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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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Jiang W, Ding S, Xu C, Ke H, Bo H, Zhao T, Ma L, Li H. Discovering the neuronal dynamics in major depressive disorder using Hidden Markov Model. Front Hum Neurosci 2023; 17:1197613. [PMID: 37457501 PMCID: PMC10340116 DOI: 10.3389/fnhum.2023.1197613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/16/2023] [Indexed: 07/18/2023] Open
Abstract
Introduction Major Depressive Disorder (MDD) is a leading cause of worldwide disability, and standard clinical treatments have limitations due to the absence of neurological evidence. Electroencephalography (EEG) monitoring is an effective method for recording neural activities and can provide electroneurophysiological evidence of MDD. Methods In this work, we proposed a probabilistic graphical model for neural dynamics decoding on MDD patients and healthy controls (HC), utilizing the Hidden Markov Model with Multivariate Autoregressive observation (HMM-MAR). We testified the model on the MODMA dataset, which contains resting-state and task-state EEG data from 53 participants, including 24 individuals with MDD and 29 HC. Results The experimental results suggest that the state time courses generated by the proposed model could regress the Patient Health Questionnaire-9 (PHQ-9) score of the participants and reveal differences between the MDD and HC groups. Meanwhile, the Markov property was observed in the neuronal dynamics of participants presented with sad face stimuli. Coherence analysis and power spectrum estimation demonstrate consistent results with the previous studies on MDD. Discussion In conclusion, the proposed HMM-MAR model has revealed its potential capability to capture the neuronal dynamics from EEG signals and interpret brain disease pathogenesis from the perspective of state transition. Compared with the previous machine-learning or deep-learning-based studies, which regarded the decoding model as a black box, this work has its superiority in the spatiotemporal pattern interpretability by utilizing the Hidden Markov Model.
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Affiliation(s)
- Wenhao Jiang
- Faculty of Computing, Harbin Institute of Technology, Harbin, China
| | - Shihang Ding
- Faculty of Computing, Harbin Institute of Technology, Harbin, China
| | - Cong Xu
- Faculty of Computing, Harbin Institute of Technology, Harbin, China
| | - Huihuang Ke
- Faculty of Computing, Harbin Institute of Technology, Harbin, China
| | - Hongjian Bo
- Shenzhen Academy of Aerospace Technology, Shenzhen, China
| | - Tiejun Zhao
- Faculty of Computing, Harbin Institute of Technology, Harbin, China
| | - Lin Ma
- Faculty of Computing, Harbin Institute of Technology, Harbin, China
| | - Haifeng Li
- Faculty of Computing, Harbin Institute of Technology, Harbin, China
- Shenzhen Academy of Aerospace Technology, Shenzhen, China
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Holmes SE, Asch RH, Davis MT, DellaGioia N, Pashankar N, Gallezot JD, Nabulsi N, Matuskey D, Sanacora G, Carson RE, Blumberg HP, Esterlis I. Differences in Quantification of the Metabotropic Glutamate Receptor 5 Across Bipolar Disorder and Major Depressive Disorder. Biol Psychiatry 2023; 93:1099-1107. [PMID: 36764853 PMCID: PMC10164841 DOI: 10.1016/j.biopsych.2022.10.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 10/06/2022] [Accepted: 10/30/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Understanding the neurobiology underlying bipolar disorder (BD) versus major depressive disorder (MDD) is crucial for accurate diagnosis and for driving the discovery of novel treatments. A promising target is the metabotropic glutamate receptor 5 (mGluR5), a modulator of glutamate transmission associated with synaptic plasticity. We measured mGluR5 availability in individuals with MDD and BD for the first time using positron emission tomography. METHODS Individuals with BD (n = 17 depressed; n = 10 euthymic) or MDD (n = 17) and healthy control (HC) individuals (n = 18) underwent imaging with [18F]FPEB positron emission tomography to quantify mGluR5 availability in regions of the prefrontal cortex, which was compared across groups and assessed in relation to depressive symptoms and cognitive function. RESULTS Prefrontal cortex mGluR5 availability was significantly different across groups (F6,116 = 2.18, p = .050). Specifically, mGluR5 was lower in BD versus MDD and HC groups, with no difference between MDD and HC groups. Furthermore, after dividing the BD group, mGluR5 was lower in both BD-depression and BD-euthymia groups versus both MDD and HC groups across regions of interest. Interestingly, lower dorsolateral prefrontal cortex mGluR5 was associated with worse depression in MDD (r = -0.67, p = .005) but not in BD. Significant negative correlations were observed between mGluR5 and working memory in MDD and BD-depression groups. CONCLUSIONS This work suggests that mGluR5 could be helpful in distinguishing BD and MDD as a possible treatment target for depressive symptoms in MDD and for cognitive alterations in both disorders. Further work is needed to confirm differentiating roles for mGluR5 in BD and MDD and to probe modulation of mGluR5 as a preventive/treatment strategy.
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Affiliation(s)
- Sophie E Holmes
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Ruth H Asch
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Margaret T Davis
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut; Department of Psychology, Yale University, New Haven, Connecticut
| | - Nicole DellaGioia
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Neha Pashankar
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Jean-Dominique Gallezot
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - Nabeel Nabulsi
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - David Matuskey
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Gerard Sanacora
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Richard E Carson
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - Hilary P Blumberg
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut; Child Study Center, Yale School of Medicine, New Haven, Connecticut
| | - Irina Esterlis
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut; Child Study Center, Yale School of Medicine, New Haven, Connecticut; Clinical Neurosciences Division, U.S. Department of Veteran Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, Connecticut.
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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: 3] [Impact Index Per Article: 3.0] [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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Xie H, Cao Y, Long X, Xiao H, Wang X, Qiu C, Jia Z. A comparative study of gray matter volumetric alterations in adults with attention deficit hyperactivity disorder and bipolar disorder type I. J Psychiatr Res 2022; 155:410-419. [PMID: 36183596 DOI: 10.1016/j.jpsychires.2022.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 07/29/2022] [Accepted: 09/16/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) and bipolar disorder type I (BD-Ι) share great overlapping symptoms and are highly comorbid. We aimed to compare and obtain the common and distinct gray matter volume (GMV) patterns in adult patients. METHOD We searched four databases to include whole-brain voxel-based morphometry studies and compared the GMV patterns between ADHD and healthy controls (HCs), between BD-I and HCs, and between ADHD and BD-I using anisotropic effect-size signed differential mapping software. RESULTS We included 677 ADHD and 452 BD-Ι patients. Compared with HCs, ADHD patients showed smaller GMV in the anterior cingulate cortex (ACC) and supramarginal gyrus but a larger caudate nucleus. Compared with HCs, BD-Ι patients showed smaller GMV in the orbitofrontal cortex, parahippocampal gyrus, and amygdala. No common GMV alterations were found, whereas ADHD showed the smaller ACC and larger amygdala relative to BD-Ι. Subgroup analyses revealed the larger insula in manic patients, which was positively associated with the Young Mania Rating Scale. The decreased median cingulate cortex (MCC) was positively associated with the ages in ADHD, whereas the MCC was negatively associated with the ages in BD-Ι. LIMITATIONS All included data were cross-sectional; Potential effects of medication and disease course were not analyzed due to the limited data. CONCLUSIONS ADHD showed altered GMV in the frontal-striatal frontal-parietal circuits, and BD-Ι showed altered GMV in the prefrontal-amygdala circuit. These findings could contribute to a better understanding of the neuropathology of the two disorders.
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Affiliation(s)
- Hongsheng Xie
- Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, 610041, China; Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Yuan Cao
- Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, 610041, China; Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Xipeng Long
- Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, 610041, China; Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Hongqi Xiao
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Xiuli Wang
- Department of Psychiatry, The Fourth People's Hospital of Chengdu, Chengdu, 610041, China
| | - Changjian Qiu
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, 610041, China.
| | - Zhiyun Jia
- Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, 610041, China; Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, China.
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Rajashekar N, Blumberg HP, Villa LM. Neuroimaging Studies of Brain Structure in Older Adults with Bipolar Disorder: A Review. JOURNAL OF PSYCHIATRY AND BRAIN SCIENCE 2022; 7:e220006. [PMID: 36092855 PMCID: PMC9453888 DOI: 10.20900/jpbs.20220006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Bipolar disorder (BD) is a common mood disorder that can have severe consequences during later life, including suffering and impairment due to mood and cognitive symptoms, elevated risk for dementia and an especially high risk for suicide. Greater understanding of the brain circuitry differences involved in older adults with BD (OABD) in later life and their relationship to aging processes is required to improve outcomes of OABD. The current literature on gray and white matter findings, from high resolution structural and diffusion-weighted magnetic resonance imaging (MRI) studies, has shown that BD in younger age groups is associated with gray matter reductions within cortical and subcortical brain regions that subserve emotion processing and regulation, as well as reduced structural integrity of white matter tracts connecting these brain regions. While fewer neuroimaging studies have focused on OABD, it does appear that many of the structural brain differences found in younger samples are present in OABD. There is also initial suggestion that there are additional brain differences, for at least a subset of OABD, that may result from more pronounced gray and white matter declines with age that may contribute to adverse outcomes. Preclinical and clinical data supporting neuro-plastic and -protective effects of mood-stabilizing medications, suggest that treatments may reverse and/or prevent the progression of brain changes thereby reducing symptoms. Future neuroimaging research implementing longitudinal designs, and large-scale, multi-site initiatives with detailed clinical and treatment data, holds promise for reducing suffering, cognitive dysfunction and suicide in OABD.
