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Differentiating white matter measures that protect against vs. predispose to bipolar disorder and other psychopathology in at-risk youth. Neuropsychopharmacology 2021; 46:2207-2216. [PMID: 34285367 PMCID: PMC8505429 DOI: 10.1038/s41386-021-01088-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 06/17/2021] [Accepted: 06/24/2021] [Indexed: 12/02/2022]
Abstract
Bipolar disorder (BD) is highly heritable. Identifying objective biomarkers reflecting pathophysiological processes predisposing to, versus protecting against BD, can help identify BD risk in offspring of BD parents. We recruited 21 BD participants with a first-degree relative with BD, 25 offspring of BD parents, 27 offspring of comparison parents with non-BD psychiatric disorders, and 32 healthy offspring of healthy parents. In at-risk groups, 23 had non-BD diagnoses and 29, no Axis-I diagnoses(healthy). Five at-risk offspring who developed BD post scan(Converters) were included. Diffusion imaging(dMRI) analysis with tract segmentation identified between-group differences in the microstructure of prefrontal tracts supporting emotional regulation relevant to BD: forceps minor, anterior thalamic radiation(ATR), cingulum bundle(CB), and uncinate fasciculus(UF). BD participants showed lower fractional anisotropy (FA) in the right CB (anterior portion) than other groups (q < 0.05); and in bilateral ATR (posterior portion) versus at-risk groups (q < 0.001). Healthy, but not non-BD, at-risk participants showed significantly higher FA in bilateral ATR clusters than healthy controls (qs < 0.05). At-risk groups showed higher FA in these clusters than BD participants (qs < 0.05). Non-BD versus healthy at-risk participants, and Converters versus offspring of BD parents, showed lower FA in the right ATR cluster (qs < 0.05). Low anterior right CB FA in BD participants versus other groups might result from having BD. High bilateral ATR FA in at-risk groups, and in healthy at-risk participants, versus healthy controls might protect against BD/other psychiatric disorders. Absence of elevated right ATR FA in non-BD versus healthy at-risk participants, and in Converters versus non-converter offspring of BD parents, might lower protection against BD in at-risk groups.
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Guglielmo R, Miskowiak KW, Hasler G. Evaluating endophenotypes for bipolar disorder. Int J Bipolar Disord 2021; 9:17. [PMID: 34046710 PMCID: PMC8160068 DOI: 10.1186/s40345-021-00220-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 02/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Phenotypic heterogeneity is a major impediment to the elucidation of the neurobiology and genetics of bipolar disorder. Endophenotype could help in reducing heterogeneity by defining biological traits that are more direct expressions of gene effects. The aim of this review is to examine the recent literature on clinical, epidemiological, neurobiological, and genetic findings and to select and evaluate candidate endophenotypes for bipolar disorder. Evaluating putative endophenotype could be helpful in better understanding the neurobiology of bipolar disorder by improving the definition of bipolar-related phenotypes in genetic studies. In this manner, research on endophenotypes could be useful to improve psychopathological diagnostics in the long-run by dissecting psychiatric macro phenotypes into biologically valid components. MAIN BODY The associations among the psychopathological and biological endophenotypes are discussed with respect to specificity, temporal stability, heritability, familiarity, and clinical and biological plausibility. Numerous findings regarding brain function, brain structure, neuropsychology and altered neurochemical pathways in patients with bipolar disorder and their relatives deserve further investigation. Overall, major findings suggest a developmental origin of this disorder as all the candidate endophenotypes that we have been able to select are present both in the early stages of the disorder as well as in subjects at risk. CONCLUSIONS Among the stronger candidate endophenotypes, we suggest circadian rhythm instability, dysmodulation of emotion and reward, altered neuroimmune state, attention and executive dysfunctions, anterior cingulate cortex thickness and early white matter abnormalities. In particular, early white matter abnormalities could be the result of a vulnerable brain on which new stressors are added in young adulthood which favours the onset of the disorder. Possible pathways that lead to a vulnerable brain are discussed starting from the data about molecular and imaging endophenotypes of bipolar disorder.
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Affiliation(s)
- Riccardo Guglielmo
- Psychiatry Research Unit, Fribourg Network for Mental Health (RFSM), University of Fribourg, Chemin du Cardinal-Journet 3, 1752, Villars-sur-Glâne, Switzerland.,Department of Neuroscience, Institute of Psychiatry, Catholic University Medical School, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Kamilla Woznica Miskowiak
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Gregor Hasler
- Psychiatry Research Unit, Fribourg Network for Mental Health (RFSM), University of Fribourg, Chemin du Cardinal-Journet 3, 1752, Villars-sur-Glâne, Switzerland.
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3
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Masuda Y, Okada G, Takamura M, Shibasaki C, Yoshino A, Yokoyama S, Ichikawa N, Okuhata S, Kobayashi T, Yamawaki S, Okamoto Y. Age-related white matter changes revealed by a whole-brain fiber-tracking method in bipolar disorder compared to major depressive disorder and healthy controls. Psychiatry Clin Neurosci 2021; 75:46-56. [PMID: 33090632 PMCID: PMC7894167 DOI: 10.1111/pcn.13166] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 09/23/2020] [Accepted: 10/15/2020] [Indexed: 02/01/2023]
Abstract
AIM Several studies have reported altered age-associated changes in white matter integrity in bipolar disorder (BD). However, little is known as to whether these age-related changes are illness-specific. We assessed disease-specific effects by controlling for age and investigated age-associated changes and Group × Age interactions in white matter integrity among major depressive disorder (MDD) patients, BD patients, and healthy controls. METHODS Healthy controls (n = 96; age range, 20-77 years), MDD patients (n = 101; age range, 25-78 years), and BD patients (n = 58; age range, 22-76 years) participated in this study. Fractional anisotropy (FA) derived from diffusion tensor imaging in 54 white matter tracts were compared after controlling for the linear and quadratic effect of age using a generalized linear model. Age-related effects and Age × Group interactions were also assessed in the model. RESULTS The main effect of group was significant in the left column and body of the fornix after controlling for both linear and quadratic effects of age, and in the left body of the corpus callosum after controlling for the quadratic effect of age. BD patients exhibited significantly lower FA relative to other groups. There was no Age × Group interaction in the tracts. CONCLUSION Significant FA reductions were found in BD patients after controlling for age, indicating that abnormal white matter integrity in BD may occur at a younger age rather than developing progressively with age.
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Affiliation(s)
- Yoshikazu Masuda
- Department of Psychiatry and Neuroscience, Hiroshima University, Hiroshima, Japan
| | - Go Okada
- Department of Psychiatry and Neuroscience, Hiroshima University, Hiroshima, Japan
| | - Masahiro Takamura
- Department of Psychiatry and Neuroscience, Hiroshima University, Hiroshima, Japan
| | - Chiyo Shibasaki
- Department of Psychiatry and Neuroscience, Hiroshima University, Hiroshima, Japan
| | - Atsuo Yoshino
- Department of Psychiatry and Neuroscience, Hiroshima University, Hiroshima, Japan
| | - Satoshi Yokoyama
- Department of Psychiatry and Neuroscience, Hiroshima University, Hiroshima, Japan
| | - Naho Ichikawa
- Department of Psychiatry and Neuroscience, Hiroshima University, Hiroshima, Japan
| | - Shiho Okuhata
- Graduate School of Engineering, Kyoto University, Kyoto, Japan
| | | | - Shigeto Yamawaki
- Department of Psychiatry and Neuroscience, Hiroshima University, Hiroshima, Japan
| | - Yasumasa Okamoto
- Department of Psychiatry and Neuroscience, Hiroshima University, Hiroshima, Japan
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4
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Hanford LC, Eckstrand K, Manelis A, Hafeman DM, Merranko J, Ladouceur CD, Graur S, McCaffrey A, Monk K, Bonar LK, Hickey MB, Goldstein TR, Goldstein BI, Axelson D, Bebko G, Bertocci MA, Gill MK, Birmaher B, Phillips ML. The impact of familial risk and early life adversity on emotion and reward processing networks in youth at-risk for bipolar disorder. PLoS One 2019; 14:e0226135. [PMID: 31830059 PMCID: PMC6907842 DOI: 10.1371/journal.pone.0226135] [Citation(s) in RCA: 9] [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: 02/03/2019] [Accepted: 11/20/2019] [Indexed: 12/11/2022] Open
Abstract
A recently developed risk calculator for bipolar disorder (BD) accounts for clinical and parental psychopathology. Yet, it is understood that both familial predisposition and early life adversity contribute to the development of BD. How the interplay between these two factors influence emotion and reward processing networks in youth at risk for BD remains unclear. In this exploratory analysis, offspring of BD parents performed emotion and reward processing tasks while undergoing a fMRI scan. Risk calculator score was used to assess risk for developing BD in the next 5 years. Environmental risk was tabulated using the Stressful Life Events Schedule (SLES). Emotion and reward processing networks were investigated for genetic and/or environment interactions. Interaction effects were found between risk calculator scores, negative SLES score and activity in right amygdala and bilateral fusiform gyri during the emotion processing task, as well as activity in the fronto-, striatal, and parietal regions during the reward processing task. Our findings are preliminary; however, they support the unique and interactive contributions of both familial and environmental risk factors on emotion and reward processing within OBP. They also identify potential neural targets to guide development of interventions for youth at greatest risk for psychiatric disorders.
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Affiliation(s)
- Lindsay C. Hanford
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Kristen Eckstrand
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Anna Manelis
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Danella M. Hafeman
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - John Merranko
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Cecile D. Ladouceur
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Simona Graur
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Alicia McCaffrey
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Kelly Monk
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Lisa K. Bonar
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Mary Beth Hickey
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Tina R. Goldstein
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Benjamin I. Goldstein
- Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada
- Pharmacology and Toxicology, University of Toronto, Toronto, Canada
| | - David Axelson
- Nationwide Children’s Hospital and The Ohio State College of Medicine, Columbus, Ohio, United States of America
| | - Genna Bebko
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Michele A. Bertocci
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Mary Kay Gill
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Boris Birmaher
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Mary L. Phillips
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
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Sehmbi M, Rowley CD, Minuzzi L, Kapczinski F, Kwiecien JM, Bock NA, Frey BN. Age-related deficits in intracortical myelination in young adults with bipolar disorder type I. J Psychiatry Neurosci 2019; 44:79-88. [PMID: 30525334 PMCID: PMC6397039 DOI: 10.1503/jpn.170220] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Previous studies have implicated white-matter-related changes in the pathophysiology of bipolar disorder. However, most of what is known is derived from in vivo subcortical white-matter imaging or postmortem studies. In this study, we investigated whole-brain intracortical myelin (ICM) content in people with bipolar disorder type I and controls. METHODS Between Sept. 1, 2014, and Jan. 31, 2017, we used a 3 T General Electric scanner to collect T1-weighted images in 45 people with bipolar disorder type I and 60 controls aged 17 to 45 years using an optimized sequence that was sensitive to ICM content. We analyzed images using a surfacebased approach. We used general linear models with quadratic age terms to examine the signal trajectory of ICM across the age range. RESULTS In healthy controls, the T1-weighted signal followed an inverted-U trajectory over age; in people with bipolar disorder type I, the association between ICM and age followed a flat trajectory (p < 0.05, Bonferroni corrected). Exploratory analyses showed that ICM signal intensity was associated with duration of illness, age of onset, and anticonvulsant and antipsychotic use in people with bipolar disorder type I (p < 0.05, uncorrected). LIMITATIONS Because of the cross-sectional nature of the study, we were unable to comment on whether the effects were due to dysmyelination or demyelination in bipolar disorder. CONCLUSION This foundational study is, to our knowledge, the first to show global age-related deficits in ICM maturation throughout the cortex in bipolar disorder. Considering the impact of myelination on the maintenance of neural synchrony and the integrity of neural connections, this work may help us better understand the cognitive and behavioural deficits seen in bipolar disorder.
