1
|
Wu Y, Su YA, Zhu L, Li J, Si T. Advances in functional MRI research in bipolar disorder: from the perspective of mood states. Gen Psychiatr 2024; 37:e101398. [PMID: 38292862 PMCID: PMC10826570 DOI: 10.1136/gpsych-2023-101398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 12/20/2023] [Indexed: 02/01/2024] Open
Abstract
Bipolar disorder is characterised by recurrent and alternating episodes of mania/hypomania and depression. Current breakthroughs in functional MRI techniques have uncovered the functional neuroanatomy of bipolar disorder. However, the pathophysiology underlying mood instability, mood switching and the development of extreme mood states is less well understood. This review presents a comprehensive overview of current evidence from functional MRI studies from the perspective of mood states. We first summarise the disrupted brain activation patterns and functional connectivity that have been reported in bipolar disorder, irrespective of the mood state. We next focus on research that solely included patients in a single mood state for a better understanding of the pathophysiology of bipolar disorder and research comparing patients with different mood states to dissect mood state-related effects. Finally, we briefly summarise current theoretical models and conclude this review by proposing potential avenues for future research. A comprehensive understanding of the pathophysiology with consideration of mood states could not only deepen our understanding of how acute mood episodes develop at a neurophysiological level but could also facilitate the identification of biological targets for personalised treatment and the development of new interventions for bipolar disorder.
Collapse
Affiliation(s)
- Yankun Wu
- Department of Clinical Psychopharmacology, Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Yun-Ai Su
- Department of Clinical Psychopharmacology, Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Linlin Zhu
- Department of Clinical Psychopharmacology, Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Jitao Li
- Department of Clinical Psychopharmacology, Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Tianmei Si
- Department of Clinical Psychopharmacology, Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| |
Collapse
|
2
|
Xia Y, Sun H, Hua L, Dai Z, Wang X, Tang H, Han Y, Du Y, Zhou H, Zou H, Yao Z, Lu Q. Spontaneous beta power, motor-related beta power and cortical thickness in major depressive disorder with psychomotor disturbance. Neuroimage Clin 2023; 38:103433. [PMID: 37216848 PMCID: PMC10209543 DOI: 10.1016/j.nicl.2023.103433] [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: 04/06/2023] [Revised: 05/05/2023] [Accepted: 05/11/2023] [Indexed: 05/24/2023]
Abstract
INTRODUCTION The psychomotor disturbance is a common symptom in patients with major depressive disorder (MDD). The neurological mechanisms of psychomotor disturbance are intricate, involving alterations in the structure and function of motor-related regions. However, the relationship among changes in the spontaneous activity, motor-related activity, local cortical thickness, and psychomotor function remains unclear. METHOD A total of 140 patients with MDD and 68 healthy controls performed a simple right-hand visuomotor task during magnetoencephalography (MEG) scanning. All patients were divided into two groups according to the presence of psychomotor slowing. Spontaneous beta power, movement-related beta desynchronization (MRBD), absolute beta power during movement and cortical characteristics in the bilateral primary motor cortex were compared using general linear models with the group as a fixed effect and age as a covariate. Finally, the moderated mediation model was tested to examine the relationship between brain metrics with group differences and psychomotor performance. RESULTS The patients with psychomotor slowing showed higher spontaneous beta power, movement-related beta desynchronization and absolute beta power during movement than patients without psychomotor slowing. Compared with the other two groups, significant decreases were found in cortical thickness of the left primary motor cortex in patients with psychomotor slowing. Our moderated mediation model showed that the increased spontaneous beta power indirectly affected impaired psychomotor performance by abnormal MRBD, and the indirect effects were moderated by cortical thickness. CONCLUSION These results suggest that patients with MDD have aberrant cortical beta activity at rest and during movement, combined with abnormal cortical thickness, contributing to the psychomotor disturbance observed in this patient population.
Collapse
Affiliation(s)
- Yi Xia
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Hao Sun
- Nanjing Brain Hospital, Medical School of Nanjing University, Nanjing 210093, China
| | - Lingling Hua
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Zhongpeng Dai
- School of Biological Sciences & Medical Engineering, Southeast University, Nanjing 210096, China; Child Development and Learning Science, Key Laboratory of Ministry of Education, Southeast University, Nanjing 210096, China
| | - Xiaoqin Wang
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Hao Tang
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Yinglin Han
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Yishan Du
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Hongliang Zhou
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Haowen Zou
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China; Nanjing Brain Hospital, Medical School of Nanjing University, Nanjing 210093, China
| | - Zhijian Yao
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China; School of Biological Sciences & Medical Engineering, Southeast University, Nanjing 210096, China; Nanjing Brain Hospital, Medical School of Nanjing University, Nanjing 210093, China.
| | - Qing Lu
- School of Biological Sciences & Medical Engineering, Southeast University, Nanjing 210096, China; Child Development and Learning Science, Key Laboratory of Ministry of Education, Southeast University, Nanjing 210096, China.
| |
Collapse
|
3
|
Verdolini N, Moreno-Ortega M, Salgado-Pineda P, Monté G, de Aragón AM, Dompablo M, McKenna PJ, Salvador R, Palomo T, Pomarol-Clotet E, Rodriguez-Jimenez R. Failure of deactivation in bipolar disorder during performance of an fMRI adapted version of the Stroop task. J Affect Disord 2023; 329:307-314. [PMID: 36863465 DOI: 10.1016/j.jad.2023.02.132] [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: 08/01/2022] [Revised: 02/22/2023] [Accepted: 02/23/2023] [Indexed: 03/04/2023]
Abstract
INTRODUCTION Few studies have examined the functional brain correlates of the performance of the Stroop task in bipolar disorder (BD). It is also not known whether it is associated with failure of de-activation in the default mode network, as has been found in studies using other tasks. METHODS Twenty-four BD patients and 48 age, sex and educationally estimated intellectual quotient (IQ) matched healthy subjects (HS) underwent a functional MRI during performance of the counting Stroop task. Task-related activations (incongruent versus congruent condition) and de-activations (incongruent versus fixation) were examined using whole-brain, voxel-based methodology. RESULTS Both the BD patients and the HS showed activation in a cluster encompassing the left dorsolateral and ventrolateral prefrontal cortex and the rostral anterior cingulate cortex and supplementary motor area, with no differences between them. The BD patients, however, showed significant failure of de-activation in the medial frontal cortex and the posterior cingulate cortex/precuneus. CONCLUSIONS The failure to find activation differences between BD patients and controls suggests that the 'regulative' component of cognitive control remains intact in the disorder, at least outside episodes of illness. The failure of de-activation found adds to evidence documenting trait-like default mode network dysfunction in the disorder.
Collapse
Affiliation(s)
- Norma Verdolini
- FIDMAG Germanes Hospitalàries Research Foundation, c/Dr. Pujades 38, 08830, Sant Boi de Llobregat, Barcelona, Spain; Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036 Barcelona, Spain; CIBERSAM (Biomedical Research Networking Centre in Mental Health), Spain
| | - Marta Moreno-Ortega
- CIBERSAM (Biomedical Research Networking Centre in Mental Health), Spain; Division of Experimental Therapeutics, Department of Psychiatry, New York State Psychiatric Institute/Columbia University Medical Center, New York, USA
| | - Pilar Salgado-Pineda
- FIDMAG Germanes Hospitalàries Research Foundation, c/Dr. Pujades 38, 08830, Sant Boi de Llobregat, Barcelona, Spain; CIBERSAM (Biomedical Research Networking Centre in Mental Health), Spain
| | - Gemma Monté
- FIDMAG Germanes Hospitalàries Research Foundation, c/Dr. Pujades 38, 08830, Sant Boi de Llobregat, Barcelona, Spain
| | - Ana Martínez de Aragón
- Department of Radiology, Hospital Universitario 12 de Octubre, Avda. De Córdoba s/n, 28041 Madrid, Spain
| | - Mónica Dompablo
- CIBERSAM (Biomedical Research Networking Centre in Mental Health), Spain; Department of Psychiatry, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Cardenal Cisneros, Centro de Enseñanza Superior adscrito a la Universidad Complutense de Madrid, Spain
| | - Peter J McKenna
- FIDMAG Germanes Hospitalàries Research Foundation, c/Dr. Pujades 38, 08830, Sant Boi de Llobregat, Barcelona, Spain; CIBERSAM (Biomedical Research Networking Centre in Mental Health), Spain
| | - Raymond Salvador
- FIDMAG Germanes Hospitalàries Research Foundation, c/Dr. Pujades 38, 08830, Sant Boi de Llobregat, Barcelona, Spain; CIBERSAM (Biomedical Research Networking Centre in Mental Health), Spain
| | - Tomás Palomo
- CIBERSAM (Biomedical Research Networking Centre in Mental Health), Spain; Facultad de Medicina, Universidad Complutense de Madrid (UCM), Madrid, Spain
| | - Edith Pomarol-Clotet
- FIDMAG Germanes Hospitalàries Research Foundation, c/Dr. Pujades 38, 08830, Sant Boi de Llobregat, Barcelona, Spain; CIBERSAM (Biomedical Research Networking Centre in Mental Health), Spain.
| | - Roberto Rodriguez-Jimenez
- CIBERSAM (Biomedical Research Networking Centre in Mental Health), Spain; Department of Psychiatry, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid (UCM), Madrid, Spain
| |
Collapse
|
4
|
Tian F, Wang X, Long X, Roberts N, Feng C, Yue S, Jia Z. The Correlation of Reduced Fractional Anisotropy in the Cingulum With Suicide Risk in Bipolar Disorder. Front Psychiatry 2021; 12:707622. [PMID: 34803753 PMCID: PMC8595246 DOI: 10.3389/fpsyt.2021.707622] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 10/06/2021] [Indexed: 02/04/2023] Open
Abstract
Objective: This study aims to investigate the significant alterations in brain white matter integrity in individuals with bipolar disorder (BD) who had attempted suicide by applying a tract-based spatial statistics (TBSS) approach with tensor-based spatial normalization. Methods: A TBSS approach with novel tensor-based registration was used to compare the white matter fractional anisotropy (FA) between 51 individuals with BD, of whom 19 had attempted suicide, and 43 healthy controls (HC). The suicide attempt was assessed with the Columbia-Suicide Severity Rating Scale (C-SSRS). In addition, we also investigated the correlations of FA values with clinical measures in BD, including illness duration, and the severity of depression and anxiety measured by the Hamilton Depression Rating Scale (HAMD) and Hamilton Anxiety Rating Scale (HAMA), respectively. Results: A significant reduction of FA value in the hippocampal cingulum was observed in BD individuals who had attempted suicide compared with those who had not. For the genu/body of the corpus callosum, inferior fronto-occipital fasciculus, uncinate fasciculus, and anterior thalamic radiation, the reductions in FA values were significantly greater in both BD subgroups who attempted suicide and who did not, compared to HC. The correlation analysis showed that the illness duration of attempters was correlated to the FA value of the genu of the corpus callosum, while the HAMD and HAMA scores of non-attempters were relevant to the FA of the superior longitudinal fasciculus. Conclusion: The observation that white matter integrity was altered in the hippocampal cingulum in BD individuals who attempted suicide suggested that this brain area may be the neurobiological basis of suicide attempts. Our findings also support the involvement of white matter (WM) microstructure of frontal-subcortical circuits in the neurobiological mechanism of BD. In addition, the illness duration of patients with attempted suicide may have an effect on the altered integrity of the corpus callosum.