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Affiliation(s)
- Niroop Rajashekar
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06511, USA
| | - Hilary P. Blumberg
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06511, USA
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT 06520, USA
- Child Study Center, Yale School of Medicine, New Haven, CT 06519, USA
| | - Luca M. Villa
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06511, USA
- Department of Psychiatry, University of Oxford, Oxford, OX37JX, UK
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Drachman R, Colic L, Sankar A, Spencer L, Goldman DA, Villa LM, Kim JA, Oquendo MA, Pittman B, Blumberg HP. Rethinking "aggression" and impulsivity in bipolar disorder: Risk, clinical and brain circuitry features. J Affect Disord 2022; 303:331-339. [PMID: 35181384 PMCID: PMC9109470 DOI: 10.1016/j.jad.2022.02.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 02/11/2022] [Accepted: 02/14/2022] [Indexed: 12/21/2022]
Abstract
BACKGROUND Elevated aggression and impulsivity are implicated in Bipolar Disorder (BD); however, relationships between these behavioral constructs have not been clarified, which can lead to misconceptions with negative consequences including stigma and adverse outcomes including suicide. The study aimed to clarify brain-based distinctions between the two constructs and their associations to risk factors, symptoms and suicide thoughts and behaviors. METHODS Self-rated Brown-Goodwin Aggression (BGA) and Barratt Impulsiveness Scale (BIS) scores were compared between adults with BD (n = 38, 74% female) and healthy controls (HC, n = 29, 64% female). Relationships were examined between BGA and BIS with childhood trauma questionnaire (CTQ), mood, comorbidities, and magnetic resonance imaging gray matter volume (GMV) assessments. RESULTS In BD, BGA and BIS total scores were both elevated and associated with childhood maltreatment (CM), particularly emotional CM, depression, substance use disorders (SUDs) and suicide attempts (SAs). BGA scores were increased by items corresponding to dysregulation of emotional and social behavior and associated with elevated mood states and suicide ideation and GMV decreases in bilateral orbitofrontal cortex and left posterior insula brain regions, previously associated with these behaviors and clinical features. BIS motor impulsiveness scores were associated with GMV decreases in anterior cingulate cortex implicated in mood and behavioral dyscontrol. LIMITATIONS modest sample size, self-reports CONCLUSIONS: The findings suggest separable brain-based domains of dysfunction in BD of motor impulsiveness versus emotionally dysregulated feelings that are primarily self-directed. Both domains are associated with suicide behavior and modifiable risk factors of CM, depression and SUDs that could be targeted for prevention.
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Affiliation(s)
- Rebecca Drachman
- Department of Psychiatry, Yale School of Medicine, 60 Temple Street, Suite 6B, New Haven, CT 06511, USA
| | - Lejla Colic
- Department of Psychiatry, Yale School of Medicine, 60 Temple Street, Suite 6B, New Haven, CT 06511, USA; Department of Psychiatry, Jena University Hospital, Jena, Germany
| | - Anjali Sankar
- Department of Psychiatry, Yale School of Medicine, 60 Temple Street, Suite 6B, New Haven, CT 06511, USA
| | - Linda Spencer
- Department of Psychiatry, Yale School of Medicine, 60 Temple Street, Suite 6B, New Haven, CT 06511, USA
| | - Danielle A Goldman
- Department of Psychiatry, Yale School of Medicine, 60 Temple Street, Suite 6B, New Haven, CT 06511, USA; Interdepartmental Neuroscience Program, Yale School of Medicine, New Haven, CT 06511, USA
| | - Luca M Villa
- Department of Psychiatry, Yale School of Medicine, 60 Temple Street, Suite 6B, New Haven, CT 06511, USA
| | - Jihoon A Kim
- Department of Psychiatry, Yale School of Medicine, 60 Temple Street, Suite 6B, New Haven, CT 06511, USA
| | - Maria A Oquendo
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Brian Pittman
- Department of Psychiatry, Yale School of Medicine, 60 Temple Street, Suite 6B, New Haven, CT 06511, USA
| | - Hilary P Blumberg
- Department of Psychiatry, Yale School of Medicine, 60 Temple Street, Suite 6B, New Haven, CT 06511, USA; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT 06511, USA; Child Study Center, Yale School of Medicine, New Haven, CT 06511, USA.
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Graph theory analysis of whole brain functional connectivity to assess disturbances associated with suicide attempts in bipolar disorder. Transl Psychiatry 2022; 12:7. [PMID: 35013103 PMCID: PMC8748935 DOI: 10.1038/s41398-021-01767-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 10/25/2021] [Accepted: 11/12/2021] [Indexed: 12/22/2022] Open
Abstract
Brain targets to lower the high risk of suicide in Bipolar Disorder (BD) are needed. Neuroimaging studies employing analyses dependent on regional assumptions could miss hubs of dysfunction critical to the pathophysiology of suicide behaviors and their prevention. This study applied intrinsic connectivity distribution (ICD), a whole brain graph-theoretical approach, to identify hubs of functional connectivity (FC) disturbances associated with suicide attempts in BD. ICD, from functional magnetic resonance imaging data acquired while performing a task involving implicit emotion regulation processes important in BD and suicide behaviors, was compared across 40 adults with BD with prior suicide attempts (SAs), 49 with BD with no prior attempts (NSAs) and 51 healthy volunteers (HVs). Areas of significant group differences were used as seeds to identify regional FC differences and explore associations with suicide risk-related measures. ICD was significantly lower in SAs than in NSAs and HVs in bilateral ventromedial prefrontal cortex (vmPFC) and right anterior insula (RaIns). Seed connectivity revealed altered FC from vmPFC to bilateral anteromedial orbitofrontal cortex, left ventrolateral PFC (vlPFC) and cerebellum, and from RaIns to right vlPFC and temporopolar cortices. VmPFC and RaIns ICD were negatively associated with suicidal ideation severity, and vmPFC ICD with hopelessness and attempt lethality severity. The findings suggest that SAs with BD have vmPFC and RaIns hubs of dysfunction associated with altered FC to other ventral frontal, temporopolar and cerebellar cortices, and with suicidal ideation, hopelessness, and attempt lethality. These hubs may be targets for novel therapeutics to reduce suicide risk in BD.
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Li H, Cui L, Cao L, Zhang Y, Liu Y, Deng W, Zhou W. Identification of bipolar disorder using a combination of multimodality magnetic resonance imaging and machine learning techniques. BMC Psychiatry 2020; 20:488. [PMID: 33023515 PMCID: PMC7542439 DOI: 10.1186/s12888-020-02886-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 09/21/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Bipolar disorder (BPD) is a common mood disorder that is often goes misdiagnosed or undiagnosed. Recently, machine learning techniques have been combined with neuroimaging methods to aid in the diagnosis of BPD. However, most studies have focused on the construction of classifiers based on single-modality MRI. Hence, in this study, we aimed to construct a support vector machine (SVM) model using a combination of structural and functional MRI, which could be used to accurately identify patients with BPD. METHODS In total, 44 patients with BPD and 36 healthy controls were enrolled in the study. Clinical evaluation and MRI scans were performed for each subject. Next, image pre-processing, VBM and ReHo analyses were performed. The ReHo values of each subject in the clusters showing significant differences were extracted. Further, LASSO approach was recruited to screen features. Based on selected features, the SVM model was established, and discriminant analysis was performed. RESULTS After using the two-sample t-test with multiple comparisons, a total of 8 clusters were extracted from the data (VBM = 6; ReHo = 2). Next, we used both VBM and ReHo data to construct the new SVM classifier, which could effectively identify patients with BPD at an accuracy of 87.5% (95%CI: 72.5-95.3%), sensitivity of 86.4% (95%CI: 64.0-96.4%), and specificity of 88.9% (95%CI: 63.9-98.0%) in the test data (p = 0.0022). CONCLUSIONS A combination of structural and functional MRI can be of added value in the construction of SVM classifiers to aid in the accurate identification of BPD in the clinic.
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Affiliation(s)
- Hao Li
- grid.412615.5Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China ,grid.484195.5Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, No.58 Zhongshan Road 2, Guangzhou, 510080 China
| | - Liqian Cui
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China. .,Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, No.58 Zhongshan Road 2, Guangzhou, 510080, China.
| | - Liping Cao
- Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou Huiai Hospital, Guangzhou, Guangdong, China.
| | - Yizhi Zhang
- grid.452505.30000 0004 1757 6882Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou Huiai Hospital, Guangzhou, Guangdong China
| | - Yueheng Liu
- grid.216417.70000 0001 0379 7164Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan China ,Chinese National Clinical Research Center on Mental Disorders (Xiangya), Changsha, Hunan China
| | - Wenhao Deng
- grid.452505.30000 0004 1757 6882Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou Huiai Hospital, Guangzhou, Guangdong China
| | - Wenjin Zhou
- grid.452505.30000 0004 1757 6882Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou Huiai Hospital, Guangzhou, Guangdong China
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10
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Dai W, Chen M, Duan W, Zhao L, Bolo NR, Tamminga C, Clementz BA, Pearlson GD, Alsop DC, Keshavan M. Abnormal perfusion fluctuation and perfusion connectivity in bipolar disorder measured by dynamic arterial spin labeling. Bipolar Disord 2020; 22:401-410. [PMID: 31630476 DOI: 10.1111/bdi.12856] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES We sought to evaluate whether dynamic Arterial Spin Labeling (dASL), a novel quantitative technique robust to artifacts and noise that especially arise in inferior brain regions, could characterize neural substrates of BD pathology and symptoms. METHODS Forty-five subjects (19 BD patients, 26 controls) were imaged using a dASL sequence. Maps of average perfusion, perfusion fluctuation, and perfusion connectivity with anterior cingulate cortex (ACC) were derived. Patient symptoms were quantified along four symptom dimensions determined using factor analysis of the subjects from the Bipolar and Schizophrenia Network on Intermediate Phenotypes (BSNIP) study. Maps of the perfusion measures were compared between BD patients and controls and correlated with the symptom dimensions in the BD patients only by voxel-level and region-level analyses. RESULTS BD patients exhibited (i) significantly increased perfusion fluctuations in the left fusiform and inferior temporal regions (P = .020, voxel-level corrected) and marginally increased perfusion fluctuations in the right temporal pole and inferior temporal regions (P = .063, cluster-level corrected), (ii) significantly increased perfusion connectivity between ACC and the occipitoparietal cortex (P = .050, cluster-level corrected). In BD patients, positive symptoms were negatively associated with ACC perfusion connectivity to the right orbitofrontal and superior frontal regions (P = .002, cluster-level corrected) and right orbitofrontal and inferior frontal regions (P = .023, cluster-level corrected). CONCLUSION The abnormal perfusion fluctuations and connectivity alterations may underlie the mood fluctuations and cognitive and emotional dysregulation that characterize BD.