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Affiliation(s)
- Manpreet Sehmbi
- From the Graduate Student, MiNDS Neuroscience Graduate Program, McMaster University, Hamilton, ON (Sehmbi, Rowley); the Mood Disorders Program, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON (Minuzzi, Kapczinski, Frey); the Women’s Health Concerns Clinic, St. Joseph’s Healthcare, Hamilton, ON (Minuzzi, Frey); the Department of Pathology and Molecular Medicine, M. deGroote School of Medicine, McMaster University, Hamilton, ON (Kwiecien); the Department of Psychology, Neuroscience, and Behaviour, McMaster University, Hamilton, ON (Bock); and the Department of Clinical Pathomorphology, Medical University of Lublin, Poland (Kwiecien)
| | - Christopher D. Rowley
- From the Graduate Student, MiNDS Neuroscience Graduate Program, McMaster University, Hamilton, ON (Sehmbi, Rowley); the Mood Disorders Program, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON (Minuzzi, Kapczinski, Frey); the Women’s Health Concerns Clinic, St. Joseph’s Healthcare, Hamilton, ON (Minuzzi, Frey); the Department of Pathology and Molecular Medicine, M. deGroote School of Medicine, McMaster University, Hamilton, ON (Kwiecien); the Department of Psychology, Neuroscience, and Behaviour, McMaster University, Hamilton, ON (Bock); and the Department of Clinical Pathomorphology, Medical University of Lublin, Poland (Kwiecien)
| | - Luciano Minuzzi
- From the Graduate Student, MiNDS Neuroscience Graduate Program, McMaster University, Hamilton, ON (Sehmbi, Rowley); the Mood Disorders Program, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON (Minuzzi, Kapczinski, Frey); the Women’s Health Concerns Clinic, St. Joseph’s Healthcare, Hamilton, ON (Minuzzi, Frey); the Department of Pathology and Molecular Medicine, M. deGroote School of Medicine, McMaster University, Hamilton, ON (Kwiecien); the Department of Psychology, Neuroscience, and Behaviour, McMaster University, Hamilton, ON (Bock); and the Department of Clinical Pathomorphology, Medical University of Lublin, Poland (Kwiecien)
| | - Flavio Kapczinski
- From the Graduate Student, MiNDS Neuroscience Graduate Program, McMaster University, Hamilton, ON (Sehmbi, Rowley); the Mood Disorders Program, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON (Minuzzi, Kapczinski, Frey); the Women’s Health Concerns Clinic, St. Joseph’s Healthcare, Hamilton, ON (Minuzzi, Frey); the Department of Pathology and Molecular Medicine, M. deGroote School of Medicine, McMaster University, Hamilton, ON (Kwiecien); the Department of Psychology, Neuroscience, and Behaviour, McMaster University, Hamilton, ON (Bock); and the Department of Clinical Pathomorphology, Medical University of Lublin, Poland (Kwiecien)
| | - Jacek M. Kwiecien
- From the Graduate Student, MiNDS Neuroscience Graduate Program, McMaster University, Hamilton, ON (Sehmbi, Rowley); the Mood Disorders Program, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON (Minuzzi, Kapczinski, Frey); the Women’s Health Concerns Clinic, St. Joseph’s Healthcare, Hamilton, ON (Minuzzi, Frey); the Department of Pathology and Molecular Medicine, M. deGroote School of Medicine, McMaster University, Hamilton, ON (Kwiecien); the Department of Psychology, Neuroscience, and Behaviour, McMaster University, Hamilton, ON (Bock); and the Department of Clinical Pathomorphology, Medical University of Lublin, Poland (Kwiecien)
| | - Nicholas A. Bock
- From the Graduate Student, MiNDS Neuroscience Graduate Program, McMaster University, Hamilton, ON (Sehmbi, Rowley); the Mood Disorders Program, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON (Minuzzi, Kapczinski, Frey); the Women’s Health Concerns Clinic, St. Joseph’s Healthcare, Hamilton, ON (Minuzzi, Frey); the Department of Pathology and Molecular Medicine, M. deGroote School of Medicine, McMaster University, Hamilton, ON (Kwiecien); the Department of Psychology, Neuroscience, and Behaviour, McMaster University, Hamilton, ON (Bock); and the Department of Clinical Pathomorphology, Medical University of Lublin, Poland (Kwiecien)
| | - Benicio N. Frey
- From the Graduate Student, MiNDS Neuroscience Graduate Program, McMaster University, Hamilton, ON (Sehmbi, Rowley); the Mood Disorders Program, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON (Minuzzi, Kapczinski, Frey); the Women’s Health Concerns Clinic, St. Joseph’s Healthcare, Hamilton, ON (Minuzzi, Frey); the Department of Pathology and Molecular Medicine, M. deGroote School of Medicine, McMaster University, Hamilton, ON (Kwiecien); the Department of Psychology, Neuroscience, and Behaviour, McMaster University, Hamilton, ON (Bock); and the Department of Clinical Pathomorphology, Medical University of Lublin, Poland (Kwiecien)
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6
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Acuff HE, Versace A, Bertocci MA, Hanford LC, Ladouceur CD, Manelis A, Monk K, Bonar L, McCaffrey A, Goldstein BI, Goldstein TR, Sakolsky D, Axelson D, Birmaher B, Phillips ML. White matter - emotion processing activity relationships in youth offspring of bipolar parents. J Affect Disord 2019; 243:153-164. [PMID: 30243195 PMCID: PMC6476540 DOI: 10.1016/j.jad.2018.09.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 07/31/2018] [Accepted: 09/09/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND Early detection of Bipolar Disorder (BD) is critical for targeting interventions to delay or prevent illness onset. Yet, the absence of objective BD biomarkers makes accurately identifying at-risk youth difficult. In this study, we examined how relationships between white matter tract (WMT) structure and activity in emotion processing neural circuitry differentiate youth at risk for BD from youth at risk for other psychiatric disorders. METHODS Offspring (ages 8-17) of parents with BD (OBP, n = 32), offspring of comparison parents with non-BD psychopathology (OCP, n = 30), and offspring of healthy parents (OHP, n = 24) underwent diffusion tensor and functional magnetic resonance imaging while performing an emotional face processing task. Penalized and multiple regression analyses included GROUP(OBP,OCP)xWMT interactions as main independent variables, and emotion processing activity as dependent variables, to determine significant group differences in WMT-activity relationships. RESULTS 8 GROUPxWMT interaction variables contributed to 16.5% of the variance in amygdala and prefrontal cortical activity to happy faces. Of these, significant group differences in slopes (inverse for OBP, positive for OCP) existed for the relationship between forceps minor radial diffusivity and rostral anterior cingulate activity (p = 0.014). Slopes remained significantly different in unmedicated youth without psychiatric disorders (p = 0.017) and were moderated by affective lability symptoms (F(1,29) = 5.566, p = 0.036). LIMITATIONS Relatively small sample sizes were included. CONCLUSIONS Forceps minor radial diffusivity-rostral anterior cingulate activity relationships may reflect underlying neuropathological processes that contribute to affectively labile youth at risk for BD and may help differentiate them from youth at risk for other psychiatric disorders.
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Affiliation(s)
- Heather E. Acuff
- Departments of Neuroscience, Psychology, and Psychiatry, Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA, USA,Medical Scientist Training Program, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Amelia Versace
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | | | | | | | - Anna Manelis
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kelly Monk
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lisa Bonar
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Alicia McCaffrey
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Tina R. Goldstein
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Dara Sakolsky
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - David Axelson
- Department of Psychiatry, Nationwide Children’s Hospital and The Ohio State College of Medicine, Columbus, OH, USA
| | | | - Boris Birmaher
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mary L. Phillips
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
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7
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Deng W, Zhang B, Zou W, Zhang X, Cheng X, Guan L, Lin Y, Lao G, Ye B, Li X, Yang C, Ning Y, Cao L. Abnormal Degree Centrality Associated With Cognitive Dysfunctions in Early Bipolar Disorder. Front Psychiatry 2019; 10:140. [PMID: 30949078 PMCID: PMC6435527 DOI: 10.3389/fpsyt.2019.00140] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 02/26/2019] [Indexed: 01/09/2023] Open
Abstract
Delayed diagnosis of bipolar disorder (BD) is common. However, diagnostic validity may be enhanced using reliable neurobiological markers for BD. Degree centrality (DC) is one such potential marker that enables researchers to visualize neuronal network abnormalities in the early stages of some neuropsychiatric disorders. In the present study, we measured resting-state DC abnormalities and cognitive deficits in order to identify early neurobiological markers for BD. We recruited 23 patients with BD who had recently experienced manic episodes (duration of illness <2 years) and 46 matched healthy controls. Our findings indicated that patients with BD exhibited DC abnormalities in frontal areas, temporal areas, the right postcentral gyrus, and the posterior lobe of the cerebellum. Moreover, correlation analysis revealed that psychomotor speed indicators were associated with DC in the superior temporal and inferior temporal gyri, while attention indicators were associated with DC in the inferior temporal gyrus, in patients with early BD. Our findings suggest that DC abnormalities in neural emotion regulation circuits are present in patients with early BD, and that correlations between attention/psychomotor speed deficits and temporal DC abnormalities may represent early markers of BD.
