrontal regions was less consistent. Accuracy values for assignment of diagnosis were generally lower in BD than in SCZ. Few studies reported significant symptom associations; however, these generally implicated limbic regions in association with manic symptoms. CONCLUSIONS Although there are a limited number of studies and a cautious approach is warranted, activation differences were found in the medial temporal lobe and associated limbic regions, suggesting the presence of differences in the neurobiological substrates of SCZ and BD. Future studies examining symptom dimensions, risk-associated genes, and the effects of medication will aid clarification of the mechanisms behind these differences.
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Affiliation(s)
- Heather C Whalley
- Division of Psychiatry, School of Molecular and Clinical Medicine, University of Edinburgh, Edinburgh, UK.
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219
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Blond BN, Fredericks CA, Blumberg HP. Functional neuroanatomy of bipolar disorder: structure, function, and connectivity in an amygdala-anterior paralimbic neural system. Bipolar Disord 2012; 14:340-55. [PMID: 22631619 PMCID: PMC3880745 DOI: 10.1111/j.1399-5618.2012.01015.x] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES In past decades, neuroimaging research in bipolar disorder has demonstrated a convergence of findings in an amygdala-anterior paralimbic cortex neural system. This paper reviews behavioral neurology literature that first suggested a central role for this neural system in the disorder and the neuroimaging evidence that supports it. METHODS Relevant articles are reviewed to provide an amygdala-anterior paralimbic cortex neural system model of bipolar disorder, including articles from the fields of behavioral neurology and neuroanatomy, and neuroimaging. RESULTS The literature is highly supportive of key roles for the amygdala, anterior paralimbic cortices, and connections among these structures in the emotional dysregulation of bipolar disorder. The functions subserved by their more widely distributed connection sites suggest that broader system dysfunction could account for the range of functions-from neurovegetative to cognitive-disrupted in the disorder. Abnormalities in some components of this neural system are apparent by adolescence, while others, such as those in rostral prefrontal regions, appear to progress over adolescence and young adulthood, suggesting a neurodevelopmental model of the disorder. However, some findings conflict, which may reflect the small sample sizes of some studies, and clinical heterogeneity and methodological differences across studies. CONCLUSIONS Consistent with models derived from early behavioral neurology studies, neuroimaging studies support a central role for an amygdala-anterior paralimbic neural system in bipolar disorder, and implicate abnormalities in the development of this system in the disorder. This system will be an important focus of future studies on the developmental pathophysiology, detection, treatment, and prevention of the disorder.
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Affiliation(s)
- Benjamin N Blond
- Department of Psychiatry, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
| | - Carolyn A Fredericks
- Department of Psychiatry, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
| | - Hilary P Blumberg
- Department of Psychiatry, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA,Department of Diagnostic Radiology, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA,The Child Study Center, Yale School of Medicine, New Haven, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA,Research Enhancement Award Program Depression Center, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
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220
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Strakowski SM, Adler CM, Almeida J, Altshuler LL, Blumberg HP, Chang KD, DelBello MP, Frangou S, McIntosh A, Phillips ML, Sussman JE, Townsend JD. The functional neuroanatomy of bipolar disorder: a consensus model. Bipolar Disord 2012; 14:313-25. [PMID: 22631617 PMCID: PMC3874804 DOI: 10.1111/j.1399-5618.2012.01022.x] [Citation(s) in RCA: 349] [Impact Index Per Article: 29.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Functional neuroimaging methods have proliferated in recent years, such that functional magnetic resonance imaging, in particular, is now widely used to study bipolar disorder. However, discrepant findings are common. A workgroup was organized by the Department of Psychiatry, University of Cincinnati (Cincinnati, OH, USA) to develop a consensus functional neuroanatomic model of bipolar I disorder based upon the participants' work as well as that of others. METHODS Representatives from several leading bipolar disorder neuroimaging groups were organized to present an overview of their areas of expertise as well as focused reviews of existing data. The workgroup then developed a consensus model of the functional neuroanatomy of bipolar disorder based upon these data. RESULTS Among the participants, a general consensus emerged that bipolar I disorder arises from abnormalities in the structure and function of key emotional control networks in the human brain. Namely, disruption in early development (e.g., white matter connectivity and prefrontal pruning) within brain networks that modulate emotional behavior leads to decreased connectivity among ventral prefrontal networks and limbic brain regions, especially the amygdala. This developmental failure to establish healthy ventral prefrontal-limbic modulation underlies the onset of mania and ultimately, with progressive changes throughout these networks over time and with affective episodes, a bipolar course of illness. CONCLUSIONS This model provides a potential substrate to guide future investigations and areas needing additional focus are identified.
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Affiliation(s)
- Stephen M Strakowski
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH 45267-0559, USA.
| | - Caleb M Adler
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Jorge Almeida
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh PA
| | - Lori L Altshuler
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, The David Geffen School of Medicine, University of California at Los Angeles,Department of Psychiatry, VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Hilary P Blumberg
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Kiki D Chang
- Pediatric Bipolar Disorders Research Program, Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Melissa P DelBello
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Sophia Frangou
- Section of Neurobiology of Psychosis, Department of Psychosis Studies, Institute of Psychiatry, King’s College, London
| | - Andrew McIntosh
- Division of Psychiatry, School of Molecular and Clinical Medicine, University of Edinburgh, Edinburgh
| | - Mary L Phillips
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh PA,Department of Psychological Medicine, Cardiff, UK
| | - Jessika E Sussman
- Division of Psychiatry, School of Molecular and Clinical Medicine, University of Edinburgh, Edinburgh
| | - Jennifer D Townsend
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, The David Geffen School of Medicine, University of California at Los Angeles
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221
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Liu J, Blond BN, van Dyck LI, Spencer L, Wang F, Blumberg HP. Trait and state corticostriatal dysfunction in bipolar disorder during emotional face processing. Bipolar Disord 2012; 14:432-41. [PMID: 22524493 PMCID: PMC3361579 DOI: 10.1111/j.1399-5618.2012.01018.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Convergent evidence supports limbic, anterior paralimbic, and prefrontal cortex (PFC) abnormalities in emotional processing in bipolar disorder (BD) and suggests that some abnormalities are mood-state dependent and others persist into euthymia. However, few studies have assessed elevated, depressed, and euthymic mood states while individuals processed emotional stimuli of varying valence to investigate trait- and state-related neural system responses. Here, regional brain responses to positive, negative, and neutral emotional stimuli were assessed in individuals with BD during elevated, depressed, and euthymic mood states. METHODS One hundred and thirty-four subjects participated in functional magnetic resonance imaging scanning while processing faces depicting happy, fearful, and neutral expressions: 76 with BD (18 in elevated mood states, 19 depressed, 39 euthymic) and 58 healthy comparison (HC) individuals. Analyses were performed for BD trait- and mood state-related features. RESULTS Ventral anterior cingulate cortex (VACC), orbitofrontal cortex (OFC), and ventral striatum responses to happy and neutral faces were decreased in the BD group, compared to the HC group, and were not influenced by mood state. Elevated mood states were associated with decreased right rostral PFC activation to fearful and neutral faces, and depression was associated with increased left OFC activation to fearful faces. CONCLUSIONS The findings suggest that abnormal VACC, OFC, and ventral striatum responses to happy and neutral stimuli are trait features of BD. Acute mood states may be associated with additional lateralized abnormalities of diminished right rostral PFC responses to fearful and neutral stimuli in elevated states and increased left OFC responses to fearful stimuli in depressed states.
