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Long Y, Pan N, Yu Y, Zhang S, Qin K, Chen Y, Sweeney JA, DelBello MP, Gong Q. Shared and Distinct Neurobiological Bases of Bipolar Disorder and Attention-Deficit/Hyperactivity Disorder in Children and Adolescents: A Comparative Meta-Analysis of Structural Abnormalities. J Am Acad Child Adolesc Psychiatry 2024; 63:586-604. [PMID: 38072245 DOI: 10.1016/j.jaac.2023.09.551] [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: 06/23/2023] [Revised: 09/14/2023] [Accepted: 12/01/2023] [Indexed: 01/02/2024]
Abstract
OBJECTIVE Pediatric bipolar disorder (PBD) and attention-deficit/hyperactivity disorder (ADHD) frequently co-occur and share dysfunctions in affective and cognitive domains. As the neural substrates underlying their overlapping and dissociable symptomatology have not been well delineated, a meta-analysis of whole-brain voxel-based morphometry studies in PBD and ADHD was conducted. METHOD A systematic literature search was performed in PubMed, Web of Science, and Embase. The seed-based d mapping toolbox was used to identify altered clusters of PBD or ADHD and obtain their conjunctive and comparative abnormalities. Suprathreshold patterns were subjected to large-scale network analysis to identify affected brain networks. RESULTS The search revealed 10 PBD studies (268 patients) and 32 ADHD studies (1,333 patients). Decreased gray matter volumes in the right insula and anterior cingulate cortex relative to typically developing individuals were conjunctive in PBD and ADHD. Reduced volumes in the right inferior frontal gyrus, left orbitofrontal cortex, and hippocampus were more substantial in PBD, while decreased volumes in the left precentral gyrus, left inferior frontal gyrus, and right superior frontal gyrus were more pronounced in ADHD. Neurodevelopmental effects modulated patterns of the left hippocampus in PBD and those of the left inferior frontal gyrus in ADHD. CONCLUSION These findings suggest that PBD and ADHD are characterized by both common and distinct patterns of gray matter volume alterations. Their overlapping abnormalities may represent a transdiagnostic problem of attention and emotion regulation shared by PBD and ADHD, whereas the disorder-differentiating substrates may contribute to the relative differences in cognitive and affective features that define the 2 disorders. PLAIN LANGUAGE SUMMARY Pediatric bipolar disorder (BD) and attention-deficit/hyperactivity disorder (ADHD) frequently co-occur, with overlapping changes in emotional and cognitive functioning. This meta-analysis summarizes findings from 10 articles on BD and 32 articles on ADHD to identify similarities and differences in brain structure between youth with BD and youth with ADHD. The authors found that both disorders share decreased gray matter volumes in the right insula and anterior cingulate cortex, which play important roles in emotion processing and attention, respectively. Youth with BD had decreased gray matter volume in the right inferior frontal gyrus, left orbitofrontal gyrus, and left hippocampus, while youth with ADHD had decreased volumes in the left precentral gyrus, left inferior frontal gyrus, and right superior frontal gyrus. STUDY PREREGISTRATION INFORMATION Structural Brain Abnormalities of Attention-Deficit/Hyperactivity Disorder and Bipolar Disorder in Children/Adolescents: An Overlapping Meta-analysis; https://osf.io; trg4m.
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Affiliation(s)
- Yajing Long
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Nanfang Pan
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China; University of Cincinnati, Cincinnati, Ohio
| | - Yifan Yu
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, Sichuan, China; Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Shufang Zhang
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, Sichuan, China; Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Kun Qin
- University of Cincinnati, Cincinnati, Ohio; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, Sichuan, China; Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Ying Chen
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, Sichuan, China; Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - John A Sweeney
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China; University of Cincinnati, Cincinnati, Ohio
| | | | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China; West China Xiamen Hospital of Sichuan University, Xiamen, China.
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Mitchell RHB, Grigorian A, Robertson A, Toma S, Luciw NJ, Karthikeyan S, Mutsaerts HJMM, Fiksenbaum L, Metcalfe AWS, MacIntosh BJ, Goldstein BI. Sex differences in cerebral blood flow among adolescents with bipolar disorder. Bipolar Disord 2024; 26:33-43. [PMID: 37217255 DOI: 10.1111/bdi.13326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
BACKGROUND Abnormalities in cerebral blood flow (CBF) are common in bipolar disorder (BD). Despite known differences in CBF between healthy adolescent males and females, sex differences in CBF among adolescents with BD have never been studied. OBJECTIVE To examine sex differences in CBF among adolescents with BD versus healthy controls (HC). METHODS CBF images were acquired using arterial spin labeling (ASL) perfusion magnetic resonance imaging (MRI) in 123 adolescents (72 BD: 30M, 42F; 51 HC: 22M, 29F) matched for age (13-20 years). Whole brain voxel-wise analysis was performed in a general linear model with sex and diagnosis as fixed factors, sex-diagnosis interaction effect, and age as a covariate. We tested for main effects of sex, diagnosis, and their interaction. Results were thresholded at cluster forming p = 0.0125, with posthoc Bonferroni correction (p = 0.05/4 groups). RESULTS A main effect of diagnosis (BD > HC) was observed in the superior longitudinal fasciculus (SLF), underlying the left precentral gyrus (F =10.24 (3), p < 0.0001). A main effect of sex (F > M) on CBF was detected in the precuneus/posterior cingulate cortex (PCC), left frontal and occipital poles, left thalamus, left SLF, and right inferior longitudinal fasciculus (ILF). No regions demonstrated a significant sex-by-diagnosis interaction. Exploratory pairwise testing in regions with a main effect of sex revealed greater CBF in females with BD versus HC in the precuneus/PCC (F = 7.1 (3), p < 0.01). CONCLUSION Greater CBF in female adolescents with BD versus HC in the precuneus/PCC may reflect the role of this region in the neurobiological sex differences of adolescent-onset BD. Larger studies targeting underlying mechanisms, such as mitochondrial dysfunction or oxidative stress, are warranted.
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Affiliation(s)
- Rachel H B Mitchell
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Anahit Grigorian
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Andrew Robertson
- Department of Kinesiology, Research Institute for Aging, University of Waterloo, Ontario, Canada
| | - Simina Toma
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Nicholas J Luciw
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Sudhir Karthikeyan
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Henri J M M Mutsaerts
- Radiology and Nuclear Medicine Vrje Universiteit Amsterdam, Amsterdam UMC location VUmc, Amsterdam, Netherlands
- Amsterdam Neuroscience, Brain Imaging, Amsterdam, Netherlands
| | - Lisa Fiksenbaum
- Department of Applied Psychology and Human Development, University of Toronto, Toronto, Ontario, Canada
| | - Arron W S Metcalfe
- Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Program , Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Bradley J MacIntosh
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
- Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Program , Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Benjamin I Goldstein
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Pharmacology, University of Toronto, Toronto, Ontario, Canada
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Chen MH, Lin HM, Sue YR, Yu YC, Yeh PY. Meta-analysis reveals a reduced surface area of the amygdala in individuals with attention deficit/hyperactivity disorder. Psychophysiology 2023; 60:e14308. [PMID: 37042481 DOI: 10.1111/psyp.14308] [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: 03/08/2022] [Revised: 02/15/2023] [Accepted: 03/03/2023] [Indexed: 04/13/2023]
Abstract
Despite the reported lack of structural alterations in the amygdala of individuals with attention deficit/hyperactivity disorder (ADHD) in previous meta-analyses, subsequent observational studies produced conflicting results. Through incorporating the updated data from observational studies on structural features of the amygdala in ADHD, the primary goal of this study was to examine the anatomical differences in amygdala between subjects with ADHD and their neurotypical controls. Using the appropriate keyword strings, we searched the PubMed, Embase, and Web of Science databases for English articles from inception to February 2022. Eligibility criteria included observational studies comparing the structure of the amygdala between ADHD subjects and their comparators using magnetic resonance imaging (MRI). Subgroup analyses were conducted focusing on the amygdala side, as well as the use of different scanners and approach to segmentation. The effects of other continuous variables, such as age, intelligence quotient, and male percentage, on amygdala size were also investigated. Of the 5703 participants in 16 eligible studies, 2928 were diagnosed with ADHD. Compared with neurotypical controls, subjects with ADHD had a smaller amygdala surface area (particularly in the left hemisphere) but without a significant difference in volume between the two groups. Subgroup analysis of MRI scanners and different approaches to segmentation showed no statistically significant difference. There was no significant correlation between continuous variables and amygdala size. Our results showed consistent surface morphological alterations of the amygdala, in particular on the left side, in subjects with ADHD. However, the preliminary findings based on the limited data available for analysis warrant future studies for verification.
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Affiliation(s)
- Meng-Hsiang Chen
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- College of Medicine, Chang Gung University, Kaohsiung, Taiwan
| | - Hsiu-Man Lin
- Division of Child and Adolescent Psychiatry & Division of Developmental and Behavioral Pediatrics, China Medical University Children's Hospital, Taichung, Taiwan
| | - Yu-Ru Sue
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Yun-Chen Yu
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Pin-Yang Yeh
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan
- Clinical Psychology Center, Asia University Hospital, Taichung, Taiwan
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Dhikav V, Parakh M, Pandey K, Jangid H, Khicher P. Hippocampal Volume in Children with Attention Deficit Hyperactivity Disorder and Speech and Language Delay. Ann Indian Acad Neurol 2023; 26:431-434. [PMID: 37970300 PMCID: PMC10645236 DOI: 10.4103/aian.aian_77_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 04/20/2023] [Accepted: 06/17/2023] [Indexed: 11/17/2023] Open
Abstract
Introduction Hippocampus is a complex brain structure located deep in the temporal lobes of the brain. The structure has been implicated in several disorders related to cognition. Reports are emerging of its involvement in attention deficit hyperactivity disorder (ADHD). The current study was planned to assess the volume of the hippocampus in children with ADHD and speech and language delay with normal birth history using magnetic resonance imaging (MRI) of the brain. Material and Methods MRI brain of 12 children (age range = 3-6 years) and 22 controls with clinical diagnosis of ADHD as per Diagnostic and Statistical Manual-5 were obtained in oblique coronal sequence (T1 weighted). The entire hippocampus formation was outlined manually using Image-J software available freely from www.freesurfer.com. Results were expressed as volume cubic millimeters ± SD. Results Volumes of the hippocampi of children with ADHD were 2450.2 ± 667 mm3 (R) and 2505.8 ± 878.5 mm3 (L), respectively. The mean volume (bilateral) of the cases was 2478 ± 772.75 mm3. The right hippocampal volume of the controls was 3255.8 ± 1374.3 mm3 (R) and that of the left side was 3159.3 ± 1451 (L) mm3, respectively. Conclusion Current study reported a substantial shrinkage (23%) of the left and right hippocampus in children with ADHD compared to controls.