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Affiliation(s)
- Wenhao Deng
- Department of Early Intervention, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Bin Zhang
- Department of Early Intervention, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wenjin Zou
- Department of Radiology, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaofei Zhang
- Department of Early Intervention, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiongchao Cheng
- Department of Early Intervention, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Lijie Guan
- Department of Early Intervention, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yin Lin
- Department of Child and Adolescent, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Guohui Lao
- Department of Early Intervention, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Biyu Ye
- Department of Early Intervention, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xuan Li
- Department of Early Intervention, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Chanjuan Yang
- Department of Child and Adolescent, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yuping Ning
- Mental Health Institute, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Liping Cao
- Department of Early Intervention, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China.,Department of Child and Adolescent, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
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8
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Versace A, Ladouceur CD, Graur S, Acuff HE, Bonar LK, Monk K, McCaffrey A, Yendiki A, Leemans A, Travis MJ, Diwadkar VA, Holland SK, Sunshine JL, Kowatch RA, Horwitz SM, Frazier TW, Arnold LE, Fristad MA, Youngstrom EA, Findling RL, Goldstein BI, Goldstein T, Axelson D, Birmaher B, Phillips ML. Diffusion imaging markers of bipolar versus general psychopathology risk in youth at-risk. Neuropsychopharmacology 2018; 43:2212-2220. [PMID: 29795244 PMCID: PMC6135796 DOI: 10.1038/s41386-018-0083-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 03/31/2018] [Accepted: 04/10/2018] [Indexed: 12/22/2022]
Abstract
Bipolar disorder (BD) is highly heritable. Thus, studies in first-degree relatives of individuals with BD could lead to the discovery of objective risk markers of BD. Abnormalities in white matter structure reported in at-risk individuals could play an important role in the pathophysiology of BD. Due to the lack of studies with other at-risk offspring, however, it remains unclear whether such abnormalities reflect BD-specific or generic risk markers for future psychopathology. Using a tract-profile approach, we examined 18 major white matter tracts in 38 offspring of BD parents, 36 offspring of comparison parents with non-BD psychopathology (depression, attention-deficit/hyperactivity disorder), and 41 offspring of healthy parents. Both at-risk groups showed significantly lower fractional anisotropy (FA) in left-sided tracts (cingulum, inferior longitudinal fasciculus, forceps minor), and significantly greater FA in right-sided tracts (uncinate fasciculus and inferior longitudinal fasciculus), relative to offspring of healthy parents (P < 0.05). These abnormalities were present in both healthy and affected youth in at-risk groups. Only offspring (particularly healthy offspring) of BD parents showed lower FA in the right superior longitudinal fasciculus relative to healthy offspring of healthy parents (P < 0.05). We show, for the first time, important similarities, and some differences, in white matter structure between offspring of BD and offspring of non-BD parents. Findings suggest that lower left-sided and higher right-sided FA in tracts important for emotional regulation may represent markers of risk for general, rather than BD-specific, psychopathology. Lower FA in the right superior longitudinal fasciculus may protect against development of BD in offspring of BD parents.
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Affiliation(s)
- A Versace
- 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
| | - H E Acuff
- Departments of Neuroscience, Psychology, and Psychiatry, Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA, USA
- Medical Scientist Training Program, University of Pittsburgh School of Medicine, 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
| | - K Monk
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - A McCaffrey
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - A Yendiki
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - A Leemans
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M J Travis
- LAMS Consortium, Epping, NSW, 1710, Australia
| | | | - S K Holland
- LAMS Consortium, Epping, NSW, 1710, Australia
| | | | - R A Kowatch
- LAMS Consortium, Epping, NSW, 1710, Australia
| | - S M Horwitz
- LAMS Consortium, Epping, NSW, 1710, Australia
| | - T W Frazier
- LAMS Consortium, Epping, NSW, 1710, Australia
| | - L E Arnold
- Department of Psychiatry, Nationwide Children's Hospital and The Ohio State College of Medicine, Columbus, OH, USA
| | - M A Fristad
- LAMS Consortium, Epping, NSW, 1710, Australia
| | | | | | - B I Goldstein
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - T Goldstein
- 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 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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9
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Roberts G, Perry A, Lord A, Frankland A, Leung V, Holmes-Preston E, Levy F, Lenroot RK, Mitchell PB, Breakspear M. Structural dysconnectivity of key cognitive and emotional hubs in young people at high genetic risk for bipolar disorder. Mol Psychiatry 2018; 23:413-421. [PMID: 27994220 PMCID: PMC5794888 DOI: 10.1038/mp.2016.216] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 09/30/2016] [Accepted: 10/04/2016] [Indexed: 01/01/2023]
Abstract
Emerging evidence suggests that psychiatric disorders are associated with disturbances in structural brain networks. Little is known, however, about brain networks in those at high risk (HR) of bipolar disorder (BD), with such disturbances carrying substantial predictive and etiological value. Whole-brain tractography was performed on diffusion-weighted images acquired from 84 unaffected HR individuals with at least one first-degree relative with BD, 38 young patients with BD and 96 matched controls (CNs) with no family history of mental illness. We studied structural connectivity differences between these groups, with a focus on highly connected hubs and networks involving emotional centres. HR participants showed lower structural connectivity in two lateralised sub-networks centred on bilateral inferior frontal gyri and left insular cortex, as well as increased connectivity in a right lateralised limbic sub-network compared with CN subjects. BD was associated with weaker connectivity in a small right-sided sub-network involving connections between fronto-temporal and temporal areas. Although these sub-networks preferentially involved structural hubs, the integrity of the highly connected structural backbone was preserved in both groups. Weaker structural brain networks involving key emotional centres occur in young people at genetic risk of BD and those with established BD. In contrast to other psychiatric disorders such as schizophrenia, the structural core of the brain remains intact, despite the local involvement of network hubs. These results add to our understanding of the neurobiological correlates of BD and provide predictions for outcomes in young people at high genetic risk for BD.
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Affiliation(s)
- G Roberts
- School of Psychiatry, University of New South Wales, Randwick, NSW, Australia,Black Dog Institute, Prince of Wales Hospital, Randwick, NSW, Australia
| | - A Perry
- School of Psychiatry, University of New South Wales, Randwick, NSW, Australia,Program of Mental Health Research, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia,Metro North Mental Health Service, Brisbane, QLD, Australia,Centre for Healthy Brain Ageing, Randwick, NSW, Australia
| | - A Lord
- Program of Mental Health Research, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - A Frankland
- School of Psychiatry, University of New South Wales, Randwick, NSW, Australia,Black Dog Institute, Prince of Wales Hospital, Randwick, NSW, Australia
| | - V Leung
- School of Psychiatry, University of New South Wales, Randwick, NSW, Australia,Black Dog Institute, Prince of Wales Hospital, Randwick, NSW, Australia
| | - E Holmes-Preston
- School of Psychiatry, University of New South Wales, Randwick, NSW, Australia,Black Dog Institute, Prince of Wales Hospital, Randwick, NSW, Australia
| | - F Levy
- School of Psychiatry, University of New South Wales, Randwick, NSW, Australia,Prince of Wales Hospital, Randwick, NSW, Australia
| | - R K Lenroot
- School of Psychiatry, University of New South Wales, Randwick, NSW, Australia,Neuroscience Research Australia, Randwick, NSW, Australia
| | - P B Mitchell
- School of Psychiatry, University of New South Wales, Randwick, NSW, Australia,Black Dog Institute, Prince of Wales Hospital, Randwick, NSW, Australia,Prince of Wales Hospital, Randwick, NSW, Australia
| | - M Breakspear
- Program of Mental Health Research, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia,Metro North Mental Health Service, Brisbane, QLD, Australia,Systems Neuroscience Group, QIMR Berghofer Institute of Medical Research, 300 Herston Road, Herston, QLD, Australia. E-mail:
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10
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Intellectual Functioning in Offspring of Parents with Bipolar Disorder: A Review of the Literature. Brain Sci 2017; 7:brainsci7110143. [PMID: 29143763 PMCID: PMC5704150 DOI: 10.3390/brainsci7110143] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 10/12/2017] [Accepted: 10/20/2017] [Indexed: 11/17/2022] Open
Abstract
Impaired intellectual functioning is an important risk factor for the emergence of severe mental illness. Unlike many other forms of mental disorder however, the association between bipolar disorder and intellectual deficits is unclear. In this narrative review, we examine the current evidence on intellectual functioning in children and adolescents at risk for developing bipolar disorder. The results are based on 18 independent, peer-reviewed publications from 1980 to 2017 that met criteria for this study. The findings yielded no consistent evidence of lower or higher intellectual quotient (IQ) in offspring of parents diagnosed with bipolar disorder. Some tentative evidence was found for lower performance IQ in offspring of bipolar parents as compared to controls. It is recommended that future research examine variability in intellectual functioning and potential moderators. These findings demonstrate the need to examine how intellectual functioning unfolds across development given the potential role of IQ as a marker of vulnerability or resilience in youth at high risk for affective disorders.
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11
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The Lausanne-Geneva cohort study of offspring of parents with mood disorders: methodology, findings, current sample characteristics, and perspectives. Soc Psychiatry Psychiatr Epidemiol 2017; 52:1041-1058. [PMID: 28396906 DOI: 10.1007/s00127-017-1382-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 03/29/2017] [Indexed: 01/26/2023]
Abstract
PURPOSE Studies focusing on the offspring of affected parents utilize the well-established familial aggregation of mood disorders as a powerful tool for the identification of risk factors, early clinical manifestations, and prodromes of mood disorders in these offspring. The major goals of the Lausanne-Geneva mood cohort study are to: (1) assess the familial aggregation of bipolar and unipolar mood disorders; (2) prospectively identify risk factors for mood disorders as well as their early signs and prodromes; (3) identify their endophenotypes including cognitive features, alterations in brain structure, HPA-axis dysregulation, and abnormalities of the circadian rhythm of activity. METHODS Probands with bipolar disorders, major depressive disorder, and controls with at least one child aged from 4 to 17.9 years at study intake, their offspring, as well as their spouses are invited to take part in follow-up assessments at predetermined ages of the offspring. Direct semi-structured diagnostic interviews have been used for all participants. Probands, spouses, and adult offspring also undergo neurocognitive testing, anthropomorphic measures and biochemical exams, structural Magnetic Resonance Imaging, as well as objective assessments of physical activity using accelerometers in combination with ecological momentary assessments. RESULTS Currently, our study has up to seven follow-up assessments extending over a period of 20 years. There are 214 probands and 389 offspring with one direct interview before age 18 as well as a second assessment over follow-up. Data on 236 co-parents are also available from whom 55% have been directly interviewed. First publications support the specificity of the familial aggregation of BPD and the strong influence of an early onset of the parental BPD, which amplifies the risk of developing this disorder in offspring. CONCLUSIONS Information from clinical, biological, cognitive, and behavioral measures, based on contemporary knowledge, should further enhance our understanding of mood disorder psychopathology, its consequences, and underlying mechanisms.
