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Altinay MI, Hulvershorn LA, Karne H, Beall EB, Anand A. Differential Resting-State Functional Connectivity of Striatal Subregions in Bipolar Depression and Hypomania. Brain Connect 2016. [PMID: 26824737 DOI: 10.1089/brain.2015.0396.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Bipolar disorder (BP) is characterized by periods of depression (BPD) and (hypo)mania (BPM), but the underlying state-related brain circuit abnormalities are not fully understood. Striatal functional activation and connectivity abnormalities have been noted in BP, but consistent findings have not been reported. To further elucidate striatal abnormalities in different BP states, this study investigated differences in resting-state functional connectivity of six striatal subregions in BPD, BPM, and healthy control (HC) subjects. Ninety medication-free subjects (30 BPD, 30 BPM, and 30 HC), closely matched for age and gender, were scanned using 3T functional magnetic resonance imaging (fMRI) acquired at resting state. Correlations of low-frequency blood oxygen level dependent signal fluctuations for six previously described striatal subregions were used to obtain connectivity maps of each subregion. Using a factorial design, main effects for differences between groups were obtained and post hoc pairwise group comparisons performed. BPD showed increased connectivity of the dorsal caudal putamen with somatosensory areas such as the insula and temporal gyrus. BPM group showed unique increased connectivity between left dorsal caudate and midbrain regions, as well as increased connectivity between ventral striatum inferior and thalamus. In addition, both BPD and BPM exhibited widespread functional connectivity abnormalities between striatal subregions and frontal cortices, limbic regions, and midbrain structures. In summary, BPD exhibited connectivity abnormalities of associative and somatosensory subregions of the putamen, while BPM exhibited connectivity abnormalities of associative and limbic caudate. Most other striatal subregion connectivity abnormalities were common to both groups and may be trait related.
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Affiliation(s)
- Murat I Altinay
- 1 Center for Behavioral Health , Cleveland Clinic, Cleveland, Ohio
| | - Leslie A Hulvershorn
- 1 Center for Behavioral Health , Cleveland Clinic, Cleveland, Ohio.,2 Department of Psychiatry, Indiana University School of Medicine , Indianapolis, Indiana
| | - Harish Karne
- 1 Center for Behavioral Health , Cleveland Clinic, Cleveland, Ohio.,2 Department of Psychiatry, Indiana University School of Medicine , Indianapolis, Indiana
| | - Erik B Beall
- 3 Imaging Institute, Cleveland Clinic , Cleveland, Ohio
| | - Amit Anand
- 1 Center for Behavioral Health , Cleveland Clinic, Cleveland, Ohio.,2 Department of Psychiatry, Indiana University School of Medicine , Indianapolis, Indiana
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352
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Altinay MI, Hulvershorn LA, Karne H, Beall EB, Anand A. Differential Resting-State Functional Connectivity of Striatal Subregions in Bipolar Depression and Hypomania. Brain Connect 2016; 6:255-65. [PMID: 26824737 DOI: 10.1089/brain.2015.0396] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Bipolar disorder (BP) is characterized by periods of depression (BPD) and (hypo)mania (BPM), but the underlying state-related brain circuit abnormalities are not fully understood. Striatal functional activation and connectivity abnormalities have been noted in BP, but consistent findings have not been reported. To further elucidate striatal abnormalities in different BP states, this study investigated differences in resting-state functional connectivity of six striatal subregions in BPD, BPM, and healthy control (HC) subjects. Ninety medication-free subjects (30 BPD, 30 BPM, and 30 HC), closely matched for age and gender, were scanned using 3T functional magnetic resonance imaging (fMRI) acquired at resting state. Correlations of low-frequency blood oxygen level dependent signal fluctuations for six previously described striatal subregions were used to obtain connectivity maps of each subregion. Using a factorial design, main effects for differences between groups were obtained and post hoc pairwise group comparisons performed. BPD showed increased connectivity of the dorsal caudal putamen with somatosensory areas such as the insula and temporal gyrus. BPM group showed unique increased connectivity between left dorsal caudate and midbrain regions, as well as increased connectivity between ventral striatum inferior and thalamus. In addition, both BPD and BPM exhibited widespread functional connectivity abnormalities between striatal subregions and frontal cortices, limbic regions, and midbrain structures. In summary, BPD exhibited connectivity abnormalities of associative and somatosensory subregions of the putamen, while BPM exhibited connectivity abnormalities of associative and limbic caudate. Most other striatal subregion connectivity abnormalities were common to both groups and may be trait related.
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Affiliation(s)
- Murat I Altinay
- 1 Center for Behavioral Health , Cleveland Clinic, Cleveland, Ohio
| | - Leslie A Hulvershorn
- 1 Center for Behavioral Health , Cleveland Clinic, Cleveland, Ohio.,2 Department of Psychiatry, Indiana University School of Medicine , Indianapolis, Indiana
| | - Harish Karne
- 1 Center for Behavioral Health , Cleveland Clinic, Cleveland, Ohio.,2 Department of Psychiatry, Indiana University School of Medicine , Indianapolis, Indiana
| | - Erik B Beall
- 3 Imaging Institute, Cleveland Clinic , Cleveland, Ohio
| | - Amit Anand
- 1 Center for Behavioral Health , Cleveland Clinic, Cleveland, Ohio.,2 Department of Psychiatry, Indiana University School of Medicine , Indianapolis, Indiana
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353
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Portugal LCL, Rosa MJ, Rao A, Bebko G, Bertocci MA, Hinze AK, Bonar L, Almeida JRC, Perlman SB, Versace A, Schirda C, Travis M, Gill MK, Demeter C, Diwadkar VA, Ciuffetelli G, Rodriguez E, Forbes EE, Sunshine JL, Holland SK, Kowatch RA, Birmaher B, Axelson D, Horwitz SM, Arnold EL, Fristad MA, Youngstrom EA, Findling RL, Pereira M, Oliveira L, Phillips ML, Mourao-Miranda J. Can Emotional and Behavioral Dysregulation in Youth Be Decoded from Functional Neuroimaging? PLoS One 2016; 11:e0117603. [PMID: 26731403 PMCID: PMC4701457 DOI: 10.1371/journal.pone.0117603] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 12/15/2015] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION High comorbidity among pediatric disorders characterized by behavioral and emotional dysregulation poses problems for diagnosis and treatment, and suggests that these disorders may be better conceptualized as dimensions of abnormal behaviors. Furthermore, identifying neuroimaging biomarkers related to dimensional measures of behavior may provide targets to guide individualized treatment. We aimed to use functional neuroimaging and pattern regression techniques to determine whether patterns of brain activity could accurately decode individual-level severity on a dimensional scale measuring behavioural and emotional dysregulation at two different time points. METHODS A sample of fifty-seven youth (mean age: 14.5 years; 32 males) was selected from a multi-site study of youth with parent-reported behavioral and emotional dysregulation. Participants performed a block-design reward paradigm during functional Magnetic Resonance Imaging (fMRI). Pattern regression analyses consisted of Relevance Vector Regression (RVR) and two cross-validation strategies implemented in the Pattern Recognition for Neuroimaging toolbox (PRoNTo). Medication was treated as a binary confounding variable. Decoded and actual clinical scores were compared using Pearson's correlation coefficient (r) and mean squared error (MSE) to evaluate the models. Permutation test was applied to estimate significance levels. RESULTS Relevance Vector Regression identified patterns of neural activity associated with symptoms of behavioral and emotional dysregulation at the initial study screen and close to the fMRI scanning session. The correlation and the mean squared error between actual and decoded symptoms were significant at the initial study screen and close to the fMRI scanning session. However, after controlling for potential medication effects, results remained significant only for decoding symptoms at the initial study screen. Neural regions with the highest contribution to the pattern regression model included cerebellum, sensory-motor and fronto-limbic areas. CONCLUSIONS The combination of pattern regression models and neuroimaging can help to determine the severity of behavioral and emotional dysregulation in youth at different time points.
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Affiliation(s)
- Liana C. L. Portugal
- Department of Computer Science, Centre for Computational Statistics and Machine Learning, University College London, London, United Kingdom
- Department of Physiology and Pharmacology, Federal Fluminense University, Niteroi, Brazil
| | - Maria João Rosa
- Department of Computer Science, Centre for Computational Statistics and Machine Learning, University College London, London, United Kingdom
| | - Anil Rao
- Department of Computer Science, Centre for Computational Statistics and Machine Learning, University College London, London, United Kingdom
| | - Genna Bebko
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, United States of America
| | - Michele A. Bertocci
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, United States of America
| | - Amanda K. Hinze
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, United States of America
| | - Lisa Bonar
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, United States of America
| | - Jorge R. C. Almeida
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, United States of America
| | - Susan B. Perlman
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, United States of America
| | - Amelia Versace
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, United States of America
| | - Claudiu Schirda
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, United States of America
| | - Michael Travis
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, United States of America
| | - Mary Kay Gill
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, United States of America
| | - Christine Demeter
- University Hospitals Case Medical Center/Case Western Reserve University, Cleveland, United States of America
| | - Vaibhav A. Diwadkar
- Department of Psychiatry and Behavioral Neuroscience, Wayne State University, Detroit, United States of America
| | - Gary Ciuffetelli
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, United States of America
| | - Eric Rodriguez
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, United States of America
| | - Erika E. Forbes
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, United States of America
| | - Jeffrey L. Sunshine
- University Hospitals Case Medical Center/Case Western Reserve University, Cleveland, United States of America
| | - Scott K. Holland
- Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, United States of America
| | - Robert A. Kowatch
- The Research Institute at Nationwide Children’s Hospital, Columbus, United States of America
| | - Boris Birmaher
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, United States of America
| | - David Axelson
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, United States of America
| | - Sarah M. Horwitz
- Department of Child Psychiatry, New York University School of Medicine, New York, United States of America
| | - Eugene L. Arnold
- Department of Psychiatry, Ohio State University, Columbus, United States of America
| | - Mary A. Fristad
- Department of Psychiatry, Ohio State University, Columbus, United States of America
| | - Eric A. Youngstrom
- Department of Psychology, University of North Carolina at Chapel Hill, Chapel Hill, United States of America
| | - Robert L. Findling
- University Hospitals Case Medical Center/Case Western Reserve University, Cleveland, United States of America
- Department of Psychiatry, Johns Hopkins University, Baltimore, United States of America
| | - Mirtes Pereira
- Department of Physiology and Pharmacology, Federal Fluminense University, Niteroi, Brazil
| | - Leticia Oliveira
- Department of Physiology and Pharmacology, Federal Fluminense University, Niteroi, Brazil
| | - Mary L. Phillips
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, United States of America
- Department of Psychological Medicine, Cardiff University, Cardiff, United Kingdom
| | - Janaina Mourao-Miranda
- Department of Computer Science, Centre for Computational Statistics and Machine Learning, University College London, London, United Kingdom
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354
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Savitz J, Morris HM, Drevets WC. Neuroimaging Studies of Bipolar Depression: Therapeutic Implications. BIPOLAR DEPRESSION: MOLECULAR NEUROBIOLOGY, CLINICAL DIAGNOSIS, AND PHARMACOTHERAPY 2016. [DOI: 10.1007/978-3-319-31689-5_8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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355
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Manelis A, Ladouceur CD, Graur S, Monk K, Bonar LK, Hickey MB, Dwojak AC, Axelson D, Goldstein BI, Goldstein TR, Bebko G, Bertocci MA, Gill MK, Birmaher B, Phillips ML. Altered functioning of reward circuitry in youth offspring of parents with bipolar disorder. Psychol Med 2016; 46:197-208. [PMID: 26373895 PMCID: PMC4674341 DOI: 10.1017/s003329171500166x] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Offspring of parents with bipolar disorder (BD) (BO) are at higher risk of BD than offspring of parents with non-BD psychopathology (NBO), although both groups are at higher risk than offspring of psychiatrically healthy parents (HC) for other affective and psychiatric disorders. Abnormal functioning in reward circuitry has been demonstrated previously in individuals with BD. We aimed to determine whether activation and functional connectivity in this circuitry during risky decision-making differentiated BO, NBO and HC. METHOD BO (n = 29; mean age = 13.8 years; 14 female), NBO (n = 28; mean age = 13.9 years; 12 female) and HC (n = 23; mean age = 13.7 years; 11 female) were scanned while performing a number-guessing reward task. Of the participants, 11 BO and 12 NBO had current non-BD psychopathology; five BO and four NBO were taking psychotropic medications. RESULTS A 3 (group) × 2 (conditions: win-control/loss-control) analysis of variance revealed a main effect of group on right frontal pole activation: BO showed significantly greater activation than HC. There was a significant main effect of group on functional connectivity between the bilateral ventral striatum and the right ventrolateral prefrontal cortex (Z > 3.09, cluster-p < 0.05): BO showed significantly greater negative functional connectivity than other participants. These between-group differences remained after removing youth with psychiatric disorders and psychotropic medications from analyses. CONCLUSIONS This is the first study to demonstrate that reward circuitry activation and functional connectivity distinguish BO from NBO and HC. The fact that the pattern of findings remained when comparing healthy BO v. healthy NBO v. HC suggests that these neuroimaging measures may represent trait-level neurobiological markers conferring either risk for, or protection against, BD in youth.