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Affiliation(s)
- Vikas Dhikav
- Department of Health Research, Govt. of India, ICMR-NIIRNCD (Formerly Called as Desert Medicine Research Centre), Airforce Road, Jodhpur, Rajasthan, India
| | - Manish Parakh
- Department of Paediatrics, Dr. SN Medical College, Jodhpur, Rajasthan, India
| | - Kajal Pandey
- Department of Health Research, Govt. of India, ICMR-NIIRNCD (Formerly Called as Desert Medicine Research Centre), Airforce Road, Jodhpur, Rajasthan, India
| | - Hemant Jangid
- Department of Radiology, Dr. SN Medical College, Jodhpur, Rajasthan, India
| | - Pankaj Khicher
- Department of Radiology, Dr. SN Medical College, Jodhpur, Rajasthan, India
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Long X, Li L, Wang X, Cao Y, Wu B, Roberts N, Gong Q, Kemp GJ, Jia Z. Gray matter alterations in adolescent major depressive disorder and adolescent bipolar disorder. J Affect Disord 2023; 325:550-563. [PMID: 36669567 DOI: 10.1016/j.jad.2023.01.049] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 12/24/2022] [Accepted: 01/11/2023] [Indexed: 01/19/2023]
Abstract
BACKGROUND Gray matter volume (GMV) alterations in several emotion-related brain areas are implicated in mood disorders, but findings have been inconsistent in adolescents with major depressive disorder (MDD) or bipolar disorder (BD). METHODS We conducted a comprehensive meta-analysis of 35 region-of-interest (ROI) and 18 whole-brain voxel-based morphometry (VBM) MRI studies in adolescent MDD and adolescent BD, and indirectly compared the results in the two groups. The effects of age, sex, and other demographic and clinical scale scores were explored using meta-regression analysis. RESULTS In the ROI meta-analysis, right putamen volume was decreased in adolescents with MDD, while bilateral amygdala volume was decreased in adolescents with BD compared to healthy controls (HC). In the whole-brain VBM meta-analysis, GMV was increased in right middle frontal gyrus and decreased in left caudate in adolescents with MDD compared to HC, while in adolescents with BD, GMV was increased in left superior frontal gyrus and decreased in limbic regions compared with HC. MDD vs BD comparison revealed volume alteration in the prefrontal-limbic system. LIMITATION Different clinical features limit the comparability of the samples, and small sample size and insufficient clinical details precluded subgroup analysis or meta-regression analyses of these variables. CONCLUSIONS Distinct patterns of GMV alterations in adolescent MDD and adolescent BD could help to differentiate these two populations and provide potential diagnostic biomarkers.
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Affiliation(s)
- Xipeng Long
- Department of Nuclear Medicine, West China Hospital of Sichuan University, No. 37 GuoXue Xiang, Chengdu 610041, Sichuan, PR China; Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, PR China
| | - Lei Li
- Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, PR China; Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, PR China
| | - Xiuli Wang
- Department of Clinical Psychiatry, the Fourth People's Hospital of Chengdu, Chengdu 610041, Sichuan, PR China
| | - Yuan Cao
- Department of Nuclear Medicine, West China Hospital of Sichuan University, No. 37 GuoXue Xiang, Chengdu 610041, Sichuan, PR China
| | - Baolin Wu
- Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, PR China; Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, PR China
| | - Neil Roberts
- The Queens Medical Research Institute (QMRI), School of Clinical Sciences, University of Edinburgh, Edinburgh, UK
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, PR China; Department of Radiology, West China Xiamen Hospital of Sichuan University, 699Jinyuan Xi Road, Jimei District, 361021 Xiamen, Fujian, PR China
| | - Graham J Kemp
- Liverpool Magnetic Resonance Imaging Center (LiMRIC) and Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Zhiyun Jia
- Department of Nuclear Medicine, West China Hospital of Sichuan University, No. 37 GuoXue Xiang, Chengdu 610041, Sichuan, PR China; Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, PR China.
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Yu M, Gao X, Niu X, Zhang M, Yang Z, Han S, Cheng J, Zhang Y. Meta-analysis of structural and functional alterations of brain in patients with attention-deficit/hyperactivity disorder. Front Psychiatry 2022; 13:1070142. [PMID: 36683981 PMCID: PMC9853532 DOI: 10.3389/fpsyt.2022.1070142] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 12/05/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND A large and growing body of neuroimaging research has concentrated on patients with attention-deficit/hyperactivity disorder (ADHD), but with inconsistent conclusions. This article was intended to investigate the common and certain neural alterations in the structure and function of the brain in patients with ADHD and further explore the differences in brain alterations between adults and children with ADHD. METHODS We conducted an extensive literature search of whole-brain voxel-based morphometry (VBM) and functional magnetic resonance imaging (fMRI) studies associated with ADHD. Two separate meta-analyses with the seed-based d mapping software package for functional neural activation and gray matter volume (GMV) were carried out, followed by a joint analysis and a subgroup analysis. RESULTS This analysis included 29 VBM studies and 36 fMRI studies. Structurally, VBM analysis showed that the largest GMV diminutions in patients with ADHD were in several frontal-parietal brain regions, the limbic system, and the corpus callosum. Functionally, fMRI analysis discovered significant hypoactivation in several frontal-temporal brain regions, the right postcentral gyrus, the left insula, and the corpus callosum. CONCLUSION This study showed that abnormal alterations in the structure and function of the left superior frontal gyrus and the corpus callosum may be the key brain regions involved in the pathogenesis of ADHD in patients and may be employed as an imaging metric for patients with ADHD pending future research. In addition, this meta-analysis discovered neuroanatomical or functional abnormalities in other brain regions in patients with ADHD as well as findings that can be utilized to guide future research.
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Affiliation(s)
- Miaomiao Yu
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Key Laboratory for Functional Magnetic Resonance Imaging and Molecular Imaging of Henan Province, Zhengzhou, China.,Engineering Technology Research Center for Detection and Application of Brain Function of Henan Province, Zhengzhou, China.,Engineering Research Center of Medical Imaging Intelligent Diagnosis and Treatment of Henan Province, Zhengzhou, China.,Key Laboratory of Magnetic Resonance and Brain Function of Henan Province, Zhengzhou, China.,Key Laboratory of Brain Function and Cognitive Magnetic Resonance Imaging of Zhengzhou, Zhengzhou, China.,Key Laboratory of Imaging Intelligence Research Medicine of Henan Province, Zhengzhou, China
| | - Xinyu Gao
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Key Laboratory for Functional Magnetic Resonance Imaging and Molecular Imaging of Henan Province, Zhengzhou, China.,Engineering Technology Research Center for Detection and Application of Brain Function of Henan Province, Zhengzhou, China.,Engineering Research Center of Medical Imaging Intelligent Diagnosis and Treatment of Henan Province, Zhengzhou, China.,Key Laboratory of Magnetic Resonance and Brain Function of Henan Province, Zhengzhou, China.,Key Laboratory of Brain Function and Cognitive Magnetic Resonance Imaging of Zhengzhou, Zhengzhou, China.,Key Laboratory of Imaging Intelligence Research Medicine of Henan Province, Zhengzhou, China
| | - Xiaoyu Niu
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Key Laboratory for Functional Magnetic Resonance Imaging and Molecular Imaging of Henan Province, Zhengzhou, China.,Engineering Technology Research Center for Detection and Application of Brain Function of Henan Province, Zhengzhou, China.,Engineering Research Center of Medical Imaging Intelligent Diagnosis and Treatment of Henan Province, Zhengzhou, China.,Key Laboratory of Magnetic Resonance and Brain Function of Henan Province, Zhengzhou, China.,Key Laboratory of Brain Function and Cognitive Magnetic Resonance Imaging of Zhengzhou, Zhengzhou, China.,Key Laboratory of Imaging Intelligence Research Medicine of Henan Province, Zhengzhou, China
| | - Mengzhe Zhang
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Key Laboratory for Functional Magnetic Resonance Imaging and Molecular Imaging of Henan Province, Zhengzhou, China.,Engineering Technology Research Center for Detection and Application of Brain Function of Henan Province, Zhengzhou, China.,Engineering Research Center of Medical Imaging Intelligent Diagnosis and Treatment of Henan Province, Zhengzhou, China.,Key Laboratory of Magnetic Resonance and Brain Function of Henan Province, Zhengzhou, China.,Key Laboratory of Brain Function and Cognitive Magnetic Resonance Imaging of Zhengzhou, Zhengzhou, China.,Key Laboratory of Imaging Intelligence Research Medicine of Henan Province, Zhengzhou, China
| | - Zhengui Yang
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Key Laboratory for Functional Magnetic Resonance Imaging and Molecular Imaging of Henan Province, Zhengzhou, China.,Engineering Technology Research Center for Detection and Application of Brain Function of Henan Province, Zhengzhou, China.,Engineering Research Center of Medical Imaging Intelligent Diagnosis and Treatment of Henan Province, Zhengzhou, China.,Key Laboratory of Magnetic Resonance and Brain Function of Henan Province, Zhengzhou, China.,Key Laboratory of Brain Function and Cognitive Magnetic Resonance Imaging of Zhengzhou, Zhengzhou, China.,Key Laboratory of Imaging Intelligence Research Medicine of Henan Province, Zhengzhou, China
| | - Shaoqiang Han
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Key Laboratory for Functional Magnetic Resonance Imaging and Molecular Imaging of Henan Province, Zhengzhou, China.,Engineering Technology Research Center for Detection and Application of Brain Function of Henan Province, Zhengzhou, China.,Engineering Research Center of Medical Imaging Intelligent Diagnosis and Treatment of Henan Province, Zhengzhou, China.,Key Laboratory of Magnetic Resonance and Brain Function of Henan Province, Zhengzhou, China.,Key Laboratory of Brain Function and Cognitive Magnetic Resonance Imaging of Zhengzhou, Zhengzhou, China.,Key Laboratory of Imaging Intelligence Research Medicine of Henan Province, Zhengzhou, China
| | - Jingliang Cheng
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Key Laboratory for Functional Magnetic Resonance Imaging and Molecular Imaging of Henan Province, Zhengzhou, China.,Engineering Technology Research Center for Detection and Application of Brain Function of Henan Province, Zhengzhou, China.,Engineering Research Center of Medical Imaging Intelligent Diagnosis and Treatment of Henan Province, Zhengzhou, China.,Key Laboratory of Magnetic Resonance and Brain Function of Henan Province, Zhengzhou, China.,Key Laboratory of Brain Function and Cognitive Magnetic Resonance Imaging of Zhengzhou, Zhengzhou, China.,Key Laboratory of Imaging Intelligence Research Medicine of Henan Province, Zhengzhou, China
| | - Yong Zhang
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Key Laboratory for Functional Magnetic Resonance Imaging and Molecular Imaging of Henan Province, Zhengzhou, China.,Engineering Technology Research Center for Detection and Application of Brain Function of Henan Province, Zhengzhou, China.,Engineering Research Center of Medical Imaging Intelligent Diagnosis and Treatment of Henan Province, Zhengzhou, China.,Key Laboratory of Magnetic Resonance and Brain Function of Henan Province, Zhengzhou, China.,Key Laboratory of Brain Function and Cognitive Magnetic Resonance Imaging of Zhengzhou, Zhengzhou, China.,Key Laboratory of Imaging Intelligence Research Medicine of Henan Province, Zhengzhou, China
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Mucci F, Avella MT, Marazziti D. ADHD with Comorbid Bipolar Disorders: A Systematic Review of Neurobiological, Clinical and Pharmacological Aspects Across the Lifespan. Curr Med Chem 2020; 26:6942-6969. [PMID: 31385763 DOI: 10.2174/0929867326666190805153610] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 06/05/2018] [Accepted: 11/15/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Attention deficit hyperactivity (ADHD) disorder is a neurodevelopmental disorder characterized by inattention, hyperactivity, disruptive behaviour, and impulsivity. Despite considered typical of children for a long time, the persistence of ADHD symptoms in adulthood gained increasing interest during the last decades. Indeed, its diagnosis, albeit controversial, is rarely carried out even because ADHD is often comorbid with several other psychiatric diosrders, in particular with bipolar disorders (BDs), a condition that complicates the clinical picture, assessment and treatment. AIMS The aim of this paper was to systematically review the scientific literature on the neurobiological, clinical features and current pharmacological management of ADHD comorbid with BDs across the entire lifespan, with a major focus on the adulthood. DISCUSSION The pharmacology of ADHD-BD in adults is still empirical and influenced by the individual experience of the clinicians. Stimulants are endowed of a prompt efficacy and safety, whilst non-stimulants are useful when a substance abuse history is detected, although they require some weeks in order to be fully effective. In any case, an in-depth diagnostic and clinical evaluation of the single individual is mandatory. CONCLUSION The comorbidity of ADHD with BD is still a controversial matter, as it is the notion of adult ADHD as a distinct nosological category. Indeed, some findings highlighted the presence of common neurobiological mechanisms and overlapping clinical features, although disagreement does exist. In any case, while expecting to disentangle this crucial question, a correct management of this comorbidity is essential, which requires the co-administration of mood stabilizers. Further controlled clinical studies in large samples of adult ADHD-BD patients appear extremely urgent in order to better define possible therapeutic guidelines, as well as alternative approaches for this potentially invalidating condition.