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12
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McNamara RK, Szeszko PR, Smesny S, Ikuta T, DeRosse P, Vaz FM, Milleit B, Hipler UC, Wiegand C, Hesse J, Amminger GP, Malhotra AK, Peters BD. Polyunsaturated fatty acid biostatus, phospholipase A 2 activity and brain white matter microstructure across adolescence. Neuroscience 2016; 343:423-433. [PMID: 27998778 DOI: 10.1016/j.neuroscience.2016.12.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 11/21/2016] [Accepted: 12/03/2016] [Indexed: 12/29/2022]
Abstract
Adolescence is a period of major brain white matter (WM) changes, and membrane lipid metabolism likely plays a critical role in brain WM myelination. Long-chain polyunsaturated fatty acids (LC-PUFAs) are essential components of cell membranes including oligodendrocytes, and LC-PUFA release and turnover in membranes is regulated by phospholipase A2 enzymes. To investigate the role of membrane lipid metabolism in healthy WM myelination across adolescence, the present study examined the relationship between membrane LC-PUFA biostatus, phospholipase A2 activity, and brain WM microstructure in healthy subjects aged 9-20years (n=30). Diffusion tensor imaging (DTI) was performed to measure average fractional anisotropy (FA) and diffusivity (indices sensitive to WM myelination) of nine major cerebral WM tracts. Blood samples were collected to measure erythrocyte membrane fatty acid concentrations and plasma intracellular phospholipase A2 activity (inPLA2). Plasma inPLA2 activity showed a significant U-curved association with WM radial diffusivity, and an inverted U-curved association with WM FA, independent of age. A significant positive linear correlation was observed between docosahexaenoic acid concentration and axial diffusivity in the corpus callosum. These findings suggest that there may be optimal physiological inPLA2 activity levels associated with healthy WM myelination in late childhood and adolescence. Myelination may be mediated by cleavage of docosahexaenoic acid from membrane phospholipids by inPLA2. These findings have implications for our understanding of the role of LC-PUFA homeostasis in myelin-related neurodevelopmental disorders.
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Affiliation(s)
- Robert K McNamara
- Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, OH 45219, USA.
| | - Philip R Szeszko
- Division of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, NY 11004, USA; Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY 11030, USA.
| | - Stefan Smesny
- Department of Psychiatry, University Hospital Jena, D-07743 Jena, Germany.
| | - Toshikazu Ikuta
- Division of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, NY 11004, USA; Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY 11030, USA.
| | - Pamela DeRosse
- Division of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, NY 11004, USA; Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY 11030, USA.
| | - Frédéric M Vaz
- Laboratory Genetic Metabolic Diseases, Academic Medical Center, 1105 AZ Amsterdam, The Netherlands.
| | - Berko Milleit
- Department of Dermatology, University Hospital Jena, Erfurter Straße 35, D-07743 Jena, Germany.
| | - Uta-Christina Hipler
- Department of Dermatology, University Hospital Jena, Erfurter Straße 35, D-07743 Jena, Germany.
| | - Cornelia Wiegand
- Department of Dermatology, University Hospital Jena, Erfurter Straße 35, D-07743 Jena, Germany.
| | - Jana Hesse
- Department of Dermatology, University Hospital Jena, Erfurter Straße 35, D-07743 Jena, Germany.
| | - G Paul Amminger
- Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville VIC 3052, Australia.
| | - Anil K Malhotra
- Division of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, NY 11004, USA; Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY 11030, USA.
| | - Bart D Peters
- Division of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, NY 11004, USA; Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY 11030, USA.
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13
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Sprooten E, Barrett J, McKay DR, Knowles EE, Mathias SR, Winkler AM, Brumbaugh MS, Landau S, Cyr L, Kochunov P, Glahn DC. A comprehensive tractography study of patients with bipolar disorder and their unaffected siblings. Hum Brain Mapp 2016; 37:3474-85. [PMID: 27198848 DOI: 10.1002/hbm.23253] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 04/01/2016] [Accepted: 04/27/2016] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Diffusion tensor imaging studies show reductions in fractional anisotropy (FA) in individuals with bipolar disorder and their unaffected siblings. However, the use of various analysis methods is an important source of between-study heterogeneity. Using tract-based spatial statistics, we previously demonstrated widespread FA reductions in patients and unaffected relatives. To better interpret the neuroanatomical pattern of this previous finding and to assess the influence of methodological heterogeneity, we here applied tractography to the same sample. METHODS Diffusion-weighted images were acquired for 96 patients, 69 unaffected siblings and 56 controls. We applied TRACULA, an extension of a global probabilistic tractography algorithm, to automatically segment 18 major fiber tracts. Average FA within each tract and at each cross-section along each tract was compared between groups. RESULTS Patients had reduced FA compared to healthy controls and their unaffected siblings in general, and in particular in the parietal part of the superior longitudinal fasciculus. In unaffected siblings, FA was nominally reduced compared to controls in the corpus callosum. Point-wise analyses indicated that similar effects were present along extended sections, but with variable effect sizes. Current symptom severity negatively correlated with FA in several fronto-limbic association tracts. CONCLUSIONS The differential sensitivity of analysis techniques likely explains between-study heterogeneity in anatomical localization of FA reductions. The present tractography analysis confirms the presence of overall FA reductions in patients with bipolar disorder, which are most pronounced in the superior longitudinal fasciculus. Unaffected siblings may display similar, albeit more subtle and anatomically restricted FA reductions. Hum Brain Mapp 37:3474-3485, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Emma Sprooten
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Jennifer Barrett
- Olin Neuropsychiatry Research Center, Institute of Living, Hartford Hospital, Hartford, Connecticut
| | - D Reese McKay
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Emma E Knowles
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Samuel R Mathias
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Anderson M Winkler
- Oxford Centre for Functional MRI Of the Brain, University of Oxford, Oxford, United Kingdom
| | - Margaret S Brumbaugh
- Olin Neuropsychiatry Research Center, Institute of Living, Hartford Hospital, Hartford, Connecticut
| | - Stefanie Landau
- Olin Neuropsychiatry Research Center, Institute of Living, Hartford Hospital, Hartford, Connecticut
| | - Lindsay Cyr
- Olin Neuropsychiatry Research Center, Institute of Living, Hartford Hospital, Hartford, Connecticut
| | - Peter Kochunov
- Department of Psychiatry, University of Maryland School of Medicine, Maryland Psychiatric Research Center, Baltimore, Maryland
| | - David C Glahn
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut.,Olin Neuropsychiatry Research Center, Institute of Living, Hartford Hospital, Hartford, Connecticut
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14
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Jacobs RH, Barba A, Gowins JR, Klumpp H, Jenkins LM, Mickey BJ, Ajilore O, Peciña M, Sikora M, Ryan KA, Hsu DT, Welsh RC, Zubieta JK, Phan KL, Langenecker SA. Decoupling of the amygdala to other salience network regions in adolescent-onset recurrent major depressive disorder. Psychol Med 2016; 46:1055-1067. [PMID: 26784396 PMCID: PMC4810773 DOI: 10.1017/s0033291715002615] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Recent meta-analyses of resting-state networks in major depressive disorder (MDD) implicate network disruptions underlying cognitive and affective features of illness. Heterogeneity of findings to date may stem from the relative lack of data parsing clinical features of MDD such as phase of illness and the burden of multiple episodes. METHOD Resting-state functional magnetic resonance imaging data were collected from 17 active MDD and 34 remitted MDD patients, and 26 healthy controls (HCs) across two sites. Participants were medication-free and further subdivided into those with single v. multiple episodes to examine disease burden. Seed-based connectivity using the posterior cingulate cortex (PCC) seed to probe the default mode network as well as the amygdala and subgenual anterior cingulate cortex (sgACC) seeds to probe the salience network (SN) were conducted. RESULTS Young adults with remitted MDD demonstrated hyperconnectivity of the left PCC to the left inferior frontal gyrus and of the left sgACC to the right ventromedial prefrontal cortex (PFC) and left hippocampus compared with HCs. Episode-independent effects were observed between the left PCC and the right dorsolateral PFC, as well as between the left amygdala and right insula and caudate, whereas the burden of multiple episodes was associated with hypoconnectivity of the left PCC to multiple cognitive control regions as well as hypoconnectivity of the amygdala to large portions of the SN. CONCLUSIONS This is the first study of a homogeneous sample of unmedicated young adults with a history of adolescent-onset MDD illustrating brain-based episodic features of illness.
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Affiliation(s)
- R. H. Jacobs
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - A. Barba
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - J. R. Gowins
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - H. Klumpp
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - L. M. Jenkins
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - B. J. Mickey
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - O. Ajilore
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - M. Peciña
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - M. Sikora
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - K. A. Ryan
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - D. T. Hsu
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
- Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA
| | - R. C. Welsh
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
- Department of Radiology, Molecular and Behavioral Neuroscience Institute, Ann Arbor, MI, USA
| | - J.-K. Zubieta
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
- Department of Radiology, Molecular and Behavioral Neuroscience Institute, Ann Arbor, MI, USA
| | - K. L. Phan
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
- Mental Health Service Line, Jesse Brown VA Medical Center, Chicago, IL, USA
| | - S. A. Langenecker
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
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15
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Collin G, van den Heuvel MP, Abramovic L, Vreeker A, de Reus MA, van Haren NEM, Boks MPM, Ophoff RA, Kahn RS. Brain network analysis reveals affected connectome structure in bipolar I disorder. Hum Brain Mapp 2015; 37:122-34. [PMID: 26454006 DOI: 10.1002/hbm.23017] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 09/18/2015] [Accepted: 09/24/2015] [Indexed: 12/14/2022] Open
Abstract
The notion that healthy brain function emerges from coordinated neural activity constrained by the brain's network of anatomical connections--i.e., the connectome--suggests that alterations in the connectome's wiring pattern may underlie brain disorders. Corroborating this hypothesis, studies in schizophrenia are indicative of altered connectome architecture including reduced communication efficiency, disruptions of central brain hubs, and affected "rich club" organization. Whether similar deficits are present in bipolar disorder is currently unknown. This study examines structural connectome topology in 216 bipolar I disorder patients as compared to 144 healthy controls, focusing in particular on central regions (i.e., brain hubs) and connections (i.e., rich club connections, interhemispheric connections) of the brain's network. We find that bipolar I disorder patients exhibit reduced global efficiency (-4.4%, P =0.002) and that this deficit relates (r = 0.56, P < 0.001) to reduced connectivity strength of interhemispheric connections (-13.0%, P = 0.001). Bipolar disorder patients were found not to show predominant alterations in the strength of brain hub connections in general, or of connections spanning brain hubs (i.e., "rich club" connections) in particular (all P > 0.1). These findings highlight a role for aberrant brain network architecture in bipolar I disorder with reduced global efficiency in association with disruptions in interhemispheric connectivity, while the central "rich club" system appears not to be particularly affected.