Collapse
Affiliation(s)
- Fangfang Tian
- Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, China.,Department of Nuclear Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiuli Wang
- Department of Clinical Psychology, The Fourth People's Hospital of Chengdu, Chengdu, China
| | - Xipeng Long
- Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, China.,Department of Radiology, Huaxi MR Research Center, West China Hospital of Sichuan University, Chengdu, China
| | - Neil Roberts
- School of Clinical Sciences, The Queens Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Can Feng
- Department of Clinical Psychology, The Fourth People's Hospital of Chengdu, Chengdu, China
| | - Suping Yue
- Department of Clinical Psychology, The Fourth People's Hospital of Chengdu, Chengdu, China
| | - Zhiyun Jia
- Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, China.,Department of Radiology, Huaxi MR Research Center, West China Hospital of Sichuan University, Chengdu, China
| |
Collapse
|
5
|
Ushakova VM, Morozova AY, Reznik AM, Kostyuk GP, Chekhonin VP. Molecular Biological Aspects of Depressive Disorders: A Modern View. Mol Biol 2020. [DOI: 10.1134/s0026893320050118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
6
|
Psychomotor retardation in depression: A critical measure of the forced swim test. Behav Brain Res 2019; 372:112047. [DOI: 10.1016/j.bbr.2019.112047] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 06/17/2019] [Accepted: 06/17/2019] [Indexed: 12/20/2022]
|
7
|
Moore TM, Calkins ME, Satterthwaite TD, Roalf DR, Rosen AFG, Gur RC, Gur RE. Development of a computerized adaptive screening tool for overall psychopathology ("p"). J Psychiatr Res 2019; 116:26-33. [PMID: 31176109 PMCID: PMC6649661 DOI: 10.1016/j.jpsychires.2019.05.028] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 04/29/2019] [Accepted: 05/31/2019] [Indexed: 11/21/2022]
Abstract
A substantial body of work supports the existence of a general psychopathology factor ("p"). Psychometrically, this is important because it implies that there is a psychological phenomenon (overall psychopathology) that can be measured and potentially used in clinical research or treatment. The present study aimed to construct, calibrate, and begin to validate a computerized adaptive (CAT) screener for "p". In a large community sample (N = 4544; age 11-21), we modeled 114 clinical items using a bifactor multidimensional item response theory (MIRT) model and constructed a fully functional (and public) CAT for assessing "p" called the Overall mental illness (OMI) screener. In a random, non-overlapping sample (N = 1019) with extended phenotyping (neuroimaging) from the same community cohort, adaptive versions of the OMI screener (10-, 20-, and 40-item) were simulated and compared to the full 114-item test in their ability to predict demographic characteristics, common mental disorders, and brain parameters. The OMI screener performed almost as well as the full test, despite being only a small fraction of the length. For prediction of 13 mental disorders, the mid-length (20-item) adaptive version showed mean area under the receiver operating characteristic curve of 0.76, compared to 0.79 for the full version. For prediction of brain parameters, mean absolute standardized relationship was 0.06 for the 20-item adaptive version, compared to 0.07 for the full form. This brief, public tool may facilitate the rapid and accurate measurement of overall psychopathology in large-scale studies and in clinical practice.
Collapse
Affiliation(s)
- Tyler M Moore
- Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.
| | - Monica E Calkins
- Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Theodore D Satterthwaite
- Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - David R Roalf
- Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Adon F G Rosen
- Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Ruben C Gur
- Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA; VISN4 Mental Illness Research, Education, and Clinical Center at the Philadelphia VA Medical Center, Philadelphia, PA, 19104, USA
| | - Raquel E Gur
- Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| |
Collapse
|
8
|
Abstract
Neuropsychiatric illnesses including mood disorders are accompanied by cognitive impairment, which impairs work capacity and quality of life. However, there is a lack of treatment options that would lead to solid and lasting improvement of cognition. This is partially due to the absence of valid and reliable neurocircuitry-based biomarkers for pro-cognitive effects. This systematic review therefore examined the most consistent neural underpinnings of cognitive impairment and cognitive improvement in unipolar and bipolar disorders. We identified 100 studies of the neuronal underpinnings of working memory and executive skills, learning and memory, attention, and implicit learning and 9 studies of the neuronal basis for cognitive improvements. Impairments across several cognitive domains were consistently accompanied by abnormal activity in dorsal prefrontal (PFC) cognitive control regions-with the direction of this activity depending on patients' performance levels-and failure to suppress default mode network (DMN) activity. Candidate cognition treatments seemed to enhance task-related dorsal PFC and temporo-parietal activity when performance increases were observed, and to reduce their activity when performance levels were unchanged. These treatments also attenuated DMN hyper-activity. In contrast, nonspecific cognitive improvement following symptom reduction was typically accompanied by decreased limbic reactivity and reversal of pre-treatment fronto-parietal hyper-activity. Together, the findings highlight some common neural correlates of cognitive impairments and cognitive improvements. Based on this evidence, studies are warranted to examine the reliability and predictive validity of target engagement in the identified neurocircuitries as a biomarker model of pro-cognitive effects.
Collapse
|
9
|
King JB, Anderson JS, Yurgelun-Todd DA, Subramaniam P, Ehrler MR, Lopez-Larson MP. Decreased anterior cingulate activation in a motor task in youths with bipolar disorder. J Child Psychol Psychiatry 2018; 59:900-907. [PMID: 29451300 PMCID: PMC6041159 DOI: 10.1111/jcpp.12875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/03/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Bipolar disorder (BP) is characterized by abnormal shifts in mood between episodes of mania and severe depression, both of which have been linked with psychomotor disturbances. This study compares brain activation patterns in motor networks between euthymic youths with BP and healthy controls (HC) during the completion of a simple motor task. METHODS Thirty-five youths with BP and 35 HC (aged 10-19) completed a self-paced sequential bilateral finger-tapping task, consisting of a 4-minute scan block with alternating 20-second periods of either the tapping task (six blocks) or rest (six blocks), while undergoing functional magnetic resonance imaging. Clinical and behavioral symptoms were assessed using the Child Behavior Checklist (CBCL). A between-group whole-brain analysis compared activation pattern differences while controlling for effects of age and sex. Clusters meeting whole-brain false discovery rate (FDR) correction (qFDR < .05) were considered statistically significant. Post hoc analyses evaluating comorbid attention-deficit/hyperactivity disorder (ADHD) in the BP group were also conducted. RESULTS Significantly decreased activation was found in the anterior cingulate cortex (ACC) in youths with BP compared to HC. Furthermore, ACC activation was negatively correlated with CBCL mood dysregulation profile scores in the BP group. No significant differences in functional activation patterns were found between youths with BP and comorbid ADHD and those with only BP. CONCLUSIONS These findings suggest a potential common mechanism of impaired ACC modulation between emotion dysregulation and motor processing in youths with BP.
Collapse
Affiliation(s)
- Jace B. King
- Department of Radiology, University of Utah, Salt Lake City, UT, USA,Interdepartmental Program in Neuroscience, University of Utah, Salt Lake City, UT, USA,Diagnostic Neuroimaging, University of Utah, Salt Lake City, UT USA,Correspondence: Jace B. King, University of Utah, Imaging and Neurosciences Center, 729 Arapeen Drive, Salt Lake City, UT, 84108, USA; Phone: 801-585-9667;
| | - Jeffrey S. Anderson
- Department of Radiology, University of Utah, Salt Lake City, UT, USA,Interdepartmental Program in Neuroscience, University of Utah, Salt Lake City, UT, USA,School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Deborah A. Yurgelun-Todd
- Interdepartmental Program in Neuroscience, University of Utah, Salt Lake City, UT, USA,Diagnostic Neuroimaging, University of Utah, Salt Lake City, UT USA,School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Punitha Subramaniam
- Interdepartmental Program in Neuroscience, University of Utah, Salt Lake City, UT, USA,Diagnostic Neuroimaging, University of Utah, Salt Lake City, UT USA
| | | | - Melissa P. Lopez-Larson
- Diagnostic Neuroimaging, University of Utah, Salt Lake City, UT USA,School of Medicine, University of Utah, Salt Lake City, UT, USA
| |
Collapse
|
10
|
Duarte DGG, Neves MDCL, Albuquerque MR, Turecki G, Ding Y, de Souza-Duran FL, Busatto G, Correa H. Structural brain abnormalities in patients with type I bipolar disorder and suicidal behavior. Psychiatry Res Neuroimaging 2017; 265:9-17. [PMID: 28494347 DOI: 10.1016/j.pscychresns.2017.04.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 04/24/2017] [Accepted: 04/28/2017] [Indexed: 12/20/2022]
Abstract
Some studies have identified brain morphological changes in the frontolimbic network (FLN) in bipolar subjects who attempt suicide (SA). The present study investigated neuroanatomical abnormalities in the FLN to find a possible neural signature for suicidal behavior in patients with bipolar disorder type I (BD-I). We used voxel-based morphometry to compare euthymic patients with BD-I who had attempted suicide (n=20), who had not attempted suicide (n=19) and healthy controls (HCs) (n=20). We also assessed the highest medical lethality of their previous SA. Compared to the participants who had not attempted suicide, the patients with BD-I who had attempted suicide exhibited significantly increased gray matter volume (GMV) in the right rostral anterior cingulate cortex (ACC), which was more pronounced and extended further to the left ACC in the high-lethality subgroup (p<0.05, with family-wise error (FWE) correction for multiple comparisons using small-volume correction). GMV in the insula and orbitofrontal cortex was also related to suicide lethality (p<0.05, FWE-corrected). The current findings suggest that morphological changes in the FLN could be a signature of previous etiopathogenic processes affecting regions related to suicidality and its severity in BD-I patients.