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Affiliation(s)
- A Manelis
- Department of Psychiatry,Western Psychiatric Institute and Clinic,University of Pittsburgh Medical Center,University of Pittsburgh,Pittsburgh,PA,USA
| | - C D Ladouceur
- Department of Psychiatry,Western Psychiatric Institute and Clinic,University of Pittsburgh Medical Center,University of Pittsburgh,Pittsburgh,PA,USA
| | - S Graur
- Department of Psychiatry,Western Psychiatric Institute and Clinic,University of Pittsburgh Medical Center,University of Pittsburgh,Pittsburgh,PA,USA
| | - K Monk
- Department of Psychiatry,Western Psychiatric Institute and Clinic,University of Pittsburgh Medical Center,University of Pittsburgh,Pittsburgh,PA,USA
| | - L K Bonar
- Department of Psychiatry,Western Psychiatric Institute and Clinic,University of Pittsburgh Medical Center,University of Pittsburgh,Pittsburgh,PA,USA
| | - M B Hickey
- Department of Psychiatry,Western Psychiatric Institute and Clinic,University of Pittsburgh Medical Center,University of Pittsburgh,Pittsburgh,PA,USA
| | - A C Dwojak
- Department of Psychiatry,Western Psychiatric Institute and Clinic,University of Pittsburgh Medical Center,University of Pittsburgh,Pittsburgh,PA,USA
| | - D Axelson
- Department of Psychiatry,Nationwide Children's Hospital and The Ohio State College of Medicine,Columbus,OH,USA
| | - B I Goldstein
- Department of Psychiatry,Sunnybrook Health Sciences Centre,University of Toronto,Faculty of Medicine,Toronto,Ontario,Canada
| | - T R Goldstein
- Department of Psychiatry,Western Psychiatric Institute and Clinic,University of Pittsburgh Medical Center,University of Pittsburgh,Pittsburgh,PA,USA
| | - G Bebko
- Department of Psychiatry,Western Psychiatric Institute and Clinic,University of Pittsburgh Medical Center,University of Pittsburgh,Pittsburgh,PA,USA
| | - M A Bertocci
- Department of Psychiatry,Western Psychiatric Institute and Clinic,University of Pittsburgh Medical Center,University of Pittsburgh,Pittsburgh,PA,USA
| | - M K Gill
- Department of Psychiatry,Western Psychiatric Institute and Clinic,University of Pittsburgh Medical Center,University of Pittsburgh,Pittsburgh,PA,USA
| | - B Birmaher
- Department of Psychiatry,Western Psychiatric Institute and Clinic,University of Pittsburgh Medical Center,University of Pittsburgh,Pittsburgh,PA,USA
| | - M L Phillips
- Department of Psychiatry,Western Psychiatric Institute and Clinic,University of Pittsburgh Medical Center,University of Pittsburgh,Pittsburgh,PA,USA
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356
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Ham BJ, Greenberg T, Chase HW, Phillips ML. Impact of the glucocorticoid receptor BclI polymorphism on reward expectancy and prediction error related ventral striatal reactivity in depressed and healthy individuals. J Psychopharmacol 2016; 30:48-55. [PMID: 26349556 DOI: 10.1177/0269881115602486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There is evidence that reward-related neural reactivity is altered in depressive disorders. Glucocorticoids influence dopaminergic transmission, which is widely implicated in reward processing. However, no studies have examined the effect of glucocorticoid receptor gene polymorphisms on reward-related neural reactivity in depressed or healthy individuals. Fifty-nine depressed individuals with major depressive disorder (n=33) or bipolar disorder (n=26), and 32 healthy individuals were genotyped for the glucocorticoid receptor BclI G/C polymorphism, and underwent functional magnetic resonance imaging during a monetary reward task. We examined the effect of the glucocorticoid receptor BclI G/C polymorphism on reward expectancy (RE; expected outcome value) and prediction error (PE; discrepancy between expected and actual outcome) related ventral striatal reactivity. There was a significant interaction between reward condition and BclI genotype (p=0.007). C-allele carriers showed higher PE than RE-related right ventral striatal reactivity (p<0.001), whereas no such difference was observed in G/G homozygotes. Accordingly, C-allele carriers showed a greater difference between PE and RE-related right ventral striatal reactivity than G/G homozygotes (p<0.005), and also showed lower RE-related right ventral striatal reactivity than G/G homozygotes (p=0.011). These findings suggest a slowed transfer from PE to RE-related ventral striatal responses during reinforcement learning in C-allele carriers, regardless of diagnosis, possibly due to altered dopamine release associated with increased sensitivity to glucocorticoids.
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Affiliation(s)
- Byung-Joo Ham
- Department of Psychiatry, Korea University College of Medicine, Seoul, South Korea Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Tsafrir Greenberg
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Henry W Chase
- 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
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357
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Brady RO, Keshavan M. Emergent treatments based on the pathophysiology of bipolar disorder: A selective review. Asian J Psychiatr 2015; 18:15-21. [PMID: 26525885 PMCID: PMC4745256 DOI: 10.1016/j.ajp.2015.07.017] [Citation(s) in RCA: 8] [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: 01/19/2015] [Revised: 07/08/2015] [Accepted: 07/10/2015] [Indexed: 12/20/2022]
Abstract
Bipolar disorder is a chronic psychiatric disorder that is a cause of significant symptomatology even in the setting of optimal treatment. Most current treatments are developed from serendipity, and not based on known pathophysiology. In this review we examine a number of somatic and pharmacologic therapies that are poised to become part of the armamentarium of interventions to treat bipolar illness. As a group, these interventions are derived from a growing understanding of the biological underpinnings of bipolar disorders. We will look at emergent treatments based on our understanding of the molecular biology, neuroanatomy, and the genetics of bipolar disorder.
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Affiliation(s)
- Roscoe O Brady
- Department of Psychiatry, Beth-Israel Deaconess Medical Center, Boston, MA, United States; Department of Psychiatry, Harvard Medical School, Boston, MA, United States.
| | - Matcheri Keshavan
- Department of Psychiatry, Beth-Israel Deaconess Medical Center, Boston, MA, United States; Department of Psychiatry, Harvard Medical School, Boston, MA, United States
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358
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Abstract
Although we have gained enormous insights into neurobiological and psychological underpinnings of bipolar disorder (BD) symptoms, our knowledge concerning pathogenic mechanisms initiating recurrent affective episodes is still fragmentary. Previous research has highlighted the role of significant life events and social rhythm in recurrent episodes of mania and depression. However, most studies share the drawback of retrospective self-report data, which are prone to recall biases and limited introspective abilities. Therefore, more objective data, such as neuropsychological and neurobiological measures are needed to further unravel the pathogenic mechanisms of the dynamics of bipolar disorder. Previous research has highlighted disturbed emotional reactivity as well as impaired emotion regulation and impulse control as major behavioural characteristics of BD and aberrancies in prefrontal-limbic-striatal networks that have been proposed to be the correlates of these behavioural alterations. However, longitudinal studies assessing these neural and behavioural alterations are rare. Future research should therefore adopt prospective study designs including behavioural and neuroimaging measures underlying cognitive, emotional and motivational deficits in bipolar disorder. Particularly, these measures should be collected continuously at multiple time points as implemented in modern ambulatory assessment tools.
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359
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Bootsman F, Brouwer RM, Kemner SM, Schnack HG, van der Schot AC, Vonk R, Hillegers MHJ, Boomsma DI, Hulshoff Pol HE, Nolen WA, Kahn RS, van Haren NEM. Contribution of genes and unique environment to cross-sectional and longitudinal measures of subcortical volumes in bipolar disorder. Eur Neuropsychopharmacol 2015; 25:2197-209. [PMID: 26481908 DOI: 10.1016/j.euroneuro.2015.09.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 08/19/2015] [Accepted: 09/28/2015] [Indexed: 02/06/2023]
Abstract
The influence of genes and environment on the association between bipolar disorder (BD) and volumes of subcortical brain regions involved in emotion processing has rarely been studied. Furthermore, as far as we know, longitudinal twin studies of subcortical brain volume change in BD have not been carried out at all. In this study, we focused on the genetic and environmental contributions to cross-sectional and longitudinal measures of subcortical brain volumes in BD. A total of 99 twins from monozygotic and dizygotic pairs concordant or discordant for BD and 129 twins from monozygotic and dizygotic healthy control pairs underwent magnetic resonance imaging at baseline. Longitudinal assessment was carried out in 48 twins from monozygotic and dizygotic patient pairs and 52 twins from monozygotic and dizygotic control pairs. Subcortical volume measures were obtained with Freesurfer software and analyzed with structural equation modeling software OpenMx. At baseline, BD was phenotypically and genetically associated with smaller volumes of the thalamus, putamen and nucleus accumbens. BD was not associated with subcortical brain volume change over time in any of the examined regions. Heritability of subcortical volumes at baseline was high, whereas subcortical volume change had low heritability. Genes contributing to BD showed overlap with those associated with smaller volumes of the thalamus, putamen and nucleus accumbens at baseline. Further evaluation of genetic contributions to abnormalities in subcortical brain regions assumed to be involved in emotion processing is recommended.
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Affiliation(s)
- Florian Bootsman
- University Medical Center Utrecht Brain Center Rudolf Magnus, Utrecht, The Netherlands.
| | - Rachel M Brouwer
- University Medical Center Utrecht Brain Center Rudolf Magnus, Utrecht, The Netherlands
| | - Sanne M Kemner
- University Medical Center Utrecht Brain Center Rudolf Magnus, Utrecht, The Netherlands
| | - Hugo G Schnack
- University Medical Center Utrecht Brain Center Rudolf Magnus, Utrecht, The Netherlands
| | | | - Ronald Vonk
- Reinier van Arkel Group, ׳s-Hertogenbosch, The Netherlands
| | - Manon H J Hillegers
- University Medical Center Utrecht Brain Center Rudolf Magnus, Utrecht, The Netherlands
| | - Dorret I Boomsma
- Free University Amsterdam, Department of Biological Psychology, Amsterdam, The Netherlands
| | | | - Willem A Nolen
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, The Netherlands
| | - René S Kahn
- University Medical Center Utrecht Brain Center Rudolf Magnus, Utrecht, The Netherlands
| | - Neeltje E M van Haren
- University Medical Center Utrecht Brain Center Rudolf Magnus, Utrecht, The Netherlands
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360
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Mathieu F, Etain B, Dizier MH, Lajnef M, Lathrop M, Cabon C, Leboyer M, Henry C, Bellivier F. Genetics of emotional reactivity in bipolar disorders. J Affect Disord 2015; 188:101-6. [PMID: 26349599 DOI: 10.1016/j.jad.2015.08.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 08/12/2015] [Accepted: 08/17/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Emotional reactivity has been proposed as a relevant intermediate phenotype of bipolar disorder (BD). Our goal was to identify genetic factors underlying emotional reactivity in a sample of bipolar patients. METHODS Affect intensity (a proxy measure of emotional reactivity) was measured in a sample of 281 euthymic patients meeting DSM-IV criteria for BD. We use a validated dimensional tool, the 40-item self-report Affect Intensity Measure scale developed by Larsen and Diener. Patients with BD were genotyped for 475. 740 SNPs (using Illumina HumanHap550 Beadchips or HumanHap610 Quad chip). Association was investigated with a general mixed regression model of the continuous trait against genotypes, including gender as covariate. RESULTS Four regions (1p31.3, 3q13.11, 11p15.1 and 11q14.4) with a p-value lower or equal to 5×10(-6) were identified. In these regions, the joint effect of the four variants accounted for 24.5% of the variance of AIM score. Epistasis analysis did not detect interaction between these variants. In the 11p15.1 region, the rs10766743 located in the intron of the NELL1 gene remained significant after correction for multiple testing (p=2×10(-7)). CONCLUSIONS These findings illustrate that focusing on quantitative intermediate phenotypes can facilitate the identification of genetic susceptibility variants in BD.
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Affiliation(s)
- F Mathieu
- Inserm, UMRS-958, Paris, France; Université Paris-Diderot, Sorbonne Paris Cité, Paris, France.
| | - B Etain
- INSERM U955, Equipe de Psychiatrie Translationelle, Créteil, France; Université Paris Est, Faculté de Médecine, Créteil, France; AP-HP, Hôpitaux Universitaires Henri Mondor, DHU Pepsy, Pôle de Psychiatrie, Créteil, France; Fondation FondaMental, Créteil, France
| | - M H Dizier
- Université Paris-Diderot, Sorbonne Paris Cité, Paris, France; INSERM, UMR-S946, Paris, France
| | - M Lajnef
- INSERM U955, Equipe de Psychiatrie Translationelle, Créteil, France
| | - M Lathrop
- Commissariat à l'Energie Atomique, Institut de Génomique, Centre National de Génotypage, Evry, France
| | - C Cabon
- AP-HP, Groupe Hospitalier Henri Mondor, Plateforme de Ressources Biologiques Centre d'Investigation Clinique, Créteil F-94000, France; AP-HP, Groupe Hospitalier Saint-Louis, Lariboisière, F. Widal, Service de Psychiatrie, Paris; INSERM U955, Equipe de Psychiatrie Translationelle, Créteil, France
| | - M Leboyer
- INSERM U955, Equipe de Psychiatrie Translationelle, Créteil, France; Université Paris Est, Faculté de Médecine, Créteil, France; AP-HP, Hôpitaux Universitaires Henri Mondor, DHU Pepsy, Pôle de Psychiatrie, Créteil, France; Fondation FondaMental, Créteil, France
| | - C Henry
- INSERM U955, Equipe de Psychiatrie Translationelle, Créteil, France; Université Paris Est, Faculté de Médecine, Créteil, France; AP-HP, Hôpitaux Universitaires Henri Mondor, DHU Pepsy, Pôle de Psychiatrie, Créteil, France; Fondation FondaMental, Créteil, France
| | - F Bellivier
- Université Paris-Diderot, Sorbonne Paris Cité, Paris, France; Fondation FondaMental, Créteil, France; INSERM UMR-S1144, Paris, France
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Malhi GS, Byrow Y, Fritz K, Das P, Baune BT, Porter RJ, Outhred T. Mood disorders: neurocognitive models. Bipolar Disord 2015; 17 Suppl 2:3-20. [PMID: 26688287 DOI: 10.1111/bdi.12353] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 11/06/2015] [Indexed: 01/04/2023]
Abstract
OBJECTIVES In recent years, a number of neurocognitive models stemming from psychiatry and psychology schools of thought have conceptualized the pathophysiology of mood disorders in terms of dysfunctional neural mechanisms that underpin and drive neurocognitive processes. Though these models have been useful for advancing our theoretical understanding and facilitating important lines of research, translation of these models and their application within the clinical arena have been limited-partly because of lack of integration and synthesis. Cognitive neuroscience provides a novel perspective for understanding and modeling mood disorders. This selective review of influential neurocognitive models develops an integrative approach that can serve as a template for future research and the development of a clinically meaningful framework for investigating, diagnosing, and treating mood disorders. METHODS A selective literature search was conducted using PubMed and PsychINFO to identify prominent neurobiological and neurocognitive models of mood disorders. RESULTS Most models identify similar neural networks and brain regions and neuropsychological processes in the neurocognition of mood, however, they differ in terms of specific functions attached to neural processes and how these interact. Furthermore, cognitive biases, reward processing and motivation, rumination, and mood stability, which play significant roles in the manner in which attention, appraisal, and response processes are deployed in mood disorders, are not sufficiently integrated. The inclusion of interactions between these additional components enhances our understanding of the etiology and pathophysiology of mood disorders. CONCLUSIONS Through integration of key cognitive functions and understanding of how these interface with neural functioning within neurocognitive models of mood disorders, a framework for research can be created for translation to diagnosis and treatment of mood disorders.
