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Valizadeh P, Cattarinussi G, Sambataro F, Brambilla P, Delvecchio G. Neuroimaging alterations associated with medication use in early-onset bipolar disorder: An updated review. J Affect Disord 2023; 339:984-997. [PMID: 37481130 DOI: 10.1016/j.jad.2023.07.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 07/11/2023] [Accepted: 07/18/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND Pediatric bipolar disorder (PBD) is a severe disorder characterized by mood fluctuations starting at a young age. Several neuroimaging studies revealed a specific biological signature of PBD involving alterations in the amygdala and prefrontal regions. Considering the growing concerns regarding the effects of PBD treatments on developing brains, this review aims to provide an overview of the studies investigating the effect of mood stabilizers, antipsychotics, and anticonvulsants on neuroimaging findings in PBD. METHODS We searched PubMed, Scopus, and Web of Science to identify all structural magnetic resonance imaging (sMRI), functional magnetic resonance imaging (fMRI), and diffusion tensor imaging (DTI) studies exploring the effects of medications on neuroimaging findings in PBD. A total of 18 studies met our inclusion criteria (fMRI n = 11, sMRI n = 6, DTI n = 1). RESULTS Although the findings varied highly across the studies, some investigations consistently indicated that medications primarily affect the prefrontal cortex and the amygdala. Moreover, despite some exceptions, the reported medication effects predominantly lean towards structural and functional normalization. LIMITATIONS The reviewed studies differ in methods, medications, and fMRI paradigms. Furthermore, most studies used observational approaches with small sample sizes, minimizing the statistical power. CONCLUSIONS Evidence suggests the potential of antipsychotics and mood stabilizers to modulate the neuroimaging findings in PBD patients, mostly normalizing brain structure and function in key mood-regulating regions.
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Affiliation(s)
- Parya Valizadeh
- School of Medicine, Tehran University of Medical Science, Tehran, Iran; Neuroscience Research Group (NRG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Giulia Cattarinussi
- Department of Neuroscience (DNS), Padua Neuroscience Center, University of Padova, Padua, Italy; Padua Neuroscience Center, University of Padova, Padua, Italy
| | - Fabio Sambataro
- Department of Neuroscience (DNS), Padua Neuroscience Center, University of Padova, Padua, Italy; Padua Neuroscience Center, University of Padova, Padua, Italy
| | - Paolo Brambilla
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giuseppe Delvecchio
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
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Luo J, Yi P, Liang M, Zhang S, Tao Q, Li N, Zhang H, Wen J, Xue X, Fan C, Li X. Distinct brain activity alterations of treatment for bipolar disorders with psychotherapy and drug therapy: activation likelihood estimation meta-analysis. Psychol Med 2023; 53:625-637. [PMID: 36722029 DOI: 10.1017/s0033291722003889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUNDS Many studies suggest that both psychotherapy and drug therapy are effective in the treatment of bipolar disorders (BDs). However, the pathophysiology of both types of intervention has not been established definitively. METHODS An activation likelihood estimation meta-analysis was performed to identify the distinct brain activity alterations between psychotherapy and drug therapy for the treatment of BDs. Articles were identified by searching databases including PubMed, Embase, Cochrane Library, and Web of Science databases. Eligible studies on BDs were published up until 10 June 2021. RESULTS 21 studies were included and we conducted a meta-analysis for different therapies and imaging tasks. After receiving psychotherapy, BD patients showed increased activation in the inferior frontal gyrus (IFG) and superior temporal gyrus. While after taking drug therapy, BD patients displayed increased activation in the anterior cingulate cortex, medial frontal gyrus, IFG, and decreased activation in the posterior cingulate cortex. The regions of brain activity changes caused by psychotherapy were mostly focused on the frontal areas, while drug therapy mainly impacted on the limbic areas. Different type of tasks also affected brain regions which were activated. CONCLUSIONS Our comprehensive meta-analysis indicates that these two treatments might have effect on BD in their own therapeutic modes. Psychotherapy might have a top-down effect, while drug therapy might have a bottom-up effect. This study may contribute to differential diagnosis of BDs and would be helpful to finding more accurate neuroimaging biomarkers for BD treatment.
