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Schumer MC, Bertocci MA, Aslam HA, Graur S, Bebko G, Stiffler RS, Skeba AS, Brady TJ, Benjamin OE, Wang Y, Chase HW, Phillips ML. Patterns of Neural Network Functional Connectivity Associated With Mania/Hypomania and Depression Risk in 3 Independent Young Adult Samples. JAMA Psychiatry 2024; 81:167-177. [PMID: 37910117 PMCID: PMC10620679 DOI: 10.1001/jamapsychiatry.2023.4150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 08/24/2023] [Indexed: 11/03/2023]
Abstract
Importance Mania/hypomania is the pathognomonic feature of bipolar disorder (BD). Established, reliable neural markers denoting mania/hypomania risk to help with early risk detection and diagnosis and guide the targeting of pathophysiologically informed interventions are lacking. Objective To identify patterns of neural responses associated with lifetime mania/hypomania risk, the specificity of such neural responses to mania/hypomania risk vs depression risk, and the extent of replication of findings in 2 independent test samples. Design, Setting, and Participants This cross-sectional study included 3 independent samples of young adults aged 18 to 30 years without BD or active substance use disorder within the past 3 months who were recruited from the community through advertising. Of 603 approached, 299 were ultimately included and underwent functional magnetic resonance imaging at the University of Pittsburgh, Pittsburgh, Pennsylvania, from July 2014 to May 2023. Main Outcomes and Measures Activity and functional connectivity to approach-related emotions were examined using a region-of-interest mask supporting emotion processing and emotional regulation. The Mood Spectrum Self-Report assessed lifetime mania/hypomania risk and depression risk. In the discovery sample, elastic net regression models identified neural variables associated with mania/hypomania and depression risk; multivariable regression models identified the extent to which selected variables were significantly associated with each risk measure. Multivariable regression models then determined whether associations in the discovery sample replicated in both test samples. Results A total of 299 participants were included. The discovery sample included 114 individuals (mean [SD] age, 21.60 [1.91] years; 80 female and 34 male); test sample 1, 103 individuals (mean [SD] age, 21.57 [2.09] years; 30 male and 73 female); and test sample 2, 82 individuals (mean [SD] age, 23.43 [2.86] years; 48 female, 29 male, and 5 nonbinary). Associations between neuroimaging variables and Mood Spectrum Self-Report measures were consistent across all 3 samples. Bilateral amygdala-left amygdala functional connectivity and bilateral ventrolateral prefrontal cortex-right dorsolateral prefrontal cortex functional connectivity were positively associated with mania/hypomania risk: discovery omnibus χ2 = 1671.7 (P < .001); test sample 1 omnibus χ2 = 1790.6 (P < .001); test sample 2 omnibus χ2 = 632.7 (P < .001). Bilateral amygdala-left amygdala functional connectivity and right caudate activity were positively associated and negatively associated with depression risk, respectively: discovery omnibus χ2 = 2566.2 (P < .001); test sample 1 omnibus χ2 = 2935.9 (P < .001); test sample 2 omnibus χ2 = 1004.5 (P < .001). Conclusions and Relevance In this study of young adults, greater interamygdala functional connectivity was associated with greater risk of both mania/hypomania and depression. By contrast, greater functional connectivity between ventral attention or salience and central executive networks and greater caudate deactivation were reliably associated with greater risk of mania/hypomania and depression, respectively. These replicated findings indicate promising neural markers distinguishing mania/hypomania-specific risk from depression-specific risk and may provide neural targets to guide and monitor interventions for mania/hypomania and depression in at-risk individuals.
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Affiliation(s)
- Maya C. Schumer
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Michele A. Bertocci
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Haris A. Aslam
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Simona Graur
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Genna Bebko
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Richelle S. Stiffler
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Alexander S. Skeba
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Tyler J. Brady
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Osasumwen E. Benjamin
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Yiming Wang
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Henry W. Chase
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Mary L. Phillips
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Petruso F, Giff A, Milano B, De Rossi M, Saccaro L. Inflammation and emotion regulation: a narrative review of evidence and mechanisms in emotion dysregulation disorders. Neuronal Signal 2023; 7:NS20220077. [PMID: 38026703 PMCID: PMC10653990 DOI: 10.1042/ns20220077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 10/25/2023] [Accepted: 10/27/2023] [Indexed: 12/01/2023] Open
Abstract
Emotion dysregulation (ED) describes a difficulty with the modulation of which emotions are felt, as well as when and how these emotions are experienced or expressed. It is a focal overarching symptom in many severe and prevalent neuropsychiatric diseases, including bipolar disorders (BD), attention deficit/hyperactivity disorder (ADHD), and borderline personality disorder (BPD). In all these disorders, ED can manifest through symptoms of depression, anxiety, or affective lability. Considering the many symptomatic similarities between BD, ADHD, and BPD, a transdiagnostic approach is a promising lens of investigation. Mounting evidence supports the role of peripheral inflammatory markers and stress in the multifactorial aetiology and physiopathology of BD, ADHD, and BPD. Of note, neural circuits that regulate emotions appear particularly vulnerable to inflammatory insults and peripheral inflammation, which can impact the neuroimmune milieu of the central nervous system. Thus far, few studies have examined the link between ED and inflammation in BD, ADHD, and BPD. To our knowledge, no specific work has provided a critical comparison of the results from these disorders. To fill this gap in the literature, we review the known associations and mechanisms linking ED and inflammation in general, and clinically, in BD, ADHD, and BD. Our narrative review begins with an examination of the routes linking ED and inflammation, followed by a discussion of disorder-specific results accounting for methodological limitations and relevant confounding factors. Finally, we critically discuss both correspondences and discrepancies in the results and comment on potential vulnerability markers and promising therapeutic interventions.
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Affiliation(s)
| | - Alexis E. Giff
- Department of Neuroscience, School of Life Sciences, École Polytechnique Fédérale de Lausanne, Switzerland
| | - Beatrice A. Milano
- Sant’Anna School of Advanced Studies, Pisa, Italy
- University of Pisa, Pisa, Italy
| | | | - Luigi Francesco Saccaro
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Switzerland
- Department of Psychiatry, Geneva University Hospital, Switzerland
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Van Rheenen TE, Miskowiak K, Karantonis J, Furlong LS, Murray G, Rossell SL. Understanding familial liability for emotion regulation difficulties in bipolar disorder. Psychol Med 2022; 52:2614-2621. [PMID: 33327971 DOI: 10.1017/s0033291720004626] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND There has been relatively limited work focused on understanding whether relatives of individuals with bipolar disorder (BD) have difficulties in the regulation of emotion, particularly in relation to perceptions about whether emotions can be effectively regulated, or trait behaviours that acknowledge emotions as self-regulators themselves. In this study, we assessed the presence and extent of difficulties in these dimensions of emotion regulation in individuals with BD compared to unaffected first-degree biological relatives (FDR) for the first time. METHODS In total, 161 participants, including euthymic individuals with BD, unaffected FDRs, and healthy controls, were compared on the Difficulties in Emotion Regulation Scale (DERS) - a multi-dimensional measure of habitual emotion regulation. Clinical data were also collected and examined in relation to DERS scores in a secondary analysis. RESULTS In the BD group, difficulties were evident for most dimensions of emotion regulation as measured by the DERS; and correlated with an earlier onset of illness and more mood episodes. FDRs displayed generally normal emotion regulation, except in terms of their beliefs that emotions can be effectively regulated; on this dimension, their reported difficulty was intermediate to the BD group and controls. CONCLUSION Habitual emotion regulation difficulties in BD persist irrespective of mood state, are related to the course of illness, and should be targeted in psychological interventions. Further, the perception that emotions cannot be effectively regulated during times of distress seems to represent an endophenotype for BD.