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Affiliation(s)
- Federico Mucci
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.,Fondazione BRF, Istituto per la Ricerca Scientifica in Psichiatria e Neuroscienze, Lucca, Italy
| | - Maria Teresa Avella
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Donatella Marazziti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.,Fondazione BRF, Istituto per la Ricerca Scientifica in Psichiatria e Neuroscienze, Lucca, Italy
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Broadhouse KM, Boyes A, Winks N, Dokonal T, McLoughlin L, Parker M, Beaudequin D, Simcock G, Lagopoulos J, Hermens DF. Subcortical Volume Correlates of Psychological Distress in Early Adolescence. Dev Neurosci 2019; 41:193-202. [PMID: 31480044 DOI: 10.1159/000502339] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 07/24/2019] [Indexed: 01/02/2023] Open
Abstract
The hippocampus and amygdala have justifiably been the focus of much mental health research due to their putative roles in top-down processing control of emotion, fear, and anxiety. However, understanding the causal relationship between these regions and mental illness has been limited as current literature is lacking in the observation of neuro-structural changes preceding first episodes. Here, we report whole and sub-structural hippocampal and amygdala volume correlates of psychological distress in early adolescence. Automated hippocampal subfield and amygdala nuclei segmentation was carried out in 32 participants (12-13 years old) recruited for the Longitudinal Adolescent Brain Study (LABS) who had psychological distress scores measured by the Kessler-10. Partial correlation analyses revealed significant negative association between left whole amygdala volume and psychological distress. Sub-structure analysis revealed that smaller left hippocampal CA1 volume and left basal and accessory basal amygdala nuclei volumes were all significantly associated with higher levels of psychological distress. Four-month follow-up analysis also revealed an association between change in K10 and CA1 volume suggesting a continued relationship between this hippocampal substructure and psychological distress. Grey matter volume of subcortical sub-structures involved within the hippocampal-basolateral amygdala-prefrontal cortex loop are highly correlated and are significantly reduced in adolescents with higher levels of psychological distress, indicating these nuclei and subfields play an important role in the emergence of mental illness.
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Affiliation(s)
- Kathryn M Broadhouse
- Sunshine Coast Mind and Neuroscience Thompson Institute, University of the Sunshine Coast, Birtinya, Queensland, Australia,
| | - Amanda Boyes
- Sunshine Coast Mind and Neuroscience Thompson Institute, University of the Sunshine Coast, Birtinya, Queensland, Australia
| | - Natalie Winks
- Sunshine Coast Mind and Neuroscience Thompson Institute, University of the Sunshine Coast, Birtinya, Queensland, Australia
| | - Tayla Dokonal
- Sunshine Coast Mind and Neuroscience Thompson Institute, University of the Sunshine Coast, Birtinya, Queensland, Australia
| | - Larisa McLoughlin
- Sunshine Coast Mind and Neuroscience Thompson Institute, University of the Sunshine Coast, Birtinya, Queensland, Australia
| | - Marcella Parker
- Sunshine Coast Mind and Neuroscience Thompson Institute, University of the Sunshine Coast, Birtinya, Queensland, Australia
| | - Denise Beaudequin
- Sunshine Coast Mind and Neuroscience Thompson Institute, University of the Sunshine Coast, Birtinya, Queensland, Australia
| | - Gabrielle Simcock
- Sunshine Coast Mind and Neuroscience Thompson Institute, University of the Sunshine Coast, Birtinya, Queensland, Australia
| | - Jim Lagopoulos
- Sunshine Coast Mind and Neuroscience Thompson Institute, University of the Sunshine Coast, Birtinya, Queensland, Australia
| | - Daniel F Hermens
- Sunshine Coast Mind and Neuroscience Thompson Institute, University of the Sunshine Coast, Birtinya, Queensland, Australia
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9
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Mitchell RH, Metcalfe AW, Islam AH, Toma S, Patel R, Fiksenbaum L, Korczak D, MacIntosh BJ, Goldstein BI. Sex differences in brain structure among adolescents with bipolar disorder. Bipolar Disord 2018; 20:448-458. [PMID: 29956452 DOI: 10.1111/bdi.12663] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Bipolar disorder (BD) is twice as prevalent amongst female as amongst male adolescents. Thus far, little is known regarding the neurostructural substrates underlying this disparity. We therefore examined sex differences in neurostructural magnetic resonane imaging (MRI) phenotypes amongst adolescents with BD. METHODS T1-weighted structural MRI was acquired from 44 BD (25 female [F] and 19 male [M]) and 58 (28 F and 30 M) healthy control (HC) adolescents (13-21 years old). Whole-brain and region-of-interest (ROI) analyses examined structural volume and cortical thickness using FreeSurfer. ROIs included the ventrolateral prefrontal cortex (vlPFC), anterior cingulate cortex (ACC), amygdala and hippocampus. General linear models evaluated sex-by-diagnosis interactions, controlling for age and intracranial volume. RESULTS Whole-brain analysis revealed sex-by-diagnosis interactions in the left supramarginal gyrus (SMG) (P = .02, η2 = 0.02) and right inferior parietal lobule (IPL) volumes (P = .04, η2 = 0.01). Sex differences in HCs were found in the SMG (M > F) and IPL (F > M). In BD, sex differences were reversed and of smaller magnitude in the SMG (M < F) and of greater magnitude in the IPL (F > M), driven by trends towards smaller SMG and IPL in BD vs HC male participants (P = .05 and .14). Whole-brain analyses for cortical thickness, and ROI analyses for volume and cortical thickness, were not significant. CONCLUSIONS Normative sex differences may be disrupted in adolescent BD in the SMG and IPL, heteromodal association network hubs responsible for higher order integration of cognitive and emotional processing. Unexpectedly, these findings may inform our understanding of aberrant brain structure in adolescent BD male patients, rather than female patients. Future work should focus on replication, as well as the impact of puberty status and sex hormones on measures of brain structure and function.
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Affiliation(s)
- Rachel Hb Mitchell
- Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Canada
| | - Arron Ws Metcalfe
- Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, Canada
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Canada
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Alvi H Islam
- Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Pharmacology, University of Toronto, Toronto, Canada
| | - Simina Toma
- Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Ronak Patel
- Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Lisa Fiksenbaum
- Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Daphne Korczak
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Department of Psychiatry, Hospital for Sick Children, Toronto, Canada
| | - Bradley J MacIntosh
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Canada
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, Canada
- Physical Sciences, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Canada
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Pharmacology, University of Toronto, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
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10
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Gender differences in anomalous subcortical morphology for children with ADHD. Neurosci Lett 2018; 665:176-181. [DOI: 10.1016/j.neulet.2017.12.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 12/01/2017] [Accepted: 12/02/2017] [Indexed: 12/11/2022]
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11
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Nickel K, Tebartz van Elst L, Perlov E, Jitten-Schachenmeier R, Beier D, Endres D, Goll P, Philipsen A, Maier S. Manual morphometry of hippocampus and amygdala in adults with attention-deficit hyperactivity disorder. Psychiatry Res Neuroimaging 2017; 267:32-35. [PMID: 28734177 DOI: 10.1016/j.pscychresns.2017.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Revised: 07/10/2017] [Accepted: 07/13/2017] [Indexed: 10/19/2022]
Abstract
Previous studies have pointed to the involvement of limbic structures in the genesis of attention deficit hyperactivity disorder (ADHD). The present researchers manually segmented magnetic resonance images of 30 individuals with ADHD and 30 individually matched controls, focusing on amygdala and hippocampus volumes. Neither hippocampus nor amygdala volume differed significantly between individuals with and without ADHD. However, ADHD patients with higher hyperactivity scores had significantly smaller left amygdala volumes. This finding suggests that limbic alterations are significant in hyperactive symptoms in the pathophysiology of ADHD.