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Affiliation(s)
- Weiying Dai
- Computer Science, State University of New York at Binghamton, Binghamton, NY, USA
| | - Mingzhao Chen
- Computer Science, State University of New York at Binghamton, Binghamton, NY, USA
| | - Wenna Duan
- Computer Science, State University of New York at Binghamton, Binghamton, NY, USA
| | - Li Zhao
- Diagnostic Imaging and Radiology, Children's National Medical Center, Washington, D.C, USA
| | - Nicolas R Bolo
- Psychiatry, Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, MA, USA
| | - Carol Tamminga
- Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Brett A Clementz
- Psychology and Neuroscience, University of Georgia, Athens, GA, USA
| | | | - David C Alsop
- Radiology, Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, MA, USA
| | - Matcheri Keshavan
- Psychiatry, Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, MA, USA
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11
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Lu X, Zhong Y, Ma Z, Wu Y, Fox PT, Zhang N, Wang C. Structural imaging biomarkers for bipolar disorder: Meta-analyses of whole-brain voxel-based morphometry studies. Depress Anxiety 2019; 36:353-364. [PMID: 30475436 DOI: 10.1002/da.22866] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 10/20/2018] [Accepted: 11/06/2018] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Bipolar disorder (BD) is a common and destructive psychiatric illness worldwide. Although it is known that BD is associated with morphological abnormalities of the brain, the regions implicated in BD remain unclear. Therefore, we aimed to update current knowledge on potential structural imaging biomarkers of BD. METHODS Studies published up to January 31, 2018, were identified by a comprehensive literature search of PubMed, EBSCO, and BrainMap voxel-based morphometry (VBM) database. Whole-brain VBM studies that examined gray matter (GM) abnormalities of group comparisons between BD and healthy controls (HC) and reported results as coordinates in a standard reference space were included. Different meta-analyses were performed by activation likelihood estimation (ALE) algorithm. RESULTS A total of 46 studies with 56 experiments, including 1720 subjects and 268 foci were included. Seven different meta-analyses were calculated separately across experiments reporting decreased or increased GM volume among BD, BDΙ, BD-adults, and BD-youths groups. Fifteen regions of significantly different GM volume between four groups and HC were identified. There were extensive GM deficits in the prefrontal and temporal cortex, and enlargements in the putamen, cingulate cortex, and precuneus. CONCLUSIONS The results revealed that the thinning of prefrontal cortex was a key region in the pathophysiology of BD. The enlargement of the cingulate cortex may be implicated in a compensatory mechanism. It underscored important differences between BD-adults and BD-youths and specific biomarkers of three subgroups.
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Affiliation(s)
- Xin Lu
- School of Psychology, Nanjing Normal University, Nanjing, Jiangsu, China.,Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China.,Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, Jiangsu, China.,Cognitive Behavioral Therapy Institute of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yuan Zhong
- School of Psychology, Nanjing Normal University, Nanjing, Jiangsu, China.,Jiangsu Key Laboratory of Mental Health and Cognitive Science, Nanjing Normal University, Nanjing, Jiangsu, China
| | - Zijuan Ma
- Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China.,Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, Jiangsu, China.,Cognitive Behavioral Therapy Institute of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yun Wu
- School of Psychology, Nanjing Normal University, Nanjing, Jiangsu, China.,Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China.,Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, Jiangsu, China.,Cognitive Behavioral Therapy Institute of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Peter T Fox
- Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China.,Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, Jiangsu, China.,South Texas Veterans Healthcare System, University of Texas Health San Antonio, San Antonio, United States.,Research Imaging Institute, University of Texas Health San Antonio, San Antonio, United States
| | - Ning Zhang
- Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China.,Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, Jiangsu, China.,Cognitive Behavioral Therapy Institute of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Chun Wang
- Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China.,Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, Jiangsu, China.,Cognitive Behavioral Therapy Institute of Nanjing Medical University, Nanjing, Jiangsu, China
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12
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Chang M, Edmiston EK, Womer FY, Zhou Q, Wei S, Jiang X, Zhou Y, Ye Y, Huang H, Zuo XN, Xu K, Tang Y, Wang F. Spontaneous low-frequency fluctuations in the neural system for emotional perception in major psychiatric disorders: amplitude similarities and differences across frequency bands. J Psychiatry Neurosci 2019; 44:132-141. [PMID: 30810024 PMCID: PMC6397038 DOI: 10.1503/jpn.170226] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Growing evidence indicates both shared and distinct features of emotional perception in schizophrenia, bipolar disorder and major depressive disorder. In these disorders, alterations in spontaneous low-frequency fluctuations have been reported in the neural system for emotional perception, but the similarities and differences in the amplitude of low-frequency fluctuation (ALFF) across the 3 disorders are unknown. METHODS We compared ALFF and its signal balance in the neural system for emotional perception at 2 frequency bands (slow-5 and slow-4) in 119 participants with schizophrenia, 100 with bipolar disorder, 123 with major depressive disorder and 183 healthy controls. We performed exploratory Pearson partial correlation analyses to determine the relationship between ALFF signal balance and clinical variables. RESULTS We observed commonalities in ALFF change patterns across the 3 disorders for emotional perception neural substrates, such as increased ALFF in the anterior cerebrum (including subcortical, limbic, paralimbic and heteromodal cortical regions) and decreased ALFF in the posterior visual cortices. Schizophrenia, bipolar disorder and major depressive disorder showed significantly decreased ALFF signal balance in the neural system for emotional perception at both slow-5 and slow-4 frequency bands, with the greatest alterations for schizophrenia, followed by bipolar disorder and major depressive disorder. We found a negative correlation between ALFF signal balance and negative/disorganized symptoms in slow-4 across the 3 disorders. LIMITATIONS The relatively broad age range in our sample and the cross-sectional study design may not account for our findings. CONCLUSION The extent of the commonalities we observed further support the concept of core neurobiological disruptions shared among the 3 disorders; ALFF signal balance could be an important neuroimaging marker for the diagnosis and treatment of schizophrenia, bipolar disorder and major depressive disorder.
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Affiliation(s)
- Miao Chang
- From the Department of Radiology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China (Chang, Jiang, Wang, Wei, Xu); the Department of Psychiatry, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China (Tang, Q. Zhou, Y. Zhou); the Brain Function Research Section, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China (Chang, Edmiston, Jiang, Tang, Wang, Wei, Xu, Q. Zhou, Y. Zhou); the Department of Psychiatry, Washington University School of Medicine, St. Louis, MO (Womer); the Division of Biostatistics, University of California, Berkeley, Berkeley, CA (Huang, Ye); the CAS Key Laboratory of Behavioral Science, Institute of Psychology, Beijing, PR China (Zuo); and the Department of Psychology, University of Chinese Academy of Sciences, Beijing, PR China (Zuo)
| | - Elliot K. Edmiston
- From the Department of Radiology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China (Chang, Jiang, Wang, Wei, Xu); the Department of Psychiatry, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China (Tang, Q. Zhou, Y. Zhou); the Brain Function Research Section, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China (Chang, Edmiston, Jiang, Tang, Wang, Wei, Xu, Q. Zhou, Y. Zhou); the Department of Psychiatry, Washington University School of Medicine, St. Louis, MO (Womer); the Division of Biostatistics, University of California, Berkeley, Berkeley, CA (Huang, Ye); the CAS Key Laboratory of Behavioral Science, Institute of Psychology, Beijing, PR China (Zuo); and the Department of Psychology, University of Chinese Academy of Sciences, Beijing, PR China (Zuo)
| | - Fay Y. Womer
- From the Department of Radiology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China (Chang, Jiang, Wang, Wei, Xu); the Department of Psychiatry, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China (Tang, Q. Zhou, Y. Zhou); the Brain Function Research Section, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China (Chang, Edmiston, Jiang, Tang, Wang, Wei, Xu, Q. Zhou, Y. Zhou); the Department of Psychiatry, Washington University School of Medicine, St. Louis, MO (Womer); the Division of Biostatistics, University of California, Berkeley, Berkeley, CA (Huang, Ye); the CAS Key Laboratory of Behavioral Science, Institute of Psychology, Beijing, PR China (Zuo); and the Department of Psychology, University of Chinese Academy of Sciences, Beijing, PR China (Zuo)
| | - Qian Zhou
- From the Department of Radiology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China (Chang, Jiang, Wang, Wei, Xu); the Department of Psychiatry, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China (Tang, Q. Zhou, Y. Zhou); the Brain Function Research Section, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China (Chang, Edmiston, Jiang, Tang, Wang, Wei, Xu, Q. Zhou, Y. Zhou); the Department of Psychiatry, Washington University School of Medicine, St. Louis, MO (Womer); the Division of Biostatistics, University of California, Berkeley, Berkeley, CA (Huang, Ye); the CAS Key Laboratory of Behavioral Science, Institute of Psychology, Beijing, PR China (Zuo); and the Department of Psychology, University of Chinese Academy of Sciences, Beijing, PR China (Zuo)
| | - Shengnan Wei
- From the Department of Radiology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China (Chang, Jiang, Wang, Wei, Xu); the Department of Psychiatry, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China (Tang, Q. Zhou, Y. Zhou); the Brain Function Research Section, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China (Chang, Edmiston, Jiang, Tang, Wang, Wei, Xu, Q. Zhou, Y. Zhou); the Department of Psychiatry, Washington University School of Medicine, St. Louis, MO (Womer); the Division of Biostatistics, University of California, Berkeley, Berkeley, CA (Huang, Ye); the CAS Key Laboratory of Behavioral Science, Institute of Psychology, Beijing, PR China (Zuo); and the Department of Psychology, University of Chinese Academy of Sciences, Beijing, PR China (Zuo)
| | - Xiaowei Jiang
- From the Department of Radiology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China (Chang, Jiang, Wang, Wei, Xu); the Department of Psychiatry, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China (Tang, Q. Zhou, Y. Zhou); the Brain Function Research Section, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China (Chang, Edmiston, Jiang, Tang, Wang, Wei, Xu, Q. Zhou, Y. Zhou); the Department of Psychiatry, Washington University School of Medicine, St. Louis, MO (Womer); the Division of Biostatistics, University of California, Berkeley, Berkeley, CA (Huang, Ye); the CAS Key Laboratory of Behavioral Science, Institute of Psychology, Beijing, PR China (Zuo); and the Department of Psychology, University of Chinese Academy of Sciences, Beijing, PR China (Zuo)
