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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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Singh MK, Gorelik AJ, Stave C, Gotlib IH. Genetics, epigenetics, and neurobiology of childhood-onset depression: an umbrella review. Mol Psychiatry 2024; 29:553-565. [PMID: 38102485 DOI: 10.1038/s41380-023-02347-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 11/21/2023] [Accepted: 11/27/2023] [Indexed: 12/17/2023]
Abstract
Depression is a serious and persistent psychiatric disorder that commonly first manifests during childhood. Depression that starts in childhood is increasing in frequency, likely due both to evolutionary trends and to increased recognition of the disorder. In this umbrella review, we systematically searched the extant literature for genetic, epigenetic, and neurobiological factors that contribute to a childhood onset of depression. We searched PubMed, EMBASE, OVID/PsychInfo, and Google Scholar with the following inclusion criteria: (1) systematic review or meta-analysis from a peer-reviewed journal; (2) inclusion of a measure assessing early age of onset of depression; and (3) assessment of neurobiological, genetic, environmental, and epigenetic predictors of early onset depression. Findings from 89 systematic reviews of moderate to high quality suggest that childhood-onset depressive disorders have neurobiological, genetic, environmental, and epigenetic roots consistent with a diathesis-stress theory of depression. This review identified key putative markers that may be targeted for personalized clinical decision-making and provide important insights concerning candidate mechanisms that might underpin the early onset of depression.
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Zhu Z, Lei D, Qin K, Tallman MJ, Patino LR, Fleck DE, Gong Q, Sweeney JA, DelBello MP, McNamara RK. Cortical and subcortical structural differences in psychostimulant-free ADHD youth with and without a family history of bipolar I disorder: a cross-sectional morphometric comparison. Transl Psychiatry 2023; 13:368. [PMID: 38036505 PMCID: PMC10689449 DOI: 10.1038/s41398-023-02667-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 10/31/2023] [Accepted: 11/13/2023] [Indexed: 12/02/2023] Open
Abstract
Although attention-deficit/hyperactivity disorder (ADHD) and a family history of bipolar I disorder (BD) are associated with increased risk for developing BD, their neuroanatomical substrates remain poorly understood. This study compared cortical and subcortical gray matter morphology in psychostimulant-free ADHD youth with and without a first-degree relative with BD and typically developing healthy controls. ADHD youth (ages 10-18 years) with ('high-risk', HR) or without ('low-risk', LR) a first-degree relative with BD and healthy comparison youth (HC) were enrolled. High-resolution 3D T1-weighted images were acquired using a Philips 3.0 T MR scanner. The FreeSurfer image analysis suite was used to measure cortical thickness, surface area, and subcortical volumes. A general linear model evaluated group differences in MRI features with age and sex as covariates, and exploratory correlational analyses evaluated associations with symptom ratings. A total of n = 142 youth (mean age: 14.16 ± 2.54 years, 35.9% female) were included in the analysis (HC, n = 48; LR, n = 49; HR, n = 45). The HR group exhibited a more severe symptom profile, including higher mania and dysregulation scores, compared to the LR group. For subcortical volumes, the HR group exhibited smaller bilateral thalamic, hippocampal, and left caudate nucleus volumes compared to both LR and HC, and smaller right caudate nucleus compared with LR. No differences were found between LR and HC groups. For cortical surface area, the HR group exhibited lower parietal and temporal surface area compared with HC and LR, and lower orbitofrontal and superior frontal surface area compared to LR. The HR group exhibited lower left anterior cingulate surface area compared with HC. LR participants exhibited greater right pars opercularis surface area compared with the HC. Some cortical alterations correlated with symptom severity ratings. These findings suggest that ADHD in youth with a BD family history is associated with a more a severe symptom profile and a neuroanatomical phenotype that distinguishes it from ADHD without a BD family history.
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Affiliation(s)
- Ziyu Zhu
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, PR China
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, 45219, OH, USA
| | - Du Lei
- College of Medical Informatics, Chongqing Medical University, Chongqing, 400016, PR China.
| | - Kun Qin
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, PR China
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, 45219, OH, USA
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, Sichuan, PR China
- Department of Radiology, Taihe Hospital, Hubei University of Medicine, Shiyan, 442012, PR China
| | - Maxwell J Tallman
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, 45219, OH, USA
| | - L Rodrigo Patino
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, 45219, OH, USA
| | - David E Fleck
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, 45219, OH, USA
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, PR China.