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Affiliation(s)
- Jingyi Luo
- Centre for Translational Medicine, Second Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, China
| | - Pengcheng Yi
- Department of Clinical Psychology, the Third People's Hospital of Xiangshan County, Ningbo, China
| | - Meng Liang
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, China
| | - Shuyu Zhang
- School of Psychology, the Australian National University, Canberra, Australia
| | - Qian Tao
- Department of Psychology, School of Basic Medicine, Jinan University, Guangzhou, China
| | - Ni Li
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, China
| | - Han Zhang
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, China
| | - Jialin Wen
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, China
| | - Xinrong Xue
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, China
| | - Chuan Fan
- Department of Psychiatry, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Xiaoming Li
- Centre for Translational Medicine, Second Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, China
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Luciano M, Di Vincenzo M, Mancuso E, Marafioti N, Di Cerbo A, Giallonardo V, Sampogna G, Fiorillo A. Does the Brain Matter? Cortical Alterations in Pediatric Bipolar Disorder: A Critical Review of Structural and Functional Magnetic Resonance Studies. Curr Neuropharmacol 2023; 21:1302-1318. [PMID: 36173069 PMCID: PMC10324338 DOI: 10.2174/1570159x20666220927114417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/14/2022] [Accepted: 07/28/2022] [Indexed: 11/22/2022] Open
Abstract
Pediatric bipolar disorder (PBD) is associated with significant psychosocial impairment, high use of mental health services and a high number of relapses and hospitalization. Neuroimaging techniques provide the opportunity to study the neurodevelopmental processes underlying PBD, helping to identify the endophenotypic markers of illness and early biological markers of PBD. The aim of the study is to review available studies assessing structural and functional brain correlates associated with PBD. PubMed, ISI Web of Knowledge and PsychINFO databases have been searched. Studies were included if they enrolled patients aged 0-18 years with a main diagnosis of PBD according to ICD or DSM made by a mental health professional, adopted structural and/or functional magnetic resonance as the main neuroimaging method, were written in English and included a comparison with healthy subjects. Of the 400 identified articles, 46 papers were included. Patients with PBD present functional and anatomic alterations in structures normally affecting regulations and cognition. Structural neuroimaging revealed a significant reduction in gray matter, with cortical thinning in bilateral frontal, parietal and occipital cortices. Functional neuroimaging studies reported a reduced engagement of the frontolimbic and hyperactivation of the frontostriatal circuitry. Available studies on brain connectivity in PBD patients potentially indicate less efficient connections between regions involved in cognitive and emotional functions. A greater functional definition of alteration in brain functioning of PBD patients will be useful to set up a developmentally sensitive targeted pharmacological and nonpharmacological intervention.
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Affiliation(s)
- Mario Luciano
- Department of Psychiatry, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Matteo Di Vincenzo
- Department of Psychiatry, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Emiliana Mancuso
- Department of Psychiatry, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Niccolò Marafioti
- Department of Psychiatry, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Arcangelo Di Cerbo
- Department of Psychiatry, University of Campania “L. Vanvitelli”, Naples, Italy
| | | | - Gaia Sampogna
- Department of Psychiatry, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania “L. Vanvitelli”, Naples, Italy
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Kuang L, Gao W, Wang L, Guo Y, Cao W, Cui D, Jiao Q, Qiu J, Su L, Lu G. Increased resting-state brain entropy of parahippocampal gyrus and dorsolateral prefrontal cortex in manic and euthymic adolescent bipolar disorder. J Psychiatr Res 2021; 143:106-112. [PMID: 34479001 DOI: 10.1016/j.jpsychires.2021.08.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 06/01/2021] [Accepted: 08/17/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Alterations of brain signal complexity may reflect brain functional abnormalities. In adolescent bipolar disorder (ABD) distribution of brain regions showing abnormal complexity in different mood states remains unclear. We aimed to analyze brain entropy (BEN) alteration of functional magnetic resonance imaging (fMRI) signal to observe spatial distribution of complexity in ABD patients, as well as the relationship between this variation and clinical variables. METHODS Resting-state fMRI data were acquired from adolescents with bipolar disorder (BD) who were in manic (n = 19) and euthymic (n = 20) states, and from healthy controls (HCs, n = 17). The differences in BEN among the three groups, and their associations with clinical variables, were examined. RESULTS Compared to HCs, manic and euthymic ABD patients showed increased BEN in right parahippocampal gyrus (PHG) and left dorsolateral prefrontal cortex (DLPFC). There was no significant difference of BEN between the manic and the euthymic ABD groups. In manic ABD patients, right PHG BEN exhibited significantly positive relationship with episode times. CONCLUSIONS Increased BEN in right PHG and left DLPFC in ABD patients may cause dysfunction of corticolimbic circuitry which is important to emotional processing and cognitive control. The positive correlation between PHG BEN and episode times of manic ABD patients further expressed a close association between brain complexity and clinical symptoms. From the perspective of brain temporal dynamics, the present study complements previous findings that have reported corticolimbic dysfunction as an important contributor to the pathophysiology of BD. BEN may provide valuable evidences for understanding the underlying mechanism of ABD.