| | - Yifang Zhou
- From the Department of Radiology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China (Chang, Jiang, Wang, Wei, Xu); the Department of Psychiatry, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China (Tang, Q. Zhou, Y. Zhou); the Brain Function Research Section, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China (Chang, Edmiston, Jiang, Tang, Wang, Wei, Xu, Q. Zhou, Y. Zhou); the Department of Psychiatry, Washington University School of Medicine, St. Louis, MO (Womer); the Division of Biostatistics, University of California, Berkeley, Berkeley, CA (Huang, Ye); the CAS Key Laboratory of Behavioral Science, Institute of Psychology, Beijing, PR China (Zuo); and the Department of Psychology, University of Chinese Academy of Sciences, Beijing, PR China (Zuo)
| | - Yuting Ye
- From the Department of Radiology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China (Chang, Jiang, Wang, Wei, Xu); the Department of Psychiatry, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China (Tang, Q. Zhou, Y. Zhou); the Brain Function Research Section, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China (Chang, Edmiston, Jiang, Tang, Wang, Wei, Xu, Q. Zhou, Y. Zhou); the Department of Psychiatry, Washington University School of Medicine, St. Louis, MO (Womer); the Division of Biostatistics, University of California, Berkeley, Berkeley, CA (Huang, Ye); the CAS Key Laboratory of Behavioral Science, Institute of Psychology, Beijing, PR China (Zuo); and the Department of Psychology, University of Chinese Academy of Sciences, Beijing, PR China (Zuo)
| | - Haiyan Huang
- From the Department of Radiology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China (Chang, Jiang, Wang, Wei, Xu); the Department of Psychiatry, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China (Tang, Q. Zhou, Y. Zhou); the Brain Function Research Section, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China (Chang, Edmiston, Jiang, Tang, Wang, Wei, Xu, Q. Zhou, Y. Zhou); the Department of Psychiatry, Washington University School of Medicine, St. Louis, MO (Womer); the Division of Biostatistics, University of California, Berkeley, Berkeley, CA (Huang, Ye); the CAS Key Laboratory of Behavioral Science, Institute of Psychology, Beijing, PR China (Zuo); and the Department of Psychology, University of Chinese Academy of Sciences, Beijing, PR China (Zuo)
| | - Xi-Nian Zuo
- From the Department of Radiology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China (Chang, Jiang, Wang, Wei, Xu); the Department of Psychiatry, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China (Tang, Q. Zhou, Y. Zhou); the Brain Function Research Section, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China (Chang, Edmiston, Jiang, Tang, Wang, Wei, Xu, Q. Zhou, Y. Zhou); the Department of Psychiatry, Washington University School of Medicine, St. Louis, MO (Womer); the Division of Biostatistics, University of California, Berkeley, Berkeley, CA (Huang, Ye); the CAS Key Laboratory of Behavioral Science, Institute of Psychology, Beijing, PR China (Zuo); and the Department of Psychology, University of Chinese Academy of Sciences, Beijing, PR China (Zuo)
| | - Ke Xu
- From the Department of Radiology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China (Chang, Jiang, Wang, Wei, Xu); the Department of Psychiatry, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China (Tang, Q. Zhou, Y. Zhou); the Brain Function Research Section, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China (Chang, Edmiston, Jiang, Tang, Wang, Wei, Xu, Q. Zhou, Y. Zhou); the Department of Psychiatry, Washington University School of Medicine, St. Louis, MO (Womer); the Division of Biostatistics, University of California, Berkeley, Berkeley, CA (Huang, Ye); the CAS Key Laboratory of Behavioral Science, Institute of Psychology, Beijing, PR China (Zuo); and the Department of Psychology, University of Chinese Academy of Sciences, Beijing, PR China (Zuo)
| | - Yanqing Tang
- From the Department of Radiology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China (Chang, Jiang, Wang, Wei, Xu); the Department of Psychiatry, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China (Tang, Q. Zhou, Y. Zhou); the Brain Function Research Section, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China (Chang, Edmiston, Jiang, Tang, Wang, Wei, Xu, Q. Zhou, Y. Zhou); the Department of Psychiatry, Washington University School of Medicine, St. Louis, MO (Womer); the Division of Biostatistics, University of California, Berkeley, Berkeley, CA (Huang, Ye); the CAS Key Laboratory of Behavioral Science, Institute of Psychology, Beijing, PR China (Zuo); and the Department of Psychology, University of Chinese Academy of Sciences, Beijing, PR China (Zuo)
| | - Fei Wang
- From the Department of Radiology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China (Chang, Jiang, Wang, Wei, Xu); the Department of Psychiatry, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China (Tang, Q. Zhou, Y. Zhou); the Brain Function Research Section, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China (Chang, Edmiston, Jiang, Tang, Wang, Wei, Xu, Q. Zhou, Y. Zhou); the Department of Psychiatry, Washington University School of Medicine, St. Louis, MO (Womer); the Division of Biostatistics, University of California, Berkeley, Berkeley, CA (Huang, Ye); the CAS Key Laboratory of Behavioral Science, Institute of Psychology, Beijing, PR China (Zuo); and the Department of Psychology, University of Chinese Academy of Sciences, Beijing, PR China (Zuo)
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13
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Fan S, Lippard ET, Sankar A, Wallace A, Johnston JA, Wang F, Pittman B, Spencer L, Oquendo MA, Blumberg HP. Gray and white matter differences in adolescents and young adults with prior suicide attempts across bipolar and major depressive disorders. J Affect Disord 2019; 245:1089-1097. [PMID: 30699851 PMCID: PMC6903411 DOI: 10.1016/j.jad.2018.11.095] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 09/24/2018] [Accepted: 11/17/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Findings regarding brain circuitry abnormalities in suicide attempters (SAs) converge across bipolar disorder (BD) and major depressive disorder (MDD), the most common disorders observed in suicides. These abnormalities appear to be present during adolescence/young adulthood when suicide rates increase steeply, and suicide is a leading cause of death in this age group. Identification of brain circuitry common to adolescent/young adult SAs with BD and MDD is important for generating widely effective early prevention strategies. We examined brain circuitry in SAs in adolescents/young adults across these two disorders. METHODS Eighty-three participants (ages 14-25 years), 46 with BD (21 SAs) and 37 with MDD (19 SAs), underwent structural and diffusion-weighted magnetic resonance scanning. Whole-brain analyses compared gray matter (GM) volume and white matter (WM) fractional anisotropy (FA) between SAs and non-suicide attempters (NSAs) across and within BD and MDD (p < 0.005). RESULTS Across and within BD and MDD, SAs showed differences compared to NSAs in ventral prefrontal cortex (PFC) GM volume and fronto-limbic (including uncinate fasciculus (UF)) WM FA. Exploratory analyses showed additional within-disorder differences for BD SAs in dorsolateral PFC (dlPFC) and hippocampus GM volume and UF FA, and for MDD SAs dorsomedial and dlPFC GM and dorsal frontal WM. However, there was no significant interaction between suicide attempt status and diagnosis. LIMITATIONS Modest sample size. CONCLUSIONS Common fronto-limbic gray and white matter alterations in adolescent/young adult SAs are potential targets for suicide prevention strategies across mood disorders. Preliminary findings of disorder-specific regional findings could suggest diagnostic-specific optimal targets may exist.
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Affiliation(s)
- Siyan Fan
- Departments of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
| | - Elizabeth T.C. Lippard
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA,Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA,Department of Psychiatry, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Anjali Sankar
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Amanda Wallace
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | | | - Fei Wang
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Brian Pittman
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Linda Spencer
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Maria A. Oquendo
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania; Philadelphia, PA; USA
| | - Hilary P. Blumberg
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA,Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA,Department of Child Study Center, Yale School of Medicine, New Haven, CT, USA
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14
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Li L, Ji E, Han X, Tang F, Bai Y, Peng D, Fang Y, Zhang S, Zhang Z, Yang H. Cortical thickness and subcortical volumes alterations in euthymic bipolar I patients treated with different mood stabilizers. Brain Imaging Behav 2018; 13:1255-1264. [DOI: 10.1007/s11682-018-9950-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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15
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Weathers J, Lippard ETC, Spencer L, Pittman B, Wang F, Blumberg HP. Longitudinal Diffusion Tensor Imaging Study of Adolescents and Young Adults With Bipolar Disorder. J Am Acad Child Adolesc Psychiatry 2018; 57:111-117. [PMID: 29413143 PMCID: PMC5806147 DOI: 10.1016/j.jaac.2017.11.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 10/04/2017] [Accepted: 11/21/2017] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Longitudinal neuroimaging during adolescence/young adulthood, when bipolar disorder (BD) commonly emerges, can help elucidate the neurodevelopmental pathophysiology of BD. Adults with BD have shown reduced structural integrity in the uncinate fasciculus (UF), a white matter (WM) tract providing major connections between the amygdala and ventral prefrontal cortex (vPFC), important in emotion regulation. In this longitudinal diffusion tensor imaging (DTI) study of adolescents/young adults, we hypothesized differences in age- and time-related changes in UF integrity in BD compared to healthy controls (HC). METHOD Two DTI scans were obtained in 27 adolescents/young adults with BD and 37 HC adolescents/young adults, on average approximately 2.5 years apart. Interactions between diagnosis with age and with time for UF fractional anisotropy (FA) were assessed. Exploratory analyses were performed including euthymic-only participants with BD, and for potential influences of demographic and clinical factors. Whole-brain analyses were performed to explore for interactions in other regions. RESULTS There were significant interactions between diagnosis with age and with time for UF FA (p < .05). Healthy control adolescents/young adults showed significant UF FA increases with age and over time (p < .05), whereas no significant changes with age or over time were observed in the adolescents/young adults with BD. Significant interactions with age and time were also observed in analyses including euthymic-only participants with BD (p < .05). CONCLUSION These findings provide neuroimaging evidence supporting differences in UF WM structural development during adolescence/young adulthood, suggesting that differences in the development of an amygdala-vPFC system subserving emotion regulation may be a trait feature of BD neurodevelopment.
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Affiliation(s)
- Judah Weathers
- Yale School of Medicine, New Haven, CT; Yale Child Study Center, New Haven
| | - Elizabeth T C Lippard
- Yale School of Medicine, New Haven, CT; Dell Medical School, University of Texas at Austin, TX
| | | | | | - Fei Wang
- Yale School of Medicine, New Haven, CT; First Affiliated Hospital, China Medical University, Shenyang, China
| | - Hilary P Blumberg
- Yale School of Medicine, New Haven, CT; Yale Child Study Center, New Haven.