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Affiliation(s)
- Gin S Malhi
- Academic Department of Psychiatry, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia.,Sydney Medical School Northern, The University of Sydney, NSW 2006, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia
| | - Yulisha Byrow
- Academic Department of Psychiatry, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia.,Sydney Medical School Northern, The University of Sydney, NSW 2006, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia
| | - Kristina Fritz
- Academic Department of Psychiatry, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia.,Sydney Medical School Northern, The University of Sydney, NSW 2006, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia
| | - Pritha Das
- Academic Department of Psychiatry, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia.,Sydney Medical School Northern, The University of Sydney, NSW 2006, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia
| | - Bernhard T Baune
- Discipline of Psychiatry, University of Adelaide, Adelaide, SA, Australia
| | - Richard J Porter
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Tim Outhred
- Academic Department of Psychiatry, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia.,Sydney Medical School Northern, The University of Sydney, NSW 2006, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia
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362
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Goya-Maldonado R, Brodmann K, Keil M, Trost S, Dechent P, Gruber O. Differentiating unipolar and bipolar depression by alterations in large-scale brain networks. Hum Brain Mapp 2015; 37:808-18. [PMID: 26611711 DOI: 10.1002/hbm.23070] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 10/23/2015] [Accepted: 11/18/2015] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Misdiagnosing bipolar depression can lead to very deleterious consequences of mistreatment. Although depressive symptoms may be similarly expressed in unipolar and bipolar disorder, changes in specific brain networks could be very distinct, being therefore informative markers for the differential diagnosis. We aimed to characterize specific alterations in candidate large-scale networks (frontoparietal, cingulo-opercular, and default mode) in symptomatic unipolar and bipolar patients using resting state fMRI, a cognitively low demanding paradigm ideal to investigate patients. METHODS Networks were selected after independent component analysis, compared across 40 patients acutely depressed (20 unipolar, 20 bipolar), and 20 controls well-matched for age, gender, and education levels, and alterations were correlated to clinical parameters. RESULTS Despite comparable symptoms, patient groups were robustly differentiated by large-scale network alterations. Differences were driven in bipolar patients by increased functional connectivity in the frontoparietal network, a central executive and externally-oriented network. Conversely, unipolar patients presented increased functional connectivity in the default mode network, an introspective and self-referential network, as much as reduced connectivity of the cingulo-opercular network to default mode regions, a network involved in detecting the need to switch between internally and externally oriented demands. These findings were mostly unaffected by current medication, comorbidity, and structural changes. Moreover, network alterations in unipolar patients were significantly correlated to the number of depressive episodes. CONCLUSION Unipolar and bipolar groups displaying similar symptomatology could be clearly distinguished by characteristic changes in large-scale networks, encouraging further investigation of network fingerprints for clinical use. Hum Brain Mapp 37:808-818, 2016. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Roberto Goya-Maldonado
- Department of Psychiatry and Psychotherapy, Center for Translational Research in Systems Neuroscience and Psychiatry, University Medical Center, Georg-August-University, Goettingen, Germany
| | - Katja Brodmann
- Department of Psychiatry and Psychotherapy, Center for Translational Research in Systems Neuroscience and Psychiatry, University Medical Center, Georg-August-University, Goettingen, Germany
| | - Maria Keil
- Department of Psychiatry and Psychotherapy, Center for Translational Research in Systems Neuroscience and Psychiatry, University Medical Center, Georg-August-University, Goettingen, Germany
| | - Sarah Trost
- Department of Psychiatry and Psychotherapy, Center for Translational Research in Systems Neuroscience and Psychiatry, University Medical Center, Georg-August-University, Goettingen, Germany
| | - Peter Dechent
- Department of Cognitive Neurology, Research Group 'MR-Research in Neurology and Psychiatry', University Medical Center, Georg-August-University, Goettingen, Germany
| | - Oliver Gruber
- Department of Psychiatry and Psychotherapy, Center for Translational Research in Systems Neuroscience and Psychiatry, University Medical Center, Georg-August-University, Goettingen, Germany
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363
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Dunlop BW, Mayberg HS. Neuroimaging-based biomarkers for treatment selection in major depressive disorder. DIALOGUES IN CLINICAL NEUROSCIENCE 2015. [PMID: 25733953 PMCID: PMC4336918 DOI: 10.31887/dcns.2014.16.4/bdunlop] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
The use of neuroimaging approaches to identify likely treatment outcomes in patients with major depressive disorder is developing rapidly. Emerging work suggests that resting state pretreatment metabolic activity in the fronto-insular cortex may distinguish between patients likely to respond to psychotherapy or medication and may function as a treatment-selection biomarker. In contrast, high metabolic activity in the subgenual anterior cingulate cortex may be predictive of poor outcomes to both medication and psychotherapy, suggesting that nonstandard treatments may be pursued earlier in the treatment course. Although these findings will require replication before clinical adoption, they provide preliminary support for the concept that brain states can be measured and applied to the selection of a specific treatment most likely to be beneficial for an individual patient.
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Affiliation(s)
- Boadie W Dunlop
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, USA
| | - Helen S Mayberg
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, USA
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364
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Dannlowski U, Kugel H, Grotegerd D, Redlich R, Suchy J, Opel N, Suslow T, Konrad C, Ohrmann P, Bauer J, Kircher T, Krug A, Jansen A, Baune BT, Heindel W, Domschke K, Forstner AJ, Nöthen MM, Treutlein J, Arolt V, Hohoff C, Rietschel M, Witt SH. NCAN Cross-Disorder Risk Variant Is Associated With Limbic Gray Matter Deficits in Healthy Subjects and Major Depression. Neuropsychopharmacology 2015; 40:2510-6. [PMID: 25801500 PMCID: PMC4569958 DOI: 10.1038/npp.2015.86] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Revised: 02/03/2015] [Accepted: 03/02/2015] [Indexed: 12/31/2022]
Abstract
Genome-wide association studies have reported an association between NCAN rs1064395 genotype and bipolar disorder. This association was later extended to schizophrenia and major depression. However, the neurobiological underpinnings of these associations are poorly understood. NCAN is implicated in neuronal plasticity and expressed in subcortical brain areas, such as the amygdala and hippocampus, which are critically involved in dysfunctional emotion processing and regulation across diagnostic boundaries. We hypothesized that the NCAN risk variant is associated with reduced gray matter volumes in these areas. Gray matter structure was assessed by voxel-based morphometry on structural MRI data in two independent German samples (healthy subjects, n=512; depressed inpatients, n=171). All participants were genotyped for NCAN rs1064395. Hippocampal and amygdala region-of-interest analyses were performed within each sample. In addition, whole-brain data from the combined sample were analyzed. Risk (A)-allele carriers showed reduced amygdala and hippocampal gray matter volumes in both cohorts with a remarkable spatial overlap. In the combined sample, genotype effects observed for the amygdala and hippocampus survived correction for entire brain volume. Further effects were also observed in the left orbitofrontal cortex and the cerebellum/fusiform gyrus. We conclude that NCAN genotype is associated with limbic gray matter alterations in healthy and depressed subjects in brain areas implicated in emotion perception and regulation. The present data suggest that NCAN forms susceptibility to neurostructural deficits in the amygdala, hippocampus, and prefrontal areas independent of disease, which might lead to disorder onset in the presence of other genetic or environmental risk factors.
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Affiliation(s)
- Udo Dannlowski
- Department of Psychiatry, University of Marburg, Marburg, Germany,Department of Psychiatry, University of Münster, Münster, Germany,Department of Psychiatry, University of Marburg, Rudolf-Bultmann-Strasse 8, 35039 Marburg, Germany, Tel: +49 251 8357218, Fax: +49 251 8356612, E-mail:
| | - Harald Kugel
- Department of Clinical Radiology, University of Münster, Münster, Germany
| | | | - Ronny Redlich
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Janina Suchy
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Nils Opel
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Thomas Suslow
- Department of Psychosomatic Medicine, University of Leipzig, Leipzig, Germany
| | - Carsten Konrad
- Department of Psychiatry, University of Marburg, Marburg, Germany
| | - Patricia Ohrmann
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Jochen Bauer
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Tilo Kircher
- Department of Psychiatry, University of Marburg, Marburg, Germany
| | - Axel Krug
- Department of Psychiatry, University of Marburg, Marburg, Germany
| | - Andreas Jansen
- Department of Psychiatry, University of Marburg, Marburg, Germany
| | - Bernhard T Baune
- Discipline of Psychiatry, School of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Walter Heindel
- Department of Clinical Radiology, University of Münster, Münster, Germany
| | | | - Andreas J Forstner
- Institute of Human Genetics, University of Bonn, Bonn, Germany,Department of Genomics, Life and Brain Center, University of Bonn, Bonn, Germany
| | - Markus M Nöthen
- Institute of Human Genetics, University of Bonn, Bonn, Germany,Department of Genomics, Life and Brain Center, University of Bonn, Bonn, Germany
| | - Jens Treutlein
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Mannheim, Germany
| | - Volker Arolt
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Christa Hohoff
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Marcella Rietschel
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Mannheim, Germany
| | - Stephanie H Witt
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Mannheim, Germany
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365
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Haenisch F, Alsaif M, Guest PC, Rahmoune H, Yolken RH, Dickerson F, Bahn S. Multiplex immunoassay analysis of plasma shows differences in biomarkers related to manic or mixed mood states in bipolar disorder patients. J Affect Disord 2015; 185:12-6. [PMID: 26142689 DOI: 10.1016/j.jad.2015.05.065] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 05/20/2015] [Accepted: 05/22/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND The molecular understanding of bipolar disorder (BD) aetiology has advanced over the last years through the identification of peripheral disease biomarkers. Here, we have attempted to identify plasma biomarkers associated with distinct BD mood states. METHODS Plasma from BD patients with either a current manic (n=29) or mixed (n=17) mood state and healthy controls (n=53) were analysed using a multiplex immunoassay platform. A total of 145 hormones, growth factors, transport proteins and inflammatory factors were measured. RESULTS Plasma levels of the hormones C-peptide, progesterone and insulin, and the inflammatory protein cancer antigen 125 were altered in both mood states. The hormone peptide YY and the growth factor trafficking protein sortilin were changed only in mania patients. Finally, the inflammatory factors haptoglobin, chemokine CC4 and matrix metalloproteinase 7 were altered specifically in mixed mood patients. LIMITATIONS This study was limited by a small sample size, potential confounding effects of multiple drug treatments in the patient groups, and lack of dietary restrictions at sampling. CONCLUSIONS Plasma from mania and mixed mood BD patients revealed similar changes in proteins related to insulin signalling, suggesting that these could be trait biomarkers. However, mania patients showed specific changes in hormonal and growth factor functions and mixed mood patients had a higher number of changes in inflammation-related molecules. Further studies of these and other biomarker candidates will increase our understanding of the systemic biological pathways affected in different BD mood states. This could lead to the identification of differential surrogate readouts and potential new drug targets for improved treatment outcomes.
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Affiliation(s)
- Frieder Haenisch
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, United Kingdom
| | - Murtada Alsaif
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, United Kingdom
| | - Paul C Guest
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, United Kingdom
| | - Hassan Rahmoune
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, United Kingdom
| | | | | | - Sabine Bahn
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, United Kingdom.
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366
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Breakspear M, Roberts G, Green MJ, Nguyen VT, Frankland A, Levy F, Lenroot R, Mitchell PB. Network dysfunction of emotional and cognitive processes in those at genetic risk of bipolar disorder. Brain 2015; 138:3427-39. [DOI: 10.1093/brain/awv261] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 07/13/2015] [Indexed: 01/02/2023] Open
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367
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Higgins GA, Allyn-Feuer A, Barbour E, Athey BD. A glutamatergic network mediates lithium response in bipolar disorder as defined by epigenome pathway analysis. Pharmacogenomics 2015; 16:1547-63. [PMID: 26343379 DOI: 10.2217/pgs.15.106] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
AIM A regulatory network in the human brain mediating lithium response in bipolar patients was revealed by analysis of functional SNPs from genome-wide association studies (GWAS) and published gene association studies, followed by epigenome mapping. METHODS An initial set of 23,312 SNPs in linkage disequilibrium with lead SNPs, and sub-threshold GWAS SNPs rescued by pathway analysis, were studied in the same populations. These were assessed using our workflow and annotation by the epigenome roadmap consortium. RESULTS Twenty-seven percent of 802 SNPs that were associated with lithium response (13 published studies gene association studies and two GWAS) were shared in common with 1281 SNPs from 18 GWAS examining psychiatric disorders and adverse events associated with lithium treatment. Nineteen SNPs were annotated as active regulatory elements such as enhancers and promoters in a tissue-specific manner. They were located within noncoding regions of ten genes: ANK3, ARNTL, CACNA1C, CACNG2, CDKN1A, CREB1, GRIA2, GSK3B, NR1D1 and SLC1A2. Following gene set enrichment and pathway analysis, these genes were found to be significantly associated (p = 10(-27); Fisher exact test) with an AMPA2 glutamate receptor network in human brain. Our workflow results showed concordance with annotation of regulatory elements from the epigenome roadmap. Analysis of cognate mRNA and enhancer RNA exhibited patterns consistent with an integrated pathway in human brain. CONCLUSION This pharmacoepigenomic regulatory pathway is located in the same brain regions that exhibit tissue volume loss in bipolar disorder. Although in silico analysis requires biological validation, the approach provides value for identification of candidate variants that may be used in pharmacogenomic testing to identify bipolar patients likely to respond to lithium.
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Affiliation(s)
- Gerald A Higgins
- Department of Computational Medicine and Bioinformatics, University of Michigan Medical School, Ann Arbor, MI 48109, USA.,Pharmacogenomic Science, Assurex Health, Inc., Mason, OH 45040, USA
| | - Ari Allyn-Feuer
- Department of Computational Medicine and Bioinformatics, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Edward Barbour
- Department of Computational Medicine and Bioinformatics, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Brian D Athey
- Department of Computational Medicine and Bioinformatics, University of Michigan Medical School, Ann Arbor, MI 48109, USA.,Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI 48109, USA
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368
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Hajek T, Cooke C, Kopecek M, Novak T, Hoschl C, Alda M. Using structural MRI to identify individuals at genetic risk for bipolar disorders: a 2-cohort, machine learning study. J Psychiatry Neurosci 2015; 40:316-24. [PMID: 25853284 PMCID: PMC4543094 DOI: 10.1503/jpn.140142] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Brain imaging is of limited diagnostic use in psychiatry owing to clinical heterogeneity and low sensitivity/specificity of between-group neuroimaging differences. Machine learning (ML) may better translate neuroimaging to the level of individual participants. Studying unaffected offspring of parents with bipolar disorders (BD) decreases clinical heterogeneity and thus increases sensitivity for detection of biomarkers. The present study used ML to identify individuals at genetic high risk (HR) for BD based on brain structure. METHODS We studied unaffected and affected relatives of BD probands recruited from 2 sites (Halifax, Canada, and Prague, Czech Republic). Each participant was individually matched by age and sex to controls without personal or family history of psychiatric disorders. We applied support vector machines (SVM) and Gaussian process classifiers (GPC) to structural MRI. RESULTS We included 45 unaffected and 36 affected relatives of BD probands matched by age and sex on an individual basis to healthy controls. The SVM of white matter distinguished unaffected HR from control participants (accuracy = 68.9%, p = 0.001), with similar accuracy for the GPC (65.6%, p = 0.002) or when analyzing data from each site separately. Differentiation of the more clinically heterogeneous affected familiar group from healthy controls was less accurate (accuracy = 59.7%, p = 0.05). Machine learning applied to grey matter did not distinguish either the unaffected HR or affected familial groups from controls. The regions that most contributed to between-group discrimination included white matter of the inferior/middle frontal gyrus, inferior/middle temporal gyrus and precuneus. LIMITATIONS Although we recruited 126 participants, ML benefits from even larger samples. CONCLUSION Machine learning applied to white but not grey matter distinguished unaffected participants at high and low genetic risk for BD based on regions previously implicated in the pathophysiology of BD.