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Affiliation(s)
- Jie Liu
- Department of Psychiatry, Yale School of Medicine, New Haven
| | | | | | - Linda Spencer
- Department of Psychiatry, Yale School of Medicine, New Haven
| | - Fei Wang
- Department of Psychiatry, Yale School of Medicine, New Haven
| | - Hilary P. Blumberg
- Department of Psychiatry, Yale School of Medicine, New Haven,Department of Diagnostic Radiology, Yale School of Medicine, New Haven,The Child Study Center, Yale School of Medicine, New Haven,Research Enhancement Award Program Depression Center, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
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222
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Kim P, Thomas LA, Rosen BH, Moscicki AM, Brotman MA, Zarate CA, Blair RJR, Pine DS, Leibenluft E. Differing amygdala responses to facial expressions in children and adults with bipolar disorder. Am J Psychiatry 2012; 169:642-9. [PMID: 22535257 PMCID: PMC3383787 DOI: 10.1176/appi.ajp.2012.11081245] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Child and adult bipolar patients show both behavioral deficits in face emotion processing and abnormal amygdala activation. However, amygdala function in pediatric relative to adult bipolar patients has not been compared directly. The authors used functional MRI to compare amygdala activity during a face processing task in children and adults with bipolar disorder and in healthy comparison subjects. METHOD Amygdala responses to emotional facial expressions were examined in pediatric (N=18) and adult (N=17) bipolar patients and in healthy child (N=15) and adult (N=22) volunteers. Participants performed a gender identification task while viewing fearful, angry, and neutral faces. RESULTS In response to fearful faces, bipolar patients across age groups exhibited right amygdala hyperactivity relative to healthy volunteers. However, when responses to all facial expressions were combined, pediatric patients exhibited greater right amygdala activation than bipolar adults and healthy children. CONCLUSIONS Amygdala hyperactivity in response to fearful faces is present in both youths and adults with bipolar disorder. However, compared with bipolar adults and healthy child volunteers, pediatric bipolar patients showed amygdala hyperactivity in response to a broad array of emotional faces. Thus, abnormal amygdala activation during face processing appears to be more pervasive in children than in adults with bipolar disorder. Longitudinal studies are needed to elucidate the mechanisms of this developmental difference, thus facilitating developmentally sensitive diagnosis and treatment.
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223
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Discriminating unipolar and bipolar depression by means of fMRI and pattern classification: a pilot study. Eur Arch Psychiatry Clin Neurosci 2012. [PMID: 22639242 DOI: 10.1007/s00406-012-0329-4.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
Bipolar disorders rank among the most debilitating psychiatric diseases. Bipolar depression is often misdiagnosed as unipolar depression, leading to suboptimal therapy and poor outcomes. Discriminating unipolar and bipolar depression at earlier stages of illness could therefore help to facilitate efficient and specific treatment. In the present study, the neurobiological underpinnings of emotion processing were investigated in a sample of unipolar and bipolar depressed patients matched for age, gender, and depression severity by means of fMRI. A pattern-classification approach was employed to discriminate the two samples. The pattern classification yielded up to 90 % accuracy rates discriminating the two groups. According to the feature weights of the multivariate maps, medial prefrontal and orbitofrontal regions contributed to classifications specific to unipolar depression, whereas stronger feature weights in dorsolateral prefrontal areas contribute to classifications as bipolar. Strong feature weights were observed in the amygdala for the negative faces condition, which were specific to unipolar depression, whereas higher amygdala features weights during the positive faces condition were observed, specific to bipolar subjects. Standard univariate fMRI analysis supports an interpretation, where this might be related to a higher responsiveness, by yielding a significant emotion × group interaction within the bilateral amygdala. We conclude that pattern-classification techniques could be a promising tool to classify acutely depressed subjects as unipolar or bipolar. However, since the present approach deals with small sample sizes, it should be considered as a proof-of-concept study. Hence, results have to be confirmed in larger samples preferably of unmedicated subjects.
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224
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Strakowski SM, Adler CM, Almeida J, Altshuler LL, Blumberg HP, Chang KD, DelBello MP, Frangou S, McIntosh A, Phillips ML, Sussman JE, Townsend JD. The functional neuroanatomy of bipolar disorder: a consensus model. Bipolar Disord 2012. [PMID: 22631617 DOI: 10.1111/j.1399-5618.2012.01022.x.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Functional neuroimaging methods have proliferated in recent years, such that functional magnetic resonance imaging, in particular, is now widely used to study bipolar disorder. However, discrepant findings are common. A workgroup was organized by the Department of Psychiatry, University of Cincinnati (Cincinnati, OH, USA) to develop a consensus functional neuroanatomic model of bipolar I disorder based upon the participants' work as well as that of others. METHODS Representatives from several leading bipolar disorder neuroimaging groups were organized to present an overview of their areas of expertise as well as focused reviews of existing data. The workgroup then developed a consensus model of the functional neuroanatomy of bipolar disorder based upon these data. RESULTS Among the participants, a general consensus emerged that bipolar I disorder arises from abnormalities in the structure and function of key emotional control networks in the human brain. Namely, disruption in early development (e.g., white matter connectivity and prefrontal pruning) within brain networks that modulate emotional behavior leads to decreased connectivity among ventral prefrontal networks and limbic brain regions, especially the amygdala. This developmental failure to establish healthy ventral prefrontal-limbic modulation underlies the onset of mania and ultimately, with progressive changes throughout these networks over time and with affective episodes, a bipolar course of illness. CONCLUSIONS This model provides a potential substrate to guide future investigations and areas needing additional focus are identified.
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Affiliation(s)
- Stephen M Strakowski
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH 45267-0559, USA.
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225
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Cusi AM, Nazarov A, Holshausen K, MacQueen GM, McKinnon MC. Systematic review of the neural basis of social cognition in patients with mood disorders. J Psychiatry Neurosci 2012; 37:154-69. [PMID: 22297065 PMCID: PMC3341408 DOI: 10.1503/jpn.100179] [Citation(s) in RCA: 154] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND This review integrates neuroimaging studies of 2 domains of social cognition--emotion comprehension and theory of mind (ToM)--in patients with major depressive disorder and bipolar disorder. The influence of key clinical and method variables on patterns of neural activation during social cognitive processing is also examined. METHODS Studies were identified using PsycINFO and PubMed (January 1967 to May 2011). The search terms were "fMRI," "emotion comprehension," "emotion perception," "affect comprehension," "affect perception," "facial expression," "prosody," "theory of mind," "mentalizing" and "empathy" in combination with "major depressive disorder," "bipolar disorder," "major depression," "unipolar depression," "clinical depression" and "mania." RESULTS Taken together, neuroimaging studies of social cognition in patients with mood disorders reveal enhanced activation in limbic and emotion-related structures and attenuated activity within frontal regions associated with emotion regulation and higher cognitive functions. These results reveal an overall lack of inhibition by higher-order cognitive structures on limbic and emotion-related structures during social cognitive processing in patients with mood disorders. Critically, key variables, including illness burden, symptom severity, comorbidity, medication status and cognitive load may moderate this pattern of neural activation. LIMITATIONS Studies that did not include control tasks or a comparator group were included in this review. CONCLUSION Further work is needed to examine the contribution of key moderator variables and to further elucidate the neural networks underlying altered social cognition in patients with mood disorders. The neural networks under lying higher-order social cognitive processes, including empathy, remain unexplored in patients with mood disorders.