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16
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Chang M, Womer FY, Edmiston EK, Bai C, Zhou Q, Jiang X, Wei S, Wei Y, Ye Y, Huang H, He Y, Xu K, Tang Y, Wang F. Neurobiological Commonalities and Distinctions Among Three Major Psychiatric Diagnostic Categories: A Structural MRI Study. Schizophr Bull 2018; 44:65-74. [PMID: 29036668 PMCID: PMC5768040 DOI: 10.1093/schbul/sbx028] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Schizophrenia (SZ), bipolar disorder (BD), and major depressive disorder (MDD) are distinct diagnostic categories in current psychiatric nosology, yet there is increasing evidence for shared clinical and biological features in these disorders. No previous studies have examined brain structural features concurrently in these 3 disorders. The aim of this study was to identify the extent of shared and distinct brain alterations in SZ, BD, and MDD. We examined gray matter (GM) volume and white matter (WM) integrity in a total of 485 individuals (135 with SZ, 86 with BD, 108 with MDD, and 156 healthy controls [HC]) who underwent high-resolution structural magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI) at a single site. RESULTS Significant 4-group (SZ, BD, MDD, and HC groups) differences (P < .05, corrected) in GM volumes were found primarily in the paralimbic and heteromodal corticies. Post hoc analyses showed that the SZ, BD, and MDD groups shared GM volume decreases in 87.9% of the total regional volume with significant 4-group differences. Significant 4-group differences in WM integrity (P < .05 corrected) were found in callosal, limbic-paralimbic-hetermodal, cortico-cortical, thalamocortical and cerebellar WM. Post hoc analyses revealed that the SZ and BD groups shared WM alterations in all regions, while WM alterations were not observed with MDD. CONCLUSIONS Our findings of common alterations in SZ, BD, and MDD support the presence of core neurobiological disruptions in these disorders and suggest that neural structural distinctions between these disorders may be less prominent than initially postulated, particularly between SZ and BD.
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Affiliation(s)
- Miao Chang
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, PR China,Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, PR China,Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, PR China
| | - Fay Y Womer
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO
| | - E Kale Edmiston
- Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, PR China
| | - Chuan Bai
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, PR China,Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, PR China
| | - Qian Zhou
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, PR China,Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, PR China
| | - Xiaowei Jiang
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, PR China,Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, PR China
| | - Shengnan Wei
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, PR China,Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, PR China
| | - Yange Wei
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, PR China,Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, PR China
| | - Yuting Ye
- Division of Biostatistics, University of California, Berkeley, Berkeley, CA
| | - Haiyan Huang
- Division of Biostatistics, University of California, Berkeley, Berkeley, CA
| | - Yong He
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, PR China
| | - Ke Xu
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, PR China,Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, PR China
| | - Yanqing Tang
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, PR China,Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, PR China
| | - Fei Wang
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, PR China,Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, PR China,Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, PR China,To whom correspondence should be addressed; Department of Psychiatry and Radiology, The First Affiliated Hospital, China Medical University, 155 Nanjing North Street, Heping District, Shenyang, Liaoning 110001, PR China; tel/fax: +8624-83283405, e-mail:
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17
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Fusté M, Pauls A, Worker A, Reinders AATS, Simmons A, Williams SCR, Haro JM, Hazelgrove K, Pawlby S, Conroy S, Vecchio C, Seneviratne G, Pariante CM, Mehta MA, Dazzan P. Brain structure in women at risk of postpartum psychosis: an MRI study. Transl Psychiatry 2017; 7:1286. [PMID: 29249808 PMCID: PMC5802701 DOI: 10.1038/s41398-017-0003-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 08/11/2017] [Accepted: 08/20/2017] [Indexed: 12/12/2022] Open
Abstract
Postpartum psychosis (PP) is the most severe psychiatric disorder associated with childbirth. The risk of PP is very high in women with a history of bipolar affective disorder or schizoaffective disorder. However, the neurobiological basis of PP remains poorly understood and no study has evaluated brain structure in women at risk of, or with, PP. We performed a cross-sectional study of 256 women at risk of PP and 21 healthy controls (HC) in the same postpartum period. Among women at risk, 11 who developed a recent episode of PP (PPE) (n = 2 with lifetime bipolar disorder; n = 9 psychotic disorder not otherwise specified) and 15 at risk women who did not develop an episode of PP (NPPE) (n = 10 with lifetime bipolar disorder; n = 1 with schizoaffective disorder; n = 1 with a history of PP in first-degree family member; n = 3 with previous PP). We obtained T1-weighted MRI scans at 3T and examined regional gray matter volumes with voxel-based morphometry and cortical thickness and surface area with Freesurfer. Women with PPE showed smaller anterior cingulate gyrus, superior temporal gyrus and parahippocampal gyrus compared to NPPE women. These regions also showed decreased surface area. Moreover, the NPPE group showed a larger superior and inferior frontal gyrus volume than the HC. These results should be interpreted with caution, as there were between-group differences in terms of duration of illness and interval between delivery and MRI acquisition. Nevertheless, these are the first findings to suggest that MRI can provide information on brain morphology that characterize those women at risk of PP more likely to develop an episode after childbirth.
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Affiliation(s)
- Montserrat Fusté
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neurosciences, King's College London, De Crespigny Park, London, UK, SE5 8AF. .,CIBERSAM, Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain.
| | - Astrid Pauls
- 0000 0001 2322 6764grid.13097.3cDepartment of Psychosis Studies, Institute of Psychiatry, Psychology & Neurosciences, King’s College London, De Crespigny Park, London, UK SE5 8AF
| | - Amanda Worker
- 0000 0001 2322 6764grid.13097.3cDepartment of Neuroimaging, Institute of Psychiatry, Psychology & Neurosciences, King’s College of London, De Crespigny Park, London, UK
| | - Antje A. T. S Reinders
- 0000 0001 2322 6764grid.13097.3cDepartment of Psychosis Studies, Institute of Psychiatry, Psychology & Neurosciences, King’s College London, De Crespigny Park, London, UK SE5 8AF
| | - Andrew Simmons
- 0000 0001 2322 6764grid.13097.3cDepartment of Neuroimaging, Institute of Psychiatry, Psychology & Neurosciences, King’s College of London, De Crespigny Park, London, UK ,0000 0001 2116 3923grid.451056.3National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London, London, UK
| | - Steven C. R. Williams
- 0000 0001 2322 6764grid.13097.3cDepartment of Neuroimaging, Institute of Psychiatry, Psychology & Neurosciences, King’s College of London, De Crespigny Park, London, UK ,0000 0001 2116 3923grid.451056.3National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London, London, UK
| | - Josep M. Haro
- CIBERSAM, Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain
| | - Kate Hazelgrove
- 0000 0001 2322 6764grid.13097.3cDepartment of Psychosis Studies, Institute of Psychiatry, Psychology & Neurosciences, King’s College London, De Crespigny Park, London, UK SE5 8AF
| | - Susan Pawlby
- 0000 0001 2322 6764grid.13097.3cSection of Stress, Psychiatry and Immunology and Perinatal Psychiatry, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neurosciences, King’s College London, London, UK
| | - Susan Conroy
- 0000 0001 2322 6764grid.13097.3cSection of Stress, Psychiatry and Immunology and Perinatal Psychiatry, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neurosciences, King’s College London, London, UK
| | - Costanza Vecchio
- 0000 0001 2322 6764grid.13097.3cSection of Stress, Psychiatry and Immunology and Perinatal Psychiatry, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neurosciences, King’s College London, London, UK
| | - Gertrude Seneviratne
- 0000 0001 2322 6764grid.13097.3cSection of Stress, Psychiatry and Immunology and Perinatal Psychiatry, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neurosciences, King’s College London, London, UK
| | - Carmine M. Pariante
- 0000 0001 2116 3923grid.451056.3National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London, London, UK ,0000 0001 2322 6764grid.13097.3cSection of Stress, Psychiatry and Immunology and Perinatal Psychiatry, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neurosciences, King’s College London, London, UK
| | - Mitul A. Mehta
- 0000 0001 2322 6764grid.13097.3cDepartment of Neuroimaging, Institute of Psychiatry, Psychology & Neurosciences, King’s College of London, De Crespigny Park, London, UK
| | - Paola Dazzan
- 0000 0001 2322 6764grid.13097.3cDepartment of Psychosis Studies, Institute of Psychiatry, Psychology & Neurosciences, King’s College London, De Crespigny Park, London, UK SE5 8AF ,0000 0001 2116 3923grid.451056.3National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London, London, UK
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18
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Lippard ETC, Mazure CM, Johnston JAY, Spencer L, Weathers J, Pittman B, Wang F, Blumberg HP. Brain circuitry associated with the development of substance use in bipolar disorder and preliminary evidence for sexual dimorphism in adolescents. J Neurosci Res 2017; 95:777-791. [PMID: 27870392 DOI: 10.1002/jnr.23901] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 07/29/2016] [Accepted: 08/05/2016] [Indexed: 02/06/2023]
Abstract
Substance use disorders and mood disorders are highly comorbid and confer a high risk for adverse outcomes. However, data are limited on the neurodevelopmental basis of this comorbidity. Substance use initiation typically occurs during adolescence, and sex-specific developmental mechanisms are implicated. In this preliminary study, we review the literature and investigate regional gray matter volume (GMV) associated with subsequent substance use problems in adolescents with bipolar disorder (BD) and explore these associations for females and males. Thirty adolescents with DSM-IV-diagnosed BD and minimal alcohol/substance exposure completed baseline structural magnetic resonance imaging scans. At follow-up (on average 6 years post baseline), subjects were administered the CRAFFT interview and categorized into those scoring at high ( ≥ 2: CRAFFTHIGH ) vs. low ( < 2: CRAFFTLOW ) risk for alcohol/substance problems. Lower GMV in prefrontal, insular, and temporopolar cortices were observed at baseline among adolescents with BD reporting subsequent alcohol and cannabis use compared to adolescents with BD who did not (P < 0.005, clusters ≥ 20 voxels). Lower dorsolateral prefrontal GMV was associated with future substance use in both females and males. In females, lower orbitofrontal and insula GMV was associated with future substance use, while in males, lower rostral prefrontal GMV was associated with future use. Lower orbitofrontal, insular, and temporopolar GMV was observed in those who transitioned to smoking tobacco. Findings indicate that GMV development is associated with risk for future substance use problems in adolescents with BD, with results implicating GMV development in regions subserving emotional regulation in females and regions subserving executive processes and attention in males. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Elizabeth T C Lippard
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut.,Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - Carolyn M Mazure
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut.,Women's Health Research at Yale, Yale School of Medicine, New Haven, Connecticut
| | | | - Linda Spencer
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Judah Weathers
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut.,Child Study Center, Yale School of Medicine, New Haven, Connecticut
| | - Brian Pittman
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Fei Wang
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Hilary P Blumberg
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut.,Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut.,Women's Health Research at Yale, Yale School of Medicine, New Haven, Connecticut.,Child Study Center, Yale School of Medicine, New Haven, Connecticut
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19
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Lippard ETC, Jensen KP, Wang F, Johnston JAY, Spencer L, Pittman B, Gelernter J, Blumberg HP. Effects of ANK3 variation on gray and white matter in bipolar disorder. Mol Psychiatry 2017; 22:1345-1351. [PMID: 27240527 PMCID: PMC5133179 DOI: 10.1038/mp.2016.76] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Revised: 02/23/2016] [Accepted: 04/05/2016] [Indexed: 01/22/2023]
Abstract
The single-nucleotide polymorphism rs9804190 in the Ankyrin G (ANK3) gene has been reported in genome-wide association studies to be associated with bipolar disorder (BD). However, the neural system effects of rs9804190 in BD are not known. We investigated associations between rs9804190 and gray and white matter (GM and WM, respectively) structure within a frontotemporal neural system implicated in BD. A total of 187 adolescent and adult European Americans were studied: a group homozygous for the C allele (52 individuals with BD and 56 controls) and a T-carrier group, carrying the high-risk T allele (38 BD and 41 controls). Subjects participated in high-resolution structural magnetic resonance imaging and diffusion tensor imaging (DTI) scanning. Frontotemporal region of interest (ROI) and whole-brain exploratory analyses were conducted. DTI ROI-based analysis revealed a significant diagnosis by genotype interaction within the uncinate fasciculus (P⩽0.05), with BD subjects carrying the T (risk) allele showing decreased fractional anisotropy compared with other subgroups, independent of age. Genotype effects were not observed in frontotemporal GM volume. These findings support effects of rs9804190 on frontotemporal WM in adolescents and adults with BD and suggest a mechanism contributing to WM pathology in BD.