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Affiliation(s)
- Tomas Hajek
- Correspondence to: T. Hajek, Department of Psychiatry, Dalhousie University, QEII HSC, A.J. Lane Bldg., Rm. 3093, 5909 Veteran’s Memorial Lane, Halifax, NS B3H 2E2;
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369
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Liu S, Cai W, Liu S, Zhang F, Fulham M, Feng D, Pujol S, Kikinis R. Multimodal neuroimaging computing: the workflows, methods, and platforms. Brain Inform 2015; 2:181-195. [PMID: 27747508 PMCID: PMC4737665 DOI: 10.1007/s40708-015-0020-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 08/20/2015] [Indexed: 12/20/2022] Open
Abstract
The last two decades have witnessed the explosive growth in the development and use of noninvasive neuroimaging technologies that advance the research on human brain under normal and pathological conditions. Multimodal neuroimaging has become a major driver of current neuroimaging research due to the recognition of the clinical benefits of multimodal data, and the better access to hybrid devices. Multimodal neuroimaging computing is very challenging, and requires sophisticated computing to address the variations in spatiotemporal resolution and merge the biophysical/biochemical information. We review the current workflows and methods for multimodal neuroimaging computing, and also demonstrate how to conduct research using the established neuroimaging computing packages and platforms.
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Affiliation(s)
- Sidong Liu
- School of IT, The University of Sydney, Sydney, Australia.
| | - Weidong Cai
- School of IT, The University of Sydney, Sydney, Australia
| | - Siqi Liu
- School of IT, The University of Sydney, Sydney, Australia
| | - Fan Zhang
- School of IT, The University of Sydney, Sydney, Australia
- Surgical Planning Laboratory, Harvard Medical School, Boston, USA
| | - Michael Fulham
- Department of PET and Nuclear Medicine, Royal Prince Alfred Hospital, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Dagan Feng
- School of IT, The University of Sydney, Sydney, Australia
- Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
| | - Sonia Pujol
- Surgical Planning Laboratory, Harvard Medical School, Boston, USA
| | - Ron Kikinis
- Surgical Planning Laboratory, Harvard Medical School, Boston, USA
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370
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Liu S, Cai W, Liu S, Zhang F, Fulham M, Feng D, Pujol S, Kikinis R. Multimodal neuroimaging computing: a review of the applications in neuropsychiatric disorders. Brain Inform 2015; 2:167-180. [PMID: 27747507 PMCID: PMC4737664 DOI: 10.1007/s40708-015-0019-x] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Accepted: 08/08/2015] [Indexed: 12/20/2022] Open
Abstract
Multimodal neuroimaging is increasingly used in neuroscience research, as it overcomes the limitations of individual modalities. One of the most important applications of multimodal neuroimaging is the provision of vital diagnostic data for neuropsychiatric disorders. Multimodal neuroimaging computing enables the visualization and quantitative analysis of the alterations in brain structure and function, and has reshaped how neuroscience research is carried out. Research in this area is growing exponentially, and so it is an appropriate time to review the current and future development of this emerging area. Hence, in this paper, we review the recent advances in multimodal neuroimaging (MRI, PET) and electrophysiological (EEG, MEG) technologies, and their applications to the neuropsychiatric disorders. We also outline some future directions for multimodal neuroimaging where researchers will design more advanced methods and models for neuropsychiatric research.
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Affiliation(s)
- Sidong Liu
- School of IT, The University of Sydney, Sydney, Australia.
| | - Weidong Cai
- School of IT, The University of Sydney, Sydney, Australia
| | - Siqi Liu
- School of IT, The University of Sydney, Sydney, Australia
| | - Fan Zhang
- Surgical Planning Laboratory, Harvard Medical School, Boston, USA
| | - Michael Fulham
- Department of PET and Nuclear Medicine, Royal Prince Alfred Hospital, and the Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Dagan Feng
- School of IT, The University of Sydney, Sydney, Australia
- Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
| | - Sonia Pujol
- Surgical Planning Laboratory, Harvard Medical School, Boston, USA
| | - Ron Kikinis
- Surgical Planning Laboratory, Harvard Medical School, Boston, USA
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371
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Sarrazin S, d’Albis MA, McDonald C, Linke J, Wessa M, Phillips M, Delavest M, Emsell L, Versace A, Almeida J, Mangin JF, Poupon C, Le Dudal K, Daban C, Hamdani N, Leboyer M, Houenou J. Corpus callosum area in patients with bipolar disorder with and without psychotic features: an international multicentre study. J Psychiatry Neurosci 2015; 40:352-9. [PMID: 26151452 PMCID: PMC4543098 DOI: 10.1503/jpn.140262] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Previous studies have reported MRI abnormalities of the corpus callosum (CC) in patients with bipolar disorder (BD), although only a few studies have directly compared callosal areas in psychotic versus nonpsychotic patients with this disorder. We sought to compare regional callosal areas in a large international multicentre sample of patients with BD and healthy controls. METHODS We analyzed anatomic T1 MRI data of patients with BD-I and healthy controls recruited from 4 sites (France, Germany, Ireland and the United States). We obtained the mid-sagittal areas of 7 CC subregions using an automatic CC delineation. Differences in regional callosal areas between patients and controls were compared using linear mixed models (adjusting for age, sex, handedness, brain volume, history of alcohol abuse/dependence, lithium or antipsychotic medication status, symptomatic status and site) and multiple comparisons correction. We also compared regional areas of the CC between patients with BD with and without a history of psychotic features. RESULTS We included 172 patients and 146 controls in our study. Patients with BD had smaller adjusted mid-sagittal CC areas than controls along the posterior body, the isthmus and the splenium of the CC. Patients with a positive history of psychotic features had greater adjusted area of the rostral CC region than those without a history of psychotic features. LIMITATIONS We found small to medium effect sizes, and there was no calibration technique among the sites. CONCLUSION Our results suggest that BD with psychosis is associated with a different pattern of interhemispheric connectivity than BD without psychosis and could be considered a relevant neuroimaging subtype of BD.
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Affiliation(s)
- Samuel Sarrazin
- Correspondence to: S Sarrazin, Hôpital Henri Mondor- Albert Chenevier, Pôle de psychiatrie, 40 rue de Mesly 94000 Créteil France;
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372
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Singh MK, Kelley RG, Chang KD, Gotlib IH. Intrinsic Amygdala Functional Connectivity in Youth With Bipolar I Disorder. J Am Acad Child Adolesc Psychiatry 2015; 54:763-70. [PMID: 26299298 PMCID: PMC4548854 DOI: 10.1016/j.jaac.2015.06.016] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 06/24/2015] [Accepted: 06/30/2015] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Bipolar disorder (BD) commonly begins during adolescence and may continue into adulthood. Studies in adults with BD suggest that disruptions in amygdalar neural circuitry explain the pathophysiology underlying the disorder. Importantly, however, amygdala subregion networks have not yet been examined in youth close to mania onset. The goal of this study was to compare resting state functional connectivity patterns in amygdala subregions in youth with bipolar I disorder with patterns in healthy controls. METHOD Centromedial, laterobasal, and superficial amygdala subdivisions were assessed during rest and examined in relation to clinical measures of mania in youth (14-20 years old) with bipolar I disorder who experienced only a single episode of mania (BD; n = 20) and age-matched healthy comparison youth without any personal or family history of DSM-IV Axis I disorders (HC; n = 23). RESULTS Relative to HC youth, youth with BD exhibited decreased connectivity between the laterobasal subdivision of the amygdala and the hippocampus and precentral gyrus, and increased connectivity between the laterobasal subdivision and the precuneus. Connectivity between the right laterobasal amygdala and right hippocampus was positively correlated with levels of anxiety in BD but not in HC youth, and connectivity between the right laterobasal amygdala and right precuneus was negatively correlated with insight about bipolar illness. CONCLUSION Youth with BD have abnormal amygdala resting state network connections to regions that are critical for emotional processing and self-awareness. Longitudinal studies are needed to determine whether these aberrant patterns in youth with BD can be altered with intervention and can influence the course of disorder.
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Piguet C, Fodoulian L, Aubry JM, Vuilleumier P, Houenou J. Bipolar disorder: Functional neuroimaging markers in relatives. Neurosci Biobehav Rev 2015; 57:284-96. [PMID: 26321590 DOI: 10.1016/j.neubiorev.2015.08.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Revised: 07/31/2015] [Accepted: 08/25/2015] [Indexed: 12/30/2022]
Abstract
Neural models of anatomical and functional alterations have been proposed for bipolar disorders (BD). However, studies in affected patients do not allow disentangling alterations linked to the liability to BD from those associated with the evolution, medication and comorbidities of BD. Explorations in high risk subjects allow the study of these risk markers. We reported and summarized all functional magnetic resonance imaging (fMRI) studies focusing on first-degree relatives of BD patients. We found 29 studies reporting neural correlates of working memory (WM), emotional processing, executive functions and resting state in relatives of BD patients, compared to healthy subjects. Overall, the same regions that have been involved in patients, such as the inferior frontal gyrus and limbic areas, seem to be functionally altered in high-risk subjects. We conclude that the same brain regions already implicated in the pathophysiology of the disease such as the amygdala are also associated with the risk of BD. However longitudinal studies are required to understand their implication in the transition to BD.
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Affiliation(s)
- Camille Piguet
- Department of Neuroscience, Faculty of Medicine, University of Geneva, Switzerland; Department of Mental Health and Psychiatry, Geneva University Hospital, Switzerland.
| | - Leon Fodoulian
- Department of Neuroscience, Faculty of Medicine, University of Geneva, Switzerland
| | - Jean-Michel Aubry
- Department of Mental Health and Psychiatry, Geneva University Hospital, Switzerland
| | - Patrik Vuilleumier
- Department of Neuroscience, Faculty of Medicine, University of Geneva, Switzerland; Department of Clinical Neuroscience, Geneva University Hospital, Switzerland
| | - Josselin Houenou
- NeuroSpin Neuroimaging Center, UNIACT Lab, Psychiatry Team, CEA Saclay, France; INSERM U955 Team 15 "Translational Psychiatry", Université Paris Est, APHP, CHU Mondor, DHU PePsy, Pôle de Psychiatrie, Créteil, France; FondaMental Foundation, Créteil, France
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374
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Favre P, Polosan M, Pichat C, Bougerol T, Baciu M. Cerebral Correlates of Abnormal Emotion Conflict Processing in Euthymic Bipolar Patients: A Functional MRI Study. PLoS One 2015; 10:e0134961. [PMID: 26244883 PMCID: PMC4526683 DOI: 10.1371/journal.pone.0134961] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 07/16/2015] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Patients with bipolar disorder experience cognitive and emotional impairment that may persist even during the euthymic state of the disease. These persistent symptoms in bipolar patients (BP) may be characterized by disturbances of emotion regulation and related fronto-limbic brain circuitry. The present study aims to investigate the modulation of fronto-limbic activity and connectivity in BP by the processing of emotional conflict. METHODS Fourteen euthymic BP and 13 matched healthy subjects (HS) underwent functional magnetic resonance imaging (fMRI) while performing a word-face emotional Stroop task designed to dissociate the monitoring/generation of emotional conflict from its resolution. Functional connectivity was determined by means of psychophysiological interaction (PPI) approach. RESULTS Relative to HS, BP were slower to process incongruent stimuli, reflecting higher amount of behavioral interference during emotional Stroop. Furthermore, BP showed decreased activation of the right dorsolateral prefrontal cortex (DLPFC) during the monitoring and a lack of bilateral amygdala deactivation during the resolution of the emotional conflict. In addition, during conflict monitoring, BP showed abnormal positive connectivity between the right DLPFC and several regions of the default mode network. CONCLUSIONS Overall, our results highlighted dysfunctional processing of the emotion conflict in euthymic BP that may be subtended by abnormal activity and connectivity of the DLPFC during the conflict monitoring, which, in turn, leads to failure of amygdala deactivation during the resolution of the conflict. Emotional dysregulation in BP may be underpinned by a lack of top-down cognitive control and a difficulty to focus on the task due to persistent self-oriented attention.
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Affiliation(s)
- Pauline Favre
- Univ. Grenoble Alpes, LPNC, CNRS UMR 5105, Grenoble, France
- * E-mail:
| | - Mircea Polosan
- CHU de Grenoble, Pôle Psychiatrie et Neurologie, Centre Expert en Troubles Bipolaires, Université Joseph Fourier, Grenoble, France
- Univ. Grenoble Alpes, GIN, INSERM, CHU de Grenoble, Grenoble, France
| | - Cédric Pichat
- Univ. Grenoble Alpes, LPNC, CNRS UMR 5105, Grenoble, France
| | - Thierry Bougerol
- CHU de Grenoble, Pôle Psychiatrie et Neurologie, Centre Expert en Troubles Bipolaires, Université Joseph Fourier, Grenoble, France
- Univ. Grenoble Alpes, GIN, INSERM, CHU de Grenoble, Grenoble, France
| | - Monica Baciu
- Univ. Grenoble Alpes, LPNC, CNRS UMR 5105, Grenoble, France
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375
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A Multi-Dimensional and Integrative Approach to Examining the High-Risk and Ultra-High-Risk Stages of Bipolar Disorder. EBioMedicine 2015; 2:919-28. [PMID: 26425699 PMCID: PMC4563124 DOI: 10.1016/j.ebiom.2015.06.027] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 06/25/2015] [Accepted: 06/27/2015] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Validating the high-risk (HR) and ultra-high-risk (UHR) stages of bipolar disorder (BP) may help enable early intervention strategies. METHODS We followed up with 44 offspring of parents with BP, subdividing into the HR and UHR categories. The offspring were aged 8-28 years and were free of any current DSM-IV diagnoses. Our multilevel, integrative approach encompassed gray matter (GM) volumes, brain network connectivity, neuropsychological performance, and clinical outcomes. FINDINGS Compared with the healthy controls (HCs) (n = 33), the HR offspring (n = 26) showed GM volume reductions in the right orbitofrontal cortex. Compared with the HR offspring, the UHR offspring (n = 18) exhibited increased GM volumes in four regions. Both the HR and UHR offspring displayed abnormalities in the inferior occipital cortex regarding the measures of degree and centrality, reflecting the connections and roles of the region, respectively. In the UHR versus the HR offspring, the UHR offspring exhibited upwards-shifted small world topologies that reflect high clustering and efficiency in the brain networks. Compared with the HCs, the UHR offspring had significantly lower assortativity, which was suggestive of vulnerability. Finally, processing speed, visual-spatial, and general function were impaired in the UHR offspring but not in the HR offspring. INTERPRETATION The abnormalities observed in the HR offspring appear to be inherited, whereas those associated with the UHR offspring represent stage-specific changes predisposing them to developing the disorder.