Collapse
Affiliation(s)
- Dante G G Duarte
- Mental Health Department, Universidade Federal de Minas Gerais (UFMG), Minas Gerais, Brazil.
| | - Maila de Castro L Neves
- Mental Health Department, Universidade Federal de Minas Gerais (UFMG), Minas Gerais, Brazil.
| | | | - Gustavo Turecki
- McGill Group for Suicide Studies, Department of Psychiatry, McGill University, Montreal, Canada.
| | - Yang Ding
- McGill Group for Suicide Studies, Department of Psychiatry, McGill University, Montreal, Canada.
| | - Fabio Luis de Souza-Duran
- Laboratory of Neuroimaging in Psychiatry (LIM-21), Research in Applied Neuroscience, Support Care of the University of São Paulo (NAPNA-USP), São Paulo, Brazil.
| | - Geraldo Busatto
- Laboratory of Neuroimaging in Psychiatry (LIM-21), Research in Applied Neuroscience, Support Care of the University of São Paulo (NAPNA-USP), São Paulo, Brazil.
| | - Humberto Correa
- Mental Health Department, Universidade Federal de Minas Gerais (UFMG), Minas Gerais, Brazil.
| |
Collapse
|
11
|
Altinay MI, Hulvershorn LA, Karne H, Beall EB, Anand A. Differential Resting-State Functional Connectivity of Striatal Subregions in Bipolar Depression and Hypomania. Brain Connect 2016. [PMID: 26824737 DOI: 10.1089/brain.2015.0396.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Bipolar disorder (BP) is characterized by periods of depression (BPD) and (hypo)mania (BPM), but the underlying state-related brain circuit abnormalities are not fully understood. Striatal functional activation and connectivity abnormalities have been noted in BP, but consistent findings have not been reported. To further elucidate striatal abnormalities in different BP states, this study investigated differences in resting-state functional connectivity of six striatal subregions in BPD, BPM, and healthy control (HC) subjects. Ninety medication-free subjects (30 BPD, 30 BPM, and 30 HC), closely matched for age and gender, were scanned using 3T functional magnetic resonance imaging (fMRI) acquired at resting state. Correlations of low-frequency blood oxygen level dependent signal fluctuations for six previously described striatal subregions were used to obtain connectivity maps of each subregion. Using a factorial design, main effects for differences between groups were obtained and post hoc pairwise group comparisons performed. BPD showed increased connectivity of the dorsal caudal putamen with somatosensory areas such as the insula and temporal gyrus. BPM group showed unique increased connectivity between left dorsal caudate and midbrain regions, as well as increased connectivity between ventral striatum inferior and thalamus. In addition, both BPD and BPM exhibited widespread functional connectivity abnormalities between striatal subregions and frontal cortices, limbic regions, and midbrain structures. In summary, BPD exhibited connectivity abnormalities of associative and somatosensory subregions of the putamen, while BPM exhibited connectivity abnormalities of associative and limbic caudate. Most other striatal subregion connectivity abnormalities were common to both groups and may be trait related.
Collapse
Affiliation(s)
- Murat I Altinay
- 1 Center for Behavioral Health , Cleveland Clinic, Cleveland, Ohio
| | - Leslie A Hulvershorn
- 1 Center for Behavioral Health , Cleveland Clinic, Cleveland, Ohio.,2 Department of Psychiatry, Indiana University School of Medicine , Indianapolis, Indiana
| | - Harish Karne
- 1 Center for Behavioral Health , Cleveland Clinic, Cleveland, Ohio.,2 Department of Psychiatry, Indiana University School of Medicine , Indianapolis, Indiana
| | - Erik B Beall
- 3 Imaging Institute, Cleveland Clinic , Cleveland, Ohio
| | - Amit Anand
- 1 Center for Behavioral Health , Cleveland Clinic, Cleveland, Ohio.,2 Department of Psychiatry, Indiana University School of Medicine , Indianapolis, Indiana
| |
Collapse
|
12
|
Altinay MI, Hulvershorn LA, Karne H, Beall EB, Anand A. Differential Resting-State Functional Connectivity of Striatal Subregions in Bipolar Depression and Hypomania. Brain Connect 2016; 6:255-65. [PMID: 26824737 DOI: 10.1089/brain.2015.0396] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Bipolar disorder (BP) is characterized by periods of depression (BPD) and (hypo)mania (BPM), but the underlying state-related brain circuit abnormalities are not fully understood. Striatal functional activation and connectivity abnormalities have been noted in BP, but consistent findings have not been reported. To further elucidate striatal abnormalities in different BP states, this study investigated differences in resting-state functional connectivity of six striatal subregions in BPD, BPM, and healthy control (HC) subjects. Ninety medication-free subjects (30 BPD, 30 BPM, and 30 HC), closely matched for age and gender, were scanned using 3T functional magnetic resonance imaging (fMRI) acquired at resting state. Correlations of low-frequency blood oxygen level dependent signal fluctuations for six previously described striatal subregions were used to obtain connectivity maps of each subregion. Using a factorial design, main effects for differences between groups were obtained and post hoc pairwise group comparisons performed. BPD showed increased connectivity of the dorsal caudal putamen with somatosensory areas such as the insula and temporal gyrus. BPM group showed unique increased connectivity between left dorsal caudate and midbrain regions, as well as increased connectivity between ventral striatum inferior and thalamus. In addition, both BPD and BPM exhibited widespread functional connectivity abnormalities between striatal subregions and frontal cortices, limbic regions, and midbrain structures. In summary, BPD exhibited connectivity abnormalities of associative and somatosensory subregions of the putamen, while BPM exhibited connectivity abnormalities of associative and limbic caudate. Most other striatal subregion connectivity abnormalities were common to both groups and may be trait related.
Collapse
Affiliation(s)
- Murat I Altinay
- 1 Center for Behavioral Health , Cleveland Clinic, Cleveland, Ohio
| | - Leslie A Hulvershorn
- 1 Center for Behavioral Health , Cleveland Clinic, Cleveland, Ohio.,2 Department of Psychiatry, Indiana University School of Medicine , Indianapolis, Indiana
| | - Harish Karne
- 1 Center for Behavioral Health , Cleveland Clinic, Cleveland, Ohio.,2 Department of Psychiatry, Indiana University School of Medicine , Indianapolis, Indiana
| | - Erik B Beall
- 3 Imaging Institute, Cleveland Clinic , Cleveland, Ohio
| | - Amit Anand
- 1 Center for Behavioral Health , Cleveland Clinic, Cleveland, Ohio.,2 Department of Psychiatry, Indiana University School of Medicine , Indianapolis, Indiana
| |
Collapse
|
13
|
Bipolar disorder and gambling disorder comorbidity: current evidence and implications for pharmacological treatment. J Affect Disord 2015; 167:285-98. [PMID: 24999863 DOI: 10.1016/j.jad.2014.06.023] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 06/12/2014] [Accepted: 06/12/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND The co-occurrence of bipolar disorder (BD) and gambling disorder (GD), though of clinical and public health importance, is still scarcely investigated. Comorbid BD-GD subjects experience a more severe course of illness and poorer treatment outcome, due to a range of clinical and psychosocial factors that collectively impede remission and recovery. The aim of our paper is to review the role of pharmacotherapy in the treatment of comorbid BD-GD, in order to support clinical decisions according to the best available evidence. METHODS A qualitative systematic review of studies on pharmacological treatment in comorbid BD-GD was performed. A comprehensive literature search of online databases, bibliographies of published articles and gray literature was conducted. Data on efficacy, safety and tolerability were extracted and levels of evidence were assessed. We also provide a brief overview of current epidemiological, neurobiological and clinical findings, with the intention of proposing a dimensional approach to the choice of available drugs. RESULTS The only drug with a high level of evidence is lithium. Considering the inclusion of GD in DSM-5 'Substance-related and Addictive Disorders' category, we discuss the use of other drugs with a high level of evidence currently used in BD subjects with co-occurring substance use disorders. LIMITATIONS Only few clinical trials are available and the population is limited; therefore no conclusive evidence can be inferred. CONCLUSIONS Further randomized controlled trials are required to evaluate the efficacy of pharmacological treatment strategies in large samples of patients with comorbid BD-GD. Also, attempts should be made to identify other shared clinical and psychopathological domains that are amenable to treatment.
Collapse
|
14
|
Frontal lobe hypoactivation in medication-free adults with bipolar II depression during response inhibition. Psychiatry Res 2015; 231:202-9. [PMID: 25555505 DOI: 10.1016/j.pscychresns.2014.11.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 10/29/2014] [Accepted: 11/06/2014] [Indexed: 12/23/2022]
Abstract
In executive function, specifically in response inhibition, numerous studies support the essential role for the inferior frontal cortex (IFC). Hypoactivation of the IFC during response-inhibition tasks has been found consistently in subjects with bipolar disorder during manic and euthymic states. The aim of this study was to examine whether reduced IFC activation also exists in unmedicated subjects with bipolar disorder during the depressed phase of the disorder. Participants comprised 19 medication-free bipolar II (BP II) depressed patients and 20 healthy control subjects who underwent functional magnetic resonance imaging (fMRI) while performing a Go/NoGo response-inhibition task. Whole-brain analyses were conducted to assess activation differences within and between groups. The BP II depressed group, compared with the control group, showed significantly reduced activation in right frontal regions, including the IFC (Brodmann's area (BA) 47), middle frontal gyrus (BA 10), as well as other frontal and temporal regions. IFC hypoactivation may be a persistent deficit in subjects with bipolar disorder in both acute mood states as well as euthymia, thus representing a trait feature of bipolar disorder.
Collapse
|
15
|
Implicit motor learning in bipolar disorder. J Affect Disord 2015; 174:250-6. [PMID: 25527995 DOI: 10.1016/j.jad.2014.11.043] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 11/20/2014] [Accepted: 11/23/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVES A growing number of publications describe cerebellar abnormalities in patients with bipolar disorder (BD). The aim of the following paper was to examine the functional aspects of that issue by focusing on implicit learning - a cognitive function with significant cerebellar underpinnings. METHODS 27 patients with BD and 26 healthy controls (HC), matched for age and sex took part in the study. Implicit motor learning was assessed by the serial reaction time task (SRTT), in which participants were unconsciously learning a sequence of motor reactions. The indicators of procedural learning were the decrease of reaction time (RT) across the repetition of the sequence and the rebound of RT when the sequence changed into a random set of stimuli. RESULTS BD patients did not present any indicators of the implicit learning, their RT increased across repetitions of the sequence and it decreased when the sequence changed to random. Contrary, in the control group RT decreased across the sequence repetitions and increased when the stimuli begun to appear randomly. LIMITATIONS A low subject count and a non-drug naïve patients group, medicated with atypical antipsychotic and mood stabilizers, are the most significant limitations of this study. CONCLUSIONS BD patients did not acquire procedural knowledge while performing the task, whereas HC did. To our knowledge this is the first study that shows the impairment of implicit motor learning in patients with BD. This indicates the possible cerebellar dysfunction in this disease and may provide a new neuropsychiatric approach to bipolar disorder.