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Affiliation(s)
- Guusje Collin
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Martijn P van den Heuvel
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lucija Abramovic
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Annabel Vreeker
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marcel A de Reus
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Neeltje E M van Haren
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marco P M Boks
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Roel A Ophoff
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands.,Center for Neurobehavioral Genetics, University of California Los Angeles, Los Angeles, California.,Department of Human Genetics, University of California Los Angeles, Los Angeles, California
| | - René S Kahn
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands
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16
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Toteja N, Cokol PG, Ikuta T, Kafantaris V, Peters BD, Burdick KE, John M, Malhotra AK, Szeszko PR. Age-associated alterations in corpus callosum white matter integrity in bipolar disorder assessed using probabilistic tractography. Bipolar Disord 2015; 17:381-91. [PMID: 25532972 PMCID: PMC4458202 DOI: 10.1111/bdi.12278] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Accepted: 09/01/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Atypical age-associated changes in white matter integrity may play a role in the neurobiology of bipolar disorder, but no studies have examined the major white matter tracts using nonlinear statistical modeling across a wide age range in this disorder. The goal of this study was to identify possible deviations in the typical pattern of age-associated changes in white matter integrity in patients with bipolar disorder across the age range of 9-62 years. METHODS Diffusion tensor imaging was performed in 57 (20 male and 37 female) patients with a diagnosis of bipolar disorder and 57 (20 male and 37 female) age- and sex-matched healthy volunteers. Mean diffusivity and fractional anisotropy were computed for the genu and splenium of the corpus callosum, two projection tracts, and five association tracts using probabilistic tractography. RESULTS Overall, patients had lower fractional anisotropy and higher mean diffusivity compared to healthy volunteers across all tracts (while controlling for the effects of age and age(2) ). In addition, there were greater age-associated increases in mean diffusivity in patients compared to healthy volunteers within the genu and splenium of the corpus callosum beginning in the second and third decades of life. CONCLUSIONS Our findings provide evidence for alterations in the typical pattern of white matter development in patients with bipolar disorder compared to healthy volunteers. Changes in white matter development within the corpus callosum may lead to altered inter-hemispheric communication that is considered integral to the neurobiology of the disorder.
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Affiliation(s)
- Nitin Toteja
- SUNY Downstate Medical Center, Brooklyn, NY, Kings County Hospital, Brooklyn NY
| | | | - Toshikazu Ikuta
- Department of Communication Sciences and Disorders, University of Mississippi, MI
| | - Vivian Kafantaris
- Zucker Hillside Hospital, North Shore-LIJ Health System, Glen Oaks, NY, Feinstein Institute for Medical Research, North Shore-LIJ Health System, Manhasset, NY, Departments of Psychiatry and Molecular Medicine, Hofstra North Shore – LIJ School of Medicine
| | - Bart D. Peters
- Zucker Hillside Hospital, North Shore-LIJ Health System, Glen Oaks, NY
| | - Katherine E. Burdick
- Departments of Psychiatry and Neuroscience, Mount Sinai School of Medicine, NY, NY
| | - Majnu John
- Zucker Hillside Hospital, North Shore-LIJ Health System, Glen Oaks, NY, Feinstein Institute for Medical Research, North Shore-LIJ Health System, Manhasset, NY
| | - Anil K. Malhotra
- Zucker Hillside Hospital, North Shore-LIJ Health System, Glen Oaks, NY, Feinstein Institute for Medical Research, North Shore-LIJ Health System, Manhasset, NY, Departments of Psychiatry and Molecular Medicine, Hofstra North Shore – LIJ School of Medicine
| | - Philip R. Szeszko
- Zucker Hillside Hospital, North Shore-LIJ Health System, Glen Oaks, NY, Feinstein Institute for Medical Research, North Shore-LIJ Health System, Manhasset, NY, Departments of Psychiatry and Molecular Medicine, Hofstra North Shore – LIJ School of Medicine
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17
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Roybal DJ, Barnea-Goraly N, Kelley R, Bararpour L, Howe ME, Reiss AL, Chang KD. Widespread white matter tract aberrations in youth with familial risk for bipolar disorder. Psychiatry Res 2015; 232:184-92. [PMID: 25779034 PMCID: PMC6147249 DOI: 10.1016/j.pscychresns.2015.02.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 11/21/2014] [Accepted: 02/18/2015] [Indexed: 11/15/2022]
Abstract
Few studies have examined multiple measures of white matter (WM) differences in youth with familial risk for bipolar disorder (FR-BD). To investigate WM in the FR-BD group, we used three measures of WM structure and two methods of analysis. We used fractional anisotropy (FA), axial diffusivity (AD), and radial diffusivity (RD) to analyze diffusion tensor imaging (DTI) findings in 25 youth with familial risk for bipolar disorder, defined as having both a parent with BD and mood dysregulation, and 16 sex-, age-, and IQ-matched healthy controls. We conducted a whole brain voxelwise analysis using tract based spatial statistics (TBSS). Subsequently, we conducted a complementary atlas-based, region-of-interest analysis using Diffeomap to confirm results seen in TBSS. When TBSS was used, significant widespread between-group differences were found showing increased FA, increased AD, and decreased RD in the FR-BD group in the bilateral uncinate fasciculus, cingulum, cingulate, superior fronto-occipital fasciculus (SFOF), superior longitudinal fasciculus (SLF), inferior longitudinal fasciculus, and corpus callosum. Atlas-based analysis confirmed significant between-group differences, with increased FA and decreased RD in the FR-BD group in the SLF, cingulum, and SFOF. We found significant widespread WM tract aberrations in youth with familial risk for BD using two complementary methods of DTI analysis.
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Affiliation(s)
- Donna J Roybal
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, School of Medicine(,) Stanford University, Stanford, CA, USA.
| | - Naama Barnea-Goraly
- Center for Interdisciplinary Brain Sciences Research, Department of Psychiatry, Stanford University School of Medicine, Stanford, CA, USA
| | - Ryan Kelley
- Center for Interdisciplinary Brain Sciences Research, Department of Psychiatry, Stanford University School of Medicine, Stanford, CA, USA
| | - Layla Bararpour
- Center for Interdisciplinary Brain Sciences Research, Department of Psychiatry, Stanford University School of Medicine, Stanford, CA, USA
| | - Meghan E Howe
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, School of Medicine(,) Stanford University, Stanford, CA, USA
| | - Allan L Reiss
- Center for Interdisciplinary Brain Sciences Research, Department of Psychiatry, Stanford University School of Medicine, Stanford, CA, USA
| | - Kiki D Chang
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, School of Medicine(,) Stanford University, Stanford, CA, USA
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All the world's a (clinical) stage: rethinking bipolar disorder from a longitudinal perspective. Mol Psychiatry 2015; 20:23-31. [PMID: 25048003 PMCID: PMC4303542 DOI: 10.1038/mp.2014.71] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 05/13/2014] [Accepted: 06/06/2014] [Indexed: 12/11/2022]
Abstract
Psychiatric disorders have traditionally been classified using a static, categorical approach. However, this approach falls short in facilitating understanding of the development, common comorbid diagnoses, prognosis and treatment of these disorders. We propose a 'staging' model of bipolar disorder that integrates genetic and neural information with mood and activity symptoms to describe how the disease progresses over time. From an early, asymptomatic, but 'at-risk' stage to severe, chronic illness, each stage is described with associated neuroimaging findings as well as strategies for mapping genetic risk factors. Integrating more biologic information relating to cardiovascular and endocrine systems, refining methodology for modeling dimensional approaches to disease and developing outcome measures will all be crucial in examining the validity of this model. Ultimately, this approach should aid in developing targeted interventions for each group that will reduce the significant morbidity and mortality associated with bipolar disorder.
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Arat HE, Chouinard VA, Cohen BM, Lewandowski KE, Öngür D. Diffusion tensor imaging in first degree relatives of schizophrenia and bipolar disorder patients. Schizophr Res 2015; 161:329-39. [PMID: 25542860 PMCID: PMC4308443 DOI: 10.1016/j.schres.2014.12.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 12/03/2014] [Accepted: 12/05/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES White matter (WM) abnormalities are one of the most widely and consistently reported findings in schizophrenia (SZ) and bipolar disorder (BD). If these abnormalities are inherited determinants of illness, suitable to be classified as an endophenotype, relatives of patients must also have them at higher rate compared to the general population. In this review, we evaluate published diffusion tensor imaging (DTI) studies comparing first degree relatives of SZ and BD patients and healthy control subjects. METHODS We searched PubMed, Embase and PsychInfo for DTI studies which included an unaffected relative and a healthy comparison group. RESULTS 22 studies fulfilled the inclusion criteria. WM abnormalities were found in many diverse regions in relatives of SZ patients. Although the findings were not completely consistent across studies, the most implicated areas were the frontal and temporal WM regions and the corpus callosum. Studies in relatives of BD patients were fewer in number with less consistent findings reported across studies. CONCLUSIONS Our review supports the concept of WM abnormalities as an endophenotype in SZ, with somewhat weaker evidence in BD, but larger and higher quality studies are needed to make a definitive comment.
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Affiliation(s)
- Hidayet E. Arat
- Dokuz Eylul University, Faculty of Medicine Department of Psychiatry, Izmir, Turkey,McLean Hospital, 115 Mill St., Belmont, MA, 02478 USA
| | - Virginie-Anne Chouinard
- McLean Hospital, 115 Mill St., Belmont, MA, 02478 USA,Harvard Medical School, Department of Psychiatry, Boston, MA, 02114 USA
| | - Bruce M. Cohen
- McLean Hospital, 115 Mill St., Belmont, MA, 02478 USA,Harvard Medical School, Department of Psychiatry, Boston, MA, 02114 USA
| | - Kathryn E. Lewandowski
- McLean Hospital, 115 Mill St., Belmont, MA, 02478 USA,Harvard Medical School, Department of Psychiatry, Boston, MA, 02114 USA
| | - Dost Öngür
- McLean Hospital, 115 Mill St., Belmont, MA 02478, USA; Harvard Medical School, Department of Psychiatry, Boston, MA 02114, USA.
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20
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Phillips ML, Swartz HA. A critical appraisal of neuroimaging studies of bipolar disorder: toward a new conceptualization of underlying neural circuitry and a road map for future research. Am J Psychiatry 2014; 171:829-43. [PMID: 24626773 PMCID: PMC4119497 DOI: 10.1176/appi.ajp.2014.13081008] [Citation(s) in RCA: 396] [Impact Index Per Article: 39.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE In this critical review, the authors appraise neuroimaging findings in bipolar disorder in emotion-processing, emotion-regulation, and reward-processing neural circuitry in order to synthesize the current knowledge of the neural underpinnings of bipolar disorder and provide a neuroimaging research road map for future studies. METHOD The authors examined findings from all major studies in bipolar disorder that used functional MRI, volumetric analysis, diffusion imaging, and resting-state techniques, integrating findings to provide a better understanding of larger-scale neural circuitry abnormalities in bipolar disorder. RESULTS Bipolar disorder can be conceptualized, in neural circuitry terms, as parallel dysfunction in prefrontal cortical (especially ventrolateral prefrontal cortical)-hippocampal-amygdala emotion-processing and emotion-regulation circuits bilaterally, together with an "overactive" left-sided ventral striatal-ventrolateral and orbitofrontal cortical reward-processing circuitry, resulting in characteristic behavioral abnormalities associated with bipolar disorder: emotional lability, emotional dysregulation, and heightened reward sensitivity. A potential structural basis for these functional abnormalities is gray matter volume decreases in the prefrontal and temporal cortices, the amygdala, and the hippocampus and fractional anisotropy decreases in white matter tracts connecting prefrontal and subcortical regions. CONCLUSIONS Neuroimaging studies of bipolar disorder clearly demonstrate abnormalities in neural circuits supporting emotion processing, emotion regulation, and reward processing, although there are several limitations to these studies. Future neuroimaging research in bipolar disorder should include studies adopting dimensional approaches; larger studies examining neurodevelopmental trajectories in youths with bipolar disorder or at risk for bipolar disorder; multimodal neuroimaging studies using integrated systems approaches; and studies using pattern recognition approaches to provide clinically useful individual-level data. Such studies will help identify clinically relevant biomarkers to guide diagnosis and treatment decision making for individuals with bipolar disorder.