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Affiliation(s)
| | | | | | | | - Margaret C. McKinnon
- Correspondence to: M.C. McKinnon, Mood Disorders Program, St. Joseph’s Healthcare, 100 West 5th St., Box 585, Hamilton ON L8N 3K7;
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Stoy M, Schlagenhauf F, Sterzer P, Bermpohl F, Hägele C, Suchotzki K, Schmack K, Wrase J, Ricken R, Knutson B, Adli M, Bauer M, Heinz A, Ströhle A. Hyporeactivity of ventral striatum towards incentive stimuli in unmedicated depressed patients normalizes after treatment with escitalopram. J Psychopharmacol 2012; 26:677-88. [PMID: 21926423 DOI: 10.1177/0269881111416686] [Citation(s) in RCA: 181] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Major Depressive Disorder (MDD) involves deficits in the reward system. While neuroimaging studies have focused on affective stimulus processing, few investigations have directly addressed deficits in the anticipation of incentives. We examined neural responses during gain and loss anticipation in patients with MDD before and after treatment with a selective serotonin reuptake inhibitor (SSRI). Fifteen adults with MDD and 15 healthy participants, matched for age, verbal IQ and smoking habits, were investigated in a functional magnetic resonance imaging (fMRI) study using a monetary incentive delay task. Patients were scanned drug-free and after 6 weeks of open-label treatment with escitalopram; controls were scanned twice at corresponding time points. We compared the blood oxygenation level dependent (BOLD) response during the anticipation of gain and loss with a neutral condition. A repeated measures ANOVA was calculated to identify effects of group (MDD vs. controls), time (first vs. second scan) and group-by-time interaction. Severity of depression was measured with the Hamilton Rating Scale of Depression and the Beck Depression Inventory. MDD patients showed significantly less ventral striatal activation during anticipation of gain and loss compared with controls before, but not after, treatment. There was a significant group-by-time interaction during anticipation of loss in the left ventral striatum due to a signal increase in patients after treatment. Ventral striatal hyporesponsiveness was associated with the severity of depression and in particular anhedonic symptoms. These findings suggest that MDD patients show ventral striatal hyporesponsiveness during incentive cue processing, which normalizes after successful treatment.
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Affiliation(s)
- Meline Stoy
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany.
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227
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Prefrontal cortical response to emotional faces in individuals with major depressive disorder in remission. Psychiatry Res 2012; 202:30-7. [PMID: 22595508 PMCID: PMC3995357 DOI: 10.1016/j.pscychresns.2011.11.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Revised: 10/27/2011] [Accepted: 11/02/2011] [Indexed: 11/22/2022]
Abstract
Abnormalities in the response of the orbitofrontal cortex (OFC) and dorsolateral prefrontal cortex (DLPFC) to negative emotional stimuli have been reported in acutely depressed patients. However, there is a paucity of studies conducted in unmedicated individuals with major depressive disorder in remission (rMDD) to assess whether these are trait abnormalities. To address this issue, 19 medication-free rMDD individuals and 20 healthy comparison (HC) participants were scanned using functional magnetic resonance imaging while performing an implicit emotion processing task in which they labeled the gender of faces depicting negative (fearful), positive (happy) and neutral facial expressions. The rMDD and HC groups were compared using a region-of-interest approach for two contrasts: fear vs. neutral and happy vs. neutral. Relative to HC, rMDD showed reduced activation in left OFC and DLPFC to fearful (vs. neutral) faces. Right DLPFC activation to fearful (vs. neutral) faces in the rMDD group showed a significant positive correlation with duration of euthymia. The findings support deficits in left OFC and DLPFC responses to negative emotional stimuli during euthymic periods of MDD, which may reflect trait markers of the illness or a 'scar' due to previous depression. Recovery may also be associated with compensatory increases in right DLPFC functioning.
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228
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Bediou B, Brunelin J, d'Amato T, Fecteau S, Saoud M, Hénaff MA, Krolak-Salmon P. A comparison of facial emotion processing in neurological and psychiatric conditions. Front Psychol 2012; 3:98. [PMID: 22493587 PMCID: PMC3318183 DOI: 10.3389/fpsyg.2012.00098] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Accepted: 03/16/2012] [Indexed: 11/21/2022] Open
Abstract
Patients suffering from various neurological and psychiatric disorders show different levels of facial emotion recognition (FER) impairment, sometimes from the early phases of the disease. Investigating the relative severity of deficits in FER across different clinical and high-risk populations has potential implications for the diagnosis and treatment of these diseases, and could also allow us to understand the neurobiological mechanisms of emotion perception itself. To investigate the role of the dopaminergic system and of the frontotemporal network in FER, we reanalyzed and compared data from four of our previous studies investigating FER performance in patients with frontotemporal dysfunctions and/or dopaminergic system abnormalities at different stages. The performance of patients was compared to the performance obtained by a specific group of matched healthy controls using Cohen’s d effect size. We thus compared emotion and gender recognition in patients with frontotemporal dementia (FTD), amnestic mild cognitive impairment (aMCI), Alzheimer’s disease (AD) at the mild dementia stage, major depressive disorder, Parkinson’s disease treated by l-DOPA (PD-ON) or not (PD-OFF), remitted schizophrenia (SCZ-rem), first-episode schizophrenia treated by antipsychotic medication (SCZ-ON), and drug-naïve first-episode schizophrenia (SCZ-OFF), as well as in unaffected siblings of patients with schizophrenia (SIB). The analyses revealed a pattern of differential impairment of emotion (but not gender) recognition across pathological conditions. On the one hand, dopaminergic medication seems not to modify the moderate deficits observed in SCZ and PD groups (ON vs. OFF), suggesting that the deficit is independent from the dopaminergic system. On the other hand, the observed increase in effect size of the deficit among the aMCI, AD, and FTD groups (and also among the SIB and SCZ-rem groups) suggests that the deficit is dependent on neurodegeneration of the frontotemporal neural networks. Our transnosographic approach combining clinical and high-risk populations with the impact of medication provides new information on the trajectory of impaired emotion perception in neuropsychiatric conditions, and on the role of the dopaminergic system and the frontotemporal network in emotion perception.
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229
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Woudstra S, Bochdanovits Z, van Tol MJ, Veltman DJ, Zitman FG, van Buchem MA, van der Wee NJ, Opmeer EM, Demenescu LR, Aleman A, Penninx BW, Hoogendijk WJ. Piccolo genotype modulates neural correlates of emotion processing but not executive functioning. Transl Psychiatry 2012; 2:e99. [PMID: 22832909 PMCID: PMC3337071 DOI: 10.1038/tp.2012.29] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Major depressive disorder (MDD) is characterized by affective symptoms and cognitive impairments, which have been associated with changes in limbic and prefrontal activity as well as with monoaminergic neurotransmission. A genome-wide association study implicated the polymorphism rs2522833 in the piccolo (PCLO) gene--involved in monoaminergic neurotransmission--as a risk factor for MDD. However, the role of the PCLO risk allele in emotion processing and executive function or its effect on their neural substrate has never been studied. We used functional magnetic resonance imaging (fMRI) to investigate PCLO risk allele carriers vs noncarriers during an emotional face processing task and a visuospatial planning task in 159 current MDD patients and healthy controls. In PCLO risk allele carriers, we found increased activity in the left amygdala during processing of angry and sad faces compared with noncarriers, independent of psychopathological status. During processing of fearful faces, the PCLO risk allele was associated with increased amygdala activation in MDD patients only. During the visuospatial planning task, we found no genotype effect on performance or on BOLD signal in our predefined areas as a function of increasing task load. The PCLO risk allele was found to be specifically associated with altered emotion processing, but not with executive dysfunction. Moreover, the PCLO risk allele appears to modulate amygdala function during fearful facial processing in MDD and may constitute a possible link between genotype and susceptibility for depression via altered processing of fearful stimuli. The current results may therefore aid in better understanding underlying neurobiological mechanisms in MDD.