Collapse
|
16
|
Liberg B, Rahm C. The functional anatomy of psychomotor disturbances in major depressive disorder. Front Psychiatry 2015; 6:34. [PMID: 25806006 PMCID: PMC4354237 DOI: 10.3389/fpsyt.2015.00034] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 02/19/2015] [Indexed: 12/16/2022] Open
Abstract
Psychomotor disturbances (PMD) are a classic feature of depressive disorder that provides rich clinical information. The aim our narrative review was to characterize the functional anatomy of PMD by summarizing findings from neuroimaging studies. We found evidence across several neuroimaging modalities that suggest involvement of fronto-striatal neurocircuitry, and monoaminergic pathways and metabolism. We suggest that PMD in major depressive disorder emerge from an alteration of limbic signals, which influence emotion, volition, higher-order cognitive functions, and movement.
Collapse
Affiliation(s)
- Benny Liberg
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, The University of Melbourne , Melbourne, VIC , Australia ; Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet , Stockholm , Sweden
| | - Christoffer Rahm
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, The University of Melbourne , Melbourne, VIC , Australia ; Unit of Metabolism, Department of Medicine Huddinge, Karolinska Institutet , Stockholm , Sweden
| |
Collapse
|
17
|
Marchand WR, Lee JN, Johnson S, Gale P, Thatcher J. Abnormal functional connectivity of the medial cortex in euthymic bipolar II disorder. Prog Neuropsychopharmacol Biol Psychiatry 2014; 51:28-33. [PMID: 24440372 DOI: 10.1016/j.pnpbp.2014.01.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 12/21/2013] [Accepted: 01/07/2014] [Indexed: 12/20/2022]
Abstract
This project utilized functional MRI (fMRI) and a motor activation paradigm to investigate neural circuitry in euthymic bipolar II disorder. We hypothesized that circuitry involving the cortical midline structures (CMS) would demonstrate abnormal functional connectivity. Nineteen subjects with recurrent bipolar disorder and 18 controls were studied using fMRI and a motor activation paradigm. We used functional connectivity analyses to identify circuits with aberrant connectivity. We found increased functional connectivity among bipolar subjects compared to healthy controls in two CMS circuits. One circuit included the medial aspect of the left superior frontal gyrus and the dorsolateral region of the left superior frontal gyrus. The other included the medial aspect of the right superior frontal gyrus, the dorsolateral region of the left superior frontal gyrus and the right medial frontal gyrus and surrounding region. Our results indicate that CMS circuit dysfunction persists in the euthymic state and thus may represent trait pathology. Future studies should address whether these circuits contribute to relapse of illness. Our results also suggest the possibility that aberrations of superior frontal circuitry may impact default mode network and cognitive processes.
Collapse
Affiliation(s)
- William R Marchand
- George E. Wahlen Veterans Affairs Medical Center, 500 Foothill Drive, Salt Lake City, UT 84148, USA; University of Utah, 201 Presidents Circle, Salt Lake City, UT 84112, USA.
| | - James N Lee
- George E. Wahlen Veterans Affairs Medical Center, 500 Foothill Drive, Salt Lake City, UT 84148, USA; University of Utah, 201 Presidents Circle, Salt Lake City, UT 84112, USA
| | - Susanna Johnson
- George E. Wahlen Veterans Affairs Medical Center, 500 Foothill Drive, Salt Lake City, UT 84148, USA
| | - Phillip Gale
- George E. Wahlen Veterans Affairs Medical Center, 500 Foothill Drive, Salt Lake City, UT 84148, USA; University of Utah, 201 Presidents Circle, Salt Lake City, UT 84112, USA
| | - John Thatcher
- George E. Wahlen Veterans Affairs Medical Center, 500 Foothill Drive, Salt Lake City, UT 84148, USA; University of Utah, 201 Presidents Circle, Salt Lake City, UT 84112, USA
| |
Collapse
|
18
|
Neves MDC, Albuquerque MR, Neves FS, Lage GM, Malloy-Diniz L, Nicolato R, Corrêa H. Sensorimotor performance in euthymic bipolar disorder: the MPraxis (PennCNP) analysis. ACTA ACUST UNITED AC 2014; 36:248-50. [PMID: 24676046 DOI: 10.1590/1516-4446-2013-1243] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 10/15/2013] [Indexed: 11/21/2022]
Abstract
BACKGROUND Sensorimotor deficits are an important phenomenological facet observed in patients with bipolar disorder (BD). However, there is little research on this topic. We hypothesize that the MPraxis test can be used to screen for motor impairments in BD aiming movements. METHOD The MPraxis, which is a quick and easy-to-apply computerized test, measures sensorimotor control. During the test, the participant must move the computer mouse cursor over an ever-shrinking green box and click on it once. We predict that the MPraxis test is capable of detecting differences in sensorimotor performance between patients with BD and controls. We assessed 21 euthymic type I BD patients, without DSM-IV-TR Axis I comorbidity, and 21 healthy controls. RESULTS AND CONCLUSIONS Compared to the controls, the patients with BD presented a lower response time in their movements in all conditions. Our results showed sensorimotor deficits in BD and suggested that the MPraxis test can be used to screen for motor impairments in patients with euthymic BD.
Collapse
Affiliation(s)
- Maila de C Neves
- Mental Health Department, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Maicon R Albuquerque
- Physical Education Department, Universidade Federal de Viçosa (UFV), Viçosa, MG, Brazil
| | - Fernando S Neves
- Mental Health Department, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | | | - Leandro Malloy-Diniz
- Mental Health Department, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Rodrigo Nicolato
- Mental Health Department, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Humberto Corrêa
- Mental Health Department, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| |
Collapse
|
19
|
Wesley MJ, Bickel WK. Remember the future II: meta-analyses and functional overlap of working memory and delay discounting. Biol Psychiatry 2014; 75:435-48. [PMID: 24041504 PMCID: PMC3943930 DOI: 10.1016/j.biopsych.2013.08.008] [Citation(s) in RCA: 151] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 07/03/2013] [Accepted: 08/05/2013] [Indexed: 11/27/2022]
Abstract
Previously we showed that working memory training decreased the discounting of future rewards in stimulant addicts without affecting a go/no-go task. While a relationship between delay discounting and working memory is consistent with other studies, the unique brain regions of plausible causality between these two abilities have yet to be determined. Activation likelihood estimation meta-analyses were performed on foci from studies of delay discounting (DD = 449), working memory (WM = 452), finger tapping (finger tapping = 450), and response inhibition (RI = 450). Activity maps from relatively less (finger tapping) and more (RI) demanding executive tasks were contrasted with maps of DD and WM. Overlap analysis identified unique functional coincidence between DD and WM. The anterior cingulate cortex was engaged by all tasks. Finger tapping largely engaged motor-related brain areas. In addition to motor-related areas, RI engaged frontal brain regions. The right lateral prefrontal cortex was engaged by RI, DD, and WM and was contrasted out of overlap maps. A functional cluster in the posterior portion of the left lateral prefrontal cortex emerged as the largest location of unique overlap between DD and WM. A portion of the left lateral prefrontal cortex is a unique location where delay discounting and working memory processes overlap in the brain. This area, therefore, represents a therapeutic target for improving behaviors that rely on the integration of the recent past with the foreseeable future.
Collapse
Affiliation(s)
- Michael J. Wesley
- Virginia Tech Carilion Research Institute, Virginia Tech, Roanoke, VA, USA,Addiction Recovery Research Center,Human Neuroimaging Laboratory
| | - Warren K. Bickel
- Virginia Tech Carilion Research Institute, Virginia Tech, Roanoke, VA, USA,Addiction Recovery Research Center
| |
Collapse
|
20
|
Kuiper S, McLean L, Malhi GS. To BD or not to BD: functional neuroimaging and the boundaries of bipolarity. Expert Rev Neurother 2014; 13:75-86; quiz 87. [DOI: 10.1586/ern.12.126] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
21
|
Liberg B, Klauser P, Harding IH, Adler M, Rahm C, Lundberg J, Masterman T, Wachtler C, Jonsson T, Kristoffersen-Wiberg M, Pantelis C, Wahlund B. Functional and structural alterations in the cingulate motor area relate to decreased fronto-striatal coupling in major depressive disorder with psychomotor disturbances. Front Psychiatry 2014; 5:176. [PMID: 25538633 PMCID: PMC4255491 DOI: 10.3389/fpsyt.2014.00176] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 11/21/2014] [Indexed: 01/14/2023] Open
Abstract
Psychomotor disturbances are a classic feature of major depressive disorders. These can manifest as lack of facial expressions and decreased speech production, reduced body posture and mobility, and slowed voluntary movement. The neural correlates of psychomotor disturbances in depression are poorly understood but it has been suggested that outputs from the cingulate motor area (CMA) to striatal motor regions, including the putamen, could be involved. We used functional and structural magnetic resonance imaging to conduct a region-of-interest analysis to test the hypotheses that neural activation patterns related to motor production and gray matter volumes in the CMA would be different between depressed subjects displaying psychomotor disturbances (n = 13) and matched healthy controls (n = 13). In addition, we conducted a psychophysiological interaction analysis to assess the functional coupling related to self-paced finger-tapping between the caudal CMA and the posterior putamen in patients compared to controls. We found a cluster of increased neural activation, adjacent to a cluster of decreased gray matter volume in the caudal CMA in patients compared to controls. The functional coupling between the left caudal CMA and the left putamen during finger-tapping task performance was additionally decreased in patients compared to controls. In addition, the strength of the functional coupling between the left caudal CMA and the left putamen was negatively correlated with the severity of psychomotor disturbances in the patient group. In conclusion, we found converging evidence for involvement of the caudal CMA and putamen in the generation of psychomotor disturbances in depression.