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Affiliation(s)
- Tamsyn E Van Rheenen
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne, Melbourne, Australia
- Centre for Mental Health, Faculty of Health, Arts and Design, School of Health Sciences, Swinburne University, Melbourne, Australia
| | - Kamilla Miskowiak
- Neurocognition and Emotion in Affective Disorders Group, Copenhagen Affective Disorder Research Centre, Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - James Karantonis
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne, Melbourne, Australia
- Centre for Mental Health, Faculty of Health, Arts and Design, School of Health Sciences, Swinburne University, Melbourne, Australia
| | - Lisa S Furlong
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Greg Murray
- Centre for Mental Health, Faculty of Health, Arts and Design, School of Health Sciences, Swinburne University, Melbourne, Australia
| | - Susan L Rossell
- Centre for Mental Health, Faculty of Health, Arts and Design, School of Health Sciences, Swinburne University, Melbourne, Australia
- Department of Psychiatry, St Vincent's Hospital, VIC, Australia
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Migó M, Simpson K, Peters A, Ellard KK, Chou T, Nierenberg AA, Dougherty DD, Deckersbach T. Dimensional Affective Processing in BD. Psychiatry Res 2022; 307:114304. [PMID: 34896848 PMCID: PMC8744144 DOI: 10.1016/j.psychres.2021.114304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 10/01/2021] [Accepted: 11/23/2021] [Indexed: 01/03/2023]
Abstract
Bipolar Disorder (BD) involves altered neural affective processing, but studies comparing BD patients to controls have yielded inconsistent results. This might relate to substantial variability in the nature and severity of mood symptoms among individuals with BD. Hence, we dimensionally examined the relationship between depressive and manic symptom severity and neural responses to positive and negative affective stimuli. 39 Participants with BD completed measures of depression and mania severity prior to completing a cognitive-affective processing task during fMRI. A multiple regression model was run in SPM to identify brain regions correlated with depressive and manic symptoms during positive-neutral and negative-neutral contrasts. A-priori anatomical ROIs were defined bilaterally in frontal, parietal and limbic regions. Results showed that depression severity was associated with increased activation in frontal, parietal, and limbic ROIs, regardless of valence. Mania severity was correlated with both increased and decreased activation, particularly within frontal subdivisions and during the processing of positively valenced images. In conclusion, dimensional modeling of symptom severity captures variance in neural responses to affect, which may have been previously undetected due to heterogeneity when examined at the group level. Future fMRI studies comparing BD patients and controls should account for symptom variability in BD.
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Affiliation(s)
- Marta Migó
- Department of Psychiatry, Massachusetts General Hospital / Harvard Medical School, Boston, Massachusetts
| | - Kendra Simpson
- Department of Psychiatry, Massachusetts General Hospital / Harvard Medical School, Boston, Massachusetts
| | - Amy Peters
- Department of Psychiatry, Massachusetts General Hospital / Harvard Medical School, Boston, Massachusetts
| | - Kristen K. Ellard
- Department of Psychiatry, Massachusetts General Hospital / Harvard Medical School, Boston, Massachusetts
| | - Tina Chou
- Department of Psychiatry, Massachusetts General Hospital / Harvard Medical School, Boston, Massachusetts
| | - Andrew A. Nierenberg
- Department of Psychiatry, Massachusetts General Hospital / Harvard Medical School, Boston, Massachusetts
| | - Darin D. Dougherty
- Department of Psychiatry, Massachusetts General Hospital / Harvard Medical School, Boston, Massachusetts
| | - Thilo Deckersbach
- Department of Psychiatry, Massachusetts General Hospital / Harvard Medical School, Boston, Massachusetts,University of Applied Sciences, Diploma Hochschule, Germany
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Kurtz M, Mohring P, Förster K, Bauer M, Kanske P. Deficits in explicit emotion regulation in bipolar disorder: a systematic review. Int J Bipolar Disord 2021; 9:15. [PMID: 33937951 PMCID: PMC8089068 DOI: 10.1186/s40345-021-00221-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 02/11/2021] [Indexed: 12/20/2022] Open
Abstract
Background This study aimed to compile and synthesize studies investigating explicit emotion regulation in patients with bipolar disorder and individuals at risk of developing bipolar disorder. The importance of explicit emotion regulation arises from its potential role as a marker for bipolar disorders in individuals at risk and its potent role in therapy for bipolar disorder patients. Methods To obtain an exhaustive compilation of studies dealing specifically with explicit emotion regulation in bipolar disorder, we conducted a systematic literature search in four databases. In the 15 studies we included in our review, the emotion-regulation strategies maintenance, distraction, and reappraisal (self-focused and situation-focused) were investigated partly on a purely behavioral level and partly in conjunction with neural measures. The samples used in the identified studies included individuals at increased risk of bipolar disorder, patients with current affective episodes, and patients with euthymic mood state. Results In summary, the reviewed studies' results indicate impairments in explicit emotion regulation in individuals at risk for bipolar disorder, patients with manic and depressive episodes, and euthymic patients. These deficits manifest in subjective behavioral measures as well as in neural aberrations. Further, our review reveals a discrepancy between behavioral and neural findings regarding explicit emotion regulation in individuals at risk for bipolar disorders and euthymic patients. While these groups often do not differ significantly in behavioral measures from healthy and low-risk individuals, neural differences are mainly found in frontostriatal networks. Conclusion We conclude that these neural aberrations are a potentially sensitive measure of the probability of occurrence and recurrence of symptoms of bipolar disorders and that strengthening this frontostriatal route is a potentially protective measure for individuals at risk and patients who have bipolar disorders.
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Affiliation(s)
- Marcel Kurtz
- Clinical Psychology and Behavioral Neuroscience, Faculty of Psychology, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany.
| | - Pia Mohring
- Clinical Psychology and Behavioral Neuroscience, Faculty of Psychology, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany
| | - Katharina Förster
- Clinical Psychology and Behavioral Neuroscience, Faculty of Psychology, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, Medical Faculty, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Philipp Kanske
- Clinical Psychology and Behavioral Neuroscience, Faculty of Psychology, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany.,Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
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6
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Sandner M, Zeier P, Lois G, Wessa M. Cognitive emotion regulation withstands the stress test: An fMRI study on the effect of acute stress on distraction and reappraisal. Neuropsychologia 2021; 157:107876. [PMID: 33930388 DOI: 10.1016/j.neuropsychologia.2021.107876] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 03/30/2021] [Accepted: 04/22/2021] [Indexed: 10/21/2022]
Abstract
Cognitive emotion regulation is a key mechanism for the maintenance of mental health, but may fail, when individuals are exposed to acute stress. To date, it is not well understood whether and to what extent acute stress effects contribute to impairments in emotion regulation capacities as the sparse existing studies have yielded heterogeneous results, indicating that stress timing might be a crucial factor. In the present study, 81 healthy participants underwent either an acute stress task (ScanSTRESS-C; n = 40) or a control condition (n = 41) while lying in the MRI scanner. In the subsequent Cognitive Emotion Regulation Task (CERT), participants were confronted with neutral or negative pictures and instructed to either view them, or regulate their upcoming emotions using either distraction or reappraisal. Subjective ratings of affective state as well as functional brain imaging data served to indicate emotion regulation. The results showed a successful stress manipulation as indicated by group differences in subjective wellbeing, saliva cortisol concentrations, heart rate, and functional brain activity in regions implicated in stress processing. With respect to emotion regulation, CERT data revealed a significant regulation effect at the neural and behavioral level (less negative emotional ratings after reappraisal and distraction trials compared to view trials) in both groups. However, no significant group differences were observed, neither in BOLD responses to the CERT, nor in behavioral ratings. Contrary to previous studies, our study did not reveal further evidence of stress-related effects on emotion regulation, potentially being related to differences between studies in experimental setting, timing, and procedures. This study therefore underlines the need of future studies that disentangle the complex interplay of stress and emotion regulation and identify different factors influencing their bidirectional relationship.