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Affiliation(s)
- S Woudstra
- Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands.
| | - Z Bochdanovits
- Department of Medical Genomics, VU University Medical Center, Amsterdam, The Netherlands,Neuroscience Campus Amsterdam, VU University, Amsterdam, The Netherlands
| | - M-J van Tol
- BCN Neuroimaging Center and Department of Neuroscience, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands,Leibniz Institute for Neurobiology, Otto von Guericke University, Magdeburg, Germany
| | - D J Veltman
- Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands,Neuroscience Campus Amsterdam, VU University, Amsterdam, The Netherlands
| | - F G Zitman
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - M A van Buchem
- Leiden Institute for Brain and Cognition, Leiden University, Leiden, The Netherlands,Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - N J van der Wee
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands,Leiden Institute for Brain and Cognition, Leiden University, Leiden, The Netherlands
| | - E M Opmeer
- BCN Neuroimaging Center and Department of Neuroscience, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - L R Demenescu
- BCN Neuroimaging Center and Department of Neuroscience, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands,Department of Psychiatry and Psychotherapy, RWTH Aachen University, Aachen, Germany
| | - A Aleman
- BCN Neuroimaging Center and Department of Neuroscience, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands,Department of Psychology, University of Groningen, Groningen, The Netherlands
| | - B W Penninx
- Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands,Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands,Neuroscience Campus Amsterdam, VU University, Amsterdam, The Netherlands,BCN Neuroimaging Center and Department of Neuroscience, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - W J Hoogendijk
- Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands,Neuroscience Campus Amsterdam, VU University, Amsterdam, The Netherlands,Department of Psychiatry, Erasmus MC, Rotterdam, The Netherlands
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230
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Hulvershorn LA, Karne H, Gunn AD, Hartwick SL, Wang Y, Hummer TA, Anand A. Neural activation during facial emotion processing in unmedicated bipolar depression, euthymia, and mania. Biol Psychiatry 2012; 71:603-10. [PMID: 22206876 PMCID: PMC3703667 DOI: 10.1016/j.biopsych.2011.10.038] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Revised: 10/10/2011] [Accepted: 10/29/2011] [Indexed: 11/27/2022]
Abstract
BACKGROUND Studies incorporating direct comparisons across all phases of bipolar (BP) disorder are needed to elucidate the pathophysiology of bipolar disorder. However, functional neuroimaging studies that differentiate bipolar mood states from each other and from healthy subjects are few and have yielded inconsistent findings. METHODS One hundred five unmedicated adults were recruited: 30 with current bipolar depression (BPD), 30 with current bipolar hypomania or mania (BPM), 15 bipolar euthymic (BPE), and 30 healthy control subjects (HC). All subjects were diagnosed with DSM-IV BP (type I or II) using a structured clinical interview. Groups were age- and gender-ratio matched. In 3T functional magnetic resonance imaging experiments, subjects completed a negative facial emotion matching task. RESULTS Bipolar euthymic and BPD groups exhibited increased amygdala activation compared with HCs in response to the negative faces; however, in the BPM group, this increase was not seen. Conversely, both BPE and BPM groups had increased activation in the insula relative to HCs, but in the BPD group, this effect was not seen. All three BP groups exhibited increased activation of the putamen compared with HCs. In the cortical areas, the BPM group exhibited decreased left lateral orbitofrontal cortex activation compared with both BPEs and HCs, increased dorsal anterior cingulate cortex activation compared with the BPD group, and increased dorsolateral prefrontal cortical activation compared with all other groups. CONCLUSIONS Both state- and trait-related abnormalities in corticolimbic activation were seen in response to the negative facial emotion processing in a large sample of unmedicated adults across BP mood states.
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Affiliation(s)
- Leslie A Hulvershorn
- Mood and Emotion Disorders Across the Lifespan Center, Department of Psychiatry, Indiana University School of Medicine, Indianapolis, USA
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231
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Mullin BC, Perlman SB, Versace A, de Almeida JRC, Labarbara EJ, Klein C, Ladouceur CD, Phillips ML. An fMRI study of attentional control in the context of emotional distracters in euthymic adults with bipolar disorder. Psychiatry Res 2012; 201:196-205. [PMID: 22510433 PMCID: PMC3361638 DOI: 10.1016/j.pscychresns.2011.09.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2011] [Revised: 08/08/2011] [Accepted: 09/02/2011] [Indexed: 11/23/2022]
Abstract
Inability to modulate attention away from emotional stimuli may be a key component of dysregulated emotion in bipolar disorder (BD). Previous studies of BD indicate abnormalities in neural circuitry underlying attentional control, yet few studies examined attentional control in the context of emotional distracters. We compared activity and connectivity in neural circuitry supporting attentional control and emotion processing among 22 individuals with BD type 1, currently remitted and euthymic, and 19 healthy controls. Participants performed an emotional n-back paradigm, comprising high and low attentional demand conditions, each with either emotional (happy, fearful), neutral or no face flanker distracters. During the high attentional control demand conditions without emotional distracters, BD individuals showed reduced activity relative to controls in dorsolateral prefrontal cortex, dorsal anterior cingulate cortex (dACC), and inferior parietal cortex. During the high attentional control demand conditions with fearful-face distracters, BD individuals showed greater activity than controls in these regions and amygdala and striatum. Relative to controls, BD individuals also showed abnormal patterns of effective connectivity between dACC and amygdala during high attentional control demand with emotional face distracters. Inter-episode bipolar disorder is characterized by abnormal recruitment of attentional control neural circuitry, especially in the context of emotionally distracting information.
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Affiliation(s)
- Benjamin C Mullin
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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232
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Tanaka Y, Ishitobi Y, Maruyama Y, Kawano A, Ando T, Okamoto S, Kanehisa M, Higuma H, Ninomiya T, Tsuru J, Hanada H, Kodama K, Isogawa K, Akiyoshi J. Salivary alpha-amylase and cortisol responsiveness following electrical stimulation stress in major depressive disorder patients. Prog Neuropsychopharmacol Biol Psychiatry 2012; 36:220-4. [PMID: 22063648 DOI: 10.1016/j.pnpbp.2011.10.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Revised: 09/10/2011] [Accepted: 10/07/2011] [Indexed: 10/15/2022]
Abstract
Major depressive disorder (MDD) is often associated with dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis by chronic stress. In comparison, psychosocial stress-induced activation of salivary α-amylase (sAA) functions as a marker of sympathoadrenal medullary system (SAM) activity. However, in contrast to salivary cortisol, sAA has been less extensively studied in MDD patients. The present study measured sAA and salivary cortisol levels in patients with MDD. The authors determined Profile of Mood State (POMS) and State-Trait anxiety Inventory (STAI) scores, Heart Rate Variability (HRV), and sAA and salivary cortisol levels in 88 patients with MDD and 41 healthy volunteers following the application of electrical stimulation stress. Patients with major depressive disorder were 8 points or more on Hamilton Depression Scale (HAM-D) scores. Tension-Anxiety, Depression-Dejection, Anger-Hostility, Fatigue, and Confusion scores in patients with major depressive disorder were significantly increased compared to healthy controls. In contrast, Vigor scores in patients with MDD were significantly decreased compared with healthy controls. There was no difference in heart rate variability measures between MDD patients and healthy controls. The threshold of electrical stimulation applied in MDD patients was lower than that in healthy controls. SAA levels in female MDD patients were significantly elevated relative to controls both before and after electrical stimulation. Finally, there were no differences in salivary cortisol levels between major depressive patients and controls. In the present study only three time points were explored. Furthermore, the increased secretion of sAA before and after stimulation could allude to an increased responsiveness of novel and uncontrollable situations in patients with MDD. These preliminary results suggest that sAA might be a useful biological marker of MDD.