Collapse
Affiliation(s)
- Benny Liberg
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, The University of Melbourne , Melbourne, VIC , Australia ; Section of Psychiatry, Department of Clinical Neuroscience, Karolinska Institutet , Stockholm , Sweden ; Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Medical Imaging and Technology, Karolinska Institutet , Stockholm , Sweden
| | - Paul Klauser
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, The University of Melbourne , Melbourne, VIC , Australia ; Monash Clinical and Imaging Neuroscience, School of Psychology and Psychiatry, Monash University , Clayton, VIC , Australia
| | - Ian H Harding
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, The University of Melbourne , Melbourne, VIC , Australia ; School of Psychological Sciences, Monash University , Melbourne, VIC , Australia
| | - Mats Adler
- Section of Psychiatry, Department of Clinical Neuroscience, Karolinska Institutet , Stockholm , Sweden
| | - Christoffer Rahm
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, The University of Melbourne , Melbourne, VIC , Australia ; Department of Medicine Huddinge, Karolinska Institutet , Stockholm , Sweden
| | - Johan Lundberg
- Section of Psychiatry, Department of Clinical Neuroscience, Karolinska Institutet , Stockholm , Sweden
| | - Thomas Masterman
- Section of Psychiatry, Department of Clinical Neuroscience, Karolinska Institutet , Stockholm , Sweden
| | - Caroline Wachtler
- Primary Care Research Unit, Department of General Practice, The University of Melbourne , Melbourne, VIC , Australia ; Centre for Family Medicine (CeFAM), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet , Stockholm , Sweden
| | - Tomas Jonsson
- Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Medical Imaging and Technology, Karolinska Institutet , Stockholm , Sweden ; Department of Medical Physics, Karolinska University Hospital Huddinge , Stockholm , Sweden
| | - Maria Kristoffersen-Wiberg
- Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Medical Imaging and Technology, Karolinska Institutet , Stockholm , Sweden ; Department of Radiology, Karolinska University Hospital , Stockholm , Sweden
| | - Christos Pantelis
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, The University of Melbourne , Melbourne, VIC , Australia
| | - Björn Wahlund
- Department of Energy and Engineering, Swedish University of Agricultural Sciences , Uppsala , Sweden
| |
Collapse
|
22
|
Striatal circuit function is associated with prior self-harm in remitted major depression. Neurosci Lett 2013; 557 Pt B:154-8. [DOI: 10.1016/j.neulet.2013.10.053] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 10/18/2013] [Accepted: 10/21/2013] [Indexed: 11/23/2022]
|
23
|
Marchand WR, Lee JN, Johnson S, Gale P, Thatcher J. Differences in functional connectivity in major depression versus bipolar II depression. J Affect Disord 2013; 150:527-32. [PMID: 23433856 DOI: 10.1016/j.jad.2013.01.028] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 01/28/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND Objective methods of differentiating unipolar versus bipolar depression would enhance our ability to treat these disorders by providing more accurate diagnoses. One first step towards developing diagnostic methodology is determining whether brain function as assessed by functional MRI (fMRI) and functional connectivity analyses might differentiate the two disorders. METHODS Fourteen subjects with bipolar II depression and 26 subjects with recurrent unipolar depression were studied using fMRI and functional connectivity analyses. RESULTS The first key finding of this study was that functional connectivity of the right posterior cingulate cortex differentiates bipolar II and unipolar depression. Additionally, results suggest that functional connectivity of this region is associated with suicidal ideation and depression severity in unipolar but not bipolar II depression. LIMITATIONS The primary limitation is the relatively small sample size, particularly for the correlational analyses. CONCLUSIONS The functional connectivity of right posterior cingulate cortex may differential unipolar from bipolar II depression. Further, connectivity of this region may be associated with depression severity and suicide risk in unipolar but not bipolar depression.
Collapse
Affiliation(s)
- William R Marchand
- George E. Wahlen Veterans Affairs Medical Center, VHASLCHCS 116 OP, 500 Foothill Drive, Salt Lake City, UT 84148, USA.
| | | | | | | | | |
Collapse
|
24
|
Lage GM, Malloy-Diniz LF, Neves FS, Gallo LG, Valentini AS, Corrêa H. A kinematic analysis of manual aiming control on euthymic bipolar disorder. Psychiatry Res 2013; 208:140-4. [PMID: 23102536 DOI: 10.1016/j.psychres.2012.09.046] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2012] [Revised: 08/08/2012] [Accepted: 09/25/2012] [Indexed: 10/27/2022]
Abstract
Motor deficits in tasks that require force steadiness or scaling of movement velocity have been found in bipolar disorder (BD). A potential explanation for these results is the abnormal functioning of the frontostriatal circuitry. We designed this study to investigate the possible impairments in a manual aiming task. Participants comprised 15 euthymic BD patients and 15 healthy controls, who performed 100 trials of a goal-directed manual movement with a non-inking pen on a digitizing tablet. Four different conditions of execution were required. The control condition appeared on the computer screen in 70% of the trials, and the other three conditions, (a) distractor, (b) inhibition of response and (c) higher index of difficulty, each appeared in 10% of the trials. Compared to the controls, the BD patients were less fluent in their movements, relied more heavily on visual feedback to control their manual movements and presented a lower spatial accuracy. We found that motor deficits in euthymic BD were observed in the kinematic analysis of manual aiming. Our findings are consistent with the hypothesis of abnormal functioning of the frontostriatal circuitry in euthymic BD.
Collapse
Affiliation(s)
- Guilherme M Lage
- Departamento de Educação Física da Universidade FUMEC, Rua Cobre 200, Bairro Cruzeiro, 30310-190, Faculdade de Ciências Humanas, Sociais e da Saúde, Belo Horizonte, Minas Gerais, Brazil.
| | | | | | | | | | | |
Collapse
|
25
|
Fernández-Corcuera P, Salvador R, Monté GC, Salvador Sarró S, Goikolea JM, Amann B, Moro N, Sans-Sansa B, Ortiz-Gil J, Vieta E, Maristany T, McKenna PJ, Pomarol-Clotet E. Bipolar depressed patients show both failure to activate and failure to de-activate during performance of a working memory task. J Affect Disord 2013; 148:170-8. [PMID: 22854099 DOI: 10.1016/j.jad.2012.04.009] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Revised: 03/09/2012] [Accepted: 04/10/2012] [Indexed: 01/17/2023]
Abstract
BACKGROUND Bipolar depression has been found to be associated with changes in prefrontal cortex activity during performance of cognitive tasks. However, the role of task-related de-activations has been little investigated. METHOD Forty-one bipolar depressed patients and 41 matched normal controls underwent fMRI scanning while performing baseline, 1-back and 2-back versions of the n-back task. Linear models were used to obtain maps of within-group activations and areas of differential activation between the groups. RESULTS The bipolar depressed patients showed reduced activation in the dorsolateral prefrontal cortex (DLPFC) bilaterally and several other regions. After controlling for differences in task performance only differences in the DLPFC and cerebellum remained. Left DLPFC activation was inversely correlated with Hamilton and MADRS scores. The patients showed failure to de-activate in the medial prefrontal cortex, an area corresponding to the anterior medial node of the default mode network. LIMITATIONS To confirm default mode network dysfunction demonstration of resting-state connectivity abnormalities would also be required. The study was carried out on treated patients, and did not assess for presence of depressive symptoms in the healthy controls. CONCLUSIONS Both prefrontal cortical and default mode network dysfunction appear to characterise bipolar depression. The former, but not the latter, is associated with symptom severity.
Collapse
|
26
|
Liberg B, Adler M, Jonsson T, Landén M, Rahm C, Wahlund LO, Kristoffersen-Wiberg M, Wahlund B. The neural correlates of self-paced finger tapping in bipolar depression with motor retardation. Acta Neuropsychiatr 2013; 25:43-51. [PMID: 26953073 DOI: 10.1111/j.1601-5215.2012.00659.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Motor retardation is a characteristic feature of bipolar depression, and is also a core feature of Parkinson's disease. Within the framework of the functional deafferentiation theory in Parkinson's disease, we hypothesised that motor retardation in bipolar depression is mediated by disrupted subcortical activation, leading to decreased activation of cortical motor areas during finger tapping. METHODS We used functional magnetic resonance imaging to investigate neural activity during self-paced finger tapping to elucidate whether brain regions that mediate preparation, control and execution of movement are activated differently in subjects with bipolar depression (n = 9) compared to healthy controls (n = 12). RESULTS An uncorrected whole-brain analysis revealed significant group differences in dorsolateral and ventromedial prefrontal cortex. Corrected analyses showed non-significant differences in patients compared to controls: decreased and less widespread activation of the left putamen and left pallidum; increased activity in the left thalamus and supplementary motor area; decreased activation in the left lateral pre- and primary motor cortices; absence of activation in the pre-supplementary motor area; activation of the bilateral rostral cingulate motor area. CONCLUSION Both movement preparation and execution may be affected in motor retardation, and the activity in the whole left-side motor circuit is altered during self-initiated motor performance in bipolar depression.
Collapse
Affiliation(s)
- Benny Liberg
- 1 Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden
| | - Mats Adler
- 1 Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden
| | - Tomas Jonsson
- 2 Department of Diagnostic Medical Physics, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Mikael Landén
- 1 Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden
| | - Christoffer Rahm
- 1 Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden
| | - Lars-Olof Wahlund
- 4 Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska University Hospital, Stockholm, Sweden
| | - Maria Kristoffersen-Wiberg
- 5 Department of Clinical Science, Intervention and Technology, Division of Medical Imaging and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Björn Wahlund
- 1 Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
27
|
Blond BN, Fredericks CA, Blumberg HP. Functional neuroanatomy of bipolar disorder: structure, function, and connectivity in an amygdala-anterior paralimbic neural system. Bipolar Disord 2012; 14:340-55. [PMID: 22631619 PMCID: PMC3880745 DOI: 10.1111/j.1399-5618.2012.01015.x] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES In past decades, neuroimaging research in bipolar disorder has demonstrated a convergence of findings in an amygdala-anterior paralimbic cortex neural system. This paper reviews behavioral neurology literature that first suggested a central role for this neural system in the disorder and the neuroimaging evidence that supports it. METHODS Relevant articles are reviewed to provide an amygdala-anterior paralimbic cortex neural system model of bipolar disorder, including articles from the fields of behavioral neurology and neuroanatomy, and neuroimaging. RESULTS The literature is highly supportive of key roles for the amygdala, anterior paralimbic cortices, and connections among these structures in the emotional dysregulation of bipolar disorder. The functions subserved by their more widely distributed connection sites suggest that broader system dysfunction could account for the range of functions-from neurovegetative to cognitive-disrupted in the disorder. Abnormalities in some components of this neural system are apparent by adolescence, while others, such as those in rostral prefrontal regions, appear to progress over adolescence and young adulthood, suggesting a neurodevelopmental model of the disorder. However, some findings conflict, which may reflect the small sample sizes of some studies, and clinical heterogeneity and methodological differences across studies. CONCLUSIONS Consistent with models derived from early behavioral neurology studies, neuroimaging studies support a central role for an amygdala-anterior paralimbic neural system in bipolar disorder, and implicate abnormalities in the development of this system in the disorder. This system will be an important focus of future studies on the developmental pathophysiology, detection, treatment, and prevention of the disorder.