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21
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White-matter microstructure and gray-matter volumes in adolescents with subthreshold bipolar symptoms. Mol Psychiatry 2014; 19:462-70. [PMID: 23628983 PMCID: PMC3965837 DOI: 10.1038/mp.2013.44] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Revised: 02/27/2013] [Accepted: 03/18/2013] [Indexed: 02/02/2023]
Abstract
Abnormalities in white-matter (WM) microstructure, as lower fractional anisotropy (FA), have been reported in adolescent-onset bipolar disorder and in youth at familial risk for bipolarity. We sought to determine whether healthy adolescents with subthreshold bipolar symptoms (SBP) would have early WM microstructural alterations and whether those alterations would be associated with differences in gray-matter (GM) volumes. Forty-two adolescents with three core manic symptoms and no psychiatric diagnosis, and 126 adolescents matched by age and sex, with no psychiatric diagnosis or symptoms, were identified after screening the IMAGEN database of 2223 young adolescents recruited from the general population. After image quality control, voxel-wise statistics were performed on the diffusion parameters using tract-based spatial statistics in 25 SBP adolescents and 77 controls, and on GM and WM images using voxel-based morphometry in 30 SBP adolescents and 106 controls. As compared with healthy controls, adolescents with SBP displayed lower FA values in a number of WM tracts, particularly in the corpus callosum, cingulum, bilateral superior and inferior longitudinal fasciculi, uncinate fasciculi and corticospinal tracts. Radial diffusivity was mainly higher in posterior parts of bilateral superior and inferior longitudinal fasciculi, inferior fronto-occipital fasciculi and right cingulum. As compared with controls, SBP adolescents had lower GM volume in the left anterior cingulate region. This is the first study to investigate WM microstructure and GM morphometric variations in adolescents with SBP. The widespread FA alterations in association and projection tracts, associated with GM changes in regions involved in mood disorders, suggest altered structural connectivity in those adolescents.
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22
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de Zwarte SMC, Johnston JAY, Cox Lippard ET, Blumberg HP. Frontotemporal White Matter in Adolescents with, and at-Risk for, Bipolar Disorder. J Clin Med 2014; 3:233-54. [PMID: 26237259 PMCID: PMC4449671 DOI: 10.3390/jcm3010233] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 02/13/2014] [Accepted: 02/17/2014] [Indexed: 12/13/2022] Open
Abstract
Frontotemporal neural systems are highly implicated in the emotional dysregulation characteristic of bipolar disorder (BD). Convergent genetic, postmortem, behavioral and neuroimaging evidence suggests abnormalities in the development of frontotemporal white matter (WM) in the pathophysiology of BD. This review discusses evidence for the involvement of abnormal WM development in BD during adolescence, with a focus on frontotemporal WM. Findings from diffusion tensor imaging (DTI) studies in adults and adolescents are reviewed to explore possible progressive WM abnormalities in the disorder. Intra- and interhemispheric frontotemporal abnormalities were reported in adults with BD. Although evidence in children and adolescents with BD to date has been limited, similar intrahemispheric and interhemispheric findings have also been reported. The findings in youths suggest that these abnormalities may represent a trait marker present early in the course of BD. Functional connectivity studies, demonstrating a relationship between WM abnormalities and frontotemporal dysfunction in BD, and DTI studies of vulnerability in first-degree relatives of individuals with BD, are discussed. Together, findings suggest the involvement of abnormal frontotemporal WM development in the pathophysiology of BD and that these abnormalities may be early trait markers of vulnerability; however, more studies are critically needed.
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Affiliation(s)
- Sonja M C de Zwarte
- Department of Psychiatry, Yale School of Medicine, 300 George Street, Suite 901, New Haven, CT 06511, USA.
| | - Jennifer A Y Johnston
- Department of Psychiatry, Yale School of Medicine, 300 George Street, Suite 901, New Haven, CT 06511, USA.
| | - Elizabeth T Cox Lippard
- Department of Psychiatry, Yale School of Medicine, 300 George Street, Suite 901, New Haven, CT 06511, USA.
| | - Hilary P Blumberg
- Department of Psychiatry, Yale School of Medicine, 300 George Street, Suite 901, New Haven, CT 06511, USA.
- Department of Diagnostic Radiology, Yale School of Medicine, New Haven, CT 06511, USA.
- Child Study Center, Yale School of Medicine, New Haven, CT 06511, USA.
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23
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Lu D, Jiao Q, Zhong Y, Gao W, Xiao Q, Liu X, Lin X, Cheng W, Luo L, Xu C, Lu G, Su L. Altered baseline brain activity in children with bipolar disorder during mania state: a resting-state study. Neuropsychiatr Dis Treat 2014; 10:317-23. [PMID: 24570585 PMCID: PMC3933715 DOI: 10.2147/ndt.s54663] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Previous functional magnetic resonance imaging (fMRI) studies have shown abnormal functional connectivity in regions involved in emotion processing and regulation in pediatric bipolar disorder (PBD). Recent studies indicate, however, that task-dependent neural changes only represent a small fraction of the brain's total activity. How the brain allocates the majority of its resources at resting state is still unknown. We used the amplitude of low-frequency fluctuation (ALFF) method of fMRI to explore the spontaneous neuronal activity in resting state in PBD patients. METHODS Eighteen PBD patients during the mania phase and 18 sex-, age- and education-matched healthy subjects were enrolled in this study and all patients underwent fMRI scanning. The ALFF method was used to compare the resting-state spontaneous neuronal activity between groups. Correlation analysis was performed between the ALFF values and Young Mania Rating Scale scores. RESULTS Compared with healthy controls, PBD patients presented increased ALFF in bilateral caudate and left pallidum as well as decreased ALFF in left precuneus, left superior parietal lobule, and bilateral inferior occipital gyrus. Additionally, ALFF values in left pallidum were positively correlated with Young Mania Rating Scale score in PBD. CONCLUSION The abnormal resting-state neuronal activities of the basal ganglia, parietal cortex, and occipital cortex may play an important role in the pathophysiology in PBD patients.
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Affiliation(s)
- Dali Lu
- Mental Health Institute of the Second Xiangya Hospital, Key Laboratory of Psychiatry and Mental Health of Hunan Province, Central South University, Changsha, People's Republic of China
| | - Qing Jiao
- Department of Radiology, Taishan Medical University, Taian, People's Republic of China
| | - Yuan Zhong
- Department of Medical Imaging, Jinling Hospital, Nanjing University School of Medicine, Nanjing, People's Republic of China ; School of Psychology, Nanjing Normal University, Nanjing, People's Republic of China
| | - Weijia Gao
- Mental Health Institute of the Second Xiangya Hospital, Key Laboratory of Psychiatry and Mental Health of Hunan Province, Central South University, Changsha, People's Republic of China
| | - Qian Xiao
- Mental Health Institute of the Second Xiangya Hospital, Key Laboratory of Psychiatry and Mental Health of Hunan Province, Central South University, Changsha, People's Republic of China
| | - Xiaoqun Liu
- Mental Health Institute of the Second Xiangya Hospital, Key Laboratory of Psychiatry and Mental Health of Hunan Province, Central South University, Changsha, People's Republic of China
| | - Xiaoling Lin
- School of Nursing of Central South University, Changsha, People's Republic of China
| | - Wentao Cheng
- Department of Pediatric and Geriatric Psychiatry, Fuzhou Neuropsychiatric Hospital, Fuzhou, People's Republic of China
| | - Lanzhu Luo
- Department of Pediatric and Geriatric Psychiatry, Fuzhou Neuropsychiatric Hospital, Fuzhou, People's Republic of China
| | - Chuanjian Xu
- Department of Medical Imaging, Jinling Hospital, Nanjing University School of Medicine, Nanjing, People's Republic of China
| | - Guangming Lu
- Department of Radiology, Taishan Medical University, Taian, People's Republic of China
| | - Linyan Su
- Mental Health Institute of the Second Xiangya Hospital, Key Laboratory of Psychiatry and Mental Health of Hunan Province, Central South University, Changsha, People's Republic of China
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Sprooten E, Brumbaugh MS, Knowles EE, McKay DR, Lewis J, Barrett J, Landau S, Cyr L, Kochunov P, Winkler AM, Pearlson GD, Glahn DC. Reduced white matter integrity in sibling pairs discordant for bipolar disorder. Am J Psychiatry 2013; 170:1317-25. [PMID: 24185242 PMCID: PMC4119087 DOI: 10.1176/appi.ajp.2013.12111462] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Several lines of evidence indicate that white matter integrity is compromised in bipolar disorder, but the nature, extent, and biological causes remain elusive. To determine the extent to which white matter deficits in bipolar disorder are familial, the authors investigated white matter integrity in a large sample of bipolar patients, unaffected siblings, and healthy comparison subjects. METHOD The authors collected diffusion imaging data for 64 adult bipolar patients, 60 unaffected siblings (including 54 discordant sibling pairs), and 46 demographically matched comparison subjects. Fractional anisotropy was compared between the groups using voxel-wise tract-based spatial statistics and by extracting mean fractional anisotropy from 10 regions of interest. Additionally, intraclass correlation coefficients were calculated between the sibling pairs as an index of familiality. RESULTS Widespread fractional anisotropy reductions in bipolar patients (>40,000 voxels) and more subtle reductions in their siblings, mainly restricted to the corpus callosum, posterior thalamic radiations, and left superior longitudinal fasciculus (>2,000 voxels) were observed. Similarly, region-of-interest analysis revealed significant reductions in most white matter regions in patients. In siblings, fractional anisotropy in the posterior thalamic radiation and the forceps was nominally reduced. Significant between-sibling correlations were found for mean fractional anisotropy across the tract-based spatial statistic skeleton, within significant clusters, and within nearly all regions of interest. CONCLUSIONS These findings emphasize the relevance of white matter to neuropathology and familiality of bipolar disorder and encourage further use of white matter integrity markers as endophenotypes in genetic studies.