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Affiliation(s)
- Yoshihiro Tanaka
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Hasama-Machi, Oita 879-5593, Japan
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233
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Voxel based morphometric and diffusion tensor imaging analysis in male bipolar patients with first-episode mania. Prog Neuropsychopharmacol Biol Psychiatry 2012; 36:231-8. [PMID: 22119745 DOI: 10.1016/j.pnpbp.2011.11.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Revised: 10/18/2011] [Accepted: 11/05/2011] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Structural abnormality of both gray and white matter has been detected in patients with bipolar disorder (BD). But results were greatly inconsistent across studies which were most likely attributed to heterogeneous populations as well as processing techniques. The present study aimed to investigate brain structural and microstructural alterations in a relative homogenous sample of bipolar mania. METHODS 3D T1-weighted magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI) were conducted in 18 patients with BD and 27 healthy volunteers. Gray matter (GM) and white matter (WM) differences were evaluated using voxel-based morphometry (VBM) and voxel-based analysis of fractional anisotropy (FA) maps derived from DTI, respectively. RESULTS Patients with BD had a larger volume of GM in the left thalamus and bilateral basal ganglia, including the bilateral putamen and extending to the left claustrum, as well as reduced FA values in the left posterior corona radiata. CONCLUSIONS By combined analysis, alterations in subcortical GM areas and part of the corresponding association fiber area were detected. Compared with observations in homogeneous samples, our findings indicate that disruption of the limbic network may be intrinsic to BD.
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234
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Olsavsky AK, Brotman MA, Rutenberg JG, Muhrer EJ, Deveney CM, Fromm SJ, Towbin K, Pine DS, Leibenluft E. Amygdala hyperactivation during face emotion processing in unaffected youth at risk for bipolar disorder. J Am Acad Child Adolesc Psychiatry 2012; 51:294-303. [PMID: 22365465 PMCID: PMC3292775 DOI: 10.1016/j.jaac.2011.12.008] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Revised: 12/06/2011] [Accepted: 12/07/2011] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Youth at familial risk for bipolar disorder (BD) show deficits in face emotion processing, but the neural correlates of these deficits have not been examined. This preliminary study tests the hypothesis that, relative to healthy comparison (HC) subjects, both BD subjects and youth at risk for BD (i.e., those with a first-degree BD relative) will demonstrate amygdala hyperactivation when viewing fearful and happy faces. The at-risk youth were unaffected, in that they had no history of mood disorder. METHOD Amygdala activity was examined in 101 unrelated participants, 8 to 18 years old. Age, gender, and IQ-matched groups included BD (N = 32), unaffected at-risk (N = 13), and HC (N = 56). During functional magnetic resonance imaging, participants attended to emotional and nonemotional aspects of fearful and happy faces. RESULTS While rating their fear of fearful faces, both BD and unaffected at-risk subjects exhibited amygdala hyperactivity versus HC. There were no between-group differences in amygdala activity in response to happy faces. Post-hoc comparisons revealed that, in at-risk youth, familial risk status (offspring versus sibling), presence of Axis I diagnosis (n = 1 attention-deficit/hyperactivity disorder [ADHD], n = 1 social phobia), and history of medication exposure (n = 1) did not influence imaging findings. CONCLUSIONS We found amygdala hyperactivation in both unaffected at-risk and BD youth while rating their fear of fearful faces. These pilot data suggest that both face emotion labeling deficits and amygdala hyperactivity during face processing should receive further study as potential BD endophenotypes. Longitudinal studies should test whether amygdala hyperactivity to fearful faces predicts conversion to BD in at-risk youth.
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Affiliation(s)
- Aviva K. Olsavsky
- Section on Bipolar Spectrum Disorders, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, US Department of Health and Human Services, Bethesda, Maryland,David Geffen School of Medicine at the University of California Los Angeles
| | - Melissa A. Brotman
- Section on Bipolar Spectrum Disorders, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, US Department of Health and Human Services, Bethesda, Maryland
| | - Julia G. Rutenberg
- Section on Bipolar Spectrum Disorders, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, US Department of Health and Human Services, Bethesda, Maryland
| | - Eli J. Muhrer
- Section on Bipolar Spectrum Disorders, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, US Department of Health and Human Services, Bethesda, Maryland
| | - Christen M. Deveney
- Section on Bipolar Spectrum Disorders, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, US Department of Health and Human Services, Bethesda, Maryland
| | - Stephen J. Fromm
- Section on Bipolar Spectrum Disorders, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, US Department of Health and Human Services, Bethesda, Maryland
| | - Kenneth Towbin
- Section on Bipolar Spectrum Disorders, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, US Department of Health and Human Services, Bethesda, Maryland
| | - Daniel S. Pine
- Section on Bipolar Spectrum Disorders, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, US Department of Health and Human Services, Bethesda, Maryland
| | - Ellen Leibenluft
- Section on Bipolar Spectrum Disorders, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, US Department of Health and Human Services, Bethesda, Maryland
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235
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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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Risk or resilience? Empathic abilities in patients with bipolar disorders and their first-degree relatives. J Psychiatr Res 2012; 46:382-8. [PMID: 22133461 DOI: 10.1016/j.jpsychires.2011.11.006] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2011] [Revised: 11/11/2011] [Accepted: 11/14/2011] [Indexed: 02/02/2023]
Abstract
Endophenotypes are intermediate phenotypes which are considered a more promising marker of genetic risk than illness itself. While previous research mostly used cognitive deficits, emotional functions are of greater relevance for bipolar disorder regarding the characteristic emotional hyper-reactability and deficient social-emotional competence. Hence, the aim of the present study was to clarify whether empathic abilities can serve as a possible endophenotype of bipolar disorder by applying a newly developed task in bipolar patients and their first-degree relatives. Three components of empathy (emotion recognition, perspective taking and affective responsiveness) have been assessed in a sample of 21 bipolar patients, 21 first-degree relatives and 21 healthy controls. Data analysis indicated significant differences between controls and patients for emotion recognition and affective responsiveness but not for perspective taking. This shows that in addition to difficulties in recognizing facial emotional expressions, bipolar patients have difficulties in identifying emotions they would experience in a given situation. However, the ability to take the perspective of another person in an emotional situation was intact but decreased with increasing severity of residual hypomanic and depressive symptoms. Relatives performed comparably bad on emotion recognition but did not differ from controls or patients in affective responsiveness. This study is the first to show that deficient emotion recognition is the only component of empathy which forms a possible endophenotype of bipolar disorder. This has important implications for prevention strategies. Furthermore, changes in affective responsiveness in first-degree relatives show a potential resilience marker.
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237
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Cousins DA, Grunze H. Interpreting magnetic resonance imaging findings in bipolar disorder. CNS Neurosci Ther 2012; 18:201-7. [PMID: 22449107 PMCID: PMC6493435 DOI: 10.1111/j.1755-5949.2011.00280.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Revised: 06/13/2011] [Accepted: 08/04/2011] [Indexed: 02/05/2023] Open
Abstract
The episodic nature of bipolar disorder together with the ostensibly polar extremes of mania and depression have favored the acceptance of a functional model postulating regionally disturbed brain activity returning to normal with time or treatment. Seemingly contrary to that view, anatomical imaging studies have demonstrated abnormalities in brain structure which could reflect neurodegeneration or represent disturbed neuronal development. Resolution may come from an appreciation of adult neurogenesis, especially given the neuroprotective properties of drugs, such as lithium and their effects on brain volume. The brain regions vulnerable to structural changes also show evidence of dysfunction, giving rise to corticolimbic dysregulation interpretations of bipolar disorder. This article reviews the structural and functional magnetic resonance imaging data in bipolar disorder. Its focus is on the interpretation of findings in light of recent developments in the fields of neurobiology and image analysis, with particular attention paid to both the confounding effects of medication and the baseline energy state of the brain.