Collapse
Affiliation(s)
- Benjamin N Blond
- Department of Psychiatry, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
| | - Carolyn A Fredericks
- Department of Psychiatry, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
| | - Hilary P Blumberg
- Department of Psychiatry, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA,Department of Diagnostic Radiology, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA,The Child Study Center, Yale School of Medicine, New Haven, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA,Research Enhancement Award Program Depression Center, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
| |
Collapse
|
28
|
Strakowski SM, Adler CM, Almeida J, Altshuler LL, Blumberg HP, Chang KD, DelBello MP, Frangou S, McIntosh A, Phillips ML, Sussman JE, Townsend JD. The functional neuroanatomy of bipolar disorder: a consensus model. Bipolar Disord 2012; 14:313-25. [PMID: 22631617 PMCID: PMC3874804 DOI: 10.1111/j.1399-5618.2012.01022.x] [Citation(s) in RCA: 349] [Impact Index Per Article: 29.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Functional neuroimaging methods have proliferated in recent years, such that functional magnetic resonance imaging, in particular, is now widely used to study bipolar disorder. However, discrepant findings are common. A workgroup was organized by the Department of Psychiatry, University of Cincinnati (Cincinnati, OH, USA) to develop a consensus functional neuroanatomic model of bipolar I disorder based upon the participants' work as well as that of others. METHODS Representatives from several leading bipolar disorder neuroimaging groups were organized to present an overview of their areas of expertise as well as focused reviews of existing data. The workgroup then developed a consensus model of the functional neuroanatomy of bipolar disorder based upon these data. RESULTS Among the participants, a general consensus emerged that bipolar I disorder arises from abnormalities in the structure and function of key emotional control networks in the human brain. Namely, disruption in early development (e.g., white matter connectivity and prefrontal pruning) within brain networks that modulate emotional behavior leads to decreased connectivity among ventral prefrontal networks and limbic brain regions, especially the amygdala. This developmental failure to establish healthy ventral prefrontal-limbic modulation underlies the onset of mania and ultimately, with progressive changes throughout these networks over time and with affective episodes, a bipolar course of illness. CONCLUSIONS This model provides a potential substrate to guide future investigations and areas needing additional focus are identified.
Collapse
Affiliation(s)
- Stephen M Strakowski
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH 45267-0559, USA.
| | - Caleb M Adler
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Jorge Almeida
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh PA
| | - Lori L Altshuler
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, The David Geffen School of Medicine, University of California at Los Angeles,Department of Psychiatry, VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Hilary P Blumberg
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Kiki D Chang
- Pediatric Bipolar Disorders Research Program, Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Melissa P DelBello
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Sophia Frangou
- Section of Neurobiology of Psychosis, Department of Psychosis Studies, Institute of Psychiatry, King’s College, London
| | - Andrew McIntosh
- Division of Psychiatry, School of Molecular and Clinical Medicine, University of Edinburgh, Edinburgh
| | - Mary L Phillips
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh PA,Department of Psychological Medicine, Cardiff, UK
| | - Jessika E Sussman
- Division of Psychiatry, School of Molecular and Clinical Medicine, University of Edinburgh, Edinburgh
| | - Jennifer D Townsend
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, The David Geffen School of Medicine, University of California at Los Angeles
| |
Collapse
|
29
|
Strakowski SM, Adler CM, Almeida J, Altshuler LL, Blumberg HP, Chang KD, DelBello MP, Frangou S, McIntosh A, Phillips ML, Sussman JE, Townsend JD. The functional neuroanatomy of bipolar disorder: a consensus model. Bipolar Disord 2012. [PMID: 22631617 DOI: 10.1111/j.1399-5618.2012.01022.x.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Functional neuroimaging methods have proliferated in recent years, such that functional magnetic resonance imaging, in particular, is now widely used to study bipolar disorder. However, discrepant findings are common. A workgroup was organized by the Department of Psychiatry, University of Cincinnati (Cincinnati, OH, USA) to develop a consensus functional neuroanatomic model of bipolar I disorder based upon the participants' work as well as that of others. METHODS Representatives from several leading bipolar disorder neuroimaging groups were organized to present an overview of their areas of expertise as well as focused reviews of existing data. The workgroup then developed a consensus model of the functional neuroanatomy of bipolar disorder based upon these data. RESULTS Among the participants, a general consensus emerged that bipolar I disorder arises from abnormalities in the structure and function of key emotional control networks in the human brain. Namely, disruption in early development (e.g., white matter connectivity and prefrontal pruning) within brain networks that modulate emotional behavior leads to decreased connectivity among ventral prefrontal networks and limbic brain regions, especially the amygdala. This developmental failure to establish healthy ventral prefrontal-limbic modulation underlies the onset of mania and ultimately, with progressive changes throughout these networks over time and with affective episodes, a bipolar course of illness. CONCLUSIONS This model provides a potential substrate to guide future investigations and areas needing additional focus are identified.
Collapse
Affiliation(s)
- Stephen M Strakowski
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH 45267-0559, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Marchand WR, Lee JN, Johnson S, Thatcher J, Gale P, Wood N, Jeong EK. Striatal and cortical midline circuits in major depression: implications for suicide and symptom expression. Prog Neuropsychopharmacol Biol Psychiatry 2012; 36:290-9. [PMID: 22079109 DOI: 10.1016/j.pnpbp.2011.10.016] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Revised: 10/25/2011] [Accepted: 10/26/2011] [Indexed: 10/15/2022]
Abstract
BACKGROUND In major depression, the neural mechanisms underlying suicide related thoughts and behaviors as well as the expression of other depressive symptoms are incompletely characterized. Evidence indicates that both the striatum and cortical midline structures (CMS) may be involved with both suicide and emotional dysregulation in unipolar illness. The aim of this study was to identify striatal-CMS circuits associated with current depression severity and suicidal ideation (SI) as well as a history of self-harm. METHODS Twenty-two male subjects with recurrent unipolar depression were studied using functional MRI. All subjects were unmedicated and without current psychiatric comorbidity. Correlational analyses were used to determine whether striatal-CMS functional connectivity was associated with any of the three clinical variables. RESULTS A network involving the bilateral striatum and anterior CMS was found to be associated with depressive symptom severity. Current SI was associated with a similar but less extensive circuit in the left hemisphere. A distinct striatal motor/sensory network was associated with self-harm behaviors, but not current SI or depression severity. CONCLUSIONS The striatal-anterior CMS circuit likely plays a significant role in the expression of depressive symptoms and SI. In contrast, a striatum-motor/sensory cortex network may be a trait marker of suicide-related behaviors. If replicated, this result might eventually lead to the development of a biomarker that would be useful for studies of pharmacologic and/or psychotherapeutic suicide prevention interventions.
Collapse
Affiliation(s)
- William R Marchand
- George E. Wahlen Veterans Affairs Medical Center, 500 Foothill Drive, Salt Lake City, UT 84148, USA.
| | | | | | | | | | | | | |
Collapse
|
31
|
Marchand WR, Lee JN, Suchy Y, Johnson S, Thatcher J, Gale P. Aberrant functional connectivity of cortico-basal ganglia circuits in major depression. Neurosci Lett 2012; 514:86-90. [PMID: 22395089 DOI: 10.1016/j.neulet.2012.02.063] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Revised: 02/08/2012] [Accepted: 02/20/2012] [Indexed: 11/20/2022]
Abstract
There is considerable evidence of functional abnormalities of the cortico-basal ganglia circuitry in affective disorders. However, it has been unknown whether this represented primary pathology within these circuits or altered activation as a result of aberrant input from other brain regions. The aim of this study was to test the hypothesis that cortico-basal ganglia circuit dysfunction represents primary pathology in unipolar depression. Eighteen male subjects with recurrent unipolar depression and eighteen controls without psychiatric illness were studied using functional MRI and functional connectivity analyses. All unipolar subjects were unmedicated and without current psychiatric comorbidity. Compared to controls, unipolar subjects exhibited altered connectivity between bilateral subcortical components of the circuitry (putamen-thalamus) and left hemisphere input and output components. Results provided evidence that functional abnormalities of these circuits represent primary pathology. Further, we found that age of onset but not duration of illness impacts circuit function. These findings suggest that the cortico-basal ganglia circuitry is likely one of several loci of primary pathology in major depression. Additionally, early age of onset is associated with greater circuit abnormality and as such may impact clinical characteristics and/or treatment response through a mechanism of decreasing functional connectivity of some circuit segments. Finally, altered cortico-basal ganglia circuit connectivity with cortical regions (anterior cingulate, inferior frontal gyrus and sensorimotor) may contribute to the emotional dysregulation, impaired emotional recognition and psychomotor symptoms associated with unipolar illness.
Collapse
Affiliation(s)
- William R Marchand
- George E. Wahlen Veterans Affairs Medical Center, 500 Foothill Drive, Salt Lake City, UT 84148, USA
| | | | | | | | | | | |
Collapse
|
32
|
Marchand WR, Lee JN, Suchy Y, Garn C, Chelune G, Johnson S, Wood N. Functional architecture of the cortico-basal ganglia circuitry during motor task execution: correlations of strength of functional connectivity with neuropsychological task performance among female subjects. Hum Brain Mapp 2012; 34:1194-207. [PMID: 22287185 DOI: 10.1002/hbm.21505] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Revised: 09/15/2011] [Accepted: 10/06/2011] [Indexed: 01/21/2023] Open
Abstract
The primary aim of this study was to enhance our understanding of the functional architecture of the cortico-basal ganglia circuitry during motor task execution. Twenty right-handed female subjects without any history of neuropsychiatric illness underwent fMRI at 3 T. The activation paradigm was a complex motor task completed with the nondominant hand. Analyses of functional connectivity strength were conducted for pairs of structures in input, intrinsic, and output segments of the circuitry. Next, connectivity strengths were correlated with results of neurocognitive testing conducted outside of the scanner, which provided information about both motor and cognitive processes. For input pathways, results indicate that SMA-striatum interactions are particularly relevant for motor behavior and disruptions may impact both motor and cognitive functions. For intrinsic pathways, results indicate that thalamus (VA nucleus) to striatum feedback pathway appears to have an important role during task execution and carries information relevant for motor planning. Together, these findings add to accumulating evidence that the GPe may play a role in higher order basal ganglia processing. A potentially controversial finding was that strong functional connectivity appears to occur across intrinsic inhibitory pathways. Finally, output (thalamus to cortex) feedback was only correlated with motor planning. This result suggests circuit processes may be more relevant for future behaviors than the execution of the current task.