- Department of Radiology, West China Xiamen Hospital of Sichuan University, Xiamen, 361021, Fujian, PR China.
| | - John A Sweeney
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, PR China
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, 45219, OH, USA
| | - Melissa P DelBello
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, 45219, OH, USA
| | - Robert K McNamara
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, 45219, OH, USA
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Long X, Li L, Wang X, Cao Y, Wu B, Roberts N, Gong Q, Kemp GJ, Jia Z. Gray matter alterations in adolescent major depressive disorder and adolescent bipolar disorder. J Affect Disord 2023; 325:550-563. [PMID: 36669567 DOI: 10.1016/j.jad.2023.01.049] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 12/24/2022] [Accepted: 01/11/2023] [Indexed: 01/19/2023]
Abstract
BACKGROUND Gray matter volume (GMV) alterations in several emotion-related brain areas are implicated in mood disorders, but findings have been inconsistent in adolescents with major depressive disorder (MDD) or bipolar disorder (BD). METHODS We conducted a comprehensive meta-analysis of 35 region-of-interest (ROI) and 18 whole-brain voxel-based morphometry (VBM) MRI studies in adolescent MDD and adolescent BD, and indirectly compared the results in the two groups. The effects of age, sex, and other demographic and clinical scale scores were explored using meta-regression analysis. RESULTS In the ROI meta-analysis, right putamen volume was decreased in adolescents with MDD, while bilateral amygdala volume was decreased in adolescents with BD compared to healthy controls (HC). In the whole-brain VBM meta-analysis, GMV was increased in right middle frontal gyrus and decreased in left caudate in adolescents with MDD compared to HC, while in adolescents with BD, GMV was increased in left superior frontal gyrus and decreased in limbic regions compared with HC. MDD vs BD comparison revealed volume alteration in the prefrontal-limbic system. LIMITATION Different clinical features limit the comparability of the samples, and small sample size and insufficient clinical details precluded subgroup analysis or meta-regression analyses of these variables. CONCLUSIONS Distinct patterns of GMV alterations in adolescent MDD and adolescent BD could help to differentiate these two populations and provide potential diagnostic biomarkers.
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Affiliation(s)
- Xipeng Long
- Department of Nuclear Medicine, West China Hospital of Sichuan University, No. 37 GuoXue Xiang, Chengdu 610041, Sichuan, PR China; Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, PR China
| | - Lei Li
- Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, PR China; Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, PR China
| | - Xiuli Wang
- Department of Clinical Psychiatry, the Fourth People's Hospital of Chengdu, Chengdu 610041, Sichuan, PR China
| | - Yuan Cao
- Department of Nuclear Medicine, West China Hospital of Sichuan University, No. 37 GuoXue Xiang, Chengdu 610041, Sichuan, PR China
| | - Baolin Wu
- Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, PR China; Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, PR China
| | - Neil Roberts
- The Queens Medical Research Institute (QMRI), School of Clinical Sciences, University of Edinburgh, Edinburgh, UK
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, PR China; Department of Radiology, West China Xiamen Hospital of Sichuan University, 699Jinyuan Xi Road, Jimei District, 361021 Xiamen, Fujian, PR China
| | - Graham J Kemp
- Liverpool Magnetic Resonance Imaging Center (LiMRIC) and Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Zhiyun Jia
- Department of Nuclear Medicine, West China Hospital of Sichuan University, No. 37 GuoXue Xiang, Chengdu 610041, Sichuan, PR China; Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, PR China.
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5
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Puramat P, Dimick MK, Kennedy KG, Zai CC, Kennedy JL, MacIntosh BJ, Goldstein BI. Neurostructural and neurocognitive correlates of APOE ε4 in youth bipolar disorder. J Psychopharmacol 2023; 37:408-419. [PMID: 36919310 DOI: 10.1177/02698811221147151] [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] [Indexed: 03/16/2023]
Abstract
BACKGROUND Bipolar disorder (BD) is a clinical risk factor for Alzheimer's disease (AD). Apolipoprotein E ε4 (APOE ε4), a genetic risk factor for AD, has been associated with brain structure and neurocognition in healthy youth. AIMS We evaluated whether there was an association between APOE ε4 with neurostructure and neurocognition in youth with BD. METHODS Participants included 150 youth (78 BD:19 ε4-carriers, 72 controls:17 ε4-carriers). 3T-magnetic resonance imaging yielded measures of cortical thickness, surface area, and volume. Regions-of-interest (ROI) and vertex-wise analyses of the cortex were conducted. Neurocognitive tests of attention and working memory were examined. RESULTS Vertex-wise analyses revealed clusters with a diagnosis-by-APOE ε4 interaction effect for surface area (p = 0.002) and volume (p = 0.046) in pars triangularis (BD ε4-carriers > BD noncarriers), and surface area (p = 0.03) in superior frontal gyrus (controls ε4-carriers > other groups). ROI analyses were not significant. A significant interaction effect for working memory (p = 0.001) appeared to be driven by nominally poorer performance in BD ε4-carriers but not control ε4-carriers; however, post hoc contrasts were not significant. CONCLUSIONS APOE ε4 was associated with larger neurostructural metrics in BD and controls, however, the regional association of APOE ε4 with neurostructure differed between groups. The role of APOE ε4 on neurodevelopmental processes is a plausible explanation for the observed differences. Future studies should evaluate the association of APOE ε4 with pars triangularis and its neurofunctional implications among youth with BD.