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Affiliation(s)
- Magdalena Sandner
- Department of Clinical Psychology and Neuropsychology, Institute of Psychology, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Peter Zeier
- Department of Clinical Psychology and Neuropsychology, Institute of Psychology, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Giannis Lois
- Department of Microeconomics and Public Economics, School of Business and Economics, Maastricht University, the Netherlands
| | - Michèle Wessa
- Department of Clinical Psychology and Neuropsychology, Institute of Psychology, Johannes Gutenberg-University Mainz, Mainz, Germany; Leibniz Institute for Resilience Research (LIR), Research Group Wessa, Mainz, Germany.
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7
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Haugwitz B. Music therapy in the early detection and indicated prevention in persons at risk of bipolar disorders: State of knowledge and potential. BRITISH JOURNAL OF MUSIC THERAPY 2021. [DOI: 10.1177/1359457521997386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Bipolar disorders are among the most severe mental illnesses. The onset of the disorder is frequently preceded by phases with subsyndromal symptoms. In Germany, psychiatric early detection centres provide prevention services for help-seeking young people which focus on risk research. This article considers how music therapy contributes to the indicated prevention of bipolar disorders in preparation for a qualitative research study. The article presents a narrative literature review on research into early detection and prediction in bipolar disorders and approaches to prevention. The rationale for the use of music therapy in this context is discussed, with consideration of research questions leading to the next stage of the study.
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Affiliation(s)
- Beate Haugwitz
- University of Augsburg, Germany; University Hospital Carl Gustav Carus Dresden, Germany
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8
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Berboth S, Windischberger C, Kohn N, Morawetz C. Test-retest reliability of emotion regulation networks using fMRI at ultra-high magnetic field. Neuroimage 2021; 232:117917. [PMID: 33652143 DOI: 10.1016/j.neuroimage.2021.117917] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 01/29/2021] [Accepted: 02/22/2021] [Indexed: 12/12/2022] Open
Abstract
Given the importance of emotion regulation in affective disorders, emotion regulation is at the focus of attempts to identify brain biomarkers of disease risk, treatment response, and brain development. However, to be useful as an indicator for individual characteristics of brain functions - particularly as a biomarker in a clinical context - ensuring reliability is a key challenge. Here, we systematically evaluated test-retest reliability of task-based functional magnetic resonance imaging (fMRI) activity within neural networks associated with emotion generation and regulation across three sessions. Acquiring fMRI data at ultra-high field (7T), we examined region- and voxel-wise test-retest reliability of brain activity in response to a well-established emotion regulation task for predefined region-of-interests (ROIs) implicated in four neural networks. Test-retest reliability varied considerably across the emotion regulation networks and respective ROIs. However, core emotion regulation regions, including the ventrolateral and dorsolateral prefrontal cortex (vlPFC and dlPFC) as well as the middle temporal gyrus (MTG) showed high reliability. Our findings thus support the role of these prefrontal and temporal regions as promising candidates for the study of individual differences in emotion regulation as well as for neurobiological biomarkers in clinical neuroscience research.
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Affiliation(s)
- Stella Berboth
- Department of Neurology, Charité Universitätsmedizin Berlin, Germany; Department of Education and Psychology, Freie Universität Berlin, Germany; Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Austria
| | | | - Nils Kohn
- Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmengen, Netherlands
| | - Carmen Morawetz
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Austria; Institute of Psychology, University of Innsbruck, Austria.
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Kjærstad HL, Mistarz N, Coello K, Stanislaus S, Melbye SA, Harmer CJ, Vinberg M, Miskowiak K, Kessing LV. Aberrant cognition in newly diagnosed patients with bipolar disorder and their unaffected relatives. Psychol Med 2020; 50:1808-1819. [PMID: 31456531 DOI: 10.1017/s0033291719001867] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Patients with bipolar disorder (BD) experience persistent impairments in both affective and non-affective cognitive function, which is associated with a worse course of illness and poor functional outcomes. Nevertheless, the temporal progression of cognitive dysfunction in BD remains unclear and the identification of objective endophenotypes can inform the aetiology of BD. METHODS The present study is a cross-sectional investigation of cognitive baseline data from the longitudinal Bipolar Illness Onset-study. One hundred seventy-two remitted patients newly diagnosed with BD, 52 of their unaffected relatives (UR), and 110 healthy controls (HC) were compared on a large battery of behavioural cognitive tasks tapping into non-affective (i.e. neurocognitive) and affective (i.e. emotion processing and regulation) cognition. RESULTS Relative to HCs, patients with BD exhibited global neurocognitive deficits (ps < 0.001), as well as aberrant emotion processing and regulation (ps ⩽ 0.011); including decreased emotional reactivity to positive social scenarios, impaired ability to down-regulate positive emotion, as well as a specific deficit in the ability to recognise surprised facial expressions. Their URs also showed a trend towards difficulties identifying surprised faces (p = 0.075). No other differences in cognitive function were found for URs compared to HCs. CONCLUSIONS Neurocognitive deficits and impairments within emotion processing and regulation may be illness-related deficits of BD that present after illness-onset, whereas processing of emotional faces may represent an early risk marker of BD. However, longitudinal studies are needed to examine the association between cognitive impairments and illness progression in BD.
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Affiliation(s)
- Hanne Lie Kjærstad
- Copenhagen Affective Disorder research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Nicolaj Mistarz
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Klara Coello
- Copenhagen Affective Disorder research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Sharleny Stanislaus
- Copenhagen Affective Disorder research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Sigurd Arne Melbye
- Copenhagen Affective Disorder research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Catherine J Harmer
- Department of Psychiatry, University of Oxford, Oxford, UK and
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Maj Vinberg
- Copenhagen Affective Disorder research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Kamilla Miskowiak
- Copenhagen Affective Disorder research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Lars Vedel Kessing
- Copenhagen Affective Disorder research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Njau S, Townsend J, Wade B, Hellemann G, Bookheimer S, Narr K, Brooks JO. Neural Subtypes of Euthymic Bipolar I Disorder Characterized by Emotion Regulation Circuitry. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2020; 5:591-600. [PMID: 32513391 DOI: 10.1016/j.bpsc.2020.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 02/26/2020] [Accepted: 02/27/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Current diagnostic strategy for bipolar disorders relies on symptomological classification. Yet, responses to both pharmacological and psychotherapeutic treatments vary widely, suggesting that underlying neuropathological differences are not well defined by current nosology. Classifying patients with bipolar disorder based on emotion regulation network (ERN) activation may account for some of the heterogeneity within the disorder. METHODS Euthymic participants diagnosed with bipolar I disorder (n = 86) and healthy subjects (n = 80) underwent functional magnetic resonance imaging scans while engaged in emotional reappraisal of negative stimuli. After determining average regional activations in key network regions, we applied agglomerative hierarchical clustering to identify subtypes of bipolar disorder. Next, we examined relations among neural subtypes, demographic variables, and mood symptoms. RESULTS Analyses revealed two primary neural subtypes of euthymic bipolar I disorder participants. The first subtype, ERN cluster 1, was characterized by increased amygdala activation and slightly increased ventrolateral prefrontal and subgenual cingulate activation, whereas ERN cluster 2 was defined by decreased amygdala activation with wider-spread prefrontal activation. Cluster 1 was associated with a higher number of hospitalizations for depression (odds ratio = 1.30, 95% confidence interval = 1.02-1.64) and later onset of manic episodes (odds ratio = 1.06, 95% confidence interval = 1.00-21.13) than cluster 2. ERN clusters of healthy subjects differed from bipolar disorder clusters and were defined by differential activation of the prefrontal cortex. ERN clusters of healthy subjects, which differed from bipolar disorder clusters, were defined by differential activation of the prefrontal cortex. CONCLUSIONS Emotion regulation circuitry can distinguish neurobiological subtypes of bipolar disorder in the euthymic state. These subtypes, which are differentially associated with indices of illness severity and subsyndromal affective symptoms, may help to inform relapse risk and more personalized treatment approaches.