Collapse
Affiliation(s)
- William R Marchand
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, Utah, USA.
| | | | | | | | | | | | | |
Collapse
|
33
|
Tang Y, Li Y, Wang N, Li H, Li H, Wang J. The altered cortical connectivity during spatial search for facial expressions in major depressive disorder. Prog Neuropsychopharmacol Biol Psychiatry 2011; 35:1891-900. [PMID: 21888943 DOI: 10.1016/j.pnpbp.2011.08.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2011] [Revised: 07/28/2011] [Accepted: 08/09/2011] [Indexed: 11/28/2022]
Abstract
To characterize the altered directed connectivity within a distributed cortical network, as is associated with the impaired attention modulation involved in the manifestation of mood disorder in depression, short-window partial directed coherence (PDC) combining with the event-related brain potentials (ERPs) was applied in this study. ERPs were recorded from 13 normal subjects and 12 depressed patients during visual search for facial expressions. The evoked N2 component of ERPs by responding to all neutral faces (F(1,22)=5.51, P<0.05) and the positive face was reduced in the depressed patients as compared to the normal subjects (F(1,22)=5.71, P<0.05), while the evoked N2 component by detecting the negative face showed no significant between-group effect (F(1,22)=2.10, P=0.16). The reduced N2 amplitude reflected deficits in effortful attentional modulation in depression. Obtained PDC values within the N2 time-window (150-300 ms post stimulus) showed weaker intra-frontal and intra-central directed interactions and enhanced occipital information output when responding to all neutral faces in depression relative to those in the normal group. Few decreased intra-frontal directed interactions were observed when detecting the emotional face in depression. The altered cortical directed connectivity contributed to the impairment occurring in the effortful attention modulation in depression. Our findings supported that the impaired attention modulation processing in depression was associated with the altered cortical connectivity.
Collapse
Affiliation(s)
- Yingying Tang
- Shanghai Mental Health Center, Shanghai Jiao Tong University, School of Medicine, Shanghai 200030, China
| | | | | | | | | | | |
Collapse
|
34
|
Marchand WR, Lee JN, Garn C, Thatcher J, Gale P, Kreitschitz S, Johnson S, Wood N. Striatal and cortical midline activation and connectivity associated with suicidal ideation and depression in bipolar II disorder. J Affect Disord 2011; 133:638-45. [PMID: 21621263 DOI: 10.1016/j.jad.2011.04.039] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Revised: 03/31/2011] [Accepted: 04/27/2011] [Indexed: 11/17/2022]
Abstract
BACKGROUND Considerable evidence implicates dysfunction of striatal and cortical midline structure (CMS) circuitry in mood disorders. Whether such aberrations exist in bipolar II depression is unknown. METHODS Sixteen unmedicated subjects with bipolar II depression and 19 healthy controls were studied using functional MRI and a motor activation paradigm. Analyses of both activation and functional connectivity were conducted. RESULTS A history of suicidal ideation (SI) was negatively correlated with activation of the left putamen while depression severity was positively correlated with activation of the left thalamus. The superior bilateral putamen was simultaneously correlated with depression severity and anti-correlated with SI. Striatal functional connectivity was altered with the bilateral CMS and right inferior parietal lobule. Depression severity was correlated with strength of connectivity between the bilateral striatum and the right lingual gyrus and left cerebellum. LIMITATIONS Only males experiencing an episode of major depression were studied. CONCLUSIONS Striatal and CMS circuit abnormalities likely contribute to the neurobiology of bipolar II depression. Altered connectivity of the striatum may directly impact depression severity. Further, dissociable components of activation associated with depression severity and suicidal ideation may exist. Finally, the motor activation paradigm used in this study appears to be a useful probe of some neural processes underlying bipolar II depression.
Collapse
Affiliation(s)
- William R Marchand
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, USA.
| | | | | | | | | | | | | | | |
Collapse
|
35
|
Toward a functional neuroanatomical signature of bipolar disorder: quantitative evidence from the neuroimaging literature. Psychiatry Res 2011; 193:71-9. [PMID: 21676596 DOI: 10.1016/j.pscychresns.2011.02.011] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Revised: 02/18/2011] [Accepted: 02/24/2011] [Indexed: 11/21/2022]
Abstract
The present meta-analysis quantitatively reviewed the functional neuroimaging literature on bipolar disorder (BPD) to better characterize its neuroanatomical signature with respect to the influence of mood state, test conditions, and clinical demographics on regional brain activation. Fifty-five functional neuroimaging studies published between 1987 and 2010 met criteria for inclusion, encompassing a total of 774 adult patients with BPD and 810 healthy adult controls. A meta-analysis was conducted comparing the activation states of multiple brain regions in BPD patients and control subjects. Despite heterogeneity across studies, our findings support the view that limbic hyperactivity and frontal hypoactivity are neurobiological correlates of BPD. Our findings also highlight the involvement of many brain regions and circuits, as well as the critical role of mood state and test conditions in the functional impairments of BPD. This review represents the first attempt to quantitatively articulate the magnitude of functional brain abnormality in BPD, and, in so doing, provides a synthesis of evidence in line with current network models of the disorder. Overall, this review offers support for, and seeks to help guide, the continued use of functional neuroimaging as an informative probe into the complex neurobiology of BPD.
Collapse
|
36
|
Marchand WR, Lee JN, Suchy Y, Garn C, Johnson S, Wood N, Chelune G. Age-related changes of the functional architecture of the cortico-basal ganglia circuitry during motor task execution. Neuroimage 2011; 55:194-203. [DOI: 10.1016/j.neuroimage.2010.12.030] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Revised: 12/08/2010] [Accepted: 12/09/2010] [Indexed: 10/18/2022] Open
|
37
|
Chen CH, Suckling J, Lennox BR, Ooi C, Bullmore ET. A quantitative meta-analysis of fMRI studies in bipolar disorder. Bipolar Disord 2011; 13:1-15. [PMID: 21320248 DOI: 10.1111/j.1399-5618.2011.00893.x] [Citation(s) in RCA: 332] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Functional magnetic resonance imaging (fMRI) has been widely used to identify state and trait markers of brain abnormalities associated with bipolar disorder (BD). However, the primary literature is composed of small-to-medium-sized studies, using diverse activation paradigms on variously characterized patient groups, which can be difficult to synthesize into a coherent account. This review aimed to synthesize current evidence from fMRI studies in midlife adults with BD and to investigate whether there is support for the theoretical models of the disorder. METHODS We used voxel-based quantitative meta-analytic methods to combine primary data on anatomical coordinates of activation from 65 fMRI studies comparing normal volunteers (n = 1,074) and patients with BD (n = 1,040). RESULTS Compared to normal volunteers, patients with BD underactivated the inferior frontal cortex (IFG) and putamen and overactivated limbic areas, including medial temporal structures (parahippocampal gyrus, hippocampus, and amygdala) and basal ganglia. Dividing studies into those using emotional and cognitive paradigms demonstrated that the IFG abnormalities were manifest during both cognitive and emotional processing, while increased limbic activation was mainly related to emotional processing. In further separate comparisons between healthy volunteers and patient subgroups in each clinical state, the IFG was underactive in manic but not in euthymic and depressed states. Limbic structures were not overactive in association with mood states, with the exception of increased amygdala activation in euthymic states when including region-of-interest studies. CONCLUSIONS In summary, our results showed abnormal frontal-limbic activation in BD. There was attenuated activation of the IFG or ventrolateral prefrontal cortex, which was consistent across emotional and cognitive tasks and particularly related to the state of mania, and enhanced limbic activation, which was elicited by emotional and not cognitive tasks, and not clearly related to mood states.
Collapse
Affiliation(s)
- Chi-Hua Chen
- Brain Mapping Unit, Department of Psychiatry, University of Cambridge GlaxoSmithKline Clinical Unit Cambridge, Addenbrooke's Hospital, Cambridge, UK.
| | | | | | | | | |
Collapse
|
38
|
Abstract
OBJECTIVES A large and diverse literature has implicated abnormalities of striatal structure and function in both unipolar and bipolar disorder. Recent functional imaging studies have greatly expanded this body of research. The aim of this review is to provide a comprehensive and critical appraisal of the relevant literature. METHODS A total of 331 relevant articles were reviewed to develop an integrated overview of striatal function in mood disorders. RESULTS There is compelling evidence from multiple studies that functional abnormalities of the striatum and greater corticostriatal circuitry exist in at least some forms of affective illness. The literature does not yet provide data to determine whether these aberrations represent primary pathology or they contribute directly to symptom expression. Finally, there is considerable evidence that bipolar disorder may be associated with striatal hyperactivity and some suggestion that unipolar illness may be associated with hypoactivation. CONCLUSIONS Additional research investigating striatal function in affective disorders will be critical to the development of comprehensive models of the neurobiology of these conditions.
Collapse
Affiliation(s)
- William R Marchand
- Department of Veterans Affairs, VISN 19 MIRECC, 5500 Foothill, Salt Lake City, UT 84148, USA.
| | | |
Collapse
|
39
|
Marchand WR. Cortico-basal ganglia circuitry: a review of key research and implications for functional connectivity studies of mood and anxiety disorders. Brain Struct Funct 2010; 215:73-96. [PMID: 20938681 DOI: 10.1007/s00429-010-0280-y] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Accepted: 09/22/2010] [Indexed: 11/25/2022]
Abstract
There is considerable evidence that dysfunction of the cortico-basal ganglia circuits may be associated with several mood and anxiety disorders. However, it is unclear whether circuit abnormalities contribute directly either to the neurobiology of these conditions or to the manifestation of symptoms. Understanding the role of these pathways in psychiatric illness has been limited by an incomplete characterization of normal function. In recent years, studies using animal models and human functional imaging have greatly expanded the literature describing normal cortico-basal ganglia circuit function. In this paper, recent key studies of circuit function using human and animal models are reviewed and integrated with findings from other studies conducted over the previous decades. The literature suggests several hypotheses of cortico-basal ganglia circuitry function in mood and anxiety disorders that warrant further exploration. Hypotheses are proposed herein based upon the cortico-basal ganglia mechanisms of: (1) feedforward and feedback control, (2) circuit integration and (3) emotional control. These are presented as models of circuit function, which may be particularly relevant to future investigations using neuroimaging and functional connectivity analyses.