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Affiliation(s)
- Liangfeng Kuang
- Department of Radiology, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, China
| | - Weijia Gao
- Department of Child Psychology, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Luoyu Wang
- Institute of Psychological Sciences, Hangzhou Normal University, Hangzhou, China; Department of Radiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yongxin Guo
- Department of Radiology, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, China
| | - Weifang Cao
- Department of Radiology, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, China
| | - Dong Cui
- Department of Radiology, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, China
| | - Qing Jiao
- Department of Radiology, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, China.
| | - Jianfeng Qiu
- Department of Radiology, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, 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, China
| | - Guangming Lu
- Department of Medical Imaging, Jinling Hospital, Clinical School of Medical College, Nanjing University, Nanjing, China
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Laidi C, Houenou J. Brain functional effects of psychopharmacological treatments in bipolar disorder. Eur Neuropsychopharmacol 2016; 26:1695-1740. [PMID: 27617780 DOI: 10.1016/j.euroneuro.2016.06.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 06/06/2016] [Accepted: 06/18/2016] [Indexed: 12/29/2022]
Abstract
Functional magnetic resonance imaging (fMRI) studies have contributed to the understanding of bipolar disorder. However the effect of medication on brain activation remains poorly understood. We conducted an extensive literature review on PubMed and ScienceDirect to investigate the influence of medication in fMRI studies, including both longitudinal and cross-sectional studies, which aimed at assessing this influence. Although we reported all reviewed studies, we gave greater emphasis to studies with the most robust methodology. One hundred and forty studies matched our inclusion criteria and forty-seven studies demonstrated an effect of pharmacological treatment on fMRI blood oxygen level dependent (BOLD) signal in adults and children with bipolar disorder. Out of these studies, nineteen were longitudinal. Most of cross-sectional studies suffered from methodological bias, due to post-hoc analyses performed on a limited number of patients and did not find any effect of medication. However, both longitudinal and cross-sectional studies showing an impact of treatment tend to suggest that medication prescribed to patients with bipolar disorder mostly influenced brain activation in prefrontal regions, when measured by tasks involving emotional regulation and processing as well as non-emotional cognitive tasks. FMRI promises to elucidate potential new biomarkers in bipolar disorder and could be used to evaluate the effect of new therapeutic compounds. Further research is needed to disentangle the effect of medication and the influence of the changes in mood state on brain activation in patients with bipolar disorder.
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Affiliation(s)
- Charles Laidi
- APHP, Mondor University Hospitals, DHU PePsy, Psychiatry Department, Créteil, France; INSERM, U955, IMRB, Translational Psychiatry, Créteil, France; Faculté de médecine de Créteil, Université Paris Est Créteil (UPEC), France; Fondation FondaMental, Créteil, France; UNIACT Lab, Psychiatry Team, NeuroSpin, I2BM, CEA Saclay, Gif Sur Yvette, Cedex, France.