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Affiliation(s)
- Parnian Puramat
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Pharmacology and Toxicology, University of Toronto Faculty of Medicine, Toronto, ON, Canada
| | - Mikaela K Dimick
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Pharmacology and Toxicology, University of Toronto Faculty of Medicine, Toronto, ON, Canada
| | - Kody G Kennedy
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Pharmacology and Toxicology, University of Toronto Faculty of Medicine, Toronto, ON, Canada
| | - Clement C Zai
- Neurogenetics Section and Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto Faculty of Medicine, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - James L Kennedy
- Neurogenetics Section and Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto Faculty of Medicine, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Bradley J MacIntosh
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada.,Hurvitz Brain Sciences, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Pharmacology and Toxicology, University of Toronto Faculty of Medicine, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto Faculty of Medicine, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
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Friedlander ANH, Mitchell RHB, Dimick MK, Kennedy KG, MacIntosh BJ, Goldstein BI. Clinical and neuroimaging characteristics of monozygotic 16-Year-Old twins discordant for bipolar disorder: A case study. Bipolar Disord 2022; 24:836-839. [PMID: 36117325 DOI: 10.1111/bdi.13258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Alana N H Friedlander
- Centre for Youth Bipolar Disorder, Child and Youth Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Rachel H B Mitchell
- Department of Psychiatry, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada.,Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Mikaela K Dimick
- Centre for Youth Bipolar Disorder, Child and Youth Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Pharmacology and Toxicology, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Kody G Kennedy
- Centre for Youth Bipolar Disorder, Child and Youth Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Pharmacology and Toxicology, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Bradley J MacIntosh
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.,Hurvitz Brain Sciences, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Child and Youth Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada.,Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Pharmacology and Toxicology, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
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Cattarinussi G, Bellani M, Maggioni E, Sambataro F, Brambilla P, Delvecchio G. Resting-state functional connectivity and spontaneous brain activity in early-onset bipolar disorder: A review of functional Magnetic Resonance Imaging studies. J Affect Disord 2022; 311:463-471. [PMID: 35580695 DOI: 10.1016/j.jad.2022.05.055] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 05/04/2022] [Accepted: 05/10/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Early-onset bipolar disorder (BD) is a complex psychiatric illness characterized by mood swings, irritability and functional impairments. To improve our understanding of the pathophysiology of the disorder, we collected the existing resting-state functional Magnetic Resonance Imaging (rs-fMRI) studies exploring resting-state functional connectivity (rs-FC) and spontaneous activity alterations in children and adolescents with BD. METHODS A search on PubMed, Web of Science and Scopus was conducted to identify all the relevant rs-fMRI investigations conducted in early-onset BD. A total of 14 studies employing different methodological approaches to explore rs-FC and spontaneous activity in early-onset BD were included (independent component analysis, n = 1; seed-based analysis, n = 7; amplitude of low frequency fluctuations analysis, n = 2; regional homogeneity analysis, n = 4). RESULTS Overall, the studies showed abnormalities within the Default Mode Network (DMN) and between the DMN and the Salience Network (SN). Moreover, widespread alterations in rs-FC and spontaneous brain activity within and between cortico-limbic structures, involving primarily the occipital and frontal lobes, amygdala, hippocampus, insula, thalamus and striatum were also reported. LIMITATIONS The small sample sizes, the use of medications, the presence of comorbidities and the heterogeneity in methods hamper the integration of the study findings. CONCLUSIONS Early-onset BD seems to be characterized by selective rs-FC and spontaneous activity dysfunctions in DMN and SN as well as in the cortico-limbic and cortico-striatal circuits, which could explain the emotive and cognitive deficits observed in this disabling psychiatric illness.