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376
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Manelis A, Ladouceur CD, Graur S, Monk K, Bonar LK, Hickey MB, Dwojak AC, Axelson D, Goldstein BI, Goldstein TR, Bebko G, Bertocci MA, Hafeman DM, Gill MK, Birmaher B, Phillips ML. Altered amygdala-prefrontal response to facial emotion in offspring of parents with bipolar disorder. Brain 2015; 138:2777-90. [PMID: 26112339 DOI: 10.1093/brain/awv176] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Accepted: 04/26/2015] [Indexed: 12/23/2022] Open
Abstract
This study aimed to identify neuroimaging measures associated with risk for, or protection against, bipolar disorder by comparing youth offspring of parents with bipolar disorder versus youth offspring of non-bipolar parents versus offspring of healthy parents in (i) the magnitude of activation within emotional face processing circuitry; and (ii) functional connectivity between this circuitry and frontal emotion regulation regions. The study was conducted at the University of Pittsburgh Medical Centre. Participants included 29 offspring of parents with bipolar disorder (mean age = 13.8 years; 14 females), 29 offspring of non-bipolar parents (mean age = 13.8 years; 12 females) and 23 healthy controls (mean age = 13.7 years; 11 females). Participants were scanned during implicit processing of emerging happy, sad, fearful and angry faces and shapes. The activation analyses revealed greater right amygdala activation to emotional faces versus shapes in offspring of parents with bipolar disorder and offspring of non-bipolar parents than healthy controls. Given that abnormally increased amygdala activation during emotion processing characterized offspring of both patient groups, and that abnormally increased amygdala activation has often been reported in individuals with already developed bipolar disorder and those with major depressive disorder, these neuroimaging findings may represent markers of increased risk for affective disorders in general. The analysis of psychophysiological interaction revealed that offspring of parents with bipolar disorder showed significantly more negative right amygdala-anterior cingulate cortex functional connectivity to emotional faces versus shapes, but significantly more positive right amygdala-left ventrolateral prefrontal cortex functional connectivity to happy faces (all P-values corrected for multiple tests) than offspring of non-bipolar parents and healthy controls. Taken together with findings of increased amygdala-ventrolateral prefrontal cortex functional connectivity, and decreased amygdala-anterior cingulate cortex functional connectivity previously shown in individuals with bipolar disorder, these connectivity patterns in offspring of parents with bipolar disorder may be risk markers for, rather than markers conferring protection against, bipolar disorder in youth. The patterns of activation and functional connectivity remained unchanged after removing medicated participants and those with current psychopathology from analyses. This is the first study to demonstrate that abnormal functional connectivity patterns within face emotion processing circuitry distinguish offspring of parents with bipolar disorder from those of non-bipolar parents and healthy controls.
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Affiliation(s)
- Anna Manelis
- 1 Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Cecile D Ladouceur
- 1 Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Simona Graur
- 1 Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kelly Monk
- 1 Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Lisa K Bonar
- 1 Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mary Beth Hickey
- 1 Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Amanda C Dwojak
- 1 Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - David Axelson
- 2 Department of Psychiatry, Nationwide Children's Hospital and The Ohio State College of Medicine, Columbus, Ohio, USA
| | - Benjamin I Goldstein
- 3 Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Faculty of Medicine, Toronto, Ontario, Canada
| | - Tina R Goldstein
- 1 Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Genna Bebko
- 1 Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Michele A Bertocci
- 1 Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Danella M Hafeman
- 1 Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mary Kay Gill
- 1 Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Boris Birmaher
- 1 Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mary L Phillips
- 1 Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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377
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Madison JM, Zhou F, Nigam A, Hussain A, Barker DD, Nehme R, van der Ven K, Hsu J, Wolf P, Fleishman M, O’Dushlaine C, Rose S, Chambert K, Lau FH, Ahfeldt T, Rueckert EH, Sheridan SD, Fass DM, Nemesh J, Mullen TE, Daheron L, McCarroll S, Sklar P, Perlis RH, Haggarty SJ. Characterization of bipolar disorder patient-specific induced pluripotent stem cells from a family reveals neurodevelopmental and mRNA expression abnormalities. Mol Psychiatry 2015; 20:703-17. [PMID: 25733313 PMCID: PMC4440839 DOI: 10.1038/mp.2015.7] [Citation(s) in RCA: 138] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 10/29/2014] [Accepted: 12/19/2014] [Indexed: 02/07/2023]
Abstract
Bipolar disorder (BD) is a common neuropsychiatric disorder characterized by chronic recurrent episodes of depression and mania. Despite evidence for high heritability of BD, little is known about its underlying pathophysiology. To develop new tools for investigating the molecular and cellular basis of BD, we applied a family-based paradigm to derive and characterize a set of 12 induced pluripotent stem cell (iPSC) lines from a quartet consisting of two BD-affected brothers and their two unaffected parents. Initially, no significant phenotypic differences were observed between iPSCs derived from the different family members. However, upon directed neural differentiation, we observed that CXCR4 (CXC chemokine receptor-4) expressing central nervous system (CNS) neural progenitor cells (NPCs) from both BD patients compared with their unaffected parents exhibited multiple phenotypic differences at the level of neurogenesis and expression of genes critical for neuroplasticity, including WNT pathway components and ion channel subunits. Treatment of the CXCR4(+) NPCs with a pharmacological inhibitor of glycogen synthase kinase 3, a known regulator of WNT signaling, was found to rescue a progenitor proliferation deficit in the BD patient NPCs. Taken together, these studies provide new cellular tools for dissecting the pathophysiology of BD and evidence for dysregulation of key pathways involved in neurodevelopment and neuroplasticity. Future generation of additional iPSCs following a family-based paradigm for modeling complex neuropsychiatric disorders in conjunction with in-depth phenotyping holds promise for providing insights into the pathophysiological substrates of BD and is likely to inform the development of targeted therapeutics for its treatment and ideally prevention.
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Affiliation(s)
- Jon M. Madison
- Stanley Center for Psychiatric Research, Broad Institute of MIT & Harvard, Cambridge, MA 02142, USA,Psychiatric & Neurodevelopmental Genetics Unit, Center for Human Genetics Research, Massachusetts General Hospital, Boston, MA 02114, USA,Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA,Correspondence: (JM), (SJH)
| | - Fen Zhou
- Stanley Center for Psychiatric Research, Broad Institute of MIT & Harvard, Cambridge, MA 02142, USA,Psychiatric & Neurodevelopmental Genetics Unit, Center for Human Genetics Research, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Aparna Nigam
- Stanley Center for Psychiatric Research, Broad Institute of MIT & Harvard, Cambridge, MA 02142, USA,Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Ali Hussain
- Stanley Center for Psychiatric Research, Broad Institute of MIT & Harvard, Cambridge, MA 02142, USA,Psychiatric & Neurodevelopmental Genetics Unit, Center for Human Genetics Research, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Douglas D. Barker
- Stanley Center for Psychiatric Research, Broad Institute of MIT & Harvard, Cambridge, MA 02142, USA
| | - Ralda Nehme
- Stanley Center for Psychiatric Research, Broad Institute of MIT & Harvard, Cambridge, MA 02142, USA,Department of Stem Cell & Regenerative Biology, Harvard University, Cambridge, MA,Department of Neurology, Massachusetts General Hospital & Harvard Medical School, Boston, MA 02114, USA
| | - Karlijn van der Ven
- Psychiatric & Neurodevelopmental Genetics Unit, Center for Human Genetics Research, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Jenny Hsu
- Stanley Center for Psychiatric Research, Broad Institute of MIT & Harvard, Cambridge, MA 02142, USA,Psychiatric & Neurodevelopmental Genetics Unit, Center for Human Genetics Research, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Pavlina Wolf
- Stanley Center for Psychiatric Research, Broad Institute of MIT & Harvard, Cambridge, MA 02142, USA,Psychiatric & Neurodevelopmental Genetics Unit, Center for Human Genetics Research, Massachusetts General Hospital, Boston, MA 02114, USA,Department of Neurology, Massachusetts General Hospital & Harvard Medical School, Boston, MA 02114, USA
| | - Morgan Fleishman
- Stanley Center for Psychiatric Research, Broad Institute of MIT & Harvard, Cambridge, MA 02142, USA,Psychiatric & Neurodevelopmental Genetics Unit, Center for Human Genetics Research, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Colm O’Dushlaine
- Stanley Center for Psychiatric Research, Broad Institute of MIT & Harvard, Cambridge, MA 02142, USA
| | - Sam Rose
- Stanley Center for Psychiatric Research, Broad Institute of MIT & Harvard, Cambridge, MA 02142, USA
| | - Kimberly Chambert
- Stanley Center for Psychiatric Research, Broad Institute of MIT & Harvard, Cambridge, MA 02142, USA
| | - Frank H. Lau
- Department of Stem Cell & Regenerative Biology, Harvard University, Cambridge, MA
| | - Tim Ahfeldt
- Department of Stem Cell & Regenerative Biology, Harvard University, Cambridge, MA
| | - Erroll H. Rueckert
- Stanley Center for Psychiatric Research, Broad Institute of MIT & Harvard, Cambridge, MA 02142, USA,Psychiatric & Neurodevelopmental Genetics Unit, Center for Human Genetics Research, Massachusetts General Hospital, Boston, MA 02114, USA,Chemical Neurobiology Laboratory, Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Steven D. Sheridan
- Chemical Neurobiology Laboratory, Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Daniel M. Fass
- Stanley Center for Psychiatric Research, Broad Institute of MIT & Harvard, Cambridge, MA 02142, USA,Department of Neurology, Massachusetts General Hospital & Harvard Medical School, Boston, MA 02114, USA,Chemical Neurobiology Laboratory, Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA 02114, USA
| | - James Nemesh
- Stanley Center for Psychiatric Research, Broad Institute of MIT & Harvard, Cambridge, MA 02142, USA,Department of Genetics, Harvard Medical School, Boston, MA 02115, USA
| | - Thomas E. Mullen
- Stanley Center for Psychiatric Research, Broad Institute of MIT & Harvard, Cambridge, MA 02142, USA,Department of Genetics, Harvard Medical School, Boston, MA 02115, USA
| | - Laurence Daheron
- Department of Stem Cell & Regenerative Biology, Harvard University, Cambridge, MA
| | - Steve McCarroll
- Stanley Center for Psychiatric Research, Broad Institute of MIT & Harvard, Cambridge, MA 02142, USA,Department of Genetics, Harvard Medical School, Boston, MA 02115, USA
| | - Pamela Sklar
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY 10029, USA
| | - Roy H. Perlis
- Stanley Center for Psychiatric Research, Broad Institute of MIT & Harvard, Cambridge, MA 02142, USA,Psychiatric & Neurodevelopmental Genetics Unit, Center for Human Genetics Research, Massachusetts General Hospital, Boston, MA 02114, USA,Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA,Chemical Neurobiology Laboratory, Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Stephen J. Haggarty
- Stanley Center for Psychiatric Research, Broad Institute of MIT & Harvard, Cambridge, MA 02142, USA,Psychiatric & Neurodevelopmental Genetics Unit, Center for Human Genetics Research, Massachusetts General Hospital, Boston, MA 02114, USA,Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA,Department of Neurology, Massachusetts General Hospital & Harvard Medical School, Boston, MA 02114, USA,Chemical Neurobiology Laboratory, Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA 02114, USA,Correspondence: (JM), (SJH)
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378
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Abstract
BACKGROUND Bipolar disorder type I (BD-I) is associated with emotion dysregulation. However, experimentally controlled studies of emotion regulation (ER), particularly those examining the brain correlates of the putative deficits, are scarce and their results inconsistent. METHOD Nineteen euthymic BD-I patients and 17 healthy controls (HC) underwent functional magnetic resonance imaging while performing a visual ER 2 × 2 factorial task, with instruction (Look or Decrease) and valence (Negative or Neutral) as within-subject factors. Emotional ratings were collected after each picture presentation to assess regulation success. RESULTS BD-I patients were successful at downregulating their emotions, although to a lesser degree than HC. Both groups engaged brain regions previously implicated in ER; however, unlike HC, patients engaged some of those regions, particularly the ventrolateral prefrontal cortex (VLPFC) in the Negative Look and Neutral Decrease conditions. Moreover, patients failed to show the reduced amygdala activation in the Negative Decrease condition observed in HC. CONCLUSION Our findings suggest that BD-I patients are able to downregulate their emotions when instructed to do so. However, they also appear to engage their ER network, particularly the VLPFC, even when not required to do so. These findings may help explain their often-reported difficulty in regulating emotions in everyday life despite their attempts to do so.
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Affiliation(s)
- F Corbalán
- Douglas Mental Health University Institute,Montreal,Canada
| | - S Beaulieu
- Douglas Mental Health University Institute,Montreal,Canada
| | - J L Armony
- Douglas Mental Health University Institute,Montreal,Canada
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379
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Pathak G, Ibrahim BA, McCarthy SA, Baker K, Kelly MP. Amphetamine sensitization in mice is sufficient to produce both manic- and depressive-related behaviors as well as changes in the functional connectivity of corticolimbic structures. Neuropharmacology 2015; 95:434-47. [PMID: 25959066 DOI: 10.1016/j.neuropharm.2015.04.026] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Revised: 04/21/2015] [Accepted: 04/24/2015] [Indexed: 10/23/2022]
Abstract
It has been suggested that amphetamine abuse and withdrawal mimics the diverse nature of bipolar disorder symptomatology in humans. Here, we determined if a single paradigm of amphetamine sensitization would be sufficient to produce both manic- and depressive-related behaviors in mice. CD-1 mice were subcutaneously dosed for 5 days with 1.8 mg/kg d-amphetamine or vehicle. On days 6-31 of withdrawal, amphetamine-sensitized (AS) mice were compared to vehicle-treated (VT) mice on a range of behavioral and biochemical endpoints. AS mice demonstrated reliable mania- and depression-related behaviors from day 7 to day 28 of withdrawal. Relative to VT mice, AS mice exhibited long-lasting mania-like hyperactivity following either an acute 30-min restraint stress or a low-dose 1 mg/kg d-amphetamine challenge, which was attenuated by the mood-stabilizers lithium and quetiapine. In absence of any challenge, AS mice showed anhedonia-like decreases in sucrose preference and depression-like impairments in the off-line consolidation of motor memory, as reflected by the lack of spontaneous improvement across days of training on the rotarod. AS mice also demonstrated a functional impairment in nest building, an ethologically-relevant activity of daily living. Western blot analyses revealed a significant increase in methylation of histone 3 at lysine 9 (H3K9), but not lysine 4 (H3K4), in hippocampus of AS mice relative to VT mice. In situ hybridization for the immediate-early gene activity-regulated cytoskeleton-associated protein (Arc) further revealed heightened activation of corticolimbic structures, decreased functional connectivity between frontal cortex and striatum, and increased functional connectivity between the amygdala and hippocampus of AS mice. The effects of amphetamine sensitization were blunted in C57BL/6J mice relative to CD-1 mice. These results show that a single amphetamine sensitization protocol is sufficient to produce behavioral, functional, and biochemical phenotypes in mice that are relevant to bipolar disorder.