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Affiliation(s)
- E T C Lippard
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - K P Jensen
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Department of Psychiatry, VA Connecticut Healthcare System, West Haven, CT, USA
| | - F Wang
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - J A Y Johnston
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - L Spencer
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - B Pittman
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - J Gelernter
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Department of Psychiatry, VA Connecticut Healthcare System, West Haven, CT, USA
| | - H P Blumberg
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
- Department of Psychiatry, VA Connecticut Healthcare System, West Haven, CT, USA
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20
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Johnston JAY, Wang F, Liu J, Blond BN, Wallace A, Liu J, Spencer L, Cox Lippard ET, Purves KL, Landeros-Weisenberger A, Hermes E, Pittman B, Zhang S, King R, Martin A, Oquendo MA, Blumberg HP. Multimodal Neuroimaging of Frontolimbic Structure and Function Associated With Suicide Attempts in Adolescents and Young Adults With Bipolar Disorder. Am J Psychiatry 2017; 174:667-675. [PMID: 28135845 PMCID: PMC5939580 DOI: 10.1176/appi.ajp.2016.15050652] [Citation(s) in RCA: 150] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Bipolar disorder is associated with high risk for suicidal behavior that often develops in adolescence and young adulthood. Elucidation of involved neural systems is critical for prevention. This study of adolescents and young adults with bipolar disorder with and without a history of suicide attempts combines structural, diffusion tensor, and functional MR imaging methods to investigate implicated abnormalities in the morphology and structural and functional connectivity within frontolimbic systems. METHOD The study had 26 participants with bipolar disorder who had a prior suicide attempt (the attempter group) and 42 participants with bipolar disorder without a suicide attempt (the nonattempter group). Regional gray matter volume, white matter integrity, and functional connectivity during processing of emotional stimuli were compared between groups, and differences were explored for relationships between imaging modalities and associations with suicide-related symptoms and behaviors. RESULTS Compared with the nonattempter group, the attempter group showed significant reductions in gray matter volume in the orbitofrontal cortex, hippocampus, and cerebellum; white matter integrity in the uncinate fasciculus, ventral frontal, and right cerebellum regions; and amygdala functional connectivity to the left ventral and right rostral prefrontal cortex. In exploratory analyses, among attempters, there was a significant negative correlation between right rostral prefrontal connectivity and suicidal ideation and between left ventral prefrontal connectivity and attempt lethality. CONCLUSIONS Adolescent and young adult suicide attempters with bipolar disorder demonstrate less gray matter volume and decreased structural and functional connectivity in a ventral frontolimbic neural system subserving emotion regulation. Among attempters, reductions in amygdala-prefrontal functional connectivity may be associated with severity of suicidal ideation and attempt lethality.
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Affiliation(s)
| | - Fei Wang
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, US
| | - Jie Liu
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, US
| | - Benjamin N. Blond
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, US
| | - Amanda Wallace
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, US
| | - Jiacheng Liu
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, US
| | - Linda Spencer
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, US
| | | | - Kirstin L. Purves
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, US,Division of Psychology and Language Sciences, University College London, London, UK
| | - Angeli Landeros-Weisenberger
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, US,Child Study Center, Yale School of Medicine, New Haven, CT, USA
| | - Eric Hermes
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, US
| | - Brian Pittman
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, US
| | - Sheng Zhang
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, US
| | - Robert King
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, US,Child Study Center, Yale School of Medicine, New Haven, CT, USA
| | - Andrés Martin
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, US,Child Study Center, Yale School of Medicine, New Haven, CT, USA
| | - Maria A. Oquendo
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - Hilary P. Blumberg
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, US,Child Study Center, Yale School of Medicine, New Haven, CT, USA
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21
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Liu X, Guo Z, Ding Y, Li J, Wang G, Hou H, Chen X, Yu E. Abnormal baseline brain activity in Alzheimer’s disease patients with depression: a resting-state functional magnetic resonance imaging study. Neuroradiology 2017; 59:709-714. [DOI: 10.1007/s00234-017-1854-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 05/17/2017] [Indexed: 01/15/2023]
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22
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Abstract
Bipolar disorder is associated with subtle neuroanatomical deficits including lateral
ventricular enlargement, grey matter deficits incorporating limbic system structures, and distributed
white matter pathophysiology. Substantial heterogeneity has been identified by structural neuroimaging
studies to date and differential psychotropic medication use is potentially a substantial contributor to
this. This selective review of structural neuroimaging and diffusion tensor imaging studies considers
evidence that lithium, mood stabilisers, antipsychotic medication and antidepressant medications are
associated with neuroanatomical variation. Most studies are negative and suffer from methodological
weaknesses in terms of directly assessing medication effects on neuroanatomy, since they commonly
comprise posthoc assessments of medication associations with neuroimaging metrics in small heterogenous patient
groups. However the studies which report positive findings tend to form a relatively consistent picture whereby lithium
and antiepileptic mood stabiliser use is associated with increased regional grey matter volume, especially in limbic
structures. These findings are further supported by the more methodologically robust studies which include large numbers of
patients or repeated intra-individual scanning in longitudinal designs. Some similar findings of an apparently ameliorative
effect of lithium on white matter microstructure are also emerging. There is less support for an effect of antipsychotic or
antidepressant medication on brain structure in bipolar disorder, but these studies are further limited by methodological
difficulties. In general the literature to date supports a normalising effect of lithium and mood stabilisers on brain structure
in bipolar disorder, which is consistent with the neuroprotective characteristics of these medications identified by
preclinical studies.
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Affiliation(s)
- Colm McDonald
- National University of Ireland Galway, Galway, Ireland.
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23
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Najt P, Wang F, Spencer L, Johnston JAY, Cox Lippard ET, Pittman BP, Lacadie C, Staib LH, Papademetris X, Blumberg HP. Anterior Cortical Development During Adolescence in Bipolar Disorder. Biol Psychiatry 2016; 79:303-10. [PMID: 26033826 PMCID: PMC4595154 DOI: 10.1016/j.biopsych.2015.03.026] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 03/25/2015] [Accepted: 03/29/2015] [Indexed: 12/23/2022]
Abstract
BACKGROUND Increasing evidence supports a neurodevelopmental model for bipolar disorder (BD), with adolescence as a critical period in its development. Developmental abnormalities of anterior paralimbic and heteromodal frontal cortices, key structures in emotional regulation processes and central in BD, are implicated. However, few longitudinal studies have been conducted, limiting understanding of trajectory alterations in BD. In this study, we performed longitudinal neuroimaging of adolescents with and without BD and assessed volume changes over time, including changes in tissue overall and within gray and white matter. Larger decreases over time in anterior cortical volumes in the adolescents with BD were hypothesized. Gray matter decreases and white matter increases are typically observed during adolescence in anterior cortices. It was hypothesized that volume decreases over time in BD would reflect alterations in those processes, showing larger gray matter contraction and decreased white matter expansion. METHODS Two high-resolution magnetic resonance imaging scans were obtained approximately 2 years apart for 35 adolescents with bipolar I disorder (BDI) and 37 healthy adolescents. Differences over time between groups were investigated for volume overall and specifically for gray and white matter. RESULTS Relative to healthy adolescents, adolescents with BDI showed greater volume contraction over time in a region including insula and orbitofrontal, rostral, and dorsolateral prefrontal cortices (p < .05, corrected), including greater gray matter contraction and decreased white matter expansion over time, in the BD compared with the healthy group. CONCLUSIONS The findings support neurodevelopmental abnormalities during adolescence in BDI in anterior cortices, including altered developmental trajectories of anterior gray and white matter.
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Affiliation(s)
- Pablo Najt
- Departments of Psychiatry, New Haven, Connecticut
| | - Fei Wang
- Departments of Psychiatry, New Haven, Connecticut
| | | | | | | | | | | | - Lawrence H Staib
- Diagnostic Radiology, New Haven, Connecticut.; Electrical Engineering, New Haven, Connecticut
| | - Xenophon Papademetris
- Diagnostic Radiology, New Haven, Connecticut.; Biomedical Engineering, New Haven, Connecticut
| | - Hilary P Blumberg
- Departments of Psychiatry, New Haven, Connecticut.; Diagnostic Radiology, New Haven, Connecticut.; Child Study Center, Yale School of Medicine, New Haven, Connecticut..
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24
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Lui S, Yao L, Xiao Y, Keedy SK, Reilly JL, Keefe RS, Tamminga CA, Keshavan MS, Pearlson GD, Gong Q, Sweeney JA. Resting-state brain function in schizophrenia and psychotic bipolar probands and their first-degree relatives. Psychol Med 2015; 45:97-108. [PMID: 25066779 PMCID: PMC5836742 DOI: 10.1017/s003329171400110x] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Schizophrenia (SCZ) and psychotic bipolar disorder (PBD) share considerable overlap in clinical features, genetic risk factors and co-occurrence among relatives. The common and unique functional cerebral deficits in these disorders, and in unaffected relatives, remain to be identified. METHOD A total of 59 healthy controls, 37 SCZ and 57 PBD probands and their unaffected first-degree relatives (38 and 28, respectively) were studied using resting-state functional magnetic resonance imaging (rfMRI). Regional cerebral function was evaluated by measuring the amplitude of low-frequency fluctuations (ALFF). Areas with ALFF alterations were used as seeds in whole-brain functional connectivity analysis. We then tested whether abnormalities identified in probands were present in unaffected relatives. RESULTS SCZ and PBD probands both demonstrated regional hypoactivity in the orbital frontal cortex and cingulate gyrus, as well as abnormal connectivity within striatal-thalamo-cortical networks. SCZ probands showed greater and more widely distributed ALFF alterations including the thalamus and bilateral parahippocampal gyri. Increased parahippocampal ALFF was related to positive symptoms and cognitive deficit. PBD patients showed uniquely increased functional connectivity between the thalamus and bilateral insula. Only PBD relatives showed abnormal connectivity within striatal-thalamo-cortical networks seen in both proband groups. CONCLUSIONS The present findings reveal a common pattern of deficits in frontostriatal circuitry across SCZ and PBD, and unique regional and functional connectivity abnormalities that distinguish them. The abnormal network connectivity in PBD relatives that was present in both proband groups may reflect genetic susceptibility associated with risk for psychosis, but within-family associations of this measure were not high.