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Affiliation(s)
- Stephanie Njau
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California
| | - Jennifer Townsend
- Department of Psychiatry and Biobehavioral Sciences and Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, California
| | - Benjamin Wade
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California
| | - Gerhard Hellemann
- Department of Psychiatry and Biobehavioral Sciences and Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, California
| | - Susan Bookheimer
- Department of Psychiatry and Biobehavioral Sciences and Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, California
| | - Katherine Narr
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California; Department of Psychiatry and Biobehavioral Sciences and Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, California
| | - John O Brooks
- Department of Psychiatry and Biobehavioral Sciences and Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, California.
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11
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Qi S, Basanovic J, Wang L, Xiang S, Hu W, Yi X. Regulation of negative emotions through positive reappraisal and distancing in high-trait-anxious women. J Affect Disord 2020; 267:191-202. [PMID: 32217219 DOI: 10.1016/j.jad.2020.02.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 01/08/2020] [Accepted: 02/08/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Positive reappraisal and distancing are two distinct cognitive reappraisal strategies for emotion regulation. Critically however, research examining the impact of elevated trait anxiety on cognitive reappraisal has often conflated these strategies. Thus, the present study investigated whether high-trait-anxious (HTA) women can effectively utilize positive reappraisal and distancing to regulate emotional responses to negative stimuli. METHODS Twenty-six HTA women and twenty-seven low-trait-anxious (LTA) women were investigated in a self-generated reappraisal paradigm. Subjective measures of emotional regulation and event-related potentials (ERPs) were recorded while participants were instructed to passively view neutral or negative pictures, or to reinterpret negative pictures in a positive way (positive reappraisal) or a detached and unemotional way (distancing). RESULTS HTA women, as compared to LTA women, reported smaller reductions in negative affect after positive reappraisal and smaller reductions in emotional arousal after distancing. Though ERP data did not reveal corresponding differences in the centro-parietal late positive potential during emotion regulation, data did reveal HTA women exhibited enhanced recruitment of cognitive control during positive reappraisal and greater preparatory processing before engaging in distancing. LIMITATIONS Future research should examine the generalizability of the present results in clinical anxiety individuals, male sample and other reappraisal strategies. CONCLUSIONS Overall, HTA women appeared to recruit more cortical resources, suggestive of compensatory mechanisms, to achieve a similar performance as LTA women when engaging in positive reappraisal and distancing strategies to regulate negative emotions. Therefore, the findings demonstrate that HTA women are characterized by the inefficient implementation of positive reappraisal and distancing strategies.
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Affiliation(s)
- Senqing Qi
- MOE Key Laboratory of Modern Teaching Technology, Shaanxi Normal University, China.
| | - Julian Basanovic
- Centre for the Advancement of Research on Emotion, School of Psychological Science, University of Western Australia, Australia
| | - Luchun Wang
- MOE Key Laboratory of Modern Teaching Technology, Shaanxi Normal University, China
| | - Shuoqi Xiang
- MOE Key Laboratory of Modern Teaching Technology, Shaanxi Normal University, China
| | - Weiping Hu
- MOE Key Laboratory of Modern Teaching Technology, Shaanxi Normal University, China; Collaborative Innovation Center of Assessment for Basic Education Quality, Beijing, China.
| | - Xinfa Yi
- MOE Key Laboratory of Modern Teaching Technology, Shaanxi Normal University, China
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12
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Trotti RL, Parker DA, Sabatinelli D, Tamminga CA, Gershon ES, Keedy SK, Keshavan MS, Pearlson GD, Sweeney JA, McDowell JE, Clementz BA. Electrophysiological correlates of emotional scene processing in bipolar disorder. J Psychiatr Res 2020; 120:83-90. [PMID: 31634753 PMCID: PMC10499256 DOI: 10.1016/j.jpsychires.2019.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 08/12/2019] [Accepted: 10/03/2019] [Indexed: 12/19/2022]
Abstract
Emotional dysfunction is a core feature of bipolar I disorder (BD). Behavioral data suggest that emotional processing may differ based on history of psychosis, but physiological studies frequently disregard this differentiating feature. Face processing studies indicate that emotion-related components of event-related potentials (ERPs) are abnormal in BD, but fMRI data using emotional scenes are mixed. The current study used ERPs to examine emotional scene perception in BD with and without a history of psychosis (BDP, BDNP). 386 participants from the PARDIP consortium (HC = 181, BDP = 130, BDNP = 75) viewed neutral, pleasant, and unpleasant scenes from the International Affective Picture System (IAPS) during continuous EEG recording. The early posterior negativity (EPN) and late positive potential (LPP) were examined for group and stimulus effects. Analyses were conducted for groups on and off medications to examine associations between medication status, psychosis, and ERP response. Group differences were found between HC and BD in emotional modulation of the EPN and between HC and BDP in the LPP to pleasant images. There was a significant interaction between psychosis history and anticonvulsant status in the EPN, but no other medication associations were found. The relationship between neural/self-reported emotional responses and clinical symptoms were examined with canonical correlations, but no significant associations were found. Results from this large well characterized sample indicate mild deviations in neural reactivity related to medication, mood, and psychosis history. However, processing of emotional scenes appears mostly intact in individuals with BD regardless of symptom severity.
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Affiliation(s)
- Rebekah L Trotti
- Department of Psychology and Neuroscience, University of Georgia, 500 DW Brooks Drive, Athens, GA, 30606, USA
| | - David A Parker
- Department of Psychology and Neuroscience, University of Georgia, 500 DW Brooks Drive, Athens, GA, 30606, USA
| | - Dean Sabatinelli
- Department of Psychology and Neuroscience, University of Georgia, 500 DW Brooks Drive, Athens, GA, 30606, USA
| | - Carol A Tamminga
- University of Texas Southwestern Medical Center, 2201 Inwood Rd., NE5.110, Dallas, TX, 75390, USA
| | - Elliot S Gershon
- University of Chicago, 5841 S. Maryland Ave, Chicago, IL, 60637, USA
| | - Sarah K Keedy
- University of Chicago, 5841 S. Maryland Ave, Chicago, IL, 60637, USA
| | | | - Godfrey D Pearlson
- Institute of Living, Hartford Hospital, 200 Retreat Ave., Hartford, CT, 06106, USA
| | - John A Sweeney
- University of Texas Southwestern Medical Center, 2201 Inwood Rd., NE5.110, Dallas, TX, 75390, USA
| | - Jennifer E McDowell
- Department of Psychology and Neuroscience, University of Georgia, 500 DW Brooks Drive, Athens, GA, 30606, USA
| | - Brett A Clementz
- Department of Psychology and Neuroscience, University of Georgia, 500 DW Brooks Drive, Athens, GA, 30606, USA.
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13
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McGrogan CL, Dodd AL, Smith MA. Emotion regulation strategies in mania risk: A systematic review. J Clin Psychol 2019; 75:2106-2118. [PMID: 31385293 DOI: 10.1002/jclp.22841] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Difficulties in emotion regulation may contribute to the development of mania. This review aimed to assess how emotion regulation strategies reported by individuals at risk of mania compare with clinical and nonclinical controls. METHODS Search terms relating to mania risk and emotion regulation were entered into three databases. Sixteen studies were included. RESULTS Mania risk was typically associated with overall endorsement of emotion regulation strategies, particularly dampening, and positive and negative rumination. CONCLUSIONS Findings were limited by overall lack of evidence for individual strategies, lack of consideration of key mediating factors and reliance upon self-report designs.