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Affiliation(s)
- G Pathak
- University of South Carolina School of Medicine, Columbia, SC 29209, USA
| | - B A Ibrahim
- University of South Carolina School of Medicine, Columbia, SC 29209, USA
| | | | - K Baker
- Pfizer, Neuroscience, Groton, CT 06340, USA
| | - M P Kelly
- University of South Carolina School of Medicine, Columbia, SC 29209, USA.
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380
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Fusing Functional MRI and Diffusion Tensor Imaging Measures of Brain Function and Structure to Predict Working Memory and Processing Speed Performance among Inter-episode Bipolar Patients. J Int Neuropsychol Soc 2015; 21:330-41. [PMID: 26037664 PMCID: PMC4655813 DOI: 10.1017/s1355617715000314] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Evidence for abnormal brain function as measured with diffusion tensor imaging (DTI) and functional magnetic resonance imaging (fMRI) and cognitive dysfunction have been observed in inter-episode bipolar disorder (BD) patients. We aimed to create a joint statistical model of white matter integrity and functional response measures in explaining differences in working memory and processing speed among BD patients. Medicated inter-episode BD (n=26; age=45.2±10.1 years) and healthy comparison (HC; n=36; age=46.3±11.5 years) participants completed 51-direction DTI and fMRI while performing a working memory task. Participants also completed a processing speed test. Tract-based spatial statistics identified common white matter tracts where fractional anisotropy was calculated from atlas-defined regions of interest. Brain responses within regions of interest activation clusters were also calculated. Least angle regression was used to fuse fMRI and DTI data to select the best joint neuroimaging predictors of cognitive performance for each group. While there was overlap between groups in which regions were most related to cognitive performance, some relationships differed between groups. For working memory accuracy, BD-specific predictors included bilateral dorsolateral prefrontal cortex from fMRI, splenium of the corpus callosum, left uncinate fasciculus, and bilateral superior longitudinal fasciculi from DTI. For processing speed, the genu and splenium of the corpus callosum and right superior longitudinal fasciculus from DTI were significant predictors of cognitive performance selectively for BD patients. BD patients demonstrated unique brain-cognition relationships compared to HC. These findings are a first step in discovering how interactions of structural and functional brain abnormalities contribute to cognitive impairments in BD.
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381
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Kim SH, Kim TY, Ryu V, Ha RY, Lee SJ, Ha K, Cho HS. Manic patients exhibit more utilitarian moral judgments in comparison with euthymic bipolar and healthy persons. Compr Psychiatry 2015; 58:37-44. [PMID: 25598287 DOI: 10.1016/j.comppsych.2014.12.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 11/27/2014] [Accepted: 12/23/2014] [Indexed: 10/24/2022] Open
Abstract
Both emotional and cognitive processes are involved in moral judgments. Ventromedial prefrontal lesions are related to impaired prosocial emotions and emotional dysregulation, and patients with these lesions exhibit increased utilitarian judgments of emotionally salient personal moral dilemmas. Bipolar patients experiencing manic episode also have impaired emotional regulation and behavioral control. We investigated the characteristics of moral judgment in manic and euthymic patients with bipolar disorder using the 50 hypothetical moral dilemma task (17 non-moral, 20 personal, and 13 impersonal). Our study included 27 manic bipolar patients, 26 euthymic bipolar patients, and 42 healthy controls. Subjects were instructed to determine whether or not each dilemma was morally acceptable, and their reaction times were recorded. Manic patients showed significantly greater utilitarian judgment than euthymic patients and normal controls for personal moral dilemmas. However, there were no significant between-group differences for the non-moral and impersonal moral dilemmas. Our results suggest that increased utilitarian judgments of personal moral dilemmas may be a state-related finding observed only in manic patients. This difference in moral judgment assessments may reflect the decision-making characteristics and underlying neurobiological mechanisms of bipolar disorder, especially during the manic state.
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Affiliation(s)
- Sung Hwa Kim
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Tae Young Kim
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Vin Ryu
- Department of Psychiatry, Seoul National Hospital, Seoul, Republic of Korea
| | - Ra Yeon Ha
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Su Jin Lee
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyooseob Ha
- Department of Psychiatry, Seoul National Hospital, Seoul, Republic of Korea; Department of Neuropsychiatry, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Hyun-Sang Cho
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
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382
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Abstract
The eating disorders (EDs) anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED) are severe psychiatric disorders with high mortality. There are many symptoms, such as food restriction, episodic binge eating, purging, or excessive exercise that are either overlapping or lie on opposite ends of a scale or spectrum across those disorders. Identifying how specific ED behaviors are linked to particular neurobiological mechanisms could help better categorize ED subgroups and develop specific treatments. This review provides support from recent brain imaging research that brain structure and function measures can be linked to disorder-specific biological or behavioral variables, which may help distinguish ED subgroups, or find commonalities between them. Brain structure and function may therefore be suitable research targets to further study the relationship between dimensions of behavior and brain function relevant to EDs and beyond the categorical AN, BN, and BED distinctions.
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383
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Abstract
Although neurobiological mechanisms of bipolar disorder (BD) are still unclear, neural models of the disease have recently been conceptualised thanks to neuroimaging. Indeed, magnetic resonance imaging (MRI) studies investigating structural and functional connectivity between different areas of the brain suggest an altered prefrontal-limbic coupling leading to disrupted emotional processing in BD, including uncinate fasciculus, amygdala, parahippocampal cortex, cingulate cortex as well corpus callosum. Specifically, these models assume an altered prefrontal control over a hyperactivity of the subcortical limbic structures implicated in automatic emotional processing. This impaired mechanism may finally trigger emotional hyper-reactivity and mood episodes. In this review, we first summarised some key neuroimaging studies on BD. In the second part of the work, we focused on the heterogeneity of the available studies. This variability is partly due to methodological factors (i.e., small sample size) and differences among studies (i.e., MRI acquisition and post-processing analyses) and partly to the clinical heterogeneity of BD. We finally outlined how epidemiological studies should indicate which risk factors and clinical dimensions of BD are relevant to be studied with neuroimaging in order to reduce heterogeneity and go beyond diagnostic categories.
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384
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Hippocampal structure and function in individuals with bipolar disorder: a systematic review. J Affect Disord 2015; 174:113-25. [PMID: 25496759 DOI: 10.1016/j.jad.2014.11.001] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 10/15/2014] [Accepted: 11/02/2014] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Bipolar disorder (BD) is a psychiatric disorder accompanied by deficits in declarative memory. Given the importance of the hippocampus in declarative memory, it is not surprising that BD patients have been reported to show hippocampal abnormalities. OBJECTIVES Review evidence about structural and functional hippocampal abnormalities in BD. METHODS Systematic review of studies comparing BD patients and healthy controls with respect to hippocampal structure or function. RESULTS Twenty-five studies were included, together involving 1043 patients, 21 of which compared patients to controls. Decrease in hippocampal volume was found in four of 18 studies using adult samples, and two of three samples using adolescents. Four studies revealed localized hippocampal deficits. Meta-analysis revealed a significant but small effect with lower hippocampal volumes when comparing all BD patients with controls. Lithium treatment was associated with larger hippocampal volumes across studies. The three functional studies yielded contradictory evidence. LIMITATIONS Studies were only cross-sectional in nature and all used MRI or fMRI to investigate hippocampal volume or function. Heterogeneous patients groups and different methodologies for hippocampal segmentation, may have contributed to difficulties when comparing the different studies. CONCLUSIONS There seems to be a small reduction in hippocampal volume in BD, which perhaps is more pronounced in early-onset BD and is counteracted by a neuroprotective effect of lithium treatment. However, how these structural abnormalities relate to functional deficits is largely unclear. Given the few functional neuroimaging studies and given the lack of congruence in these results, further investigation of especially hippocampal function in BD is recommended.
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385
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Abstract
The Kraepelinian dichotomy between schizophrenia (SZ) and bipolar disorder (BD) is being challenged by recent epidemiological and biological studies. We performed a comparative review of neuroimaging features in both conditions at several scales: whole-brain and regional volumes, brain activity, connectivity, and networks. Structural volumetric neuroimaging studies suggest a common pattern of volume decreases, but networks studies reveal a clearer distinction between BD and SZ with an altered connectivity generalized to all brain networks in SZ and restricted to limbic, paralimbic, and interhemispheric networks in BD.
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386
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Balaraman Y, Lahiri DK, Nurnberger JI. Variants in Ion Channel Genes Link Phenotypic Features of Bipolar Illness to Specific Neurobiological Process Domains. MOLECULAR NEUROPSYCHIATRY 2015; 1:23-35. [PMID: 27602355 DOI: 10.1159/000371886] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 01/05/2015] [Indexed: 11/19/2022]
Abstract
Recent advances in genome-wide association studies are pointing towards a major role for voltage-gated ion channels in neuropsychiatric disorders and, in particular, bipolar disorder (BD). The phenotype of BD is complex, with symptoms during mood episodes and deficits persisting between episodes. We have tried to elucidate the common neurobiological mechanisms associated with ion channel signaling in order to provide a new perspective on the clinical symptoms and possible endophenotypes seen in BD patients. We propose a model in which the multiple variants in genes coding for ion channel proteins would perturb motivational circuits, synaptic plasticity, myelination, hypothalamic-pituitary-adrenal axis function, circadian neuronal rhythms, and energy regulation. These changes in neurobiological mechanisms would manifest in endophenotypes of aberrant reward processing, white matter hyperintensities, deficits in executive function, altered frontolimbic connectivity, increased amygdala activity, increased melatonin suppression, decreased REM latency, and aberrant myo-inositol/ATP shuttling. The endophenotypes result in behaviors of poor impulse control, motivational changes, cognitive deficits, abnormal stress response, sleep disturbances, and energy changes involving different neurobiological process domains. The hypothesis is that these disturbances start with altered neural circuitry during development, following which multiple environmental triggers may disrupt the neuronal excitability balance through an activity-dependent molecular process, resulting in clinical mood episodes.
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Affiliation(s)
- Yokesh Balaraman
- Institute of Psychiatric Research, Department of Psychiatry, Neuroscience Research Center, Indiana University School of Medicine, Indianapolis, Ind., USA
| | - Debomoy K Lahiri
- Institute of Psychiatric Research, Department of Psychiatry, Neuroscience Research Center, Indiana University School of Medicine, Indianapolis, Ind., USA
| | - John I Nurnberger
- Institute of Psychiatric Research, Department of Psychiatry, Neuroscience Research Center, Indiana University School of Medicine, Indianapolis, Ind., USA
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387
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Phillips ML, Chase HW, Sheline YI, Etkin A, Almeida JR, Deckersbach T, Trivedi MH. Identifying predictors, moderators, and mediators of antidepressant response in major depressive disorder: neuroimaging approaches. Am J Psychiatry 2015; 172:124-38. [PMID: 25640931 PMCID: PMC4464814 DOI: 10.1176/appi.ajp.2014.14010076] [Citation(s) in RCA: 183] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Despite significant advances in neuroscience and treatment development, no widely accepted biomarkers are available to inform diagnostics or identify preferred treatments for individuals with major depressive disorder. METHOD In this critical review, the authors examine the extent to which multimodal neuroimaging techniques can identify biomarkers reflecting key pathophysiologic processes in depression and whether such biomarkers may act as predictors, moderators, and mediators of treatment response that might facilitate development of personalized treatments based on a better understanding of these processes. RESULTS The authors first highlight the most consistent findings from neuroimaging studies using different techniques in depression, including structural and functional abnormalities in two parallel neural circuits: serotonergically modulated implicit emotion regulation circuitry, centered on the amygdala and different regions in the medial prefrontal cortex; and dopaminergically modulated reward neural circuitry, centered on the ventral striatum and medial prefrontal cortex. They then describe key findings from the relatively small number of studies indicating that specific measures of regional function and, to a lesser extent, structure in these neural circuits predict treatment response in depression. CONCLUSIONS Limitations of existing studies include small sample sizes, use of only one neuroimaging modality, and a focus on identifying predictors rather than moderators and mediators of differential treatment response. By addressing these limitations and, most importantly, capitalizing on the benefits of multimodal neuroimaging, future studies can yield moderators and mediators of treatment response in depression to facilitate significant improvements in shorter- and longer-term clinical and functional outcomes.
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388
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Neuroprotective kynurenine metabolite indices are abnormally reduced and positively associated with hippocampal and amygdalar volume in bipolar disorder. Psychoneuroendocrinology 2015; 52:200-11. [PMID: 25486577 PMCID: PMC4297593 DOI: 10.1016/j.psyneuen.2014.11.015] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 10/30/2014] [Accepted: 11/17/2014] [Indexed: 12/12/2022]
Abstract
Inflammation-related changes in the concentrations of kynurenine-pathway metabolites occur in depression secondary to medical conditions but have not been well characterized in primary bipolar disorder (BD), with contradictory results potentially attributable to the presence or absence of psychosis and/or medication effects. In contrast, reductions in hippocampal and amygdalar volume that theoretically reflect dendritic atrophy occurring in the context of a neurotoxic process are commonly reported in unmedicated BD patients. Here we tested whether the concentrations of putatively neuroprotective (kynurenic acid, KynA) and neurotoxic (3-hydroxy-kynurenine, 3HK and quinolinic acid, QA) kynurenine-pathway metabolites were altered in primary BD and whether these metabolites were associated with hippocampal and amygdalar volume. Twenty-five moderately-to-severely depressed unmedicated subjects and 38 moderately-to-severely depressed medicated subjects who met DSM-IV-TR criteria for BD, as well as 48 healthy controls (HCs) completed a structural MRI scan and provided a blood sample for kynurenine metabolite analysis, performed using high performance liquid chromatography with tandem mass spectrometry. Gray matter volumes were measured with the automated segmentation software, FreeSurfer. A putative neuroprotective index, KynA/QA, was significantly lower in the BD subjects relative to the HCs, a finding that was unrelated to current treatment with medication or a prior history of psychosis. Further, another putative neuroprotective index, KynA/3HK was positively associated with hippocampal volume in the BD group after controlling for age, sex, body mass index (BMI), and intracranial volume (ICV). Kyn/3HK was significantly associated with total amygdalar volume in the BD group, but after controlling for age, sex, BMI, but not ICV, this association was reduced to a trend. In addition, Kyn/3HK was positively associated with amygdalar volume in the HCs although the association was no longer significant after accounting for the effects of age, sex, and BMI. The results raise the possibility that BD-associated abnormalities in kynurenine metabolism may impact the structure of the hippocampus and amygdala, highlighting a pathway through which inflammation may exert neuropathological effects in the context of depression.