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Affiliation(s)
- Kathrin Nickel
- Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center, Faculty of Medicine, University of Freiburg, Hauptstr. 5, 79104 Freiburg, Germany.
| | - Ludger Tebartz van Elst
- Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center, Faculty of Medicine, University of Freiburg, Hauptstr. 5, 79104 Freiburg, Germany
| | - Evgeniy Perlov
- Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center, Faculty of Medicine, University of Freiburg, Hauptstr. 5, 79104 Freiburg, Germany; Luzerner Psychiatrie, Hospital St. Urban, Schafmattstrasse 1, 4915 St. Urban, Switzerland
| | - Renate Jitten-Schachenmeier
- Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center, Faculty of Medicine, University of Freiburg, Hauptstr. 5, 79104 Freiburg, Germany
| | - Daniel Beier
- Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center, Faculty of Medicine, University of Freiburg, Hauptstr. 5, 79104 Freiburg, Germany
| | - Dominique Endres
- Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center, Faculty of Medicine, University of Freiburg, Hauptstr. 5, 79104 Freiburg, Germany
| | - Peter Goll
- Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center, Faculty of Medicine, University of Freiburg, Hauptstr. 5, 79104 Freiburg, Germany
| | - Alexandra Philipsen
- Medical Campus University of Oldenburg, School of Medicine and Health Sciences, Psychiatry and Psychotherapy - University Hospital Karl-Jaspers-Hospital, Hermann-Ehlers-Str. 7, 26160 Bad Zwischenahn, Germany
| | - Simon Maier
- Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center, Faculty of Medicine, University of Freiburg, Hauptstr. 5, 79104 Freiburg, Germany
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12
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Seymour KE, Tang X, Crocetti D, Mostofsky SH, Miller MI, Rosch KS. Anomalous subcortical morphology in boys, but not girls, with ADHD compared to typically developing controls and correlates with emotion dysregulation. Psychiatry Res 2017; 261:20-28. [PMID: 28104573 PMCID: PMC5335909 DOI: 10.1016/j.pscychresns.2017.01.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 01/04/2017] [Accepted: 01/05/2017] [Indexed: 10/20/2022]
Abstract
There has been limited investigation of volume and shape difference in subcortical structures in children with ADHD and a paucity of examination of the influence of sex on these findings. The objective of this study was to examine morphology (volume and shape) of subcortical structures and their association with emotion dysregulation (ED) in girls and boys with ADHD as compared to their typically-developing (TD) counterparts. Participants included 218 children ages 8-12 years old with and without DSM-IV ADHD. Structural magnetic resonance images were obtained, and shape analyses were conducted using large deformation diffeomorphic metric mapping (LDDMM). Compared to TD boys, boys with ADHD showed reduced volumes in the bilateral globus pallidus and amygdala. There were no volumetric differences in any structure between ADHD and TD girls. Shape analysis revealed localized compressions within the globus pallidus, putamen and amygdala in ADHD boys relative to TD boys, as well as significant correlations between increased ED and unique subregion expansion in right globus pallidus, putamen, and right amygdala. Our findings suggest a sexually dimorphic pattern of differences in subcortical structures in children with ADHD compared to TD children, and a possible neurobiological mechanism by which boys with ADHD demonstrate increased difficulties with ED.
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Affiliation(s)
- Karen E. Seymour
- Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine
- Center for Neurodevelopmental and Imaging Research, Kennedy Krieger Institute
| | - Xiaoying Tang
- Sun Yat-sen University Carnegie Mellon University (SYSU-CMU) Joint Institute of Engineering, Sun Yat-sen University, Guangzhou, Guangdong, China
- School of Electronics and Information Technology, Sun Yat-sen University, Guangzhou, Guangdong, China
- SYSU-CMU International Joint Research Institute, Shunde, Guangdong, China
| | - Deana Crocetti
- Center for Neurodevelopmental and Imaging Research, Kennedy Krieger Institute
| | - Stewart H. Mostofsky
- Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine
- Center for Neurodevelopmental and Imaging Research, Kennedy Krieger Institute
- Department of Neurology, Johns Hopkins University School of Medicine
| | | | - Keri S. Rosch
- Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine
- Center for Neurodevelopmental and Imaging Research, Kennedy Krieger Institute
- Department of Neuropsychology, Kennedy Krieger Institute
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13
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Seymour KE, Miller L. ADHD and Depression: the Role of Poor Frustration Tolerance. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2017; 4:14-18. [PMID: 32864293 DOI: 10.1007/s40474-017-0105-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Unipolar depression is a common comorbidity in children with ADHD with rates ranging from 12-50%. Compared to children with ADHD alone, children with comorbid ADHD and depression require more intense interventions since they experience higher levels of stress and more psychosocial and familial problems. One mechanism hypothesized to underlie the relationship between ADHD and depression is emotion dysregulation. Cross-sectional and longitudinal research has shown that emotion dysregulation mediates the relationship between ADHD and depression. However, there are a number of limitations in the extant literature regarding emotion dysregulation as a mechanism underlying the relationship between ADHD and depression. This article aims to review those limitations and propose that by examining a specific type of emotion dysregulation, poor frustration tolerance, we may gain critical insight into the mechanisms underlying ADHD and depression. We discuss the construct of frustration, its neural basis and evidence that poor frustration tolerance is a key impairment in children with ADHD. We conclude by suggesting that poor frustration tolerance may be a key mechanism underlying the relationship between ADHD and depression, and provide recommendations for how future research can utilize affective neuroscience techniques to examine the neural, behavioral and clinical correlates of frustration tolerance in children with ADHD to more comprehensively examine this relationship.
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Affiliation(s)
- Karen E Seymour
- Center for Neurodevelopmental and Imaging Research, Kennedy Krieger Institute, 716 North Broadway, Room 335, Baltimore, MD 21205, USA
| | - Leslie Miller
- Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine, 4940 Eastern Ave D2E, Baltimore, MD 21224, USA
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14
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Wyciszkiewicz A, Pawlak MA, Krawiec K. Cerebellar Volume in Children With Attention-Deficit Hyperactivity Disorder (ADHD). J Child Neurol 2017; 32:215-221. [PMID: 27888270 DOI: 10.1177/0883073816678550] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Attention Deficit Hyperactivity Disorder (ADHD) is associated with altered cerebellar volume and cerebellum is associated with cognitive performance. However there are mixed results regarding the cerebellar volume in young patients with ADHD. To clarify the size and direction of this effect, we conducted the analysis on the large public database of brain images. The aim of this study was to confirm that cerebellar volume in ADHD is smaller than in control subjects in currently the largest publicly available cohort of ADHD subjects.We applied cross-sectional case control study design by comparing 286 ADHD patients (61 female) with age and gender matched control subjects. Volumetric measurements of cerebellum were obtained using automated segmentation with FreeSurfer 5.1. Statistical analysis was performed in R-CRAN statistical environment. Patients with ADHD had significantly smaller total cerebellar volumes (134.5±17.11cm3 vs.138.90±15.32 cm3). The effect was present in both females and males (males 136.9±14.37 cm3 vs. 141.20±14.75 cm3; females 125.7±12.34 cm3 vs. 131.20±15.03 cm3). Age was positively and significantly associated with the cerebellar volumes. These results indicate either delayed or disrupted cerebellar development possibly contributing to ADHD pathophysiology.
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Affiliation(s)
- Aleksandra Wyciszkiewicz
- 1 Department of Neurochemistry and Neuropathology, Poznan University of Medical Sciences, Poznan, Poland
| | - Mikolaj A Pawlak
- 2 Department of Neurology and Cerebrovascular Disorders, Poznan University of Medical Sciences, Poznan, Poland
| | - Krzysztof Krawiec
- 3 Institute of Computing Science, Poznan University of Technology, Poznan, Poland
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15
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Dickstein DP, Axelson D, Weissman AB, Yen S, Hunt JI, Goldstein BI, Goldstein TR, Liao F, Gill MK, Hower H, Frazier TW, Diler RS, Youngstrom EA, Fristad MA, Arnold LE, Findling RL, Horwitz SM, Kowatch RA, Ryan ND, Strober M, Birmaher B, Keller MB. Cognitive flexibility and performance in children and adolescents with threshold and sub-threshold bipolar disorder. Eur Child Adolesc Psychiatry 2016; 25:625-38. [PMID: 26438382 PMCID: PMC5040213 DOI: 10.1007/s00787-015-0769-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 09/01/2015] [Indexed: 01/03/2023]
Abstract
Greater understanding of cognitive function in children and adolescents with bipolar disorder (BD) is of critical importance to improve our ability to design targeted treatments to help with real-world impairment, including academic performance. We sought to evaluate cognitive performance among children with either BD type I, II, or "not otherwise specified" (NOS) participating in multi-site Course and Outcome of Bipolar Youth study compared to typically developing controls (TDC) without psychopathology. In particular, we sought to test the hypothesis that BD-I and BD-II youths with full threshold episodes of mania or hypomania would have cognitive deficits, including in reversal learning, vs. those BD-NOS participants with sub-threshold episodes and TDCs. N = 175 participants (BD-I = 81, BD-II = 11, BD-NOS = 28, TDC = 55) completed Cambridge Neuropsychological Automated Testing Battery (CANTAB) tasks. A priori analyses of the simple reversal stage of the CANTAB intra-/extra-dimensional shift task showed that aggregated BD-I/II participants required significantly more trials to complete the task than either BD-NOS participants with sub-syndromal manic/hypomanic symptoms or than TDCs. BD participants across sub-types had impairments in sustained attention and information processing for emotionally valenced words. Our results align with prior findings showing that BD-I/II youths with distinct episodes have specific alterations in reversal learning. More broadly, our study suggests that further work is necessary to see the interaction between neurocognitive performance and longitudinal illness course. Additional work is required to identify the neural underpinnings of these differences as targets for potential novel treatments, such as cognitive remediation.
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Affiliation(s)
- Daniel P Dickstein
- Department of Psychiatry and Human Behavior, Division of Child-Family Psychiatry, Bradley Hospital, Alpert Medical School of Brown University, East Providence, RI, USA.
- PediMIND Program, Bradley Hospital, 1011 Veterans Memorial Parkway, East Providence, RI, 02915, USA.