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Affiliation(s)
- Claire L McGrogan
- Department of Psychology, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Alyson L Dodd
- Department of Psychology, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Michael A Smith
- Department of Psychology, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom.,Medical School, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Australia
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14
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Ellard KK, Gosai AK, Felicione JM, Peters AT, Shea CV, Sylvia LG, Nierenberg AA, Widge AS, Dougherty DD, Deckersbach T. Deficits in frontoparietal activation and anterior insula functional connectivity during regulation of cognitive-affective interference in bipolar disorder. Bipolar Disord 2019; 21:244-258. [PMID: 30565822 PMCID: PMC6504612 DOI: 10.1111/bdi.12709] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 07/17/2018] [Accepted: 09/30/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Bipolar disorders (BD) are characterized by emotion and cognitive dysregulation. Mapping deficits in the neurocircuitry of cognitive-affective regulation allows for potential identification of intervention targets. This study used functional MRI data in BD patients and healthy controls during performance on a task requiring cognitive and inhibitory control superimposed on affective images, assessing cognitive and affective interference. METHODS Functional MRI data were collected from 39 BD patients and 36 healthy controls during performance on the Multi-Source Interference Task overlaid on images from the International Affective Picture System (MSIT-IAPS). Analyses examined patterns of activation in a priori regions implicated in cognitive and emotional processing. Functional connectivity to the anterior insula during task performance was also examined, given this region's role in emotion-cognition integration. RESULTS BD patients showed significantly less activation during cognitive interference trials in inferior parietal lobule, dorsomedial prefrontal cortex, anterior insula, mid-cingulate, and ventrolateral prefrontal cortex regardless of affective valence. BD patients showed deviations in functional connectivity with anterior insula in regions of the default mode and frontoparietal control networks during negatively valenced cognitive interference trials. CONCLUSIONS Our findings show disruptions in cognitive regulation and inhibitory control in BD patients in the presence of irrelevant affective distractors. Results of this study suggest one pathway to dysregulation in BD is through inefficient integration of affective and cognitive information, and highlight the importance of developing interventions that target emotion-cognition integration in BD.
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Affiliation(s)
- Kristen K Ellard
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Aishwarya K Gosai
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Julia M Felicione
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Amy T Peters
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois
| | - Conor V Shea
- Department of Neuroscience, Boston University, Boston, Massachusetts
| | - Louisa G Sylvia
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Andrew A Nierenberg
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alik S Widge
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Darin D Dougherty
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Thilo Deckersbach
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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15
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Ellard KK, Gosai AG, Bernstein EE, Kaur N, Sylvia LG, Camprodon JA, Dougherty DD, Nierenberg AA, Deckersbach T. Intrinsic functional neurocircuitry associated with treatment response to transdiagnostic CBT in bipolar disorder with anxiety. J Affect Disord 2018; 238:383-391. [PMID: 29909301 PMCID: PMC7980284 DOI: 10.1016/j.jad.2018.06.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 05/16/2018] [Accepted: 06/01/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Anxiety in bipolar disorder (BD) exacerbates emotion dysregulation and reduces treatment response. We recently conducted a pilot trial of transdiagnostic CBT to target anxiety and emotion dysregulation in BD adjunctive to pharmacotherapy. Reductions in depression and anxiety symptoms were significantly predicted by baseline levels of neuroticism and perceived affective control, as well as changes over time in emotion regulation skills. The present study investigates mechanism of treatment response by examining the relationship between baseline emotion regulation-related neural circuitry and trial outcomes. METHODS Nineteen patients completed baseline resting state fMRI scans prior to treatment randomization. Functional connectivity between the anterior insula (AI) and regions in the salience network (SN), default mode network (DMN), and executive control network (ECN) were examined as predictors of baseline and treatment-related changes in emotion regulation. RESULTS Greater improvements in emotion regulation were predicted by weaker right dorsal AI - right ventrolateral prefrontal cortex (VLPFC; SN) and stronger bilateral dorsal AI - bilateral amygdala functional connectivity. Baseline neuroticism was negatively correlated with right dorsal AI- inferior parietal lobule (ECN) functional connectivity, and baseline deficits in perceived affective control were positively associated with ventral AI - bilateral dACC (SN) connectivity. LIMITATIONS Small sample limits interpretability of treatment-specific effects. CONCLUSION Baseline functional connectivity of emotion-regulation related neural circuitry significantly predicted change in emotion regulation-related dimensions associated with anxiety and depression symptom reduction. Future studies are needed to determine if employing methods such as neuromodulation to rehabilitate relevant neural circuitry may improve ultimate treatment outcomes of transdiagnostic CBT for BD and anxiety.
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Affiliation(s)
- Kristen K Ellard
- Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, 50 Staniford Street, Suite 580, Boston, MA 02114, United States.
| | - Aishwarya G Gosai
- Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, 50 Staniford Street, Suite 580, Boston, MA 02114, United States
| | | | | | - Lousia G Sylvia
- Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, 50 Staniford Street, Suite 580, Boston, MA 02114, United States
| | - Joan A Camprodon
- Division of Neurotherapeutics, Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, United States
| | - Darin D Dougherty
- Division of Neurotherapeutics, Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, United States
| | - Andrew A Nierenberg
- Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, 50 Staniford Street, Suite 580, Boston, MA 02114, United States
| | - Thilo Deckersbach
- Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, 50 Staniford Street, Suite 580, Boston, MA 02114, United States
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16
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Raucher-Chéné D, Terrien S, Gierski F, Obert A, Caillies S, Besche-Richard C, Kaladjian A. Neural Correlates of Semantic Inhibition in Relation to Hypomanic Traits: An fMRI Study. Front Psychiatry 2018; 9:108. [PMID: 29670548 PMCID: PMC5893717 DOI: 10.3389/fpsyt.2018.00108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 03/19/2018] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES Language modifications are a core feature of mania, but little is known about the semantic mechanisms behind these disturbances. The aim of the present study was thus to identify deficits in semantic inhibition and their respective neural activation patterns in a sample of individuals assessed for hypomanic personality traits. METHODS Thirty-six young adults with no neurological or psychiatric diagnoses were assessed for hypomanic personality traits with the Hypomanic Personality Scale (HPS) and underwent an fMRI task of semantic ambiguity resolution. RESULTS Regression analyses revealed a positive association between the HPS score and activity in the left superior frontal gyrus, left inferior parietal lobule, and anterior cingulate gyrus during semantic ambiguity resolution. CONCLUSION We found a link between HPS scores and brain areas that are part of the cognitive control loop and semantic memory network during language processing in a nonclinical sample of individuals. The hyperactivation of these regions may reflect a compensatory neural response in a population with greater vulnerability to BD.