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389
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Zanetti MV, Otaduy MC, de Sousa RT, Gattaz WF, Busatto GF, Leite CC, Machado-Vieira R. Bimodal effect of lithium plasma levels on hippocampal glutamate concentrations in bipolar II depression: a pilot study. Int J Neuropsychopharmacol 2015; 18:pyu058. [PMID: 25522399 PMCID: PMC4438538 DOI: 10.1093/ijnp/pyu058] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Accepted: 09/21/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The hippocampus has been highly implicated in the pathophysiology of bipolar disorder (BD). Nevertheless, no study has longitudinally evaluated hippocampal metabolite levels in bipolar depression under treatment with lithium. METHODS Nineteen medication-free BD patients (78.9% treatment-naïve and 73.7% with BD type II) presenting an acute depressive episode and 17 healthy controls were studied. Patients were treated for 6 weeks with lithium in an open-label trial. N-acetyl aspartate (NAA), creatine, choline, myo-Inositol, and glutamate levels were assessed in the left hippocampus before (week 0) and after (week 6) lithium treatment using 3T proton magnetic resonance spectroscopy (1H-MRS). The metabolite concentrations were estimated using internal water as reference and voxel segmentation for partial volume correction. RESULTS At baseline, acutely depressed BD patients and healthy controls exhibited similar hippocampal metabolites concentrations, with no changes after 6 weeks of lithium monotherapy. A significant correlation between antidepressant efficacy and increases in NAA concentration over time was observed. Also, there was a significant positive correlation between the changes in glutamate concentrations over follow-up and plasma lithium levels at endpoint. Mixed effects model analysis revealed a bimodal effect of lithium plasma levels in hippocampal glutamate concentrations: levels of 0.2 to 0.49 mmol/L (n=9) were associated with a decrease in glutamate concentrations, whereas the subgroup of BD subjects with "standard" lithium levels (≥ 0.50 mmol/L; n = 10) showed an overall increase in glutamate concentrations over time. CONCLUSIONS These preliminary results suggest that lithium has a bimodal action in hippocampal glutamate concentration depending on the plasma levels.
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Affiliation(s)
- Marcus V Zanetti
- Mood Disorders Program, Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, University of Sao Paulo, Brazil (Drs Zanetti, de Sousa, Gattaz, and Machado-Vieira); Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), University of São Paulo, Brazil (Drs Zanetti, Gattaz, Busatto, and Machado-Vieira); Laboratory of Psychiatric Neuroimaging, LIM-21, Department and Institute of Psychiatry, University of Sao Paulo, Brazil (Drs Zanetti and Busatto); Department of Radiology, University of Sao Paulo, Brazil (Drs Otaduy and Leite); Experimental Therapeutics and Pathophysiology Branch (ETPB), National Institute of Mental Health, NIH, Bethesda, MD (Dr Machado-Vieira).
| | - Maria C Otaduy
- Mood Disorders Program, Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, University of Sao Paulo, Brazil (Drs Zanetti, de Sousa, Gattaz, and Machado-Vieira); Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), University of São Paulo, Brazil (Drs Zanetti, Gattaz, Busatto, and Machado-Vieira); Laboratory of Psychiatric Neuroimaging, LIM-21, Department and Institute of Psychiatry, University of Sao Paulo, Brazil (Drs Zanetti and Busatto); Department of Radiology, University of Sao Paulo, Brazil (Drs Otaduy and Leite); Experimental Therapeutics and Pathophysiology Branch (ETPB), National Institute of Mental Health, NIH, Bethesda, MD (Dr Machado-Vieira)
| | - Rafael T de Sousa
- Mood Disorders Program, Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, University of Sao Paulo, Brazil (Drs Zanetti, de Sousa, Gattaz, and Machado-Vieira); Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), University of São Paulo, Brazil (Drs Zanetti, Gattaz, Busatto, and Machado-Vieira); Laboratory of Psychiatric Neuroimaging, LIM-21, Department and Institute of Psychiatry, University of Sao Paulo, Brazil (Drs Zanetti and Busatto); Department of Radiology, University of Sao Paulo, Brazil (Drs Otaduy and Leite); Experimental Therapeutics and Pathophysiology Branch (ETPB), National Institute of Mental Health, NIH, Bethesda, MD (Dr Machado-Vieira)
| | - Wagner F Gattaz
- Mood Disorders Program, Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, University of Sao Paulo, Brazil (Drs Zanetti, de Sousa, Gattaz, and Machado-Vieira); Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), University of São Paulo, Brazil (Drs Zanetti, Gattaz, Busatto, and Machado-Vieira); Laboratory of Psychiatric Neuroimaging, LIM-21, Department and Institute of Psychiatry, University of Sao Paulo, Brazil (Drs Zanetti and Busatto); Department of Radiology, University of Sao Paulo, Brazil (Drs Otaduy and Leite); Experimental Therapeutics and Pathophysiology Branch (ETPB), National Institute of Mental Health, NIH, Bethesda, MD (Dr Machado-Vieira)
| | - Geraldo F Busatto
- Mood Disorders Program, Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, University of Sao Paulo, Brazil (Drs Zanetti, de Sousa, Gattaz, and Machado-Vieira); Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), University of São Paulo, Brazil (Drs Zanetti, Gattaz, Busatto, and Machado-Vieira); Laboratory of Psychiatric Neuroimaging, LIM-21, Department and Institute of Psychiatry, University of Sao Paulo, Brazil (Drs Zanetti and Busatto); Department of Radiology, University of Sao Paulo, Brazil (Drs Otaduy and Leite); Experimental Therapeutics and Pathophysiology Branch (ETPB), National Institute of Mental Health, NIH, Bethesda, MD (Dr Machado-Vieira)
| | - Claudia C Leite
- Mood Disorders Program, Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, University of Sao Paulo, Brazil (Drs Zanetti, de Sousa, Gattaz, and Machado-Vieira); Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), University of São Paulo, Brazil (Drs Zanetti, Gattaz, Busatto, and Machado-Vieira); Laboratory of Psychiatric Neuroimaging, LIM-21, Department and Institute of Psychiatry, University of Sao Paulo, Brazil (Drs Zanetti and Busatto); Department of Radiology, University of Sao Paulo, Brazil (Drs Otaduy and Leite); Experimental Therapeutics and Pathophysiology Branch (ETPB), National Institute of Mental Health, NIH, Bethesda, MD (Dr Machado-Vieira)
| | - Rodrigo Machado-Vieira
- Mood Disorders Program, Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, University of Sao Paulo, Brazil (Drs Zanetti, de Sousa, Gattaz, and Machado-Vieira); Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), University of São Paulo, Brazil (Drs Zanetti, Gattaz, Busatto, and Machado-Vieira); Laboratory of Psychiatric Neuroimaging, LIM-21, Department and Institute of Psychiatry, University of Sao Paulo, Brazil (Drs Zanetti and Busatto); Department of Radiology, University of Sao Paulo, Brazil (Drs Otaduy and Leite); Experimental Therapeutics and Pathophysiology Branch (ETPB), National Institute of Mental Health, NIH, Bethesda, MD (Dr Machado-Vieira)
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390
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Mansur RB, Brietzke E, McIntyre RS. Is there a "metabolic-mood syndrome"? A review of the relationship between obesity and mood disorders. Neurosci Biobehav Rev 2015; 52:89-104. [PMID: 25579847 DOI: 10.1016/j.neubiorev.2014.12.017] [Citation(s) in RCA: 193] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 12/19/2014] [Accepted: 12/31/2014] [Indexed: 12/12/2022]
Abstract
Obesity and mood disorders are highly prevalent and co-morbid. Epidemiological studies have highlighted the public health relevance of this association, insofar as both conditions and its co-occurrence are associated with a staggering illness-associated burden. Accumulating evidence indicates that obesity and mood disorders are intrinsically linked and share a series of clinical, neurobiological, genetic and environmental factors. The relationship of these conditions has been described as convergent and bidirectional; and some authors have attempted to describe a specific subtype of mood disorders characterized by a higher incidence of obesity and metabolic problems. However, the nature of this association remains poorly understood. There are significant inconsistencies in the studies evaluating metabolic and mood disorders; and, as a result, several questions persist about the validity and the generalizability of the findings. An important limitation in this area of research is the noteworthy phenotypic and pathophysiological heterogeneity of metabolic and mood disorders. Although clinically useful, categorical classifications in both conditions have limited heuristic value and its use hinders a more comprehensive understanding of the association between metabolic and mood disorders. A recent trend in psychiatry is to move toward a domain specific approach, wherein psychopathology constructs are agnostic to DSM-defined diagnostic categories and, instead, there is an effort to categorize domains based on pathogenic substrates, as proposed by the National Institute of Mental Health (NIMH) Research Domain Criteria Project (RDoC). Moreover, the substrates subserving psychopathology seems to be unspecific and extend into other medical illnesses that share in common brain consequences, which includes metabolic disorders. Overall, accumulating evidence indicates that there is a consistent association of multiple abnormalities in neuropsychological constructs, as well as correspondent brain abnormalities, with broad-based metabolic dysfunction, suggesting, therefore, that the existence of a "metabolic-mood syndrome" is possible. Nonetheless, empirical evidence is necessary to support and develop this concept. Future research should focus on dimensional constructs and employ integrative, multidisciplinary and multimodal approaches.
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Affiliation(s)
- Rodrigo B Mansur
- Mood Disorders Psychopharmacology Unit (MDPU), University Health Network, University of Toronto, Toronto, Canada; Interdisciplinary Laboratory of Clinical Neuroscience (LINC), Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil.
| | - Elisa Brietzke
- Interdisciplinary Laboratory of Clinical Neuroscience (LINC), Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit (MDPU), University Health Network, University of Toronto, Toronto, Canada
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391
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Abstract
Many psychiatric disorders are characterized by intrusive, distracting, and disturbing memories that either perpetuate the illness or hinder successful treatment. For example, posttraumatic stress disorder (PTSD) involves such strong reemergence of memories associated with a traumatic event that the individual feels like the event is happening again. Furthermore, drug addiction is characterized by compulsive use and repeated relapse that is often driven by internal memories of drug use and/or by exposure to external stimuli that were associated with drug use. Therefore, identifying pharmacological methods to weaken the strength of maladaptive memories is a major goal of research efforts aimed at finding new treatments for these disorders. The primary mechanism by which memories could be pharmacologically disrupted or altered is through manipulation of memory reconsolidation. Reconsolidation occurs when an established memory is remembered or reactivated, reentering a labile state before again being consolidated into long-term memory storage. Memories are subject to disruption during this labile state. In this chapter we will discuss the preclinical and clinical studies identifying potential pharmacological methods for disrupting the integrity of maladaptive memory to treat mental illness.
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Affiliation(s)
- Jane R Taylor
- Department of Psychiatry, Yale University, New Haven, CT, USA
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392
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Impaired regulation of emotion: neural correlates of reappraisal and distraction in bipolar disorder and unaffected relatives. Transl Psychiatry 2015; 5:e497. [PMID: 25603413 PMCID: PMC4312831 DOI: 10.1038/tp.2014.137] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 11/04/2014] [Accepted: 11/18/2014] [Indexed: 12/29/2022] Open
Abstract
Deficient emotion regulation has been proposed as a crucial pathological mechanism in bipolar disorder (BD). We therefore investigated emotion regulation impairments in BD, the related neural underpinnings and their etiological relevance for the disorder. Twenty-two euthymic patients with bipolar-I disorder and 17 unaffected first-degree relatives of BD-I patients, as well as two groups of healthy gender-, age- and education-matched controls (N=22/17, respectively) were included. Participants underwent functional magnetic resonance imaging while applying two different emotion regulation techniques, reappraisal and distraction, when presented with emotional images. BD patients and relatives showed impaired downregulation of amygdala activity during reappraisal, but not during distraction, when compared with controls. This deficit was correlated with the habitual use of reappraisal. The negative connectivity of amygdala and orbitofrontal cortex (OFC) observed during reappraisal in controls was reversed in BD patients and relatives. There were no significant differences between BD patients and relatives. As being observed in BD patients and unaffected relatives, deficits in emotion regulation through reappraisal may represent heritable neurobiological abnormalities underlying BD. The neural mechanisms include impaired control of amygdala reactivity to emotional stimuli and dysfunctional connectivity of the amygdala to regulatory control regions in the OFC. These are, thus, important aspects of the neurobiological basis of increased vulnerability for BD.
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393
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Keshavan MS, Giedd J, Lau JYF, Lewis DA, Paus T. Changes in the adolescent brain and the pathophysiology of psychotic disorders. Lancet Psychiatry 2014; 1:549-58. [PMID: 26361314 DOI: 10.1016/s2215-0366(14)00081-9] [Citation(s) in RCA: 132] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 05/23/2014] [Indexed: 10/24/2022]
Abstract
Adolescence is a time of extensive neuroanatomical, functional, and chemical reorganisation of the brain which parallels substantial maturational changes in cognition and affect regulation. This period is characterised by stabilisation of synapses to diminish redundancy and increase efficiency of neural function, fine-tuning of excitatory and inhibitory neurotransmitter systems, beginning of integration between late maturing and early maturing brain structures, and development of effective connections. In effect, these so-called moving parts create a state of dynamic change that might underlie adolescent behaviours. Imbalances or changes in timing of these developmental processes clearly increase the risk for psychiatric disorders. Genetic, environmental, and epigenetic factors that shape brain development and hormonal changes that affect stress reactivity could be reasons why some, but not all, adolescents are at a heightened risk of developing a psychopathological disorder. In this Series paper, we assess the neurobiology of the changing adolescent brain, implications of this knowledge, and future research in major psychiatric disorders, particularly for psychotic disorders.