| | - David Axelson
- Department of Psychiatry, Nationwide Children's Hospital, Columbus, OH, USA
| | - Alexandra B Weissman
- Department of Psychiatry and Human Behavior, Division of Child-Family Psychiatry, Bradley Hospital, Alpert Medical School of Brown University, East Providence, RI, USA
| | - Shirley Yen
- Department of Psychiatry and Human Behavior/Butler Hospital, Alpert Medical School of Brown University, Providence, RI, USA
| | - Jeffrey I Hunt
- Department of Psychiatry and Human Behavior, Division of Child-Family Psychiatry, Bradley Hospital, Alpert Medical School of Brown University, East Providence, RI, USA
| | - Benjamin I Goldstein
- Department of Child Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto Medical Center, Toronto, ON, Canada
| | - Tina R Goldstein
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Fangzi Liao
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Mary Kay Gill
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Heather Hower
- Department of Psychiatry and Human Behavior/Butler Hospital, Alpert Medical School of Brown University, Providence, RI, USA
| | - Thomas W Frazier
- Department of Psychiatry, Center for Autism, Cleveland Clinic, Cleveland, OH, USA
| | - Rasim S Diler
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Eric A Youngstrom
- Department of Psychology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mary A Fristad
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, Ohio State University, Columbus, OH, USA
| | - L Eugene Arnold
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, Ohio State University, Columbus, OH, USA
| | - Robert L Findling
- Department of Psychiatry, Johns Hopkins University, Baltimore, MD, USA
| | - Sarah M Horwitz
- Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York City, NY, USA
| | - Robert A Kowatch
- Department of Psychiatry, Nationwide Children's Hospital, Columbus, OH, USA
| | - Neal D Ryan
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Michael Strober
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Boris Birmaher
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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16
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Tan A, Ma W, Vira A, Marwha D, Eliot L. The human hippocampus is not sexually-dimorphic: Meta-analysis of structural MRI volumes. Neuroimage 2016; 124:350-366. [DOI: 10.1016/j.neuroimage.2015.08.050] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 08/20/2015] [Accepted: 08/22/2015] [Indexed: 12/31/2022] Open
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17
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Rockhill C. Telepsychiatry intervention is better for ADHD symptoms than usual treatment augmented by telemedicine consultation. EVIDENCE-BASED MENTAL HEALTH 2015; 18:e9. [PMID: 26429338 PMCID: PMC11234590 DOI: 10.1136/eb-2015-102151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 09/11/2015] [Accepted: 09/15/2015] [Indexed: 11/03/2022]
Affiliation(s)
- Carol Rockhill
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA;
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18
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Shang CY, Chiang HL, Gau SSF. A haplotype of the norepinephrine transporter gene (SLC6A2) is associated with visual memory in attention-deficit/hyperactivity disorder. Prog Neuropsychopharmacol Biol Psychiatry 2015; 58:89-96. [PMID: 25554436 DOI: 10.1016/j.pnpbp.2014.12.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 12/17/2014] [Accepted: 12/23/2014] [Indexed: 11/25/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a common heritable childhood-onset psychiatric disorder with impaired visual memory. Based on the evidence from treatment effect of atomoxetine, which interacts directly with the norepinephrine transporter, on visual memory in children with ADHD, this study examined the linkage disequilibrium structure of the norepinephrine transporter gene (SLC6A2) and the association between SLC6A2 and ADHD and visual memory, a promising endophenotype for ADHD. This family-based association sample consisted of 382 probands with DSM-IV ADHD and their family members (n=1298 in total) of Han Chinese in Taiwan. Visual memory was assessed by the Pattern Recognition Memory (PRM) and Spatial Recognition Memory (SRM) tasks of the Cambridge Neuropsychological Test Automated Battery (CANTAB). We screened 21 polymorphisms across SLC6A2 and used the Family-Based Association Test (FBAT) to test the associations of SLC6A2 polymorphisms with ADHD and the PRM and SRM measures. In haplotype analyses, a haplotype rs36011 (T)/rs1566652 (G) was significantly associated with ADHD (minimal p=0.045) after adjustment for multiple testing. In quantitative analyses, this TG haplotype also demonstrated significant associations with visual memory measures, including mean latency of correct responses in PRM (minimal p=0.019), total correct responses in PRM (minimal p=0.018), and total correct responses in SRM (minimal p=0.015). Our novel finding of the haplotype rs36011 (T)/rs1566652 (G) as a novel genetic marker involved in both ADHD disease susceptibility and visual memory suggests that allelic variations in SLC6A2 could provide insight into the pathways leading from genotype to phenotype of ADHD.
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Affiliation(s)
- Chi-Yung Shang
- Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
| | - Huey-Ling Chiang
- Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan; Department of Psychiatry, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Susan Shur-Fen Gau
- Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Brain and Mind Sciences and Clinical Medicine, National Taiwan University, Taipei, Taiwan.
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19
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Frías Á, Palma C, Farriols N. Comorbidity in pediatric bipolar disorder: prevalence, clinical impact, etiology and treatment. J Affect Disord 2015; 174:378-89. [PMID: 25545605 DOI: 10.1016/j.jad.2014.12.008] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 12/03/2014] [Accepted: 12/04/2014] [Indexed: 01/02/2023]
Abstract
BACKGROUND Research on pediatric bipolar disorder (PBD) is providing a plethora of empirical findings regarding its comorbidity. We addressed this question through a systematic review concerning the prevalence, clinical impact, etiology and treatment of main comorbid disorders involved. METHOD A comprehensive database search was performed from 1990 to August 2014. Overall, 167 studies fulfilled the inclusion criteria. RESULTS Bipolar youth tend to suffer from comorbid disorders, with highest weighted mean prevalence rate arising from anxiety disorders (54%), followed by attention deficit hyperactivity disorder (ADHD) (48%), disruptive behavior disorders (31%), and substance use disorders (SUD) (31%). Furthermore, evidence indicates that ADHD and anxiety disorders negatively affect the symptomatology, neurocognitive profile, clinical course and the global functioning of PBD. Likewise, several theories have been posited to explain comorbidity rates in PBD, specifically common risk factors, one disorder being a risk factor for the other and nosological artefacts. Lastly, randomized controlled trials highlight a stronger therapeutic response to stimulants and atomoxetine (vs. placebo) as adjunctive interventions for comorbid ADHD symptoms. In addition, research focused on the treatment of other comorbid disorders postulates some benefits from mood stabilizers and/or SGA. LIMITATIONS Epidemiologic follow-up studies are needed to avoid the risk of nosological artefacts. Likewise, more research is needed on pervasive developmental disorders and anxiety disorders, especially regarding their etiology and treatment. CONCLUSIONS Psychiatric comorbidity is highly prevalent and is associated with a deleterious clinical effect on pediatric bipolarity. Different etiological pathways may explain the presence of these comorbid disorders among bipolar youth. Standardized treatments are providing ongoing data regarding their effectiveness for these comorbidities among bipolar youth.
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Affiliation(s)
- Álvaro Frías
- FPCEE Blanquerna, University of Ramon-Llull, Císterst 34, 08022 Barcelona, Spain; Adult Outpatient Mental Health Center, Hospital of Mataró, Mataró, Spain.
| | - Cárol Palma
- FPCEE Blanquerna, University of Ramon-Llull, Císterst 34, 08022 Barcelona, Spain; Adult Outpatient Mental Health Center, Hospital of Mataró, Mataró, Spain
| | - Núria Farriols
- FPCEE Blanquerna, University of Ramon-Llull, Císterst 34, 08022 Barcelona, Spain; Adult Outpatient Mental Health Center, Hospital of Mataró, Mataró, Spain
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Da Fonseca D, Adida M, Belzeaux R, Azorin JM. Trouble déficitaire de l’attention et/ou trouble bipolaire ? Encephale 2014; 40 Suppl 3:S23-6. [DOI: 10.1016/s0013-7006(14)70127-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Rubia K, Alegria A, Brinson H. Imaging the ADHD brain: disorder-specificity, medication effects and clinical translation. Expert Rev Neurother 2014; 14:519-38. [PMID: 24738703 DOI: 10.1586/14737175.2014.907526] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A plethora of magnetic resonance imaging studies have shown that ADHD is characterized by multiple functional and structural neural network abnormalities beyond the classical fronto-striatal model, including fronto-parieto-temporal, fronto-cerebellar and even fronto-limbic networks. There is evidence for a maturational delay in brain structure development which likely extends to brain function and structural and functional connectivity, but this needs corroboration by longitudinal imaging studies. Dysfunction of the ventrolateral prefrontal cortex seems to be more pronounced relative to other pediatric disorders and is also the most consistent target of acute psychostimulant medication. Future studies are likely to focus on using neuroimaging for clinical translation such as for individual diagnostic and prognostic classification and as a neurotherapy to reverse brain function abnormalities.
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Affiliation(s)
- Katya Rubia
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, King's College London, London, UK
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Kelley R, Chang KD, Garrett A, Alegría D, Thompson P, Howe M, L Reiss A. Deformations of amygdala morphology in familial pediatric bipolar disorder. Bipolar Disord 2013; 15:795-802. [PMID: 24034354 DOI: 10.1111/bdi.12114] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Accepted: 03/29/2013] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Smaller amygdalar volumes have been consistently observed in pediatric bipolar disorder subjects compared to healthy control subjects. Whether smaller amygdalar volume is a consequence or antecedent of the first episode of mania is not known. Additionally, smaller volume has not been localized to specific amygdala subregions. METHODS We compared surface contour maps of the amygdala between 22 youths at high risk for bipolar disorder, 26 youths meeting full diagnostic criteria for pediatric familial bipolar disorder, and 24 healthy control subjects matched for age, gender, and intelligence quotient. Amygdalae were manually delineated on three-dimensional spoiled gradient echo images by a blinded rater using established tracing protocols. Statistical surface mesh modeling algorithms supported by permutation statistics were used to identify regional surface differences between the groups. RESULTS When compared to high-risk subjects and controls, youth with bipolar disorder showed surface deformations in specific amygdalar subregions, suggesting smaller volume of the basolateral nuclei. The high-risk subjects did not differ from controls in any subregion. CONCLUSIONS These findings support previous reports of smaller amygdala volume in pediatric bipolar disorder and map the location of abnormality to specific amygdala subregions. These subregions have been associated with fear conditioning and emotion-enhanced memory. The absence of amygdala size abnormalities in youth at high risk for bipolar disorder suggests that reductions might occur after the onset of mania.
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Affiliation(s)
- Ryan Kelley
- Center for Interdisciplinary Brain Sciences Research (CIBSR), Stanford University School of Medicine, Palo Alto, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, USA
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Caseras X, Lawrence NS, Murphy K, Wise RG, Phillips ML. Ventral striatum activity in response to reward: differences between bipolar I and II disorders. Am J Psychiatry 2013; 170:533-41. [PMID: 23558337 PMCID: PMC3640293 DOI: 10.1176/appi.ajp.2012.12020169] [Citation(s) in RCA: 137] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Revised: 05/31/2012] [Accepted: 10/09/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Little is known about the neurobiology of bipolar II disorder. While bipolar I disorder is associated with abnormally elevated activity in response to reward in the ventral striatum, a key component of reward circuitry, no studies have compared reward circuitry function in bipolar I and bipolar II disorders. Furthermore, associations among reward circuitry activity, reward sensitivity, and striatal volume remain underexplored in bipolar and healthy individuals. The authors examined reward activity in the ventral striatum in participants with bipolar I and II disorders and healthy individuals, the relationships between ventral striatal activity and reward sensitivity across all participants, and between-group differences in striatal gray matter volume and relationships with ventral striatal activity across all participants. METHOD Twenty healthy comparison subjects and 32 euthymic bipolar I (N=17) and bipolar II (N=15) patients underwent a neuroimaging reward paradigm during functional MRI scanning, structural scanning, and completed psychometric and clinical assessments. RESULTS Region-of-interest analyses revealed significant ventral striatal activity in all participants during reward anticipation that was significantly greater in bipolar II patients compared with the other groups. Ventral striatal activity during reward anticipation correlated positively with reward sensitivity and fun seeking across all participants. Bipolar II patients had significantly greater left putamen volume than bipolar I patients, and left putamen volume correlated positively with left ventral striatal activity to reward anticipation in all participants. CONCLUSIONS Abnormally elevated ventral striatal activity during reward anticipation may be a potential biomarker of bipolar II disorder. These findings highlight the importance of adopting a dimensional approach in the study of neural mechanisms supporting key pathophysiological processes that may cut across psychiatric disorders.
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Affiliation(s)
- Xavier Caseras
- MRC Center for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, UK.