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Affiliation(s)
- Giulia Cattarinussi
- Department of Neuroscience (DNS), University of Padova, Padua, Italy; Padua Neuroscience Center, University of Padova, Padua, Italy
| | - Marcella Bellani
- Section of Psychiatry, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Eleonora Maggioni
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Electronics Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Fabio Sambataro
- Department of Neuroscience (DNS), University of Padova, Padua, Italy; Padua Neuroscience Center, University of Padova, Padua, Italy
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Giuseppe Delvecchio
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
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8
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Grigorian A, Kennedy KG, Luciw NJ, MacIntosh BJ, Goldstein BI. Obesity and Cerebral Blood Flow in the Reward Circuitry of Youth With Bipolar Disorder. Int J Neuropsychopharmacol 2022; 25:448-456. [PMID: 35092432 PMCID: PMC9211014 DOI: 10.1093/ijnp/pyac011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/13/2022] [Accepted: 01/27/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Bipolar disorder (BD) is associated with elevated body mass index (BMI) and increased rates of obesity. Obesity among individuals with BD is associated with more severe course of illness. Motivated by previous research on BD and BMI in youth as well as brain findings in the reward circuit, the current study investigates differences in cerebral blood flow (CBF) in youth BD with and without comorbid overweight/obesity (OW/OB). METHODS Participants consisted of youth, ages 13-20 years, including BD with OW/OB (BDOW/OB; n = 25), BD with normal weight (BDNW; n = 55), and normal-weight healthy controls (HC; n = 61). High-resolution T1-weighted and pseudo-continuous arterial spin labeling images were acquired using 3 Tesla magnetic resonance imaging. CBF differences were assessed using both region of interest and whole-brain voxel-wise approaches. RESULTS Voxel-wise analysis revealed significantly higher CBF in reward-associated regions in the BDNW group relative to the HC and BDOW/OB groups. CBF did not differ between the HC and BDOW/OB groups. There were no significant region of interest findings. CONCLUSIONS The current study identified distinct CBF levels relating to BMI in BD in the reward circuit, which may relate to underlying differences in cerebral metabolism, compensatory effects, and/or BD severity. Future neuroimaging studies are warranted to examine for changes in the CBF-OW/OB link over time and in relation to treatment.
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Affiliation(s)
- Anahit Grigorian
- Centre for Youth Bipolar Disorder, Department of Child and Youth Psychiatry, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Kody G Kennedy
- Centre for Youth Bipolar Disorder, Department of Child and Youth Psychiatry, Centre for Addiction and Mental Health, Toronto, Ontario, Canada,Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Nicholas J Luciw
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Bradley J MacIntosh
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada,Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, Toronto, Ontario, Canada,Hurvitz Brain Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Benjamin I Goldstein
- Correspondence: Benjamin I. Goldstein, MD, PhD, Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON, Canada, M6J 1H4 ()
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Liu L, Meng M, Zhu X, Zhu G. Research Status in Clinical Practice Regarding Pediatric and Adolescent Bipolar Disorders. Front Psychiatry 2022; 13:882616. [PMID: 35711585 PMCID: PMC9197260 DOI: 10.3389/fpsyt.2022.882616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 04/27/2022] [Indexed: 11/27/2022] Open
Abstract
Bipolar disorders (BDs) have high morbidity. The first onset of 27.7% of BDs occurs in children under 13 years and of 37.6% occurs in adolescents between 13 and 18 years. However, not all of the pediatric and adolescent patients with BD receive therapy in time. Therefore, studies about pediatric and adolescent patients with disorders have aroused increased attention in the scientific community. Pediatric and adolescent patients with BD present with a high prevalence rate (0.9-3.9%), and the pathogenic factors are mostly due to genetics and the environment; however, the pathological mechanisms remain unclear. Pediatric and adolescent patients with BD manifest differently from adults with BDs and the use of scales can be helpful for diagnosis and treatment evaluation. Pediatric and adolescent patients with BDs have been confirmed to have a high comorbidity rate with many other kinds of disorders. Both medication and psychological therapies have been shown to be safe and efficient methods for the treatment of BD. This review summarizes the research status related to the epidemiology, pathogenic factors, clinical manifestations, comorbidities, diagnostic and treatment scales, medications, and psychological therapies associated with BDs.