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Affiliation(s)
- Delphine Raucher-Chéné
- Psychiatry Department, University Hospital, Reims, France.,Cognition, Health and Socialization Laboratory (EA 6291), University of Reims Champagne-Ardenne, Reims, France
| | - Sarah Terrien
- Speech and Language Laboratory (UMR 7309), CNRS, Aix-en-Provence, France
| | - Fabien Gierski
- Psychiatry Department, University Hospital, Reims, France.,Cognition, Health and Socialization Laboratory (EA 6291), University of Reims Champagne-Ardenne, Reims, France
| | - Alexandre Obert
- Psychiatry Department, University Hospital, Reims, France.,Cognition, Health and Socialization Laboratory (EA 6291), University of Reims Champagne-Ardenne, Reims, France
| | - Stéphanie Caillies
- Cognition, Health and Socialization Laboratory (EA 6291), University of Reims Champagne-Ardenne, Reims, France
| | - Chrystel Besche-Richard
- Cognition, Health and Socialization Laboratory (EA 6291), University of Reims Champagne-Ardenne, Reims, France
| | - Arthur Kaladjian
- Psychiatry Department, University Hospital, Reims, France.,Cognition, Health and Socialization Laboratory (EA 6291), University of Reims Champagne-Ardenne, Reims, France
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17
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Ellard KK, Bernstein EE, Hearing C, Baek JH, Sylvia LG, Nierenberg AA, Barlow DH, Deckersbach T. Transdiagnostic treatment of bipolar disorder and comorbid anxiety using the Unified Protocol for Emotional Disorders: A pilot feasibility and acceptability trial. J Affect Disord 2017; 219:209-221. [PMID: 28577505 PMCID: PMC5571649 DOI: 10.1016/j.jad.2017.05.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 03/31/2017] [Accepted: 05/06/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND Comorbid anxiety in bipolar disorder (BD) is associated with greater illness severity, reduced treatment response, and greater impairment. Treating anxiety in the context of BD is crucial for improving illness course and outcomes. The current study examined the feasibility, acceptability and preliminary efficacy of the Unified Protocol (UP), a transdiagnostic cognitive behavioral therapy, as an adjunctive treatment to pharmacotherapy for BD and comorbid anxiety disorders. METHODS Twenty-nine patients with BD and at least one comorbid anxiety disorder were randomized to pharmacotherapy treatment-as-usual (TAU) or TAU with 18 sessions of the UP (UP+TAU). All patients completed assessments every four weeks to track symptoms, functioning, emotion regulation and temperament. Linear mixed-model regressions were conducted to track symptom changes over time and to examine the relationship between emotion-related variables and treatment response. RESULTS Satisfaction ratings were equivalent for both treatment groups. Patients in the UP+TAU group evidenced significantly greater reductions over time in anxiety and depression symptoms (Cohen's d's>0.80). Baseline levels of neuroticism, perceived affective control, and emotion regulation ability predicted magnitude of symptom change for the UP+TAU group only. Greater change in perceived control of emotions and emotion regulation skills predicted greater change in anxiety related symptoms. LIMITATIONS This was a pilot feasibility and acceptability trial; results should be interpreted with caution. CONCLUSIONS Treatment with the UP+TAU was rated high in patient satisfaction, and resulted in significantly greater improvement on indices of anxiety and depression relative to TAU. This suggests that the UP may be a feasible treatment approach for BD with comorbid anxiety.
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Affiliation(s)
- Kristen K Ellard
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
| | | | - Casey Hearing
- Department of Psychology, George Washington University, USA
| | - Ji Hyun Baek
- Department of Psychiatry, Sungkyunkwan University Samsung Medical Centre, Gyeonggi-do, Republic of Korea
| | - Louisa G Sylvia
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | | | - David H Barlow
- Department of Psychology, Boston University, Boston, MA, USA
| | - Thilo Deckersbach
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
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18
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Schönfelder S, Langer J, Schneider EE, Wessa M. Mania risk is characterized by an aberrant optimistic update bias for positive life events. J Affect Disord 2017; 218:313-321. [PMID: 28482278 DOI: 10.1016/j.jad.2017.04.073] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 04/24/2017] [Accepted: 04/28/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Early cognitive models of mania posit that a cognitive triad consisting of unrealistically optimistic beliefs about the self, world and future may predispose vulnerable individuals to develop manic symptoms. Hypomanic personality traits (HYP) pose such a vulnerability factor in the etiopathogenesis of mania. METHODS To test the cognitive tenet of overly optimistic views of the future, 24 individuals with high-HYP and 24 age- and sex-matched controls (low-HYP) performed a belief update paradigm, during which they estimated their personal chances to experience future positive and negative life events. Afterwards, they were presented with the statistical likelihood of each event occurring to a peer living in the same socio-cultural environment and given the chance to adjust their initial estimates. RESULTS High-HYP individuals exhibited an asymmetric belief revision for positive events, reflected by an exaggerated incorporation of better-than-expected and an impaired integration of worse-than-expected information, relative to their low-HYP control counterparts. The strength of this optimistic update bias was linked to the trait sensitivity of the behavioral approach system. Furthermore, high-HYP individuals demonstrated a more optimistic initial prediction bias, characterized by greater overestimations of their likelihood to experience positive events, and reported enhanced trait optimism. LIMITATIONS The cross-sectional study relied on an extreme-group design to define mania risk. CONCLUSIONS Due to the crucial role of future-oriented beliefs in guiding decision-making and goal-directed behavior, this optimistic update bias for positive events may cognitively underpin the mania-typical engagement in highly pleasurable activities despite warnings for harmful consequences.
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Affiliation(s)
- Sandra Schönfelder
- Department of Clinical Psychology and Neuropsychology, Institute for Psychology, Johannes Gutenberg-University of Mainz, Mainz, Germany.
| | - Johanna Langer
- Department of Clinical Psychology and Neuropsychology, Institute for Psychology, Johannes Gutenberg-University of Mainz, Mainz, Germany; Section for Pediatric Oncology, Haematology and Haemostaseology, University Medicine Mainz, Germany
| | - Eva Elisa Schneider
- Department of Clinical Psychology and Neuropsychology, Institute for Psychology, Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - Michèle Wessa
- Department of Clinical Psychology and Neuropsychology, Institute for Psychology, Johannes Gutenberg-University of Mainz, Mainz, Germany
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19
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Murray G, Leitan ND, Thomas N, Michalak EE, Johnson SL, Jones S, Perich T, Berk L, Berk M. Towards recovery-oriented psychosocial interventions for bipolar disorder: Quality of life outcomes, stage-sensitive treatments, and mindfulness mechanisms. Clin Psychol Rev 2017; 52:148-163. [DOI: 10.1016/j.cpr.2017.01.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 01/09/2017] [Accepted: 01/15/2017] [Indexed: 02/08/2023]
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20
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Miskowiak KW, Kjærstad HL, Meluken I, Petersen JZ, Maciel BR, Köhler CA, Vinberg M, Kessing LV, Carvalho AF. The search for neuroimaging and cognitive endophenotypes: A critical systematic review of studies involving unaffected first-degree relatives of individuals with bipolar disorder. Neurosci Biobehav Rev 2017; 73:1-22. [DOI: 10.1016/j.neubiorev.2016.12.011] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 10/05/2016] [Accepted: 12/09/2016] [Indexed: 12/16/2022]
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21
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Di Simplicio M, Renner F, Blackwell SE, Mitchell H, Stratford HJ, Watson P, Myers N, Nobre AC, Lau‐Zhu A, Holmes EA. An investigation of mental imagery in bipolar disorder: Exploring "the mind's eye". Bipolar Disord 2016; 18:669-683. [PMID: 27995690 PMCID: PMC5299482 DOI: 10.1111/bdi.12453] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 09/20/2016] [Accepted: 10/28/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Mental imagery abnormalities occur across psychopathologies and are hypothesized to drive emotional difficulties in bipolar disorder (BD). A comprehensive assessment of mental imagery in BD is lacking. We aimed to test whether (i) mental imagery abnormalities (abnormalities in cognitive stages and subjective domains) occur in BD relative to non-clinical controls; and (ii) to determine the specificity of any abnormalities in BD relative to depression and anxiety disorders. METHODS Participants included 54 subjects in the BD group (depressed/euthymic; n=27 in each subgroup), subjects with unipolar depression (n=26), subjects with anxiety disorders (n=25), and non-clinical controls (n=27) matched for age, gender, ethnicity, education, and premorbid IQ. Experimental tasks assessed cognitive (non-emotional) measures of mental imagery (cognitive stages). Questionnaires, experimental tasks, and a phenomenological interview assessed subjective domains including spontaneous imagery use, interpretation bias, and emotional mental imagery. RESULTS (i) Compared to non-clinical controls, the BD combined group reported a greater impact of intrusive prospective imagery in daily life, more vivid and "real" negative images (prospective imagery task), and higher self-involvement (picture-word task). The BD combined group showed no clear abnormalities in cognitive stages of mental imagery. (ii) When depressed individuals with BD were compared to the depressed or anxious clinical control groups, no significant differences remained-across all groups, imagery differences were associated with affective lability and anxiety. CONCLUSIONS Compared to non-clinical controls, BD is characterized by abnormalities in aspects of emotional mental imagery within the context of otherwise normal cognitive aspects. When matched for depression and anxiety, these abnormalities are not specific to BD-rather, imagery may reflect a transdiagnostic marker of emotional psychopathology.