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Skirrow C, Hosang GM, Farmer AE, Asherson P. An update on the debated association between ADHD and bipolar disorder across the lifespan. J Affect Disord 2012; 141:143-59. [PMID: 22633181 DOI: 10.1016/j.jad.2012.04.003] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Revised: 04/05/2012] [Accepted: 04/05/2012] [Indexed: 12/12/2022]
Abstract
Diagnostic formulations for attention deficit hyperactivity disorder (ADHD) and bipolar disorder (BD) both include symptoms of distractibility, psychomotor agitation and talkativeness, alongside associated emotional features (irritability and emotional lability). Treatment studies suggest the importance of accurate delineation of ADHD and BD. However, boundaries between the two disorders are blurred by the introduction of broader conceptualisations of BD. This review attempts to elucidate whether associations between ADHD and BD are likely to be driven by superficial symptomatological similarities or by a more meaningful etiological relationship between the disorders. This is achieved by outlining findings on comorbidity, temporal progression of the disorders, familial co-variation, and neurobiology in ADHD and BD across the lifespan. Longitudinal studies fail to consistently show developmental trajectories between ADHD and BD. Comparative research investigating neurobiology is in its infancy, and although some similarities are seen between ADHD and BD, studies also emphasise differences between the two disorders. However, comorbidity and family studies appear to show that the two disorders occur together and aggregate in families at higher than expected rates. Furthermore close inspection of results from population studies reveals heightened co-occurrence of ADHD and BD even in the context of high comorbidity commonly noted in psychopathology. These results point towards a meaningful association between ADHD and BD, going beyond symptomatic similarities. However, future research needs to account for heterogeneity of BD, making clear distinctions between classical episodic forms of BD, and broader conceptualisations of the disorder characterised by irritability and emotional lability, when evaluating the relationship with ADHD.
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Affiliation(s)
- Caroline Skirrow
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, United Kingdom.
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Shang CY, Gau SSF. Improving visual memory, attention, and school function with atomoxetine in boys with attention-deficit/hyperactivity disorder. J Child Adolesc Psychopharmacol 2012; 22:353-63. [PMID: 23083022 DOI: 10.1089/cap.2011.0149] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Atomoxetine is efficacious in reducing symptoms of attention- deficit/hyperactivity disorder (ADHD), but its effect on visual memory and attention needs more investigation. This study aimed to assess the effect of atomoxetine on visual memory, attention, and school function in boys with ADHD in Taiwan. METHOD This was an open-label 12 week atomoxetine treatment trial among 30 drug-naíve boys with ADHD, aged 8-16 years. Before administration of atomoxetine, the participants were assessed using psychiatric interviews, the Wechsler Intelligence Scale for Children, 3rd edition (WISC-III), the school function of the Chinese version of the Social Adjustment Inventory for Children and Adolescents (SAICA), the Conners' Continuous Performance Test (CPT), and the tasks of the Cambridge Neuropsychological Test Automated Battery (CANTAB) involving visual memory and attention: Pattern Recognition Memory, Spatial Recognition Memory, and Reaction Time, which were reassessed at weeks 4 and 12. RESULTS Our results showed there was significant improvement in pattern recognition memory and spatial recognition memory as measured by the CANTAB tasks, sustained attention and response inhibition as measured by the CPT, and reaction time as measured by the CANTAB after treatment with atomoxetine for 4 weeks or 12 weeks. In addition, atomoxetine significantly enhanced school functioning in children with ADHD. CONCLUSION Our findings suggested that atomoxetine was associated with significant improvement in visual memory, attention, and school functioning in boys with ADHD.
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Affiliation(s)
- Chi-Yung Shang
- Department of Psychiatry, National Taiwan University Hospital & College of Medicine, National Taiwan University, Taipei, Taiwan
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Jogia J, Dima D, Frangou S. Sex differences in bipolar disorder: a review of neuroimaging findings and new evidence. Bipolar Disord 2012; 14:461-71. [PMID: 22631625 DOI: 10.1111/j.1399-5618.2012.01014.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVES The sex of an individual is known to modulate the clinical presentation of bipolar disorder (BD), but little is known as to whether there are significant sex-by-diagnosis interactions on the brain structural and functional correlates of BD. METHODS We conducted a literature review of magnetic resonance imaging (MRI) studies in BD, published between January 1990 and December 2010, reporting on the effects of sex and diagnosis. In the absence of any functional MRI (fMRI) studies, this review was supplemented by original data analyses focusing on sex-by-diagnosis interactions on patterns of brain activation obtained during tasks of working memory, incentive decision-making, and facial affect processing. RESULTS We found no support for a sex-by-diagnosis interaction in global gray or white matter volume. Evidence regarding regional volumetric measures is limited, but points to complex interactions between sex and diagnosis with developmental and temperamental factors within limbic and prefrontal regions. Sex-by-diagnosis interactions were noted in the pattern of activation within the basal ganglia during incentive decision-making and within ventral prefrontal regions during facial affect processing. CONCLUSIONS Potential sex-by-diagnosis interactions influencing the brain structural and functional correlates of disease expression in BD have received limited attention. Our data suggest that the sex of an individual modulates structure and function within subcortical and cortical regions implicated in disease expression.
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Affiliation(s)
- Jigar Jogia
- Department of Psychosis Studies, Section of Neurobiology of Psychosis, Institute of Psychiatry, King's College London, London, UK
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27
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Abstract
OBJECTIVE Recent theories regarding the neuropathology of bipolar disorder suggest that both neurodevelopmental and neurodegenerative processes may play a role. While magnetic resonance imaging has provided significant insight into the structural, functional, and connectivity abnormalities associated with bipolar disorder, research assessing longitudinal changes has been more limited. However, such research is essential to elucidate the pathophysiology of the disorder. The aim of our review is to examine the extant literature for developmental and progressive structural and functional changes in individuals with and at risk for bipolar disorder. METHODS We conducted a literature review using MEDLINE and the following search terms: bipolar disorder, risk, child, adolescent, bipolar offspring, MRI, fMRI, DTI, PET, SPECT, cross-sectional, longitudinal, progressive, and developmental. Further relevant articles were identified by cross-referencing with identified manuscripts. CONCLUSIONS There is some evidence for developmental and progressive neurophysiological alterations in bipolar disorder, but the interpretation of correlations between neuroimaging findings and measures of illness exposure or age in cross-sectional studies must be performed with care. Prospective longitudinal studies placed in the context of normative developmental and atrophic changes in neural structures and pathways thought to be involved in bipolar disorder are needed to improve our understanding of the neurodevelopmental underpinnings and progressive changes associated with bipolar disorder.
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Affiliation(s)
- Marguerite Reid Schneider
- Physician Scientist Training Program, Neuroscience Graduate Program Department, University of Cincinnati College of Medicine, Cincinnati, OH 45219-0516, USA
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Hafeman DM, Chang KD, Garrett AS, Sanders EM, Phillips ML. Effects of medication on neuroimaging findings in bipolar disorder: an updated review. Bipolar Disord 2012; 14:375-410. [PMID: 22631621 DOI: 10.1111/j.1399-5618.2012.01023.x] [Citation(s) in RCA: 258] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Neuroimaging is an important tool for better understanding the neurobiological underpinnings of bipolar disorder (BD). However, potential study participants are often receiving psychotropic medications which can possibly confound imaging data. To better interpret the results of neuroimaging studies in BD, it is important to understand the impact of medications on structural magnetic resonance imaging (sMRI), functional MRI (fMRI), and diffusion tensor imaging (DTI). METHODS To better understand the impact of medications on imaging data, we conducted a literature review and searched MEDLINE for papers that included the key words bipolar disorder and fMRI, sMRI, or DTI. The search was limited to papers that assessed medication effects and had not been included in a previous review by Phillips et al. (Medication effects in neuroimaging studies of bipolar disorder. Am J Psychiatry 2008; 165: 313-320). This search yielded 74 sMRI studies, 46 fMRI studies, and 15 DTI studies. RESULTS Medication appeared to influence many sMRI studies, but had limited impact on fMRI and DTI findings. From the structural studies, the most robust finding (20/45 studies) was that lithium was associated with increased volumes in areas important for mood regulation, while antipsychotic agents and anticonvulsants were generally not. Regarding secondary analysis of the medication effects of fMRI and DTI studies, few showed significant effects of medication, although rigorous analyses were typically not possible when the majority of subjects were medicated. Medication effects were more frequently observed in longitudinal studies designed to assess the impact of particular medications on the blood oxygen level-dependent (BOLD) signal. With a few exceptions, the observed effects were normalizing, meaning that the medicated individuals with BD were more similar than their unmedicated counterparts to healthy subjects. CONCLUSIONS The effects of psychotropic medications, when present, are predominantly normalizing and thus do not seem to provide an alternative explanation for differences in volume, white matter tracts, or BOLD signal between BD participants and healthy subjects. However, the normalizing effects of medication could obfuscate differences between BD and healthy subjects, and thus might lead to type II errors.
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Affiliation(s)
- Danella M Hafeman
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
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Brown A, Biederman J, Valera E, Lomedico A, Aleardi M, Makris N, Seidman LJ. Working memory network alterations and associated symptoms in adults with ADHD and Bipolar Disorder. J Psychiatr Res 2012; 46:476-83. [PMID: 22272986 PMCID: PMC3686289 DOI: 10.1016/j.jpsychires.2012.01.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Accepted: 01/05/2012] [Indexed: 11/20/2022]
Abstract
Attention-Deficit/Hyperactivity Disorder (ADHD) and Bipolar Disorder (BPD) co-occur frequently and represent a particularly morbid clinical form of both disorders, however underlying neural circuitry contributing to the comorbidity remain understudied. Our aim was to investigate functional brain circuitry during working memory in a group of participants who meet criteria for both disorders (ADHD + BPD), and to explore the relationship of symptoms of each disorder to brain function. We used fMRI to image brain activity in 18 male adults with both ADHD and BPD, and 18 healthy control participants matched one-to-one on age, sex, and handedness, while they performed a sequential letter N-back task. We investigated differences in activation between these groups, and also correlations of brain activity during the task to symptoms of ADHD and BPD independently. We found significant hypoactivity in the subjects with ADHD + BPD vs. controls across frontal and parietal regions, and further, found that BPD and ADHD symptoms related to activity in anatomically distinct regions that were respectively characterized by activation and suppression during task. We conclude that comorbid ADHD + BPD is associated with alterations across anterior and posterior nodes of the working memory network, and symptoms of each disorder are related to anatomically and functionally distinct brain regions.