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Affiliation(s)
- Lu Liu
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China.,Department of Psychiatry, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Ming Meng
- Department of Psychiatry, The Fourth Affiliated Hospital of China Medical University, Shenyang, China.,Shenyang Mental Health Center, Shenyang, China
| | - Xiaotong Zhu
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China.,Department of Psychiatry, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Gang Zhu
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China
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10
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Integrity of the uncinate fasciculus is associated with the onset of bipolar disorder: a 6-year followed-up study. Transl Psychiatry 2021; 11:111. [PMID: 33547277 PMCID: PMC7864939 DOI: 10.1038/s41398-021-01222-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 01/05/2021] [Accepted: 01/13/2021] [Indexed: 12/25/2022] Open
Abstract
Patients with Bipolar Disorder (BD) are associated with aberrant uncinate fasciculus (UF) that connects amygdala-ventral prefrontal cortex (vPFC) system, but the casual relationship is still uncertain. The research aimed to investigate the integrity of UF among offspring of patients with BD and investigate its potential causal association with subsequent declaration of BD. The fractional anisotropy (FA) and mean diffusivity (MD) of UF were compared in asymptomatic offspring (AO, n = 46) and symptomatic offspring (SO, n = 45) with a parent with BD, and age-matched healthy controls (HCs, n = 35). Logistic regressions were performed to assess the predictive effect of UF integrity on the onset of BD. The three groups did not differ at baseline in terms of FA and MD of the UF. Nine out of 45 SO developed BD over a follow-up period of 6 years, and the right UF FA predicted the onset of BD (p = 0.038, OR = 0.212, 95% CI = 0.049-0.917). The ROC curve revealed that the right UF FA predicted BD onset (area-under-curve = 0.859) with sensitivity of 88.9% and specificity of 77.3%. The complementary whole-brain tract-based spatial statistics (TBSS) showed that widespread increases of FA were found in the SO group compared with HCs, but were not associated with the onset of BD. Our data provide evidence supporting the causal relationship between the white matter structural integrity of the amygdala-vPFC system and the onset of BD in genetically at-risk offspring of BD patients.
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11
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Yousef HA, ElSerogy YMBE, Abdelal SM, Abdel-Rahman SR. Voxel-based morphometry in patients with mood disorder bipolar I mania in comparison to normal controls. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-019-0119-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Neuroimaging is used to study brain structural alterations in neuropsychiatric diseases including bipolar disorder (BD). Voxel-based morphometry (VBM) quantifies structural changes detected in magnetic resonance imaging (MRI). The aim of this study was to identify brain structural changes in patients with mood disorder bipolar I mania, compared to healthy controls; and detect any correlations between volumetric findings and different clinical aspects of the disease. VBM was used to identify structural changes in 24 patients with bipolar I mania compared to 16 controls. Young Mania Rating Scale (YMRS) was used to evaluate clinical severity of BD. t test was used to compare differences in volumetric data and Spearman’s rank correlation coefficient was used to detect potential correlations between volumetric data and clinical parameters of BD.
Results
Compared to controls, BD patients had significantly larger right globus pallidus and right lateral ventricle. There was significant correlation between volumetric data of different brain structures and clinical criteria of BD including age of onset, illness duration, YMRS, number of manic attacks, and duration of the last attack.
Conclusions
VBM could address specific structural findings in bipolar I mania that may contribute to pathophysiology of the disease and show significant correlation with different clinical aspects of the disease.
Trial registration
This clinical trial was registered at ClinicalTrials.gov under registration number NCT03181698, registered 11 June 2017.
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12
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Cui D, Guo Y, Cao W, Gao W, Qiu J, Su L, Jiao Q, Lu G. Correlation Between Decreased Amygdala Subnuclei Volumes and Impaired Cognitive Functions in Pediatric Bipolar Disorder. Front Psychiatry 2020; 11:612. [PMID: 32670120 PMCID: PMC7332860 DOI: 10.3389/fpsyt.2020.00612] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 06/12/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The amygdala has been proposed to be involved in the pathophysiology of pediatric and adult bipolar disorder (BD). The goal of this structural magnetic resonance imaging (sMRI) study was to investigate the morphometric characteristics of amygdala subnuclei in patients with pediatric bipolar disorder (PBD) compared to healthy controls (HCs). Simultaneously, we examined correlation between amygdala subnuclei volumes and cognitive dysfunction. MATERIALS AND METHODS We assessed 40 adolescent outpatients, diagnosed with manic or euthymic PBD according to the DSM-5 criteria for BD and 19 HCs. Cognitive functions were evaluated using a Stroop color-word test (SCWT), trail making test (TMT), visual reproduction immediate recall subtest (VR I), and digit span subtest (DST). Amygdala and its subnuclei structures were automated segmented using FreeSurfer software and the volumes of them were compared between groups and correlation with clinical and cognitive outcomes was conducted. RESULTS Manic patients exhibited significantly decreased volumes in the bilateral whole amygdala and its basal nucleus, cortico-amygdaloid transition (CAT), and accessory basal nucleus (ABN) compared with HCs. Euthymic patients had decreased volume in the bilateral ABN and left CAT. In addition, we found significant positive associations between VR I scores and the right whole amygdala and its bilateral basal, right lateral, and ABN volumes in the manic group. CONCLUSION These findings support previous reports of smaller amygdala volumes and cognitive dysfunctions in PBD, and further mapping abnormalities to specific amygdala subnuclei. Correlation between basolateral volume and VR I of PBD may expand our understanding of neural abnormalities that could be targeted by treatment.