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Affiliation(s)
- Matcheri S Keshavan
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Western Psychiatric Institute and Clinic, Pittsburgh, PA, USA.
| | - Jay Giedd
- Brain Imaging Section, Child Psychiatry Branch, NIMH, Bethesda, MD, USA
| | | | - David A Lewis
- Department of Psychiatry, Western Psychiatric Institute and Clinic, Pittsburgh, PA, USA
| | - Tomáš Paus
- Rotman Research Institute and Departments of Psychology and Psychiatry, University of Toronto, Toronto, ON, Canada
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394
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Abstract
Bipolar disorder (BD) is a chronic psychiatric illness of which the etiology remains unknown. Extensive research has provided some hypotheses for the pathophysiology of this disorder; however, there are no molecular tests available to help support the diagnosis obtained by self-report and behavioral observations. A major requirement is to identify potential biomarkers that could be used for early diagnosis in patients susceptible to the disease and for its treatment. The most recently published findings regarding alterations in BD were found to be related to oxidative stress, inflammatory and trophic factor deregulation, and also polymorphisms of genes that are associated with the development of BD. Many of these targets are potential biomarkers which could help to identify the BD subgroups and to advance treatment strategies, which would beneficiate the quality of life of these patients. Therefore, the main objective of this review is to examine the recent findings and critically evaluate their potential as biomarkers for BD.
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Affiliation(s)
- Gustavo Scola
- Department of Psychiatry, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada,
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395
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Gonen T, Sharon H, Pearlson G, Hendler T. Moods as ups and downs of the motivation pendulum: revisiting reinforcement sensitivity theory (RST) in bipolar disorder. Front Behav Neurosci 2014; 8:378. [PMID: 25404902 PMCID: PMC4217503 DOI: 10.3389/fnbeh.2014.00378] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Accepted: 10/13/2014] [Indexed: 12/19/2022] Open
Abstract
Motivation is a key neurobehavioral concept underlying adaptive responses to environmental incentives and threats. As such, dysregulation of motivational processes may be critical in the formation of abnormal behavioral patterns/tendencies. According to the long standing model of the Reinforcement Sensitivity Theory (RST), motivation behaviors are driven by three neurobehavioral systems mediating the sensitivity to punishment, reward or goal-conflict. Corresponding to current neurobehavioral theories in psychiatry, this theory links abnormal motivational drives to abnormal behavior; viewing depression and mania as two abnormal extremes of reward driven processes leading to either under or over approach tendencies, respectively. We revisit the RST framework in the context of bipolar disorder (BD) and challenge this concept by suggesting that dysregulated interactions of both punishment and reward related processes better account for the psychological and neural abnormalities observed in BD. We further present an integrative model positing that the three parallel motivation systems currently proposed by the RST model, can be viewed as subsystems in a large-scale neurobehavioral network of motivational decision making.
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Affiliation(s)
- Tal Gonen
- Functional Brain Center, Wohl Institute of Advanced Imaging, Tel Aviv Medical CenterTel Aviv, Israel
- School of Psychological Sciences, Tel Aviv UniversityTel Aviv, Israel
| | - Haggai Sharon
- Functional Brain Center, Wohl Institute of Advanced Imaging, Tel Aviv Medical CenterTel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv UniversityTel Aviv, Israel
| | - Godfrey Pearlson
- Psychiatry Department, Yale School of MedicineBaltimore, MD, USA
- Olin Neuropsychiatry Research Center, Hartford HospitalHartford, CT, USA
- Psychiatry Department, Johns Hopkins UniversityHartford, CT, USA
| | - Talma Hendler
- Functional Brain Center, Wohl Institute of Advanced Imaging, Tel Aviv Medical CenterTel Aviv, Israel
- School of Psychological Sciences, Tel Aviv UniversityTel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv UniversityTel Aviv, Israel
- Sagol School of Neuroscience, Tel Aviv UniversityTel Aviv, Israel
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396
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Serafini G, Pompili M, Borgwardt S, Houenou J, Geoffroy PA, Jardri R, Girardi P, Amore M. Brain changes in early-onset bipolar and unipolar depressive disorders: a systematic review in children and adolescents. Eur Child Adolesc Psychiatry 2014; 23:1023-41. [PMID: 25212880 DOI: 10.1007/s00787-014-0614-z] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 08/29/2014] [Indexed: 01/09/2023]
Abstract
Pediatric bipolar disorder (BD) and unipolar disorder (UD) share common symptomatic and functional impairments. Various brain imaging techniques have been used to investigate the integrity of brain white matter (WM) and gray matter (GM) in these disorders. Despite promising preliminary findings, it is still unclear whether these alterations may be considered as common trait markers or may be used to distinguish BD from UD. A systematic literature search of studies between 1980 and September 2013 which reported WM/GM changes in pediatric and adolescent BD/UD, as detected by diffusion tensor imaging and voxel-based analysis was conducted. Of the 34 articles judged as eligible, 17 fulfilled our inclusion criteria and were finally retained in this review. More abnormalities have been documented in the brains of children and adolescents with BD than UD. Reductions in the volume of basal ganglia and the hippocampus appeared more specific for pediatric UD, whereas reduced corpus callosum volume and increased rates of deep WM hyperintensities were more specific for pediatric BD. Seminal papers failed to address the possibility that the differences between unipolar and bipolar samples might be related to illness severity, medication status, comorbidity or diagnosis. UD and BD present both shared and distinctive impairments in the WM and GM compartments. More WM abnormalities have been reported in children and adolescents with bipolar disease than in those with unipolar disease, maybe as a result of a low number of DTI studies in pediatric UD. Future longitudinal studies should investigate whether neurodevelopmental changes are diagnosis-specific.
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Affiliation(s)
- Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, IRCCS San Martino, Largo Rosanna Benzi 10, 16100, Genoa, Italy,
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Brooks JO, Vizueta N. Diagnostic and clinical implications of functional neuroimaging in bipolar disorder. J Psychiatr Res 2014; 57:12-25. [PMID: 25015683 DOI: 10.1016/j.jpsychires.2014.05.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 04/15/2014] [Accepted: 05/29/2014] [Indexed: 01/16/2023]
Abstract
Advances in functional neuroimaging have ushered in studies that have enhanced our understanding of the neuropathophysiology of bipolar disorder, but do not yet have clinical applications. We describe the major circuits (ventrolateral, dorsolateral, ventromedial, and anterior cingulate) thought to be involved in the corticolimbic dysregulation that may underlie mood states in patients with bipolar disorder. The potential clinical application of functional neuroimaging in bipolar disorder is considered in terms of prognostic, predictive, and treatment biomarkers. To date, most research has focused on prognostic biomarkers to differentiate patients with bipolar disorder from those with other affective or psychotic diagnoses, or healthy subjects. The search for treatment biomarkers, which suggest mechanisms of pharmacodynamic or treatment response, and predictive biomarkers has thus far involved only pediatric patients diagnosed with bipolar disorder. The results to date are encouraging and suggest that functional neuroimaging may be of eventual benefit in determining biomarkers of treatment response. Further refinement of biomarker identification, and perhaps even illness characterization are needed to find prognostic and predictive biomarkers of bipolar disorder.
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Affiliation(s)
- John O Brooks
- Department of Psychiatry & Biobehavioral Sciences, UCLA Semel Institute for Neuroscience & Human Behavior, Los Angeles, CA, USA.
| | - Nathalie Vizueta
- Department of Psychiatry & Biobehavioral Sciences, UCLA Semel Institute for Neuroscience & Human Behavior, Los Angeles, CA, USA
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398
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Preserved white matter in unmedicated pediatric bipolar disorder. Neurosci Lett 2014; 579:41-5. [PMID: 25017827 DOI: 10.1016/j.neulet.2014.06.061] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 06/17/2014] [Accepted: 06/29/2014] [Indexed: 02/02/2023]
Abstract
White matter (WM) abnormalities have been reported in bipolar disorder (BD) patients, as well as in their non-BD relatives, both children and adults. Although it is considered an emerging vulnerability marker for BD, there are no studies investigating WM alterations in pediatric unmedicated patients and young healthy offspring. In this study, we evaluated the presence of WM alterations in 18 pediatric, non medicated BD patients, as well as in 18 healthy offspring of BD type I parents and 20 healthy controls. 3T DT-MRI data were acquired and scans were processed with tract-based spatial statistics to provide measures of fractional anisotropy and diffusivity. We found no significant differences in WM microstructure between BD patients, healthy offspring and healthy controls. Previous studies that reported WM alterations investigated older subjects, either on medication (BD patients) or with psychiatric diagnoses other than BD (unaffected offspring). Our findings highlight the importance of the understanding of disease ontogeny and brain development dynamics in the search for early vulnerability markers for psychiatric disorders.
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399
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Lee MS, Anumagalla P, Talluri P, Pavuluri MN. Meta-analyses of developing brain function in high-risk and emerged bipolar disorder. Front Psychiatry 2014; 5:141. [PMID: 25404919 PMCID: PMC4217331 DOI: 10.3389/fpsyt.2014.00141] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 09/24/2014] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES Identifying early markers of brain function among those at high risk (HR) for pediatric bipolar disorder (PBD) could serve as a screening measure when children and adolescents present with subsyndromal clinical symptoms prior to the conversion to bipolar disorder. Studies on the offspring of patients with bipolar disorder who are genetically at HR have each been limited in establishing a biomarker, while an analytic review in summarizing the findings offers an improvised opportunity toward that goal. METHODS An activation likelihood estimation (ALE) meta-analysis of mixed cognitive and emotional activities using the GingerALE software from the BrainMap Project was completed. The meta-analysis of all fMRI studies contained a total of 29 reports and included PBD, HR, and typically developing (TD) groups. RESULTS The HR group showed significantly greater activation relative to the TD group in the right DLPFC-insular-parietal-cerebellar regions. Similarly, the HR group exhibited greater activity in the right DLPFC and insula as well as the left cerebellum compared to patients with PBD. Patients with PBD, relative to TD, showed greater activation in regions of the right amygdala, parahippocampal gyrus, medial PFC, left ventral striatum, and cerebellum and lower activation in the right VLPFC and the DLPFC. CONCLUSION The HR population showed increased activity, presumably indicating greater compensatory deployment, in relation to both the TD and the PBD, in the key cognition and emotion-processing regions, such as the DLPFC, insula, and parietal cortex. In contrast, patients with PBD, relative to HR and TD, showed decreased activity, which could indicate a decreased effort in multiple PFC regions in addition to widespread subcortical abnormalities, which are suggestive of a more entrenched disease process.
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Affiliation(s)
- Moon-Soo Lee
- Pediatric Brain Research and Intervention Center, University of Illinois at Chicago , Chicago, IL , USA ; College of Medicine, Korea University , Seoul , South Korea
| | - Purnima Anumagalla
- Pediatric Brain Research and Intervention Center, University of Illinois at Chicago , Chicago, IL , USA
| | - Prasanth Talluri
- Pediatric Brain Research and Intervention Center, University of Illinois at Chicago , Chicago, IL , USA
| | - Mani N Pavuluri
- Pediatric Brain Research and Intervention Center, University of Illinois at Chicago , Chicago, IL , USA
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400
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Liberg B, Klauser P, Harding IH, Adler M, Rahm C, Lundberg J, Masterman T, Wachtler C, Jonsson T, Kristoffersen-Wiberg M, Pantelis C, Wahlund B. Functional and structural alterations in the cingulate motor area relate to decreased fronto-striatal coupling in major depressive disorder with psychomotor disturbances. Front Psychiatry 2014; 5:176. [PMID: 25538633 PMCID: PMC4255491 DOI: 10.3389/fpsyt.2014.00176] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 11/21/2014] [Indexed: 01/14/2023] Open
Abstract
Psychomotor disturbances are a classic feature of major depressive disorders. These can manifest as lack of facial expressions and decreased speech production, reduced body posture and mobility, and slowed voluntary movement. The neural correlates of psychomotor disturbances in depression are poorly understood but it has been suggested that outputs from the cingulate motor area (CMA) to striatal motor regions, including the putamen, could be involved. We used functional and structural magnetic resonance imaging to conduct a region-of-interest analysis to test the hypotheses that neural activation patterns related to motor production and gray matter volumes in the CMA would be different between depressed subjects displaying psychomotor disturbances (n = 13) and matched healthy controls (n = 13). In addition, we conducted a psychophysiological interaction analysis to assess the functional coupling related to self-paced finger-tapping between the caudal CMA and the posterior putamen in patients compared to controls. We found a cluster of increased neural activation, adjacent to a cluster of decreased gray matter volume in the caudal CMA in patients compared to controls. The functional coupling between the left caudal CMA and the left putamen during finger-tapping task performance was additionally decreased in patients compared to controls. In addition, the strength of the functional coupling between the left caudal CMA and the left putamen was negatively correlated with the severity of psychomotor disturbances in the patient group. In conclusion, we found converging evidence for involvement of the caudal CMA and putamen in the generation of psychomotor disturbances in depression.
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Affiliation(s)
- Benny Liberg
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, The University of Melbourne , Melbourne, VIC , Australia ; Section of Psychiatry, Department of Clinical Neuroscience, Karolinska Institutet , Stockholm , Sweden ; Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Medical Imaging and Technology, Karolinska Institutet , Stockholm , Sweden
| | - Paul Klauser
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, The University of Melbourne , Melbourne, VIC , Australia ; Monash Clinical and Imaging Neuroscience, School of Psychology and Psychiatry, Monash University , Clayton, VIC , Australia
| | - Ian H Harding
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, The University of Melbourne , Melbourne, VIC , Australia ; School of Psychological Sciences, Monash University , Melbourne, VIC , Australia
| | - Mats Adler
- Section of Psychiatry, Department of Clinical Neuroscience, Karolinska Institutet , Stockholm , Sweden
| | - Christoffer Rahm
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, The University of Melbourne , Melbourne, VIC , Australia ; Department of Medicine Huddinge, Karolinska Institutet , Stockholm , Sweden
| | - Johan Lundberg
- Section of Psychiatry, Department of Clinical Neuroscience, Karolinska Institutet , Stockholm , Sweden
| | - Thomas Masterman
- Section of Psychiatry, Department of Clinical Neuroscience, Karolinska Institutet , Stockholm , Sweden
| | - Caroline Wachtler
- Primary Care Research Unit, Department of General Practice, The University of Melbourne , Melbourne, VIC , Australia ; Centre for Family Medicine (CeFAM), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet , Stockholm , Sweden
| | - Tomas Jonsson
- Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Medical Imaging and Technology, Karolinska Institutet , Stockholm , Sweden ; Department of Medical Physics, Karolinska University Hospital Huddinge , Stockholm , Sweden
| | - Maria Kristoffersen-Wiberg
- Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Medical Imaging and Technology, Karolinska Institutet , Stockholm , Sweden ; Department of Radiology, Karolinska University Hospital , Stockholm , Sweden
| | - Christos Pantelis
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, The University of Melbourne , Melbourne, VIC , Australia
| | - Björn Wahlund
- Department of Energy and Engineering, Swedish University of Agricultural Sciences , Uppsala , Sweden
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