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Affiliation(s)
- Ariel Brown
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
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30
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Frodl T, Skokauskas N. Meta-analysis of structural MRI studies in children and adults with attention deficit hyperactivity disorder indicates treatment effects. Acta Psychiatr Scand 2012; 125:114-26. [PMID: 22118249 DOI: 10.1111/j.1600-0447.2011.01786.x] [Citation(s) in RCA: 340] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE About 50-80% of ADHD cases have been found to persist into adulthood, but ADHD symptoms change with age. The aim of this study was to perform a meta-analysis of MRI voxel-based morphometry (VBM) and manual tracing studies to identify the differences between adults and children with ADHD as well as between treated and untreated individuals. METHOD Several databases were searched using keywords 'attention-deficit and MRI', 'ADHD and MRI'. Gray matter volumes from VBM studies and caudate volumes from tracing studies of patients and controls were analyzed using signed differential mapping. RESULTS Meta-analyses detected reduced right globus pallidus and putamen volumes in VBM studies as well as decreased caudate volumes in manual tracing studies in children with ADHD. Adult patients with ADHD showed volume reduction in the anterior cingulate cortex (ACC). A higher percentage of treated participants were associated with less changes. CONCLUSION Basal ganglia regions like the right globus pallidus, the right putamen, and the nucleus caudatus are structurally affected in children with ADHD. These changes and alterations in limbic regions like ACC and amygdala are more pronounced in non-treated populations and seem to diminish over time from child to adulthood. Treatment seems to have positive effects on brain structure.
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Affiliation(s)
- T Frodl
- Department of Psychiatry, Trinity College Dublin, Ireland.
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Shang CY, Gau SS. Visual memory as a potential cognitive endophenotype of attention deficit hyperactivity disorder. Psychol Med 2011; 41:2603-2614. [PMID: 21733210 DOI: 10.1017/s0033291711000857] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Executive functions have been proposed as endophenotypes for attention deficit hyperactivity disorder (ADHD); however, data regarding visual memory are lacking. We therefore assessed visual memory in adolescents with ADHD and their unaffected siblings compared with controls. METHOD The participants included 279 adolescents with ADHD, 108 unaffected siblings, and 173 unaffected school controls. They were assessed by using the visual memory tasks of the Cambridge Neuropsychological Test Automated Battery (CANTAB): Delayed Matching to Sample (DMS), Spatial Recognition Memory (SRM), Paired Associates Learning (PAL), and Pattern Recognition Memory (PRM). RESULTS Compared with the controls, probands with ADHD had a significantly lower number of correct responses, a higher probability of an error following a correct response and following an error response in the DMS, and a lower percentage of correct responses in the SRM. Their unaffected siblings occupied an intermediate position between ADHD probands and controls in the probability of an error following a correct response and following an error response in the DMS, and in the percentage of correct responses in the SRM. In general, lower IQ and current use of and duration of treatment with methylphenidate were associated with more severe visual memory deficits. CONCLUSIONS The present results suggest that ADHD is associated with poorer visual memory function. Visual memory assessed by the DMS and SRM tasks in the CANTAB may be a useful endophenotype for ADHD.
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Affiliation(s)
- C Y Shang
- Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
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Liu IY, Howe M, Garrett A, Karchemskiy A, Kelley R, Alegria D, Reiss A, Chang K. Striatal volumes in pediatric bipolar patients with and without comorbid ADHD. Psychiatry Res 2011; 194:14-20. [PMID: 21875781 PMCID: PMC5741181 DOI: 10.1016/j.pscychresns.2011.06.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Revised: 06/13/2011] [Accepted: 06/14/2011] [Indexed: 02/05/2023]
Abstract
The most prevalent comorbid disorder in pediatric bipolar disorder (BD) is attention-deficit/hyperactivity disorder (ADHD). As caudate volume abnormalities have been demonstrated in both BD and ADHD, this study sought to determine whether these findings could be attributed to separable effects from either diagnosis. High resolution anatomical magnetic resonance (MRI) images were obtained from youth in 4 groups: BD with comorbid ADHD (n=17), BD without comorbid ADHD (n=12), youth with ADHD alone (n=11), and healthy control subjects (n=24). Caudate, putamen, and globus pallidus volumes were manually traced for each subject using BrainImageJava software by a reliable rater blinded to diagnosis. There was a significant effect of diagnosis on striatal volumes, with ADHD associated with decreased caudate and putamen volumes, and BD associated with increased caudate, putamen, and globus pallidus volumes. Thus, the presence or absence of comorbid ADHD in patients with BD was associated with distinct alterations in caudate volumes, suggesting that these groups have different, but related, mechanisms of neuropathology.
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Affiliation(s)
| | - Meghan Howe
- Pediatric Bipolar Disorders Program, Stanford University School of Medicine, Stanford, CA
| | - Amy Garrett
- Pediatric Bipolar Disorders Program, Stanford University School of Medicine, Stanford, CA,Center for Interdisciplinary Brain Sciences Research, Stanford University, Stanford, CA
| | - Asya Karchemskiy
- Pediatric Bipolar Disorders Program, Stanford University School of Medicine, Stanford, CA
| | - Ryan Kelley
- Pediatric Bipolar Disorders Program, Stanford University School of Medicine, Stanford, CA,Center for Interdisciplinary Brain Sciences Research, Stanford University, Stanford, CA
| | - Dylan Alegria
- Pediatric Bipolar Disorders Program, Stanford University School of Medicine, Stanford, CA
| | - Allan Reiss
- Pediatric Bipolar Disorders Program, Stanford University School of Medicine, Stanford, CA,Center for Interdisciplinary Brain Sciences Research, Stanford University, Stanford, CA
| | - Kiki Chang
- Pediatric Bipolar Disorders Program, Stanford University School of Medicine, Stanford, CA,Corresponding author: Kiki Chang, M.D. 401 Quarry Rd, MC 5719, Stanford, CA 94305, , Tel: (650) 723-5511, Fax: (650) 723-5531
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Donfrancesco R, Miano S, Martines F, Ferrante L, Melegari MG, Masi G. Bipolar disorder co-morbidity in children with attention deficit hyperactivity disorder. Psychiatry Res 2011; 186:333-7. [PMID: 20692046 DOI: 10.1016/j.psychres.2010.07.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2010] [Revised: 07/05/2010] [Accepted: 07/08/2010] [Indexed: 11/30/2022]
Abstract
The present study aimed at: (1) exploring rate and clinical features of superimposed bipolar disorder (BD) in Italian children with attention deficit hyperactivity disorder (ADHD), compared with a community sample, matched for age and gender; (2) exploring predictors of BD in ADHD children, by comparing ADHD children with or without superimposed BD. We studied 173 consecutive drug-naïve outpatients with ADHD (156 males and 17 females, mean age of 9.2 ± 2.3years, age range 6-17.5 years), diagnosed with a clinical interview (Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL)); the control group consisted of a community-based sample of 100 healthy children. The rate of children with a diagnosis of BD was higher in the ADHD group (29/173, 16.7%) compared with controls (1/100, 1%), (P<0.001). Among the 29 children with ADHD+BD, 16 (55.2%) had a Bipolar Disorder-Not Otherwise Specified (BD-NOS), and 11 (37.9%) showed ultrarapid cycling. Compared with children with ADHD without BD, they showed a higher rate of combined sub-type (21/29, 72.4%), a higher score at ADHD-Rating Scale (total score and hyperactivity subscale), higher rates of major depression, oppositional defiant disorder and conduct disorder. In summary, children with ADHD present a higher risk for developing a superimposed BD. The identification of clinical features with an increased risk of BD can improve diagnosis, prognosis and treatments.
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Lopez-Larson M, Breeze JL, Kennedy DN, Hodge SM, Tang L, Moore C, Giuliano AJ, Makris N, Caviness VS, Frazier JA. Age-related changes in the corpus callosum in early-onset bipolar disorder assessed using volumetric and cross-sectional measurements. Brain Imaging Behav 2011; 4:220-31. [PMID: 20686873 DOI: 10.1007/s11682-010-9101-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Corpus callosum (CC) area abnormalities have been reported in magnetic resonance imaging (MRI) studies of adults and youths with bipolar disorder (BPD), suggesting interhemispheric communication may be abnormal in BPD and may be present early in the course of illness and affect normal neuromaturation of this structure throughout the lifecycle. Neuroimaging scans from 44 youths with DSM-IV BPD and 22 healthy controls (HC) were analyzed using cross-sectional area measurements and a novel method of volumetric parcellation. Univariate analyses of variance were conducted on CC subregions using both volume and traditional area measurements. Youths with BPD had smaller middle and posterior callosal regions, and reduced typical age-related increases in CC size. The cross-sectional area and novel volumetric methodologies resulted in similar findings. Future longitudinal assessments of CC development would track the evolution of callosal abnormalities in youths with BPD and allow exploration of the functional significance of these findings.
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Dickstein D. The diagnostic dilemma: why we need to change how we diagnose bipolar disorder in children. CEREBRUM : THE DANA FORUM ON BRAIN SCIENCE 2010; 2010:23. [PMID: 23447768 PMCID: PMC3574781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Bipolar disorder diagnosis has been rising dramatically in children for the past decade. In response to this increase, writes Daniel Dickstein, M.D., of Bradley Hospital and Brown University, researchers at the National Institute of Mental Health and elsewhere are reviewing the diagnostic criteria. In coming years, Dickstein argues, recognizing and diagnosing bipolar disorder in children should be based more on biological markers, such as brain structure and the use of neural circuits, than on the inconsistent diagnostic categories laid out in the Diagnostic and Statistical Manual of Mental Disorders.
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Dickstein DP, Finger EC, Skup M, Pine DS, Blair JR, Leibenluft E. Altered neural function in pediatric bipolar disorder during reversal learning. Bipolar Disord 2010; 12:707-19. [PMID: 21040288 PMCID: PMC3391027 DOI: 10.1111/j.1399-5618.2010.00863.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Data documenting the functional impairment associated with the diagnosis of bipolar disorder (BD) in children and adolescents highlight the need for greater understanding of its pathophysiology. Toward that end, we demonstrated previously that BD youth have behavioral deficits on reversal learning tasks. On such tasks, participants must first acquire a stimulus/response relationship through trial-and-error learning, and then discern when the stimulus/reward relationship reverses. Here, we use event-related functional magnetic resonance imaging (fMRI) to elucidate neural correlates of reversal learning deficits in euthymic BD youth compared to typically developing controls. METHOD We compared euthymic pediatric BD participants (n = 16) versus age-, sex-, and IQ-matched controls (n = 16). Our main outcome measure was blood oxygen level-dependent (BOLD) signal measured with fMRI during an event-related probabilistic reversal task. RESULTS Pediatric BD participants had significantly greater neural activity than controls in fronto-parietal regions during the reversal phase, particularly in response to punished reversal errors (p < 0.05 corrected for multiple comparisons). CONCLUSIONS Our current study suggests that during reversal learning, BD youths inefficiently recruit regions associated with processing response conflict and implementing alternative responses, including subdivisions of the frontal cortex and the parietal cortex. Such deficits are present in euthymic BD youth. Further work is necessary to evaluate the specificity of such alterations.
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Affiliation(s)
- Daniel P Dickstein
- Mood and Anxiety Disorders Program, National Institute of Mental Health, Bethesda, MD 20892, USA.