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Affiliation(s)
- David A Cousins
- Newcastle Magnetic Resonance Centre, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK.
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238
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Perlman SB, Almeida JRC, Kronhaus DM, Versace A, LaBarbara EJ, Klein CR, Phillips ML. Amygdala activity and prefrontal cortex-amygdala effective connectivity to emerging emotional faces distinguish remitted and depressed mood states in bipolar disorder. Bipolar Disord 2012; 14:162-74. [PMID: 22420592 PMCID: PMC3703524 DOI: 10.1111/j.1399-5618.2012.00999.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Few studies have employed effective connectivity (EC) to examine the functional integrity of neural circuitry supporting abnormal emotion processing in bipolar disorder (BD), a key feature of the illness. We used Granger Causality Mapping (GCM) to map EC between the prefrontal cortex (PFC) and bilateral amygdala and a novel paradigm to assess emotion processing in adults with BD. METHODS Thirty-one remitted adults with BD [(remitted BD), mean age = 32 years], 21 adults with BD in a depressed episode [(depressed BD), mean age = 33 years], and 25 healthy control participants [(HC), mean age = 31 years] performed a block-design emotion processing task requiring color-labeling of a color flash superimposed on a task-irrelevant face morphing from neutral to emotional (happy, sad, angry, or fearful). GCM measured EC preceding (top-down) and following (bottom-up) activity between the PFC and the left and right amygdalae. RESULTS Our findings indicated patterns of abnormally elevated bilateral amygdala activity in response to emerging fearful, sad, and angry facial expressions in remitted-BD subjects versus HC, and abnormally elevated right amygdala activity to emerging fearful faces in depressed-BD subjects versus HC. We also showed distinguishable patterns of abnormal EC between the amygdala and dorsomedial and ventrolateral PFC, especially to emerging happy and sad facial expressions in remitted-BD and depressed-BD subjects. DISCUSSION EC measures of neural system level functioning can further understanding of neural mechanisms associated with abnormal emotion processing and regulation in BD. Our findings suggest major differences in recruitment of amygdala-PFC circuitry, supporting implicit emotion processing between remitted-BD and depressed-BD subjects, which may underlie changes from remission to depression in BD.
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Affiliation(s)
- Susan B Perlman
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
| | - Jorge RC Almeida
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Dina M Kronhaus
- St. Catherine’s College and Computer Laboratory, University of Cambridge, Cambridge
| | - Amelia Versace
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Edmund J LaBarbara
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Crystal R Klein
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Mary L Phillips
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA,Department of Psychological Medicine, Cardiff University, Cardiff, UK
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239
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Hulvershorn LA, Cullen K, Anand A. Toward dysfunctional connectivity: a review of neuroimaging findings in pediatric major depressive disorder. Brain Imaging Behav 2012; 5:307-28. [PMID: 21901425 DOI: 10.1007/s11682-011-9134-3] [Citation(s) in RCA: 123] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Child and adolescent psychiatric neuroimaging research typically lags behind similar advances in adult disorders. While the pediatric depression imaging literature is less developed, a recent surge in interest has created the need for a synthetic review of this work. Major findings from pediatric volumetric and functional magnetic resonance imaging (fMRI), magnetic resonance spectroscopy (MRS), diffusion tensor imaging (DTI) and resting state functional connectivity studies converge to implicate a corticolimbic network of key areas that work together to mediate the task of emotion regulation. Imaging the brain of children and adolescents with unipolar depression began with volumetric studies of isolated brain regions that served to identify key prefrontal, cingulate and limbic nodes of depression-related circuitry elucidated from more recent advances in DTI and functional connectivity imaging. Systematic review of these studies preliminarily suggests developmental differences between findings in youth and adults, including prodromal neurobiological features, along with some continuity across development.
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Affiliation(s)
- Leslie A Hulvershorn
- Mood and Emotional Disorders Across the Lifespan Center, Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA.
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240
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Mourão-Miranda J, Oliveira L, Ladouceur CD, Marquand A, Brammer M, Birmaher B, Axelson D, Phillips ML. Pattern recognition and functional neuroimaging help to discriminate healthy adolescents at risk for mood disorders from low risk adolescents. PLoS One 2012; 7:e29482. [PMID: 22355302 PMCID: PMC3280237 DOI: 10.1371/journal.pone.0029482] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Accepted: 11/29/2011] [Indexed: 11/20/2022] Open
Abstract
Introduction There are no known biological measures that accurately predict future development of psychiatric disorders in individual at-risk adolescents. We investigated whether machine learning and fMRI could help to: 1. differentiate healthy adolescents genetically at-risk for bipolar disorder and other Axis I psychiatric disorders from healthy adolescents at low risk of developing these disorders; 2. identify those healthy genetically at-risk adolescents who were most likely to develop future Axis I disorders. Methods 16 healthy offspring genetically at risk for bipolar disorder and other Axis I disorders by virtue of having a parent with bipolar disorder and 16 healthy, age- and gender-matched low-risk offspring of healthy parents with no history of psychiatric disorders (12–17 year-olds) performed two emotional face gender-labeling tasks (happy/neutral; fearful/neutral) during fMRI. We used Gaussian Process Classifiers (GPC), a machine learning approach that assigns a predictive probability of group membership to an individual person, to differentiate groups and to identify those at-risk adolescents most likely to develop future Axis I disorders. Results Using GPC, activity to neutral faces presented during the happy experiment accurately and significantly differentiated groups, achieving 75% accuracy (sensitivity = 75%, specificity = 75%). Furthermore, predictive probabilities were significantly higher for those at-risk adolescents who subsequently developed an Axis I disorder than for those at-risk adolescents remaining healthy at follow-up. Conclusions We show that a combination of two promising techniques, machine learning and neuroimaging, not only discriminates healthy low-risk from healthy adolescents genetically at-risk for Axis I disorders, but may ultimately help to predict which at-risk adolescents subsequently develop these disorders.
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241
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Hamilton JP, Chen MC, Gotlib IH. Neural systems approaches to understanding major depressive disorder: an intrinsic functional organization perspective. Neurobiol Dis 2012; 52:4-11. [PMID: 23477309 DOI: 10.1016/j.nbd.2012.01.015] [Citation(s) in RCA: 204] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Revised: 01/17/2012] [Accepted: 01/26/2012] [Indexed: 11/27/2022] Open
Abstract
Recent research detailing the intrinsic functional organization of the brain provides a unique and useful framework to gain a better understanding of the neural bases of Major Depressive Disorder (MDD). In this review, we first present a brief history of neuroimaging research that has increased our understanding of the functional macro-architecture of the brain. From this macro-architectural perspective, we examine the extant body of functional neuroimaging research assessing MDD with a specific emphasis on the contributions of default-mode, executive, and salience networks in this debilitating disorder. Next, we describe recent investigations conducted in our laboratory in which we explicitly adopt a neural-system perspective in examining the relations among these networks in MDD. Finally, we offer directions for future research that we believe will facilitate the development of more detailed and integrative models of neural dysfunction in depression.