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Affiliation(s)
| | - Fritz Renner
- Medical Research Council Cognition and Brain Sciences UnitCambridgeUK
| | - Simon E Blackwell
- Medical Research Council Cognition and Brain Sciences UnitCambridgeUK,Mental Health Research and Treatment CenterRuhr‐Universität BochumBochumGermany
| | - Heather Mitchell
- Medical Research Council Cognition and Brain Sciences UnitCambridgeUK
| | | | - Peter Watson
- Medical Research Council Cognition and Brain Sciences UnitCambridgeUK
| | - Nick Myers
- Oxford Centre for Human Brain Activity (OHBA)University of OxfordOxfordUK,Department of Experimental PsychologyUniversity of OxfordOxfordUK
| | - Anna C Nobre
- Oxford Centre for Human Brain Activity (OHBA)University of OxfordOxfordUK,Department of Experimental PsychologyUniversity of OxfordOxfordUK
| | - Alex Lau‐Zhu
- Medical Research Council Cognition and Brain Sciences UnitCambridgeUK
| | - Emily A Holmes
- Medical Research Council Cognition and Brain Sciences UnitCambridgeUK,Department of Clinical NeuroscienceKarolinska InstituteStockholmSweden
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22
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Özerdem A, Ceylan D, Can G. Neurobiology of Risk for Bipolar Disorder. CURRENT TREATMENT OPTIONS IN PSYCHIATRY 2016; 3:315-329. [PMID: 27867834 PMCID: PMC5093194 DOI: 10.1007/s40501-016-0093-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Bipolar disorder (BD) is a chronic mental illness which follows a relapsing and remitting course and requires lifetime treatment. The lack of biological markers for BD is a major difficulty in clinical practice. Exploring multiple endophenotypes to fit in multivariate genetic models for BD is an important element in the process of finding tools to facilitate early diagnosis, early intervention, prevention of new episodes, and follow-up of treatment response in BD. Reviewing of studies on neuroimaging, neurocognition, and biochemical parameters in populations with high genetic risk for the illness can yield an integrative perspective on the neurobiology of risk for BD. The most up-to-date data reveals consistent deficits in executive function, response inhibition, verbal memory/learning, verbal fluency, and processing speed in risk groups for BD. Functional magnetic resonance imaging (fMRI) studies report alterations in the activity of the inferior frontal gyrus, medial prefrontal cortex, and limbic areas, particularly in the amygdala in unaffected first-degree relatives (FDR) of BD compared to healthy controls. Risk groups for BD also present altered immune and neurochemical modulation. Despite inconsistencies, accumulating data reveals cognitive and imaging markers for risk and to a less extent resilience of BD. Findings on neural modulation markers are preliminary and require further studies. Although the knowledge on the neurobiology of risk for BD has been inadequate to provide benefits for clinical practice, further studies on structural and functional changes in the brain, neurocognitive functioning, and neurochemical modulation have a potential to reveal biomarkers for risk and resilience for BD. Multimodal, multicenter, population-based studies with large sample size allowing for homogeneous subgroup analyses will immensely contribute to the elucidation of biological markers for risk for BD in an integrative model.
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Affiliation(s)
- Ayşegül Özerdem
- Department of Psychiatry, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
- Department of Neuroscience, Health Sciences Institute, Dokuz Eylül University, Izmir, Turkey
| | - Deniz Ceylan
- Department of Neuroscience, Health Sciences Institute, Dokuz Eylül University, Izmir, Turkey
- Department of Psychiatry, Gümüşhane State Hospital, Gümüşhane, Turkey
| | - Güneş Can
- Department of Psychiatry, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
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23
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The role of white matter in personality traits and affective processing in bipolar disorder. J Psychiatr Res 2016; 80:64-72. [PMID: 27302871 PMCID: PMC7083163 DOI: 10.1016/j.jpsychires.2016.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 05/27/2016] [Accepted: 06/02/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND Bipolar disorder (BD) is characterized by affective processing bias and variations in personality traits. It is still unknown whether these features are linked to the same structural brain alterations. The aim of this study was to investigate relationships between specific personality traits, white matter (WM) properties, and affective processing in BD and HC. METHODS 24 healthy controls (HC) and 38 adults with BDI (HC: 29.47 ± 2.23 years, 15 females; BDI: 32.44 ± 1.84 years, 20 females) completed clinical scales and the Big Five Inventory. They were also administered the Affective Go/No-Go (AGN) and the Rapid Visual Processing (RVP) tasks of the Cambridge Neuropsychological Test Automated Battery. Diffusion Tensor Imaging (DTI) assessed the microstructure of WM tracts. RESULTS In BDI measures of WM properties were reduced across all major brain white matter tracts. As expected, individuals with BDI reported greater neuroticism, lower agreeableness and conscientiousness, and made a greater number of errors in response to affective stimuli in the AGN task compared to HC. High neuroticism scores were associated with faster AGN latency, and overall reduced AGN accuracy in both HC and BDI. Elevated FA values were associated with reduced neuroticism and increased cognitive processing in HC but not in BDI. CONCLUSIONS Our findings showed important potential links between personality, affective processing and WM integrity in BD. In the future therapeutic interventions for BD using brain stimulation protocols might benefit from the use of DTI to target pathways underlying abnormal affective processing.
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Grierson AB, Hickie IB, Naismith SL, Scott J. The role of rumination in illness trajectories in youth: linking trans-diagnostic processes with clinical staging models. Psychol Med 2016; 46:2467-2484. [PMID: 27352637 PMCID: PMC4988274 DOI: 10.1017/s0033291716001392] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 05/04/2016] [Accepted: 05/12/2016] [Indexed: 01/04/2023]
Abstract
Research in developmental psychopathology and clinical staging models has increasingly sought to identify trans-diagnostic biomarkers or neurocognitive deficits that may play a role in the onset and trajectory of mental disorders and could represent modifiable treatment targets. Less attention has been directed at the potential role of cognitive-emotional regulation processes such as ruminative response style. Maladaptive rumination (toxic brooding) is a known mediator of the association between gender and internalizing disorders in adolescents and is increased in individuals with a history of early adversity. Furthermore, rumination shows moderate levels of genetic heritability and is linked to abnormalities in neural networks associated with emotional regulation and executive functioning. This review explores the potential role of rumination in exacerbating the symptoms of alcohol and substance misuse, and bipolar and psychotic disorders during the peak age range for illness onset. Evidence shows that rumination not only amplifies levels of distress and suicidal ideation, but also extends physiological responses to stress, which may partly explain the high prevalence of physical and mental co-morbidity in youth presenting to mental health services. In summary, the normative developmental trajectory of rumination and its role in the evolution of mental disorders and physical illness demonstrates that rumination presents a detectable, modifiable trans-diagnostic risk factor in youth.