| | - Josselin Houenou
- APHP, Mondor University Hospitals, DHU PePsy, Psychiatry Department, Créteil, France; INSERM, U955, IMRB, Translational Psychiatry, Créteil, France; Faculté de médecine de Créteil, Université Paris Est Créteil (UPEC), France; Fondation FondaMental, Créteil, France; UNIACT Lab, Psychiatry Team, NeuroSpin, I2BM, CEA Saclay, Gif Sur Yvette, Cedex, France
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Using neuroimaging to evaluate and guide pharmacological and psychotherapeutic treatments for mood disorders in children. CNS Spectr 2015; 20:359-68. [PMID: 25659836 DOI: 10.1017/s1092852914000819] [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] [Indexed: 12/18/2022]
Abstract
Mood disorders are increasing in childhood, and often require multimodal and comprehensive treatment plans to address a complex array of symptoms and associated morbidities. Pharmacotherapy, in combination with psychotherapeutic interventions, is essential for treatment and stabilization. Current evidence supports the use of a number of interventions in children and adolescents diagnosed with DSM-5 mood spectrum disorders, which are associated with impairments in prefrontal-striatal-limbic networks, which are key for emotional functioning and regulation. Yet, little is known about the neurobiological effects of interventions on the developing brain. This chapter provides a synopsis of the literature demonstrating the neural effects of psychotropic medications and psychotherapy in youth with depressive or bipolar spectrum disorders. Additional longitudinal and biological studies are warranted to characterize the effects of these interventions on all phases and stages of mood illness development in children and adolescents.
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7
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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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Garrett AS, Miklowitz DJ, Howe ME, Singh MK, Acquaye TK, Hawkey CG, Glover GH, Reiss AL, Chang KD. Changes in brain activation following psychotherapy for youth with mood dysregulation at familial risk for bipolar disorder. Prog Neuropsychopharmacol Biol Psychiatry 2015; 56:215-20. [PMID: 25283342 PMCID: PMC4258439 DOI: 10.1016/j.pnpbp.2014.09.007] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 08/28/2014] [Accepted: 09/23/2014] [Indexed: 01/05/2023]
Abstract
BACKGROUND Psychotherapy for youth with mood dysregulation can help stabilize mood and improve functioning, but the neural mechanisms of this improvement are not known. In this study we investigated the changes in brain activation underlying improvement in mood symptoms. METHODS Twenty-four subjects (ages 13-17) participated: 12 patients with clinically significant symptoms of depression and/or mania, and 12 healthy comparison subjects (HC) matched for age and sex. All subjects completed functional magnetic resonance imaging while viewing facial expressions. The patients then received up to 4 months of psychotherapy and were rescanned at end of treatment. Whole brain differences between patient and control groups were assessed with a voxel-wise analysis. Changes in activation from pre- to post-treatment within the patient group were tested for correlation with changes in mood symptoms. RESULTS At baseline the patient group had hypoactivation in the dorsolateral prefrontal cortex (DLPFC) and hyperactivation in the posterior cingulate cortex compared to the HC group. Between pre- and post-treatment activation increased in the DLPFC and decreased in the amygdala. Increases in DLPFC activation were significantly correlated with improvement in mania symptoms. DISCUSSION Enhancement of frontal executive control brain regions may underlie improvement in mood dysregulation in pediatric patients at familial risk for bipolar disorder.