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Affiliation(s)
- S. Lui
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, People’s Republic of China
| | - L. Yao
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, People’s Republic of China
| | - Y. Xiao
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, People’s Republic of China
| | - S. K. Keedy
- Department of Psychiatry, University of Chicago, Chicago, IL, USA
| | - J. L. Reilly
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - R. S. Keefe
- Department of Psychiatry, Duke University Medical Center, Durham, IL, USA
| | - C. A. Tamminga
- Department of Psychiatry, University of Texas Southwestern Medical School, Dallas, TX, USA
| | - M. S. Keshavan
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - G. D. Pearlson
- Departments of Psychiatry and Neurobiology, Yale University School of Medicine and Olin Neuropsychiatric Research Center, Hartford, CT, USA
| | - Q. Gong
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, People’s Republic of China
| | - J. A. Sweeney
- Department of Psychiatry, University of Texas Southwestern Medical School, Dallas, TX, USA
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de Zwarte SMC, Johnston JAY, Cox Lippard ET, Blumberg HP. Frontotemporal White Matter in Adolescents with, and at-Risk for, Bipolar Disorder. J Clin Med 2014; 3:233-54. [PMID: 26237259 PMCID: PMC4449671 DOI: 10.3390/jcm3010233] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 02/13/2014] [Accepted: 02/17/2014] [Indexed: 12/13/2022] Open
Abstract
Frontotemporal neural systems are highly implicated in the emotional dysregulation characteristic of bipolar disorder (BD). Convergent genetic, postmortem, behavioral and neuroimaging evidence suggests abnormalities in the development of frontotemporal white matter (WM) in the pathophysiology of BD. This review discusses evidence for the involvement of abnormal WM development in BD during adolescence, with a focus on frontotemporal WM. Findings from diffusion tensor imaging (DTI) studies in adults and adolescents are reviewed to explore possible progressive WM abnormalities in the disorder. Intra- and interhemispheric frontotemporal abnormalities were reported in adults with BD. Although evidence in children and adolescents with BD to date has been limited, similar intrahemispheric and interhemispheric findings have also been reported. The findings in youths suggest that these abnormalities may represent a trait marker present early in the course of BD. Functional connectivity studies, demonstrating a relationship between WM abnormalities and frontotemporal dysfunction in BD, and DTI studies of vulnerability in first-degree relatives of individuals with BD, are discussed. Together, findings suggest the involvement of abnormal frontotemporal WM development in the pathophysiology of BD and that these abnormalities may be early trait markers of vulnerability; however, more studies are critically needed.
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Affiliation(s)
- Sonja M C de Zwarte
- Department of Psychiatry, Yale School of Medicine, 300 George Street, Suite 901, New Haven, CT 06511, USA.
| | - Jennifer A Y Johnston
- Department of Psychiatry, Yale School of Medicine, 300 George Street, Suite 901, New Haven, CT 06511, USA.
| | - Elizabeth T Cox Lippard
- Department of Psychiatry, Yale School of Medicine, 300 George Street, Suite 901, New Haven, CT 06511, USA.
| | - Hilary P Blumberg
- Department of Psychiatry, Yale School of Medicine, 300 George Street, Suite 901, New Haven, CT 06511, USA.
- Department of Diagnostic Radiology, Yale School of Medicine, New Haven, CT 06511, USA.
- Child Study Center, Yale School of Medicine, New Haven, CT 06511, USA.
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Xu K, Liu H, Li H, Tang Y, Womer F, Jiang X, Chen K, Zhou Y, Jiang W, Luo X, Fan G, Wang F. Amplitude of low-frequency fluctuations in bipolar disorder: a resting state fMRI study. J Affect Disord 2014; 152-154:237-42. [PMID: 24120087 DOI: 10.1016/j.jad.2013.09.017] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 08/08/2013] [Accepted: 09/17/2013] [Indexed: 01/08/2023]
Abstract
OBJECTIVES The spontaneous low frequency fluctuations (LFF) of blood oxygenation level-dependent (BOLD) signal in resting state have been identified as a biological measure of baseline spontaneous activity in the brain. Increasingly, studies of spontaneous resting state functional connectivity have demonstrated neural network abnormalities in bipolar disorder (BD). This study used the amplitude of low frequency fluctuations (ALFF) to explore the regional functional changes in BD during resting state. METHODS Twenty-nine BD participants and 29 matched healthy controls (HC) were recruited to undergo resting-state functional magnetic resonance imaging scan on a 3.0T magnetic resonance imaging system. The ALFF of BOLD signal in gray matter for each participant was calculated, and then was compared between BD and HC using ALFF maps. RESULTS Compared to the HC group, the BD group showed increased ALFF in ventral prefrontal cortex, dorsal lateral prefrontal cortex, frontal eye field, insula, and putamen with extension into the ventral striatum, as well as decreased ALFF in the lingual gyrus (p<0.05, corrected). LIMITATIONS Although we observed differences in ALFF between BD and HC, we cannot conclusively state that these differences are caused by the pathophysiology of BD since most of BD participants were being treated with medications at the time of scanning. CONCLUSIONS Our results revealed altered regional brain activity in BD during resting state. The affected regions have been associated with BD pathophysiology. This suggests that methods using ALFF method may potentially be useful in further studies of this disorder.
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Affiliation(s)
- Ke Xu
- Department of Radiology, The First Affiliated Hospital, China Medical University, 155 Nanjing North Street, Shenyang, Liaoning 110001, PR China
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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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28
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Kong L, Chen K, Womer F, Jiang W, Luo X, Driesen N, Liu J, Blumberg H, Tang Y, Xu K, Wang F. Sex differences of gray matter morphology in cortico-limbic-striatal neural system in major depressive disorder. J Psychiatr Res 2013; 47:733-9. [PMID: 23453566 PMCID: PMC3626116 DOI: 10.1016/j.jpsychires.2013.02.003] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Revised: 01/31/2013] [Accepted: 02/07/2013] [Indexed: 01/04/2023]
Abstract
Sex differences are observed in both epidemiological and clinical aspects of major depressive disorder (MDD). The cortico-limbic-striatal neural system, including the prefrontal cortex, amygdala, hippocampus, and striatum, have shown sexually dimorphic morphological features and have been implicated in the dysfunctional regulation of mood and emotion in MDD. In this study, we utilized a whole-brain, voxel-based approach to examine sex differences in the regional distribution of gray matter (GM) morphological abnormalities in medication-naïve participants with MDD. Participants included 29 medication-naïve individuals with MDD (16 females and 13 males) and 33 healthy controls (HC) (17 females and 16 males). Gray matter morphology of the cortico-limbic-striatal neural system was examined using voxel-based morphometry analyzes of high-resolution structural magnetic resonance imaging scans. The main effect of diagnosis and interaction effect of diagnosis by sex on GM morphology were statistically significant (p < 0.05, corrected) in the left ventral prefrontal cortex, right amygdala, right hippocampus and bilateral caudate when comparing the MDD and HC groups. Posthoc analyzes showed that females with MDD had significant GM decreases in limbic regions (p < 0.05, corrected), compared to female HC; while males with MDD demonstrated significant GM reduction in striatal regions, (p < 0.05, corrected), compared to HC males. The observed sex-related patterns of abnormalities within the cortico-limbic-strial neural system, such as predominant prefrontal-limbic abnormalities in MDD females vs. predominant prefrontal-striatal abnormalities in MDD males, suggest differences in neural circuitry that may mediate sex differences in the clinical presentation of MDD and potential targets for sex-differentiated treatment of the disorder.
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Affiliation(s)
- Lingtao Kong
- Department of Psychiatry, The First Affiliated Hospital, China Medical University, 155 Nanjing North Street, Shenyang 110001, Liaoning, PR China
| | - Kaiyuan Chen
- Department of Psychiatry, The First Affiliated Hospital, China Medical University, 155 Nanjing North Street, Shenyang 110001, Liaoning, PR China
| | - Fay Womer
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Wenyan Jiang
- Department of Psychiatry, The First Affiliated Hospital, China Medical University, 155 Nanjing North Street, Shenyang 110001, Liaoning, PR China
| | - Xingguang Luo
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06511, USA
| | - Naomi Driesen
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06511, USA
| | - Jie Liu
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06511, USA
| | - Hilary Blumberg
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06511, USA
| | - Yanqing Tang
- Department of Psychiatry, The First Affiliated Hospital, China Medical University, 155 Nanjing North Street, Shenyang 110001, Liaoning, PR China
| | - Ke Xu
- Department of Radiology, The First Affiliated Hospital of China Medical University, 155 Nanjing North Street, Shenyang 110001, Liaoning, PR China,Corresponding Authors: Ke Xu, M.D., Ph.D., Department of Radiology, The First Affiliated Hospital, China Medical University, 155 Nanjing North Street, Shenyang 110001, Liaoning, PR China. Tel: 8624-8328-2999, Fax: 8624-8328-2997, , Fei Wang, M.D., Ph. D., Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT 06511. Tel: 203-737-2507, Fax: 203-737-2513,
| | - Fei Wang
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06511, USA,Department of Radiology, The First Affiliated Hospital of China Medical University, 155 Nanjing North Street, Shenyang 110001, Liaoning, PR China,Corresponding Authors: Ke Xu, M.D., Ph.D., Department of Radiology, The First Affiliated Hospital, China Medical University, 155 Nanjing North Street, Shenyang 110001, Liaoning, PR China. Tel: 8624-8328-2999, Fax: 8624-8328-2997, , Fei Wang, M.D., Ph. D., Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT 06511. Tel: 203-737-2507, Fax: 203-737-2513,
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29
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Wang F, Bobrow L, Liu J, Spencer L, Blumberg HP. Corticolimbic functional connectivity in adolescents with bipolar disorder. PLoS One 2012; 7:e50177. [PMID: 23185566 PMCID: PMC3503984 DOI: 10.1371/journal.pone.0050177] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Accepted: 10/22/2012] [Indexed: 11/19/2022] Open
Abstract
Convergent evidence supports regional dysfunction within a corticolimbic neural system that subserves emotional processing and regulation in adolescents and adults with bipolar disorder (BD), with abnormalities prominent within the amygdala and its major anterior paralimbic cortical connection sites including ventral anterior cingulate, orbitofrontal, insular and temporopolar cortices. Recent studies of adults with BD demonstrate abnormalities in the functional connectivity between the amygdala and anterior paralimbic regions suggesting an important role for the connections between these regions in the development of the disorder. This study tests the hypothesis that these functional connectivity abnormalities are present in adolescents with BD. Fifty-seven adolescents, twenty-one with BD and thirty-six healthy comparison (HC) adolescents, participated in functional magnetic resonance imaging while processing emotional face stimuli. The BD and HC groups were compared in the strength of functional connectivity from amygdala to the anterior paralimbic cortical regions, and explored in remaining brain regions. Functional connectivity was decreased in the BD group, compared to the HC group, during processing of emotional faces in ventral anterior cingulate (VACC), orbitofrontal, insular and temporopolar cortices (p<0.005). Orbitofrontal and VACC findings for the happy condition, and additionally right insula for the neutral condition, survived multiple comparison correction. Exploratory analyses did not reveal additional regions of group differences. This study provides evidence for decreased functional connectivity between the amygdala and anterior paralimbic cortices in adolescents with BD. This suggests that amygdala-anterior paralimbic connectivity abnormalities are early features of BD that emerge at least by adolescence in the disorder.