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Affiliation(s)
- J Paul Hamilton
- Department of Psychology, Stanford University, Stanford, CA 94305, USA
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242
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Delvecchio G, Fossati P, Boyer P, Brambilla P, Falkai P, Gruber O, Hietala J, Lawrie SM, Martinot JL, McIntosh AM, Meisenzahl E, Frangou S. Common and distinct neural correlates of emotional processing in Bipolar Disorder and Major Depressive Disorder: a voxel-based meta-analysis of functional magnetic resonance imaging studies. Eur Neuropsychopharmacol 2012; 22:100-13. [PMID: 21820878 DOI: 10.1016/j.euroneuro.2011.07.003] [Citation(s) in RCA: 172] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2011] [Revised: 06/16/2011] [Accepted: 07/06/2011] [Indexed: 01/25/2023]
Abstract
Neuroimaging studies have consistently shown functional brain abnormalities in patients with Bipolar Disorder (BD) and Major Depressive Disorder (MDD). However, the extent to which these two disorders are associated with similar or distinct neural changes remains unclear. We conducted a systematic review of functional magnetic resonance imaging studies comparing BD and MDD patients to healthy participants using facial affect processing paradigms. Relevant spatial coordinates from twenty original studies were subjected to quantitative Activation Likelihood Estimation meta-analyses based on 168 BD and 189 MDD patients and 344 healthy controls. We identified common and distinct patterns of neural engagement for BD and MDD within the facial affect processing network. Both disorders were associated with increased engagement of limbic regions. Diagnosis-specific differences were observed in cortical, thalamic and striatal regions. Decreased ventrolateral prefrontal cortical engagement was associated with BD while relative hypoactivation of the sensorimotor cortices was seen in MDD. Increased responsiveness in the thalamus and basal ganglia were associated with BD. These findings were modulated by stimulus valence. These data suggest that whereas limbic overactivation is reported consistently in patients with mood disorders, future research should consider the relevance of a wider network of regions in formulating conceptual models of BD and MDD.
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Affiliation(s)
- Giuseppe Delvecchio
- European College of Neuropsychopharmacology, Networks Initiative, Neuroimaging Network, London, UK
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Barbour T, Pruitt P, Diwadkar VA. fMRI responses to emotional faces in children and adolescents at genetic risk for psychiatric illness share some of the features of depression. J Affect Disord 2012; 136:276-85. [PMID: 22222174 PMCID: PMC5166711 DOI: 10.1016/j.jad.2011.11.036] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Accepted: 11/17/2011] [Indexed: 01/23/2023]
Abstract
BACKGROUND Fronto-limbic regions of the brain including the sub-genual (sgPFC) and medial prefrontal (mPFC) cortices are central to processing emotionally salient and hedonic stimuli (Mayberg, 2009) and implicated in depression. The relevance of cortico-limbic models of emotion and reward processing in children with genetic risk for psychiatric disorders has not been assessed. METHODS Here we studied adolescents at risk for schizophrenia (HRS) and controls (HC) using an event-related fMRI continuous affective appraisal task. HRS were divided into sub-groups based on the presence or absence of negative symptoms (Miller et al., 2003), HRS_NS+ and HRS_NS- respectively. Brain responses to positive, negative and neutral emotional stimuli were estimated. RESULTS Consistent with observations in the depressive phenotype, for positively valenced stimuli, HRS_NS+ (relative to HC and HRS_NS-) were characterized by hypo-responsivity of the sgPFC and the mPFC, but hyper-responsivity of the mid-brain. sgPFC and mPFC signals were coupled across groups. LIMITATIONS Such studies can benefit from larger sample sizes, though our observed effect sizes were in the moderate to large range. CONCLUSIONS Children and adolescents at risk for psychiatric illness and who evince reliably present negative symptoms show brain responses to socially rewarding stimuli similar to those observed in depression. Studies in at-risk children and adolescents may be important in understanding how early manifestations of depression-like characteristics impact brain function.
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Affiliation(s)
- Tracy Barbour
- Psychiatry & Behavioral Neuroscience, Wayne State University SOM
| | - Patrick Pruitt
- Psychiatry & Behavioral Neuroscience, Wayne State University SOM
| | - Vaibhav A. Diwadkar
- Psychiatry & Behavioral Neuroscience, Wayne State University SOM
- Address Correspondence: Vaibhav A. Diwadkar, PhD, Assistant Professor, Division of Brain Research & Imaging Neuroscience, Dept of Psychiatry & Behavioral Neuroscience, Wayne State University School of Medicine, UHC 9B, 4201 St. Antoine Blvd., Detroit MI 48201, , Ph: 313.577.0164, Fax: 313.577.5900
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Leboyer M, Fossati P. [Can we identify biomarkers in bipolar depression? From imaging to biology]. Encephale 2012; 37 Suppl 3:S185-90. [PMID: 22212873 DOI: 10.1016/s0013-7006(11)70051-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Biomarkers can be used to describe and quantify a biological process related to pathology or to the effect of a treatment. In bipolar depression, progresses in the fields of structural and functional imaging, but also in biological research help to identify such biomarkers. Results in structural imaging are heterogeneous. Using functional imaging, in bipolar depression we can identify an hyperactivity of limbic and striatal regions with a specific implication of the lateral part of the orbito-frontal cortex. Bipolar depression is also associated with a modification of neurotrophic factors and of factors involved in the inflammatory process. Modifications in circadian rhythms have also be described but their level of specificity have to be demonstrated. The identification of biomarkers for bipolar depression seems to be an interesting field, but it still remains in the domain of research.
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Affiliation(s)
- M Leboyer
- Université Paris-Est, faculté de médecine, UMR-S 955, Créteil, F-94010, France.
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245
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Roiser JP, Elliott R, Sahakian BJ. Cognitive mechanisms of treatment in depression. Neuropsychopharmacology 2012; 37:117-36. [PMID: 21976044 PMCID: PMC3238070 DOI: 10.1038/npp.2011.183] [Citation(s) in RCA: 354] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Revised: 08/04/2011] [Accepted: 08/04/2011] [Indexed: 12/16/2022]
Abstract
Cognitive abnormalities are a core feature of depression, and biases toward negatively toned emotional information are common, but are they a cause or a consequence of depressive symptoms? Here, we propose a 'cognitive neuropsychological' model of depression, suggesting that negative information processing biases have a central causal role in the development of symptoms of depression, and that treatments exert their beneficial effects by abolishing these biases. We review the evidence pertaining to this model: briefly with respect to currently depressed patients, and in more detail with respect to individuals at risk for depression and the effects of antidepressant treatments. As well as being present in currently depressed individuals, negative biases are detectable in those vulnerable for depression due to neuroticism, genetic risk, or previous depressive illness. Recent evidence provides strong support for the notion that both antidepressant drugs and psychological therapies modify negative biases, providing a common mechanism for understanding treatments for depression. Intriguingly, it may even be possible to predict which patients will benefit most from which treatments on the basis of neural responses to negative stimuli. However, further research is required to ascertain whether negative processing biases will be useful in predicting, detecting, and treating depression, and hence in preventing a chronic, relapsing course of illness.