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Affiliation(s)
- A. B. Grierson
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - I. B. Hickie
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - S. L. Naismith
- Charles Perkins Centre & Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - J. Scott
- Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
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Impaired down-regulation of negative emotion in self-referent social situations in bipolar disorder: A pilot study of a novel experimental paradigm. Psychiatry Res 2016; 238:318-325. [PMID: 27086251 DOI: 10.1016/j.psychres.2016.02.047] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 02/18/2016] [Accepted: 02/21/2016] [Indexed: 12/11/2022]
Abstract
Emotion dysregulation is a core feature of bipolar disorder (BD) that persists into periods of remission. Neuroimaging studies show aberrant neural responses during emotion regulation (ER) in patients with BD relative to healthy controls, but behavioural evidence for ER deficits is sparse and conflicting. This study aimed to explore ER in BD using a novel, personally relevant experimental paradigm. Twenty patients with BD and 20 patients with unipolar disorder (UD), in full or partial remission, and 20 healthy controls were given a novel computerised test. Participants were instructed to react naturally or dampen their emotional response to positive and negative social scenarios and associated self-beliefs. They were also given an established experimental task for comparison, involving reappraisal of negative affective picture stimuli, as well as a questionnaire of habitual ER strategies. BD patients showed reduced ability to down-regulate emotional responses in negative, but not positive, social scenarios relative to healthy controls and UD patients. In contrast, there were no between-group differences in the established ER task or in self-reported habitual reappraisal strategies. Findings highlight the novel social scenario paradigm as a sensitive test for detection of ER difficulties in BD.
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Emotion regulation and mania risk: Differential responses to implicit and explicit cues to regulate. J Behav Ther Exp Psychiatry 2016; 50:283-8. [PMID: 26530326 PMCID: PMC4785014 DOI: 10.1016/j.jbtep.2015.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Revised: 08/14/2015] [Accepted: 10/12/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND OBJECTIVES People prone to mania use emotion regulation (ER) strategies well when explicitly coached to do so in laboratory settings, but they find these strategies ineffective in daily life. We hypothesized that, compared with control participants, mania-prone people would show ER deficits when they received implicit, but not explicit, cues to use ER. METHODS Undergraduates (N = 66) completed the Hypomanic Personality Scale (HPS) and were randomly assigned to one of three experimental conditions: automatic ER (scrambled sentence primes), deliberate ER (verbal instructions), or control (no priming or instructions to use ER). Then, participants played a videogame designed to evoke anger. Emotion responses were measured with a multi-modal assessment of self-reported affect, psychophysiology, and facial expressions. Respiratory sinus arrhythmia (RSA) was used to index ER. RESULTS The videogame effectively elicited subjective anger, angry facial expressions, and heart rate increases when keys malfunctioned. As hypothesized, persons who were more mania prone showed greater RSA increases in the deliberate ER condition than in the automatic or control conditions. LIMITATIONS One potential limitation is the use of an analog sample. CONCLUSIONS Findings suggest that those at risk for mania require more explicit instruction to engage ER effectively.
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Terrien S, Gobin P, Coutté A, Thuaire F, Iakimova G, Mazzola-Pomietto P, Besche-Richard C. Emotional Meaning in Context in Relation to Hypomanic Personality Traits: An ERP Study. PLoS One 2015; 10:e0138877. [PMID: 26394230 PMCID: PMC4578890 DOI: 10.1371/journal.pone.0138877] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 09/04/2015] [Indexed: 12/02/2022] Open
Abstract
The ability to integrate contextual information is important for the comprehension of emotional and social situations. While some studies have shown that emotional processes and social cognition are impaired in people with hypomanic personality trait, no results have been reported concerning the neurophysiological processes mediating the processing of emotional information during the integration of contextual social information in this population. We therefore chose to conduct an ERP study dealing with the integration of emotional information in a population with hypomanic personality trait. Healthy participants were evaluated using the Hypomanic Personality Scale (HPS), and ERPs were recorded during a linguistic task in which participants silently read sentence pairs describing short social situations. The first sentence implicitly conveyed the positive or negative emotional state of a character. The second sentence was emotionally congruent or incongruent with the first sentence. We analyzed the difference in the modulation of two components (N400 and LPC) in response to the emotional word present at the end of the “target” sentences as a function of the HPS score and the emotional valence of the context. Our results showed a possible modulation of the N400 component in response to both positive and negative context among the participants who scored high on the Mood Volatility subscale of the Hypomanic Personality Scale. These results seem to indicate that the participants with hypomanic personality traits exhibited specificities in the integration of emotions at the level of the early-mobilized neurocognitive processes (N400). Participants with hypomanic personality traits found it difficult to integrate negative emotional contexts, while simultaneously exhibiting an enhanced integration of positive emotional contexts.
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Affiliation(s)
- Sarah Terrien
- Laboratoire Cognition, Santé, Socialisation, C2S, EA 6291, Université de Reims Champagne-Ardenne, Reims, France
| | - Pamela Gobin
- Laboratoire Cognition, Santé, Socialisation, C2S, EA 6291, Université de Reims Champagne-Ardenne, Reims, France
| | - Alexandre Coutté
- Laboratoire d'Anthropologie et de Psychologie Cognitive et Sociale, LAPCOS, EA 7278, Université de Nice-Sophia Antipolis, Nice, France
| | - Flavien Thuaire
- Institut des Neurosciences de la Timone, CNRS UMR 7289, Marseille, France
| | - Galina Iakimova
- Laboratoire d'Anthropologie et de Psychologie Cognitive et Sociale, LAPCOS, EA 7278, Université de Nice-Sophia Antipolis, Nice, France
| | | | - Chrystel Besche-Richard
- Laboratoire Cognition, Santé, Socialisation, C2S, EA 6291, Université de Reims Champagne-Ardenne, Reims, France; Institut Universitaire de France, Paris, France
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Breakspear M, Roberts G, Green MJ, Nguyen VT, Frankland A, Levy F, Lenroot R, Mitchell PB. Network dysfunction of emotional and cognitive processes in those at genetic risk of bipolar disorder. Brain 2015; 138:3427-39. [DOI: 10.1093/brain/awv261] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 07/13/2015] [Indexed: 01/02/2023] Open
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Impaired regulation of emotion: neural correlates of reappraisal and distraction in bipolar disorder and unaffected relatives. Transl Psychiatry 2015; 5:e497. [PMID: 25603413 PMCID: PMC4312831 DOI: 10.1038/tp.2014.137] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 11/04/2014] [Accepted: 11/18/2014] [Indexed: 12/29/2022] Open
Abstract
Deficient emotion regulation has been proposed as a crucial pathological mechanism in bipolar disorder (BD). We therefore investigated emotion regulation impairments in BD, the related neural underpinnings and their etiological relevance for the disorder. Twenty-two euthymic patients with bipolar-I disorder and 17 unaffected first-degree relatives of BD-I patients, as well as two groups of healthy gender-, age- and education-matched controls (N=22/17, respectively) were included. Participants underwent functional magnetic resonance imaging while applying two different emotion regulation techniques, reappraisal and distraction, when presented with emotional images. BD patients and relatives showed impaired downregulation of amygdala activity during reappraisal, but not during distraction, when compared with controls. This deficit was correlated with the habitual use of reappraisal. The negative connectivity of amygdala and orbitofrontal cortex (OFC) observed during reappraisal in controls was reversed in BD patients and relatives. There were no significant differences between BD patients and relatives. As being observed in BD patients and unaffected relatives, deficits in emotion regulation through reappraisal may represent heritable neurobiological abnormalities underlying BD. The neural mechanisms include impaired control of amygdala reactivity to emotional stimuli and dysfunctional connectivity of the amygdala to regulatory control regions in the OFC. These are, thus, important aspects of the neurobiological basis of increased vulnerability for BD.
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