Collapse
Affiliation(s)
- William R Marchand
- George E. Wahlen Department of Veterans Affairs Medical Center, VHASLCHCS 151, 500 Foothill, Salt Lake City, UT 84148, USA.
| |
Collapse
|
40
|
Cerullo MA, Adler CM, Delbello MP, Strakowski SM. The functional neuroanatomy of bipolar disorder. Int Rev Psychiatry 2010; 21:314-22. [PMID: 20374146 DOI: 10.1080/09540260902962107] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
In this manuscript, research articles using functional magnetic resonance imaging (fMRI) to study adult patients with bipolar disorder were reviewed. The findings from these studies identify altered brain activation in five regions in cortico-limbic pathways responsible for emotional regulation: portions of the prefrontal cortex; anterior cingulate cortex; amygdala; thalamus; and striatum. The most consistent findings were overactivation of amygdala, striatum, and thalamus. Findings in prefrontal cortex were less consistent, but most studies also showed increased activation in ventrolateral and dorsolateral prefrontal cortical areas. Excessive activation in brain regions associated with emotional regulation may contribute to the affective symptoms of bipolar disorder. However, there are several important limitations in this body of research. Even when similar tasks were used, brain activation was often discrepant among studies. Most fMRI studies examined small samples (ten or fewer bipolar subjects) limiting statistical power. Additionally, most studies were confounded by patients taking psychotropic medications. Nonetheless, from this work an anterior limbic over-activation model of bipolar disorder is emerging.
Collapse
Affiliation(s)
- Michael A Cerullo
- Department of Psychiatry, Division of Bipolar Disorders Research, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
| | | | | | | |
Collapse
|
41
|
Bhardwaj R, Chakrabarti S, Mittal BR, Sharan P. A single photon emission computerized tomography (SPECT) study of regional cerebral blood flow in bipolar disorder. World J Biol Psychiatry 2010; 11:334-43. [PMID: 20218796 DOI: 10.3109/15622970802575977] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Data on functional imaging of bipolar disorder (BD) utilizing single photon emission computerized tomography (SPECT) is limited. This study assessed regional cerebral blood flow (rCBF), using (99m)Tc-ECD SPECT, among patients with BD, with mania (N=10) or depression (N=10), compared with 10 patients with unipolar depression and 10 normal controls. Regions of interest were analysed using a semi-automatic brain quantification programme. Compared to controls, patients with mania had significantly reduced perfusion mainly in the left frontal area, also in the left anterior cingulate and parietal cortices; those with bipolar depression had significantly lowered rCBF principally in the anterior temporal regions bilaterally, as well as the left parietal area. Patients with unipolar depression had significantly lowered perfusion than controls in most of the regions examined, chiefly in the anterior temporal and frontal cortices bilaterally; they also had lowered perfusion in the right anterior temporal and frontal areas, as well as the right middle temporal area and the right thalamus, compared to patients with mania. Increased severity of psychotic symptoms was associated with reduced rCBF in patients. These results indicate that altered blood flow in the frontal-subcortical systems characterises patients with BD, as well as those with unipolar depression.
Collapse
Affiliation(s)
- Rahul Bhardwaj
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | | |
Collapse
|
42
|
Abstract
Functional neuroimaging techniques have been important research tools in the study of bipolar disorder (BPD). These methods provide measures of regional brain functioning that reflect the mental state at the time of scanning and have helped to elucidate both state and trait features of BPD. This chapter will review converging functional neuroimaging evidence implicating state and trait dysfunction in a ventral prefrontal cortex-amygdala neural system in BPD. Emerging evidence that suggests a developmental progression in dysfunction in this neural system over the course of adolescence will be considered. Finally, new research approaches that have begun to reveal the contribution of specific genetic mechanisms to regional dysfunction in the disorder, potential salutary effects of medications, and structure-function relationships will be discussed.
Collapse
|
43
|
Lee JN, Hsu EW, Rashkin E, Thatcher JW, Kreitschitz S, Gale P, Healy L, Marchand WR. Reliability of fMRI motor tasks in structures of the corticostriatal circuitry: Implications for future studies and circuit function. Neuroimage 2010; 49:1282-8. [DOI: 10.1016/j.neuroimage.2009.09.072] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2009] [Revised: 09/29/2009] [Accepted: 09/30/2009] [Indexed: 10/20/2022] Open
|
44
|
Wessa M, Houenou J, Leboyer M, Chanraud S, Poupon C, Martinot JL, Paillère-Martinot ML. Microstructural white matter changes in euthymic bipolar patients: a whole-brain diffusion tensor imaging study. Bipolar Disord 2009; 11:504-14. [PMID: 19624389 DOI: 10.1111/j.1399-5618.2009.00718.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Brain structures of a distributed ventral-limbic and dorsal brain network have been associated with altered mood states and emotion regulation in affective disorders. So far, diffusion tensor imaging studies in bipolar patients have focused on frontal/prefrontal brain regions and found alterations in white matter integrity in manic, depressed, and euthymic bipolar patients, observed as changes in fractional anisotropy and mean diffusivity. To extend previous findings, we investigated whole-brain modifications in white matter integrity in euthymic bipolar patients with minimal manic and depressive symptoms. METHODS Twenty-two patients with a DSM-IV-TR diagnosis of bipolar I and II disorder in remission, with no lifetime or present comorbidities of substance abuse, and 21 sex- and age-matched healthy controls underwent diffusion tensor imaging with diffusion gradients applied along 41 directions. Fractional anisotropy and mean diffusivity group differences were explored using two voxel-based, whole-brain analyses that differ in their normalization approaches. RESULTS Fractional anisotropy was significantly increased in bipolar patients relative to healthy controls in medial frontal, precentral, inferior parietal, and occipital white matter. No group differences in mean diffusivity were found. CONCLUSIONS The result of increased fractional anisotropy in euthymic bipolar patients in the present study suggests increased directional coherence of white matter fibers in bipolar patients during remission.
Collapse
Affiliation(s)
- Michèle Wessa
- INSERM, U797, CEA-INSERM U797 Neuroimaging and Psychiatry, IFR49, University Paris Sud, University Paris 5, Hospital Department Frédéric Joliot, IBM, Orsay, France.
| | | | | | | | | | | | | |
Collapse
|
45
|
McClure-Tone EB. Socioemotional functioning in bipolar disorder versus typical development: Behavioral and neural differences. ACTA ACUST UNITED AC 2009. [DOI: 10.1111/j.1468-2850.2009.01150.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
46
|
Abstract
There is evidence from post-mortem and magnetic resonance imaging studies that hyperintensities, oligodendroglial abnormalities, and gross white matter volumetric alterations are involved in the pathophysiology of bipolar disorder. There is also functional imaging evidence for a defect in frontal cortico-subcortical pathways in bipolar disorder, but the white matter comprising these pathways has not been well investigated. Few studies have investigated white matter integrity in patients with bipolar disorder compared to healthy volunteers and the majority of studies have used manual region-of-interest approaches. In this study, we compared fractional anisotropy (FA) values between 30 patients with bipolar disorder and 38 healthy volunteers in the brain white matter using a voxelwise analysis following intersubject registration to Talairach space. Compared to healthy volunteers, patients demonstrated significantly (p<0.001; cluster size > or =50) higher FA within the right and left frontal white matter and lower FA within the left cerebellar white matter. Examination of individual eigenvalues indicated that group differences in both axial diffusivity and radial diffusivity contributed to abnormal FA within these regions. Tractography was performed in template space on averaged diffusion tensor imaging data from all individuals. Extraction of bundles passing through the clusters that differed significantly between groups suggested that white matter abnormalities along the pontine crossing tract, corticospinal/corticopontine tracts, and thalamic radiation fibers may be involved in the pathogenesis of bipolar disorder. Our findings are consistent with models of bipolar disorder that implicate dysregulation of cortico-subcortical and cerebellar regions in the disorder and may have relevance for phenomenology.
Collapse
|
47
|
Brain injury in autonomic, emotional, and cognitive regulatory areas in patients with heart failure. J Card Fail 2008; 15:214-23. [PMID: 19327623 DOI: 10.1016/j.cardfail.2008.10.020] [Citation(s) in RCA: 129] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2008] [Revised: 08/26/2008] [Accepted: 10/14/2008] [Indexed: 12/30/2022]
Abstract
BACKGROUND Heart failure (HF) is accompanied by autonomic, emotional, and cognitive deficits, indicating brain alterations. Reduced gray matter volume and isolated white matter infarcts occur in HF, but the extent of damage is unclear. Using magnetic resonance T2 relaxometry, we evaluated the extent of injury across the entire brain in HF. METHODS AND RESULTS Proton-density and T2-weighted images were acquired from 13 HF (age 54.6 +/- 8.3 years; 69% male, left ventricular ejection fraction 0.28 +/- 0.07) and 49 controls (50.6 +/- 7.3 years, 59% male). Whole brain maps of T2 relaxation times were compared at each voxel between groups using analysis of covariance (covariates: age and gender). Higher T2 relaxation values, indicating injured brain areas (P < .005), emerged in sites that control autonomic, analgesic, emotional, and cognitive functions (hypothalamus, raphé magnus, cerebellar cortex, deep nuclei and vermis; temporal, parietal, prefrontal, occipital, insular, cingulate, and ventral frontal cortices; corpus callosum; anterior thalamus; caudate nuclei; anterior fornix and hippocampus). No brain areas showed higher T2 values in control vs. HF subjects. CONCLUSIONS Brain structural injury emerged in areas involved in autonomic, pain, mood, language, and cognitive function in HF patients. Comorbid conditions accompanying HF may result from neural injury associated with the syndrome.
Collapse
|
48
|
A neural model of voluntary and automatic emotion regulation: implications for understanding the pathophysiology and neurodevelopment of bipolar disorder. Mol Psychiatry 2008; 13:829, 833-57. [PMID: 18574483 PMCID: PMC2745893 DOI: 10.1038/mp.2008.65] [Citation(s) in RCA: 868] [Impact Index Per Article: 54.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The ability to regulate emotions is an important part of adaptive functioning in society. Advances in cognitive and affective neuroscience and biological psychiatry have facilitated examination of neural systems that may be important for emotion regulation. In this critical review we first develop a neural model of emotion regulation that includes neural systems implicated in different voluntary and automatic emotion regulatory subprocesses. We then use this model as a theoretical framework to examine functional neural abnormalities in these neural systems that may predispose to the development of a major psychiatric disorder characterized by severe emotion dysregulation, bipolar disorder.
Collapse
|
49
|
Abstract
Bipolar I disorder (BPI) is among the top 10 most debilitating illnesses globally. In this critical review, we first review recent functional neuroimaging findings in two core domains of pathology in BPI: emotion processing and executive control. These abnormalities in core domains represent potential endophenotypes of the illness. We then show that an emerging number of studies have demonstrated that neuroimaging can help to identify endophenotypic markers whose identification would help to clarify diagnosis and discriminate the depression in BPI from that of unipolar depression and identify at-risk individuals who will subsequently develop the illness (to facilitate early intervention). We end by reviewing the new directions in neuroimaging in BPI, including studies of children with bipolar disorder, potential medication effects, and the use of newer neuroimaging techniques to help us achieve the previously mentioned goals of improving BPI patients' mental well-being.
Collapse
Affiliation(s)
- Matthew T Keener
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
| | | |
Collapse
|