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Fronto-temporal spontaneous resting state functional connectivity in pediatric bipolar disorder. Biol Psychiatry 2010; 68:839-46. [PMID: 20739018 PMCID: PMC2955843 DOI: 10.1016/j.biopsych.2010.06.029] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2009] [Revised: 06/28/2010] [Accepted: 06/28/2010] [Indexed: 12/22/2022]
Abstract
BACKGROUND The recent upsurge in interest about pediatric bipolar disorder (BD) has spurred the need for greater understanding of its neurobiology. Structural and functional magnetic resonance imaging studies have implicated fronto-temporal dysfunction in pediatric BD. However, recent data suggest that task-dependent neural changes account for a small fraction of the brain's energy consumption. We now report the first use of task-independent spontaneous resting state functional connectivity (RSFC) to study the neural underpinnings of pediatric BD. METHODS We acquired task-independent RSFC blood oxygen level-dependent functional magnetic resonance imaging scans while participants were at rest and also a high-resolution anatomical image (both at three Tesla) in BD and control youths (n = 15 of each). We focused, on the basis of prior research, on the left dorsolateral prefrontal cortex (DLPFC), amygdala, and accumbens. Image processing and group-level analyses followed that of prior work. RESULTS Our primary analysis showed that pediatric BD participants had significantly greater negative RSFC between the left DLPFC and the right superior temporal gyrus versus control subjects. Secondary analyses using partial correlation showed that BD and control youths had opposite phase relationships between spontaneous RSFC fluctuations in the left DLPFC and right superior temporal gyrus. CONCLUSIONS Our data indicate that pediatric BD is characterized by altered task-independent functional connectivity in a fronto-temporal circuit that is also implicated in working memory and learning. Further study is warranted to determine the effects of age, gender, development, and treatment on this circuit in pediatric BD.
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Walshaw PD, Alloy LB, Sabb FW. Executive function in pediatric bipolar disorder and attention-deficit hyperactivity disorder: in search of distinct phenotypic profiles. Neuropsychol Rev 2010; 20:103-20. [PMID: 20165924 PMCID: PMC2834768 DOI: 10.1007/s11065-009-9126-x] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2009] [Accepted: 12/21/2009] [Indexed: 01/18/2023]
Abstract
Often, there is diagnostic confusion between bipolar disorder (BD) and attention-deficit hyperactivity disorder (ADHD) in youth due to similar behavioral presentations. Both disorders have been implicated as having abnormal functioning in the prefrontal cortex; however, there may be subtle differences in the manner in which the prefrontal cortex functions in each disorder that could assist in their differentiation. Executive function is a construct thought to be a behavioral analogy to prefrontal cortex functioning. We provide a qualitative review of the literature on performance on executive function tasks for BD and ADHD in order to determine differences in task performance and neurocognitive profile. Our review found primary differences in executive function in the areas of interference control, working memory, planning, cognitive flexibility, and fluency. These differences may begin to establish a pediatric BD profile that provides a more objective means of differential diagnosis between BD and ADHD when they are not reliably distinguished by clinical diagnostic methods.
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Affiliation(s)
- Patricia D Walshaw
- Department of Psychiatry and Biobehavioral Science, University of California Los Angeles, Los Angeles, CA, USA.
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Besnier N. Trouble bipolaire et trouble déficit d’attention avec hyperactivité. ANNALES MEDICO-PSYCHOLOGIQUES 2009. [DOI: 10.1016/j.amp.2009.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Schreibman Cohen A, Daley M, Siddarth P, Levitt J, Loesch IK, Altshuler L, Ly R, Shields WD, Gurbani S, Caplan R. Amygdala volumes in childhood absence epilepsy. Epilepsy Behav 2009; 16:436-41. [PMID: 19766541 DOI: 10.1016/j.yebeh.2009.08.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2009] [Revised: 07/11/2009] [Accepted: 08/10/2009] [Indexed: 02/03/2023]
Abstract
Abnormal amygdala volumes in pediatric mood-anxiety disorders and attention deficit hyperactivity disorder (ADHD), as well as high rates of these diagnoses in childhood absence epilepsy (CAE), prompted this study of amygdala volume in CAE. Twenty-six children with CAE and 23 normal children, aged 6.6-15.8 years, underwent MRI at 1.5 T. The tissue imaged with MRI was segmented, and amygdala volumes were obtained by manual tracings. There were no significant amygdala volume differences between the CAE and normal groups. Within the CAE group, however, the children with ADHD had significantly smaller amygdala volumes than the subjects with CAE with no psychopathology and those with mood/anxiety diagnoses. There was also a significant relationship between higher seizure frequency and greater amygdala asymmetry in the epilepsy group. Given ongoing development of the amygdala during late childhood and adolescence, despite the lack of significant group differences in amygdala volumes, the association of amygdala volume abnormalities with ADHD and seizure frequency implies a possible impact of the disorder on amygdala development and CAE-associated comorbidities, such as ADHD.
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Affiliation(s)
- Ayelet Schreibman Cohen
- Department of Psychiatry, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
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Volkow ND, Wang GJ, Kollins SH, Wigal TL, Newcorn JH, Telang F, Fowler JS, Zhu W, Logan J, Ma Y, Pradhan K, Wong C, Swanson JM. Evaluating dopamine reward pathway in ADHD: clinical implications. JAMA 2009; 302:1084-91. [PMID: 19738093 PMCID: PMC2958516 DOI: 10.1001/jama.2009.1308] [Citation(s) in RCA: 398] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
CONTEXT Attention-deficit/hyperactivity disorder (ADHD)--characterized by symptoms of inattention and hyperactivity-impulsivity--is the most prevalent childhood psychiatric disorder that frequently persists into adulthood, and there is increasing evidence of reward-motivation deficits in this disorder. OBJECTIVE To evaluate biological bases that might underlie a reward/motivation deficit by imaging key components of the brain dopamine reward pathway (mesoaccumbens). DESIGN, SETTING, AND PARTICIPANTS We used positron emission tomography to measure dopamine synaptic markers (transporters and D(2)/D(3) receptors) in 53 nonmedicated adults with ADHD and 44 healthy controls between 2001-2009 at Brookhaven National Laboratory. MAIN OUTCOME MEASURES We measured specific binding of positron emission tomographic radioligands for dopamine transporters (DAT) using [(11)C]cocaine and for D(2)/D(3) receptors using [(11)C]raclopride, quantified as binding potential (distribution volume ratio -1). RESULTS For both ligands, statistical parametric mapping showed that specific binding was lower in ADHD than in controls (threshold for significance set at P < .005) in regions of the dopamine reward pathway in the left side of the brain. Region-of-interest analyses corroborated these findings. The mean (95% confidence interval [CI] of mean difference) for DAT in the nucleus accumbens for controls was 0.71 vs 0.63 for those with ADHD (95% CI, 0.03-0.13, P = .004) and in the midbrain for controls was 0.16 vs 0.09 for those with ADHD (95% CI, 0.03-0.12; P < or = .001); for D(2)/D(3) receptors, the mean accumbens for controls was 2.85 vs 2.68 for those with ADHD (95% CI, 0.06-0.30, P = .004); and in the midbrain, it was for controls 0.28 vs 0.18 for those with ADHD (95% CI, 0.02-0.17, P = .01). The analysis also corroborated differences in the left caudate: the mean DAT for controls was 0.66 vs 0.53 for those with ADHD (95% CI, 0.04-0.22; P = .003) and the mean D(2)/D(3) for controls was 2.80 vs 2.47 for those with ADHD (95% CI, 0.10-0.56; P = .005) and differences in D(2)/D(3) in the hypothalamic region, with controls having a mean of 0.12 vs 0.05 for those with ADHD (95% CI, 0.02-0.12; P = .004). Ratings of attention correlated with D(2)/D(3) in the accumbens (r = 0.35; 95% CI, 0.15-0.52; P = .001), midbrain (r = 0.35; 95% CI, 0.14-0.52; P = .001), caudate (r = 0.32; 95% CI, 0.11-0.50; P = .003), and hypothalamic (r = 0.31; CI, 0.10-0.49; P = .003) regions and with DAT in the midbrain (r = 0.37; 95% CI, 0.16-0.53; P < or = .001). CONCLUSION A reduction in dopamine synaptic markers associated with symptoms of inattention was shown in the dopamine reward pathway of participants with ADHD.
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Affiliation(s)
- Nora D Volkow
- National Institute on Drug Abuse, 6001 Executive Blvd, Room 5274, MSC 9581, Bethesda, MD 20892, USA.
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Dickstein DP, Finger EC, Skup M, Pine DS, Blair JR, Leibenluft E, Leibenluft E. Neural activation during encoding of emotional faces in pediatric bipolar disorder. Bipolar Disord 2007; 9:679-92. [PMID: 17988357 PMCID: PMC2946159 DOI: 10.1111/j.1399-5618.2007.00418.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Neurobiological understanding of bipolar disorder (BD) is limited by a paucity of functional magnetic resonance imaging (fMRI) research examining correlates of psychological processes. To begin to address these limitations, the current study tests the hypothesis that pediatric BD (PBD) subjects exhibit altered neural activation during encoding of emotional faces compared to typically developing controls. METHODS Pediatric BD subjects (n=23; mean age=14.2+/-3.1 years) and controls (n=22; mean age=14.7+/-2.3 years) were matched on age, gender, and IQ. In this event-related fMRI study, subjects were scanned while viewing emotional faces and given a surprise recognition memory test 30 min postscan. Our main outcome measure was between-group differences in neural activation during successful versus unsuccessful face encoding. RESULTS Pediatric BD youth exhibited reduced memory for emotional faces, relative to healthy comparisons, particularly on fearful faces. Event-related fMRI analyses controlling for this behavioral difference showed that PBD subjects, compared to controls, had increased neural activation in the striatum and anterior cingulate cortex when successfully encoding happy faces and in the orbitofrontal cortex when successfully encoding angry faces. There were no between-group differences in neural activation during fearful face encoding. CONCLUSIONS Our results extend what is known about memory and face emotion processing impairments in PBD subjects by showing increased fronto-striatal activation during encoding of emotional faces. Further work is required to determine the impact of mood state, medication, and comorbid illnesses on these findings.
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Affiliation(s)
- Daniel P Dickstein
- Division of Intramural Research Program, National Institute of Mental Health, Pediatrics and Developmental Neuropsychiatry Branch, Bethesda, MD 20892-2670, USA.
| | - Elizabeth C Finger
- Mood and Anxiety Disorders Program, National Institute of Mental Health, Bethesda, MD,Department of Clinical Neurological Sciences, University of Western Ontario, London, Ontario, Canada
| | - Martha Skup
- Mood and Anxiety Disorders Program, National Institute of Mental Health, Bethesda, MD,Biostatistics Program, Yale University, New Haven, CT, USA
| | - Daniel S Pine
- Mood and Anxiety Disorders Program, National Institute of Mental Health, Bethesda, MD
| | - James R Blair
- Mood and Anxiety Disorders Program, National Institute of Mental Health, Bethesda, MD
| | - Ellen Leibenluft
- Mood and Anxiety Disorders Program, National Institute of Mental Health, Bethesda, MD
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