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25
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Thermenos HW, Keshavan MS, Juelich RJ, Molokotos E, Whitfield-Gabrieli S, Brent BK, Makris N, Seidman LJ. A review of neuroimaging studies of young relatives of individuals with schizophrenia: a developmental perspective from schizotaxia to schizophrenia. Am J Med Genet B Neuropsychiatr Genet 2013; 162B:604-35. [PMID: 24132894 DOI: 10.1002/ajmg.b.32170] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Accepted: 04/24/2013] [Indexed: 11/08/2022]
Abstract
In an effort to identify the developing abnormalities preceding psychosis, Dr. Ming T. Tsuang and colleagues at Harvard expanded Meehl's concept of "schizotaxia," and examined brain structure and function in families affected by schizophrenia (SZ). Here, we systematically review genetic (familial) high-risk (HR) studies of SZ using magnetic resonance imaging (MRI), examine how findings inform models of SZ etiology, and suggest directions for future research. Neuroimaging studies of youth at HR for SZ through the age of 30 were identified through a MEDLINE (PubMed) search. There is substantial evidence of gray matter volume abnormalities in youth at HR compared to controls, with an accelerated volume reduction over time in association with symptoms and cognitive deficits. In structural neuroimaging studies, prefrontal cortex (PFC) alterations were the most consistently reported finding in HR. There was also consistent evidence of smaller hippocampal volume. In functional studies, hyperactivity of the right PFC during performance of diverse tasks with common executive demands was consistently reported. The only longitudinal fMRI study to date revealed increasing left middle temporal activity in association with the emergence of psychotic symptoms. There was preliminary evidence of cerebellar and default mode network alterations in association with symptoms. Brain abnormalities in structure, function and neurochemistry are observed in the premorbid period in youth at HR for SZ. Future research should focus on the genetic and environmental contributions to these alterations, determine how early they emerge, and determine whether they can be partially or fully remediated by innovative treatments.
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Affiliation(s)
- H W Thermenos
- Harvard Medical School, Boston, Massachusetts; Massachusetts Mental Health Center, Division of Public Psychiatry, Boston, Massachusetts; Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
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26
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New AS, Carpenter DM, Perez-Rodriguez MM, Ripoll LH, Avedon J, Patil U, Hazlett EA, Goodman M. Developmental differences in diffusion tensor imaging parameters in borderline personality disorder. J Psychiatr Res 2013; 47:1101-9. [PMID: 23628384 PMCID: PMC3725738 DOI: 10.1016/j.jpsychires.2013.03.021] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Revised: 02/27/2013] [Accepted: 03/28/2013] [Indexed: 01/09/2023]
Abstract
BACKGROUND Borderline personality disorder (BPD) often presents during adolescence. Early detection and intervention decreases its subsequent severity. However, little is known about early predictors and biological underpinnings of BPD. The observed abnormal functional connectivity among brain regions in BPD led to studies of white matter, as the neural substrate of connectivity. However, diffusion tensor imaging (DTI) studies in adult BPD have been inconclusive, and, as yet, there are no published DTI studies in borderline adolescents. METHODS We conducted DTI tractography in 38 BPD patients (14-adolescents, 24-adults) and 32 healthy controls (13-adolescents, 19-adults). RESULTS We found bilateral tract-specific decreased fractional anisotropy (FA) in inferior longitudinal fasciculus (ILF) in BPD adolescents compared to adolescent controls. ILF FA was significantly higher in adolescent controls compared to BPD adolescents, BPD adults and adult controls (Wilks F(3,57) = 3.55, p < 0.02). Follow-up voxelwise TBSS analysis demonstrated lower FA in BPD adolescents compared to adolescent controls also in uncinate and occipitofrontal fasciculi. DISCUSSION FA generally develops along an inverted U-shape curve, increasing through adolescence, and slowly decreasing in adulthood. Our findings suggest that, in adolescent BPD, this normal developmental "peak" in FA, which is seen in healthy controls, is not achieved. This suggests a possible neural substrate for the previously reported OFC-amygdala disconnect in adults with BPD. It raises the possibility that a white matter tract abnormality in BPD present in adolescence may not be appreciable in adulthood, but a functional abnormality in the coordination among brain regions persists. Our finding represents a possible biological marker to identify those at risk for developing BPD.
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Affiliation(s)
- Antonia S. New
- The Mental Health Patient Care Center and the Mental Illness Research Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, NY,Department of Psychiatry, Mount Sinai School of Medicine, New York, NY
| | | | - M. Mercedes Perez-Rodriguez
- The Mental Health Patient Care Center and the Mental Illness Research Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, NY,Department of Psychiatry, Mount Sinai School of Medicine, New York, NY
| | - Luis H. Ripoll
- The Mental Health Patient Care Center and the Mental Illness Research Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, NY,Department of Psychiatry, Mount Sinai School of Medicine, New York, NY
| | - Jennifer Avedon
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY
| | - Uday Patil
- University of Texas Southwestern Medical Center at Dallas
| | - Erin A. Hazlett
- The Mental Health Patient Care Center and the Mental Illness Research Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, NY,Department of Psychiatry, Mount Sinai School of Medicine, New York, NY
| | - Marianne Goodman
- The Mental Health Patient Care Center and the Mental Illness Research Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, NY,Department of Psychiatry, Mount Sinai School of Medicine, New York, NY
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Abstract
In response to queries about whether brain imaging technology has reached the point where it is useful for making a clinical diagnosis and for helping to guide treatment selection, the American Psychiatric Association (APA) has recently written a position paper on the Clinical Application of Brain Imaging in Psychiatry. The following perspective piece is based on our contribution to this APA position paper, which specifically emphasized the application of neuroimaging in mood disorders. We present an introductory overview of the challenges faced by researchers in developing valid and reliable biomarkers for psychiatric disorders, followed by a synopsis of the extant neuroimaging findings in mood disorders, and an evidence-based review of the current research on brain imaging biomarkers in adult mood disorders. Although there are a number of promising results, by the standards proposed below, we argue that there are currently no brain imaging biomarkers that are clinically useful for establishing diagnosis or predicting treatment outcome in mood disorders.
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White matter microstructural abnormalities in bipolar disorder: A whole brain diffusion tensor imaging study. NEUROIMAGE-CLINICAL 2013; 2:558-68. [PMID: 24179807 PMCID: PMC3777761 DOI: 10.1016/j.nicl.2013.03.016] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Revised: 03/26/2013] [Accepted: 03/27/2013] [Indexed: 12/11/2022]
Abstract
Background Bipolar disorder (BD) is a chronic mental illness characterized by severe disruptions in mood and cognition. Diffusion tensor imaging (DTI) studies suggest that white matter (WM) tract abnormalities may contribute to the clinical hallmarks of the disorder. Using DTI and whole brain voxel-based analysis, we mapped the profile of WM anomalies in BD. All patients in our sample were euthymic and lithium free when scanned. Methods Diffusion-weighted and T1-weighted structural brain images were acquired from 23 lithium-free euthymic subjects with bipolar I disorder and 19 age- and sex-matched healthy control subjects on a 1.5 T MRI scanner. Scans were processed to provide measures of fractional anisotropy (FA) and mean and radial diffusivity (MD and RD) at each WM voxel, and processed scans were nonlinearly aligned to a customized brain imaging template for statistical group comparisons. Results Relative to controls, the bipolar group showed widespread regions of lower FA, including the corpus callosum, cortical and thalamic association fibers. MD and RD were abnormally elevated in patients in many of these same regions. Conclusions Our findings agree with prior reports of WM abnormalities in the corpus callosum and further link a bipolar diagnosis with structural abnormalities of the tapetum, fornix and stria terminalis. Future studies assessing the diagnostic specificity and prognostic implications of these abnormalities would be of interest. Using DTI and whole brain voxel-based analysis, we mapped WM anomalies in BD. Relative to controls, the bipolar group showed widespread regions of lower FA. MD and RD were abnormally elevated in patients in many of these same regions.
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Lagopoulos J, Hermens DF, Hatton SN, Tobias-Webb J, Griffiths K, Naismith SL, Scott EM, Hickie IB. Microstructural white matter changes in the corpus callosum of young people with Bipolar Disorder: a diffusion tensor imaging study. PLoS One 2013; 8:e59108. [PMID: 23527101 PMCID: PMC3602458 DOI: 10.1371/journal.pone.0059108] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Accepted: 02/11/2013] [Indexed: 12/19/2022] Open
Abstract
To date, most studies of white matter changes in Bipolar Disorder (BD) have been conducted in older subjects and with well-established disorders. Studies of young people who are closer to their illness onset may help to identify core neurobiological characteristics and separate these from consequences of repeated illness episodes or prolonged treatment. Diffusion tensor imaging (DTI) was used to examine white matter microstructural changes in 58 young patients with BD (mean age 23 years; range 16-30 years) and 40 controls. Whole brain voxelwise measures of fractional anisotropy (FA), parallel diffusivity (λ//) and radial diffusivity (λ⊥) were calculated for all subjects. White matter microstructure differences (decreased FA corrected p<.05) were found between the patients with BD and controls in the genu, body and splenium of the corpus callosum as well as the superior and anterior corona radiata. In addition, significantly increased radial diffusivity (p<.01) was found in the BD group. Neuroimaging studies of young patients with BD may help to clarify neurodevelopmental aspects of the illness and for identifying biomarkers of disease onset and progression. Our findings provide evidence of microstructural white matter changes early in the course of illness within the corpus callosum and the nature of these changes suggest they are associated with abnormalities in the myelination of axons.
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Affiliation(s)
- Jim Lagopoulos
- Clinical Research Unit, Brain and Mind Research Institute, University of Sydney, Camperdown, Australia.
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30
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Distinguishing between unipolar depression and bipolar depression: current and future clinical and neuroimaging perspectives. Biol Psychiatry 2013; 73:111-8. [PMID: 22784485 PMCID: PMC3494754 DOI: 10.1016/j.biopsych.2012.06.010] [Citation(s) in RCA: 174] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Revised: 06/13/2012] [Accepted: 06/14/2012] [Indexed: 12/16/2022]
Abstract
Differentiating bipolar disorder (BD) from recurrent unipolar depression (UD) is a major clinical challenge. Main reasons for this include the higher prevalence of depressive relative to hypo/manic symptoms during the course of BD illness and the high prevalence of subthreshold manic symptoms in both BD and UD depression. Identifying objective markers of BD might help improve accuracy in differentiating between BD and UD depression, to ultimately optimize clinical and functional outcome for all depressed individuals. Yet, only eight neuroimaging studies to date have directly compared UD and BD depressed individuals. Findings from these studies suggest more widespread abnormalities in white matter connectivity and white matter hyperintensities in BD than UD depression, habenula volume reductions in BD but not UD depression, and differential patterns of functional abnormalities in emotion regulation and attentional control neural circuitry in the two depression types. These findings suggest different pathophysiologic processes, especially in emotion regulation, reward, and attentional control neural circuitry in BD versus UD depression. This review thereby serves as a call to action to highlight the pressing need for more neuroimaging studies, using larger samples sizes, comparing BD and UD depressed individuals. These future studies should also include dimensional approaches, studies of at-risk individuals, and more novel neuroimaging approaches, such as connectivity analysis and machine learning. Ultimately, these approaches might provide biomarkers to identify individuals at future risk for BD versus UD and biological targets for more personalized treatment and new treatment developments for BD and UD depression.