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Affiliation(s)
- Fei Wang
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Laurel Bobrow
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Jie Liu
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Linda Spencer
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Hilary P. Blumberg
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, United States of America
- Child Study Center, Yale School of Medicine, New Haven, Connecticut, United States of America
- Department of Diagnostic Radiology, Yale School of Medicine, New Haven, Connecticut, United States of America
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30
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Blond BN, Fredericks CA, Blumberg HP. Functional neuroanatomy of bipolar disorder: structure, function, and connectivity in an amygdala-anterior paralimbic neural system. Bipolar Disord 2012; 14:340-55. [PMID: 22631619 PMCID: PMC3880745 DOI: 10.1111/j.1399-5618.2012.01015.x] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES In past decades, neuroimaging research in bipolar disorder has demonstrated a convergence of findings in an amygdala-anterior paralimbic cortex neural system. This paper reviews behavioral neurology literature that first suggested a central role for this neural system in the disorder and the neuroimaging evidence that supports it. METHODS Relevant articles are reviewed to provide an amygdala-anterior paralimbic cortex neural system model of bipolar disorder, including articles from the fields of behavioral neurology and neuroanatomy, and neuroimaging. RESULTS The literature is highly supportive of key roles for the amygdala, anterior paralimbic cortices, and connections among these structures in the emotional dysregulation of bipolar disorder. The functions subserved by their more widely distributed connection sites suggest that broader system dysfunction could account for the range of functions-from neurovegetative to cognitive-disrupted in the disorder. Abnormalities in some components of this neural system are apparent by adolescence, while others, such as those in rostral prefrontal regions, appear to progress over adolescence and young adulthood, suggesting a neurodevelopmental model of the disorder. However, some findings conflict, which may reflect the small sample sizes of some studies, and clinical heterogeneity and methodological differences across studies. CONCLUSIONS Consistent with models derived from early behavioral neurology studies, neuroimaging studies support a central role for an amygdala-anterior paralimbic neural system in bipolar disorder, and implicate abnormalities in the development of this system in the disorder. This system will be an important focus of future studies on the developmental pathophysiology, detection, treatment, and prevention of the disorder.
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Affiliation(s)
- Benjamin N Blond
- Department of Psychiatry, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
| | - Carolyn A Fredericks
- Department of Psychiatry, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
| | - Hilary P Blumberg
- Department of Psychiatry, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA,Department of Diagnostic Radiology, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA,The Child Study Center, Yale School of Medicine, New Haven, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA,Research Enhancement Award Program Depression Center, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
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31
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Liu J, Blond BN, van Dyck LI, Spencer L, Wang F, Blumberg HP. Trait and state corticostriatal dysfunction in bipolar disorder during emotional face processing. Bipolar Disord 2012; 14:432-41. [PMID: 22524493 PMCID: PMC3361579 DOI: 10.1111/j.1399-5618.2012.01018.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Convergent evidence supports limbic, anterior paralimbic, and prefrontal cortex (PFC) abnormalities in emotional processing in bipolar disorder (BD) and suggests that some abnormalities are mood-state dependent and others persist into euthymia. However, few studies have assessed elevated, depressed, and euthymic mood states while individuals processed emotional stimuli of varying valence to investigate trait- and state-related neural system responses. Here, regional brain responses to positive, negative, and neutral emotional stimuli were assessed in individuals with BD during elevated, depressed, and euthymic mood states. METHODS One hundred and thirty-four subjects participated in functional magnetic resonance imaging scanning while processing faces depicting happy, fearful, and neutral expressions: 76 with BD (18 in elevated mood states, 19 depressed, 39 euthymic) and 58 healthy comparison (HC) individuals. Analyses were performed for BD trait- and mood state-related features. RESULTS Ventral anterior cingulate cortex (VACC), orbitofrontal cortex (OFC), and ventral striatum responses to happy and neutral faces were decreased in the BD group, compared to the HC group, and were not influenced by mood state. Elevated mood states were associated with decreased right rostral PFC activation to fearful and neutral faces, and depression was associated with increased left OFC activation to fearful faces. CONCLUSIONS The findings suggest that abnormal VACC, OFC, and ventral striatum responses to happy and neutral stimuli are trait features of BD. Acute mood states may be associated with additional lateralized abnormalities of diminished right rostral PFC responses to fearful and neutral stimuli in elevated states and increased left OFC responses to fearful stimuli in depressed states.
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Affiliation(s)
- Jie Liu
- Department of Psychiatry, Yale School of Medicine, New Haven
| | | | | | - Linda Spencer
- Department of Psychiatry, Yale School of Medicine, New Haven
| | - Fei Wang
- Department of Psychiatry, Yale School of Medicine, New Haven
| | - Hilary P. Blumberg
- Department of Psychiatry, Yale School of Medicine, New Haven,Department of Diagnostic Radiology, Yale School of Medicine, New Haven,The Child Study Center, Yale School of Medicine, New Haven,Research Enhancement Award Program Depression Center, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
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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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Blumberg HP. Euthymia, depression, and mania: what do we know about the switch? Biol Psychiatry 2012; 71:570-1. [PMID: 22424111 PMCID: PMC3874046 DOI: 10.1016/j.biopsych.2012.02.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Accepted: 02/07/2012] [Indexed: 11/26/2022]
Affiliation(s)
- Hilary P. Blumberg
- Mood Disorders Research Program, Department of Psychiatry, Yale School of Medicine, 300 George Street, Suite 901, New Haven, CT 06511
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35
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Liu J, Chaplin TM, Wang F, Sinha R, Mayes LC, Blumberg HP. Stress reactivity and corticolimbic response to emotional faces in adolescents. J Am Acad Child Adolesc Psychiatry 2012; 51:304-12. [PMID: 22365466 PMCID: PMC3292764 DOI: 10.1016/j.jaac.2011.12.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2011] [Revised: 12/12/2011] [Accepted: 12/20/2011] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Adolescence is a critical period in the development of lifelong patterns of responding to stress. Understanding underpinnings of variations in stress reactivity in adolescents is important, as adolescents with altered stress reactivity are vulnerable to negative risk-taking behaviors including substance use, and have increased lifelong risk for psychopathology. Although both endocrinological and corticolimbic neural system mechanisms are implicated in the development of stress reactivity patterns, the roles of these systems and interactions between the systems in reactivity to social stimuli in adolescents are not clear. We investigated the relationship between cortisol response to a laboratory-based social stressor and regional brain responses to emotional face stimuli in adolescents. METHOD Changes in cortisol levels following the Trier Social Stress Test-Child version (TSST-C) were measured in 23 disadvantaged and chronically stressed adolescents who also participated in functional magnetic resonance imaging during processing of emotional faces and structural magnetic resonance imaging. The relationships between changes in cortisol following the TSST-C with regional brain activation during face processing, as well as with regional brain morphology, were assessed. RESULTS Cortisol change on the TSST-C showed a significant inverse relationship with left hippocampus response to fearful faces (p < .05, corrected); significant associations with volume were not observed. CONCLUSIONS Increased cortisol response to the Trier social stressor was associated with diminished response of the left hippocampus to faces depicting fear. This suggests that HPA-corticolimbic system mechanisms may underlie vulnerability to maladaptive responses to stress in adolescents that may contribute to development of stress-related disorders.
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Affiliation(s)
- Jie Liu
- Yale School of Medicine, New Haven, CT, USA
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36
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Chepenik LG, Wang F, Spencer L, Spann M, Kalmar JH, Womer F, Kale Edmiston E, Pittman B, Blumberg HP. Structure-function associations in hippocampus in bipolar disorder. Biol Psychol 2012; 90:18-22. [PMID: 22342942 DOI: 10.1016/j.biopsycho.2012.01.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Revised: 09/19/2011] [Accepted: 01/28/2012] [Indexed: 01/22/2023]
Abstract
Hippocampus volume decreases and verbal memory deficits have been reported in bipolar disorder (BD) as independent observations. We investigated potential associations between these deficits in subjects with BD. Hippocampus volumes were measured on magnetic resonance images of 31 subjects with BD and 32 healthy comparison (HC) subjects. The California Verbal Learning Test-Second Edition (CVLT) assessed verbal memory function in these subjects. Compared to the HC group, the BD group showed both significantly smaller hippocampus volumes and impaired performance on CVLT tests of immediate, short delay and long delay cued and free recall. Further, smaller hippocampus volume correlated with impaired performance in BD. Post hoc analyses revealed a trend towards improved memory in BD subjects taking antidepressant medications. These results support associations between morphological changes in hippocampus structure in BD and verbal memory impairment. They provide preliminary evidence pharmacotherapy may reverse hippocampus-related memory deficits.
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Affiliation(s)
- Lara G Chepenik
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
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