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Affiliation(s)
- Amy S. Garrett
- Stanford University School of Medicine, Department of Psychiatry,Center for Interdisciplinary Brain Sciences Research,Pediatric Bipolar Disorders Program
| | | | - Meghan E. Howe
- Stanford University School of Medicine, Department of Psychiatry,Pediatric Bipolar Disorders Program
| | - Manpreet K. Singh
- Stanford University School of Medicine, Department of Psychiatry,Pediatric Bipolar Disorders Program
| | - Tenah K. Acquaye
- Stanford University School of Medicine, Department of Psychiatry,Pediatric Bipolar Disorders Program
| | | | | | - Allan L. Reiss
- Stanford University School of Medicine, Department of Psychiatry,Center for Interdisciplinary Brain Sciences Research
| | - Kiki D. Chang
- Stanford University School of Medicine, Department of Psychiatry,Pediatric Bipolar Disorders Program
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Pavuluri M. Brain biomarkers of treatment for multi-domain dysfunction: pharmacological FMRI studies in pediatric mania. Neuropsychopharmacology 2015; 40:249-51. [PMID: 25482178 PMCID: PMC4262909 DOI: 10.1038/npp.2014.229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Mani Pavuluri
- Pediatric Mood Disorders Program, Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA,E-mail:
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Pavuluri M, May A. I Feel, Therefore, I am: The Insula and Its Role in Human Emotion, Cognition and the Sensory-Motor System. AIMS Neurosci 2015. [DOI: 10.3934/neuroscience.2015.1.18] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Brooks JO, Vizueta N. Diagnostic and clinical implications of functional neuroimaging in bipolar disorder. J Psychiatr Res 2014; 57:12-25. [PMID: 25015683 DOI: 10.1016/j.jpsychires.2014.05.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 04/15/2014] [Accepted: 05/29/2014] [Indexed: 01/16/2023]
Abstract
Advances in functional neuroimaging have ushered in studies that have enhanced our understanding of the neuropathophysiology of bipolar disorder, but do not yet have clinical applications. We describe the major circuits (ventrolateral, dorsolateral, ventromedial, and anterior cingulate) thought to be involved in the corticolimbic dysregulation that may underlie mood states in patients with bipolar disorder. The potential clinical application of functional neuroimaging in bipolar disorder is considered in terms of prognostic, predictive, and treatment biomarkers. To date, most research has focused on prognostic biomarkers to differentiate patients with bipolar disorder from those with other affective or psychotic diagnoses, or healthy subjects. The search for treatment biomarkers, which suggest mechanisms of pharmacodynamic or treatment response, and predictive biomarkers has thus far involved only pediatric patients diagnosed with bipolar disorder. The results to date are encouraging and suggest that functional neuroimaging may be of eventual benefit in determining biomarkers of treatment response. Further refinement of biomarker identification, and perhaps even illness characterization are needed to find prognostic and predictive biomarkers of bipolar disorder.
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Affiliation(s)
- John O Brooks
- Department of Psychiatry & Biobehavioral Sciences, UCLA Semel Institute for Neuroscience & Human Behavior, Los Angeles, CA, USA.
| | - Nathalie Vizueta
- Department of Psychiatry & Biobehavioral Sciences, UCLA Semel Institute for Neuroscience & Human Behavior, Los Angeles, CA, USA
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12
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Neurocognitive impairments among youth with pediatric bipolar disorder: a systematic review of neuropsychological research. J Affect Disord 2014; 166:297-306. [PMID: 25012445 DOI: 10.1016/j.jad.2014.05.025] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 05/18/2014] [Accepted: 05/19/2014] [Indexed: 12/23/2022]
Abstract
BACKGROUND Pediatric bipolar disorder (PBD) has emerged as a field of research in which neuropsychological studies are continuously providing new empirical findings. Despite this, a comprehensive framework for neurocognitive impairments is still lacking, and most of the evidence remains unconnected. We addressed this question through a systematic review of neuropsychological research, with the aim of elucidating the main issues concerning this topic. METHOD A comprehensive search of databases (PubMed, PsycINFO) was performed. Published manuscripts between 1990 and January 2014 were identified. Overall, 124 studies fulfilled inclusion criteria. Methodological differences between studies required a descriptive review of findings. RESULTS Evidence indicates that verbal/visual-spatial memory, processing speed, working memory, and social cognition are neurocognitive domains impaired in PBD youth. Furthermore, these deficits are greater among those who suffer acute affective symptoms, PBD type I, and/or attention deficit hyperactivity disorder (ADHD) comorbidity. In addition, several neurocognitive deficits imply certain changes in prefrontal cortex activity and are somewhat associated with psychosocial and academic disabilities. Strikingly, these deficits are consistently similar to those encountered in ADHD as well as severe mood dysregulation (SMD). Besides, some neurocognitive impairments appear before the onset of the illness and tend to maintain stable across adolescence. Finally, any therapy has not yet demonstrated to be effective on diminishing these neurocognitive impairments. LIMITATIONS More prolonged follow-up studies aimed at delineating the course of treatment and the response to it are warranted. CONCLUSIONS Despite noteworthy research on the neurocognitive profile of PBD, our knowledge is still lagging behind evidence from adult counterparts.
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