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246
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Self-referential thinking, suicide, and function of the cortical midline structures and striatum in mood disorders: possible implications for treatment studies of mindfulness-based interventions for bipolar depression. DEPRESSION RESEARCH AND TREATMENT 2012; 2012:246725. [PMID: 21961061 PMCID: PMC3180071 DOI: 10.1155/2012/246725] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/02/2011] [Revised: 07/28/2011] [Accepted: 07/29/2011] [Indexed: 12/30/2022]
Abstract
Bipolar depression is often refractory to treatment and is frequently associated with anxiety symptoms and elevated suicide risk. There is a great need for adjunctive psychotherapeutic interventions. Treatments with effectiveness for depressive and anxiety symptoms as well as suicide-related thoughts and behaviors would be particularly beneficial. Mindfulness-based interventions hold promise, and studies of these approaches for bipolar disorder are warranted. The aim of this paper is to provide a conceptual background for such studies by reviewing key findings from diverse lines of investigation. Results of that review indicate that cortical midline structures (CMS) appear to link abnormal self-referential thinking to emotional dysregulation in mood disorders. Furthermore, CMS and striatal dysfunction may play a role in the neuropathology underlying suicide-related thoughts and behaviors. Thus, combining studies of mindfulness interventions targeting abnormal self-referential thinking with functional imaging of CMS and striatal function may help delineate the neurobiological mechanisms of action of these treatments.
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247
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Bersani G, Bersani FS, Valeriani G, Robiony M, Anastasia A, Colletti C, Liberati D, Capra E, Quartini A, Polli E. Comparison of facial expression in patients with obsessive-compulsive disorder and schizophrenia using the Facial Action Coding System: a preliminary study. Neuropsychiatr Dis Treat 2012; 8:537-47. [PMID: 23269872 PMCID: PMC3529646 DOI: 10.2147/ndt.s37174] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Research shows that impairment in the expression and recognition of emotion exists in multiple psychiatric disorders. The objective of the current study was to evaluate the way that patients with schizophrenia and those with obsessive-compulsive disorder experience and display emotions in relation to specific emotional stimuli using the Facial Action Coding System (FACS). METHODS Thirty individuals participated in the study, comprising 10 patients with schizophrenia, 10 with obsessive-compulsive disorder, and 10 healthy controls. All participants underwent clinical sessions to evaluate their symptoms and watched emotion-eliciting video clips while facial activity was videotaped. Congruent/incongruent feeling of emotions and facial expression in reaction to emotions were evaluated. RESULTS Patients with schizophrenia and obsessive-compulsive disorder presented similarly incongruent emotive feelings and facial expressions (significantly worse than healthy participants). Correlations between the severity of psychopathological condition (in particular the severity of affective flattening) and impairment in recognition and expression of emotions were found. DISCUSSION Patients with obsessive-compulsive disorder and schizophrenia seem to present a similarly relevant impairment in both experiencing and displaying of emotions; this impairment may be seen as a chronic consequence of the same neurodevelopmental origin of the two diseases. Mimic expression could be seen as a behavioral indicator of affective flattening. The FACS could be used as an objective way to evaluate clinical evolution in patients.
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Affiliation(s)
- Giuseppe Bersani
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome
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Kupfer DJ, Angst J, Berk M, Dickerson F, Frangou S, Frank E, Goldstein BI, Harvey A, Laghrissi-Thode F, Leboyer M, Ostacher MJ, Sibille E, Strakowski SM, Suppes T, Tohen M, Yolken RH, Young LT, Zarate CA. Advances in bipolar disorder: selected sessions from the 2011 International Conference on Bipolar Disorder. Ann N Y Acad Sci 2011; 1242:1-25. [DOI: 10.1111/j.1749-6632.2011.06336.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Differential patterns of abnormal activity and connectivity in the amygdala-prefrontal circuitry in bipolar-I and bipolar-NOS youth. J Am Acad Child Adolesc Psychiatry 2011; 50:1275-89.e2. [PMID: 22115148 PMCID: PMC3268077 DOI: 10.1016/j.jaac.2011.09.023] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Revised: 09/20/2011] [Accepted: 09/27/2011] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The functioning of neural systems supporting emotion processing and regulation in youth with bipolar disorder not otherwise specified (BP-NOS) remains poorly understood. We sought to examine patterns of activity and connectivity in youth with BP-NOS relative to youth with bipolar disorder type I (BP-I) and healthy controls (HC). METHOD Participants (18 BP-I youth, 16 BP-NOS youth, and 18 HC) underwent functional magnetic resonance imaging while performing two emotional-face gender labeling tasks (happy/neutral, fearful/neutral). Analyses focused on a priori neural regions supporting emotion processing (amygdala) and emotion regulation (ventromedial prefrontal cortex (VMPFC), dorsolateral prefrontal cortex (DLPFC). Connectivity analyses used VMPFC as a seed region. RESULTS During the happy-face task, BP-I youth had greater amygdala, VMPFC, and DLPFC activity to happy faces whereas BP-NOS youth had reduced VMPFC and DLPFC activity to neutral faces relative to HC, and reduced amygdala, VMPFC, and DLPFC activity to neutral faces versus BP-I. During the fearful-face task, BP-I youth had reduced DLPFC activity to fearful faces whereas BP-NOS youth had reduced DLPFC activity to neutral faces relative to HC. BP-NOS youth showed greater VMPFC-DLPFC connectivity to happy faces relative to HC and BP-I youth. BP-I youth showed reduced VMPFC-amygdala connectivity to fearful faces relative to HC and BP-NOS youth. CONCLUSIONS This is the first study to document differential patterns of abnormal neural activity in, and connectivity between, neural regions supporting emotion processing and regulation in BP-NOS versus BP-I youth. Findings suggest that despite similarities in symptom presentation, there are differential patterns of abnormal neural functioning in BP-NOS and BP-I relative to HC, which might reflect an "intermediate state" in the course of BP-I illness. Future longitudinal studies are needed to relate these findings with future conversion to BP-I/II.
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250
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Stuhrmann A, Suslow T, Dannlowski U. Facial emotion processing in major depression: a systematic review of neuroimaging findings. BIOLOGY OF MOOD & ANXIETY DISORDERS 2011; 1:10. [PMID: 22738433 PMCID: PMC3384264 DOI: 10.1186/2045-5380-1-10] [Citation(s) in RCA: 298] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Accepted: 11/07/2011] [Indexed: 01/17/2023]
Abstract
BACKGROUND Cognitive models of depression suggest that major depression is characterized by biased facial emotion processing, making facial stimuli particularly valuable for neuroimaging research on the neurobiological correlates of depression. The present review provides an overview of functional neuroimaging studies on abnormal facial emotion processing in major depression. Our main objective was to describe neurobiological differences between depressed patients with major depressive disorder (MDD) and healthy controls (HCs) regarding brain responsiveness to facial expressions and, furthermore, to delineate altered neural activation patterns associated with mood-congruent processing bias and to integrate these data with recent functional connectivity results. We further discuss methodological aspects potentially explaining the heterogeneity of results. METHODS A Medline search was performed up to August 2011 in order to identify studies on emotional face processing in acutely depressed patients compared with HCs. A total of 25 studies using functional magnetic resonance imaging were reviewed. RESULTS The analysis of neural activation data showed abnormalities in MDD patients in a common face processing network, pointing to mood-congruent processing bias (hyperactivation to negative and hypoactivation to positive stimuli) particularly in the amygdala, insula, parahippocampal gyrus, fusiform face area, and putamen. Furthermore, abnormal activation patterns were repeatedly found in parts of the cingulate gyrus and the orbitofrontal cortex, which are extended by investigations implementing functional connectivity analysis. However, despite several converging findings, some inconsistencies are observed, particularly in prefrontal areas, probably caused by heterogeneities in paradigms and patient samples. CONCLUSIONS Further studies in remitted patients and high-risk samples are required to discern whether the described abnormalities represent state or trait characteristics of depression.
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Affiliation(s)
- Anja Stuhrmann
- University of Münster, Department of Psychiatry, Albert-Schweitzer-Campus 1, Building, A9, 48149 Münster, Germany.
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