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31
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Abnormal temporal lobe white matter as a biomarker for genetic risk of bipolar disorder. Biol Psychiatry 2013; 73:177-82. [PMID: 23036958 PMCID: PMC3760506 DOI: 10.1016/j.biopsych.2012.07.033] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Revised: 06/21/2012] [Accepted: 07/16/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Brain white matter (WM) abnormalities have been hypothesized to play an important role in the neurobiology of bipolar disorder (BD). The nature of these abnormalities is not well-characterized, however, and it is unknown whether they occur after disease onset or represent potential markers of genetic risk. METHODS We examined WM integrity (assessed via fractional anisotropy [FA]) with diffusion tensor imaging in patients with BD (n=26), unaffected siblings of patients with BD (n=15), and healthy volunteers (n=27) to identify WM biomarkers of genetic risk. RESULTS The FA differed significantly (p<.05; corrected) among the three groups within the right temporal WM. Unaffected siblings had FA values that were intermediate to and significantly different from those of healthy volunteers and patients with BD (healthy control subjects>unaffected siblings>BD). Moreover, FA values in this region correlated negatively and significantly with trait impulsivity in unaffected siblings. Probabilistic tractography indicated that the regional abnormality lies along the inferior fronto-occipital fasciculus, a large intrahemispheric association pathway. CONCLUSIONS Our results suggest that lower WM integrity in the right temporal lobe might be a biomarker for genetic risk of BD. It is conceivable that the attenuated nature of these WM abnormalities present in unaffected siblings allows for some preservation of adaptive emotional regulation, whereas more pronounced alterations observed in patients is related to the marked emotional dysregulation characteristic of BD.
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Blond BN, Fredericks CA, Blumberg HP. Functional neuroanatomy of bipolar disorder: structure, function, and connectivity in an amygdala-anterior paralimbic neural system. Bipolar Disord 2012; 14:340-55. [PMID: 22631619 PMCID: PMC3880745 DOI: 10.1111/j.1399-5618.2012.01015.x] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES In past decades, neuroimaging research in bipolar disorder has demonstrated a convergence of findings in an amygdala-anterior paralimbic cortex neural system. This paper reviews behavioral neurology literature that first suggested a central role for this neural system in the disorder and the neuroimaging evidence that supports it. METHODS Relevant articles are reviewed to provide an amygdala-anterior paralimbic cortex neural system model of bipolar disorder, including articles from the fields of behavioral neurology and neuroanatomy, and neuroimaging. RESULTS The literature is highly supportive of key roles for the amygdala, anterior paralimbic cortices, and connections among these structures in the emotional dysregulation of bipolar disorder. The functions subserved by their more widely distributed connection sites suggest that broader system dysfunction could account for the range of functions-from neurovegetative to cognitive-disrupted in the disorder. Abnormalities in some components of this neural system are apparent by adolescence, while others, such as those in rostral prefrontal regions, appear to progress over adolescence and young adulthood, suggesting a neurodevelopmental model of the disorder. However, some findings conflict, which may reflect the small sample sizes of some studies, and clinical heterogeneity and methodological differences across studies. CONCLUSIONS Consistent with models derived from early behavioral neurology studies, neuroimaging studies support a central role for an amygdala-anterior paralimbic neural system in bipolar disorder, and implicate abnormalities in the development of this system in the disorder. This system will be an important focus of future studies on the developmental pathophysiology, detection, treatment, and prevention of the disorder.
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Affiliation(s)
- Benjamin N Blond
- Department of Psychiatry, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
| | - Carolyn A Fredericks
- Department of Psychiatry, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
| | - Hilary P Blumberg
- Department of Psychiatry, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA,Department of Diagnostic Radiology, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA,The Child Study Center, Yale School of Medicine, New Haven, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA,Research Enhancement Award Program Depression Center, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
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Strakowski SM, Adler CM, Almeida J, Altshuler LL, Blumberg HP, Chang KD, DelBello MP, Frangou S, McIntosh A, Phillips ML, Sussman JE, Townsend JD. The functional neuroanatomy of bipolar disorder: a consensus model. Bipolar Disord 2012; 14:313-25. [PMID: 22631617 PMCID: PMC3874804 DOI: 10.1111/j.1399-5618.2012.01022.x] [Citation(s) in RCA: 349] [Impact Index Per Article: 29.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Functional neuroimaging methods have proliferated in recent years, such that functional magnetic resonance imaging, in particular, is now widely used to study bipolar disorder. However, discrepant findings are common. A workgroup was organized by the Department of Psychiatry, University of Cincinnati (Cincinnati, OH, USA) to develop a consensus functional neuroanatomic model of bipolar I disorder based upon the participants' work as well as that of others. METHODS Representatives from several leading bipolar disorder neuroimaging groups were organized to present an overview of their areas of expertise as well as focused reviews of existing data. The workgroup then developed a consensus model of the functional neuroanatomy of bipolar disorder based upon these data. RESULTS Among the participants, a general consensus emerged that bipolar I disorder arises from abnormalities in the structure and function of key emotional control networks in the human brain. Namely, disruption in early development (e.g., white matter connectivity and prefrontal pruning) within brain networks that modulate emotional behavior leads to decreased connectivity among ventral prefrontal networks and limbic brain regions, especially the amygdala. This developmental failure to establish healthy ventral prefrontal-limbic modulation underlies the onset of mania and ultimately, with progressive changes throughout these networks over time and with affective episodes, a bipolar course of illness. CONCLUSIONS This model provides a potential substrate to guide future investigations and areas needing additional focus are identified.
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Affiliation(s)
- Stephen M Strakowski
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH 45267-0559, USA.
| | - Caleb M Adler
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Jorge Almeida
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh PA
| | - Lori L Altshuler
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, The David Geffen School of Medicine, University of California at Los Angeles,Department of Psychiatry, VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Hilary P Blumberg
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Kiki D Chang
- Pediatric Bipolar Disorders Research Program, Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Melissa P DelBello
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Sophia Frangou
- Section of Neurobiology of Psychosis, Department of Psychosis Studies, Institute of Psychiatry, King’s College, London
| | - Andrew McIntosh
- Division of Psychiatry, School of Molecular and Clinical Medicine, University of Edinburgh, Edinburgh
| | - Mary L Phillips
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh PA,Department of Psychological Medicine, Cardiff, UK
| | - Jessika E Sussman
- Division of Psychiatry, School of Molecular and Clinical Medicine, University of Edinburgh, Edinburgh
| | - Jennifer D Townsend
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, The David Geffen School of Medicine, University of California at Los Angeles
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Strakowski SM, Adler CM, Almeida J, Altshuler LL, Blumberg HP, Chang KD, DelBello MP, Frangou S, McIntosh A, Phillips ML, Sussman JE, Townsend JD. The functional neuroanatomy of bipolar disorder: a consensus model. Bipolar Disord 2012. [PMID: 22631617 DOI: 10.1111/j.1399-5618.2012.01022.x.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Functional neuroimaging methods have proliferated in recent years, such that functional magnetic resonance imaging, in particular, is now widely used to study bipolar disorder. However, discrepant findings are common. A workgroup was organized by the Department of Psychiatry, University of Cincinnati (Cincinnati, OH, USA) to develop a consensus functional neuroanatomic model of bipolar I disorder based upon the participants' work as well as that of others. METHODS Representatives from several leading bipolar disorder neuroimaging groups were organized to present an overview of their areas of expertise as well as focused reviews of existing data. The workgroup then developed a consensus model of the functional neuroanatomy of bipolar disorder based upon these data. RESULTS Among the participants, a general consensus emerged that bipolar I disorder arises from abnormalities in the structure and function of key emotional control networks in the human brain. Namely, disruption in early development (e.g., white matter connectivity and prefrontal pruning) within brain networks that modulate emotional behavior leads to decreased connectivity among ventral prefrontal networks and limbic brain regions, especially the amygdala. This developmental failure to establish healthy ventral prefrontal-limbic modulation underlies the onset of mania and ultimately, with progressive changes throughout these networks over time and with affective episodes, a bipolar course of illness. CONCLUSIONS This model provides a potential substrate to guide future investigations and areas needing additional focus are identified.
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Affiliation(s)
- Stephen M Strakowski
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH 45267-0559, USA.
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Fusar-Poli P, Howes O, Bechdolf A, Borgwardt S. Mapping vulnerability to bipolar disorder: a systematic review and meta-analysis of neuroimaging studies. J Psychiatry Neurosci 2012; 37:170-84. [PMID: 22297067 PMCID: PMC3341409 DOI: 10.1503/jpn.110061] [Citation(s) in RCA: 99] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Although early interventions in individuals with bipolar disorder may reduce the associated personal and economic burden, the neurobiologic markers of enhanced risk are unknown. METHODS Neuroimaging studies involving individuals at enhanced genetic risk for bipolar disorder (HR) were included in a systematic review. We then performed a region of interest (ROI) analysis and a whole-brain meta-analysis combined with a formal effect-sizes meta-analysis in a subset of studies. RESULTS There were 37 studies included in our systematic review. The overall sample for the systematic review included 1258 controls and 996 HR individuals. No significant differences were detected between HR individuals and controls in the selected ROIs: striatum, amygdala, hippocampus, pituitary and frontal lobe. The HR group showed increased grey matter volume compared with patients with established bipolar disorder. The HR individuals showed increased neural response in the left superior frontal gyrus, medial frontal gyrus and left insula compared with controls, independent from the functional magnetic resonance imaging task used. There were no publication biases. Sensitivity analysis confirmed the robustness of these results. LIMITATIONS As the included studies were cross-sectional, it remains to be determined whether the observed neurofunctional and structural alterations represent risk factors that can be clinically used in preventive interventions for prodromal bipolar disorder. CONCLUSION Accumulating structural and functional imaging evidence supports the existence of neurobiologic trait abnormalities in individuals at genetic risk for bipolar disorder at various scales of investigation.
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Affiliation(s)
- Paolo Fusar-Poli
- Institute of Psychiatry, Department of Psychosis Studies, King's College London, London, United Kingdom.
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Ladouceur CD, Peper JS, Crone EA, Dahl RE. White matter development in adolescence: the influence of puberty and implications for affective disorders. Dev Cogn Neurosci 2012; 2:36-54. [PMID: 22247751 PMCID: PMC3256931 DOI: 10.1016/j.dcn.2011.06.002] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Revised: 06/03/2011] [Accepted: 06/05/2011] [Indexed: 12/19/2022] Open
Abstract
There have been rapid advances in understanding a broad range of changes in brain structure and function during adolescence, and a growing interest in identifying which of these neurodevelopmental changes are directly linked with pubertal maturation—at least in part because of their potential to provide insights into the numerous emotional and behavioral health problems that emerge during this developmental period. This review focuses on what is known about the influence of puberty on white matter development in adolescence.We focus on white matter because of its role in providing the structural architectural organization of the brain and as a structural correlate of communication within complex neural systems. We begin with a review of studies that report sex differences or sex by age interactions in white matter development as these findings can provide, although indirectly,information relevant to puberty-related changes. Studies are also critically reviewed based on methodological procedures used to assess pubertal maturation and relations with white matter changes. Findings are discussed in light of their implications for the development of neural systems underlying the regulation of emotion and behavior and how alterations in the development of these systems may mediate risk for affective disorders in vulnerable adolescents.
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Affiliation(s)
- Cecile D Ladouceur
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O’Hara St., Pittsburgh, PA 15213, United States.
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