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Affiliation(s)
- Dong Cui
- College of Radiology, Shandong First Medical University (Shandong Academy of Medical Sciences), Taian, China.,Collaborative Innovation Center of Magnetic Resonance Imaging of Brain Disease, Shandong First Medical University, Shandong Academy of MedicalSciences, Taian, China
| | - Yongxin Guo
- College of Radiology, Shandong First Medical University (Shandong Academy of Medical Sciences), Taian, China.,Collaborative Innovation Center of Magnetic Resonance Imaging of Brain Disease, Shandong First Medical University, Shandong Academy of MedicalSciences, Taian, China
| | - Weifang Cao
- College of Radiology, Shandong First Medical University (Shandong Academy of Medical Sciences), Taian, China.,Collaborative Innovation Center of Magnetic Resonance Imaging of Brain Disease, Shandong First Medical University, Shandong Academy of MedicalSciences, Taian, China
| | - Weijia Gao
- Department of Child Psychology, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jianfeng Qiu
- College of Radiology, Shandong First Medical University (Shandong Academy of Medical Sciences), Taian, China
| | - Linyan Su
- Mental Health Institute of The Second Xiangya Hospital, Central South University, Changsha, China
| | - Qing Jiao
- College of Radiology, Shandong First Medical University (Shandong Academy of Medical Sciences), Taian, China.,Collaborative Innovation Center of Magnetic Resonance Imaging of Brain Disease, Shandong First Medical University, Shandong Academy of MedicalSciences, Taian, China
| | - Guangming Lu
- Department of Medical Imaging, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
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13
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Feldstein Ewing SW, Hudson KA, Caouette J, Mayer AR, Thayer RE, Ryman SG, Bryan AD. Sexual risk-taking and subcortical brain volume in adolescence. Ann Behav Med 2019; 52:393-405. [PMID: 29659656 DOI: 10.1093/abm/kax027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background The developmental period of adolescence marks the initiation of new socioemotional and physical behaviors, including sexual intercourse. However, little is known about neurodevelopmental influences on adolescent sexual decision-making. Purpose We sought to determine how subcortical brain volume correlated with condom use, and whether those associations differed by gender and pubertal development. Methods We used FreeSurfer to extract subcortical volume among N = 169 sexually experienced youth (mean age 16.07 years; 31.95% female). We conducted multiple linear regressions to examine the relationship between frequency of condom use and subcortical volume, and whether these associations would be moderated by gender and pubertal development. Results We found that the relationship between brain volume and condom use was better accounted for by pubertal development than by gender, and moderated the association between limbic brain volume and condom use. No significant relationships were observed in reward areas (e.g., nucleus accumbens) or prefrontal cortical control areas. Conclusions These data highlight the potential relevance of subcortical socioemotional processing structures in adolescents' sexual decision-making.
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Affiliation(s)
- Sarah W Feldstein Ewing
- Department of Psychiatry, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, M/C DC7P, Portland, OR
| | - Karen A Hudson
- Department of Psychiatry, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, M/C DC7P, Portland, OR
| | - Justin Caouette
- Department of Psychiatry, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, M/C DC7P, Portland, OR
| | | | - Rachel E Thayer
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO
| | | | - Angela D Bryan
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO
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14
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Fernandes HM, Cabral J, van Hartevelt TJ, Lord LD, Gleesborg C, Møller A, Deco G, Whybrow PC, Petrovic P, James AC, Kringelbach ML. Disrupted brain structural connectivity in Pediatric Bipolar Disorder with psychosis. Sci Rep 2019; 9:13638. [PMID: 31541155 PMCID: PMC6754428 DOI: 10.1038/s41598-019-50093-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 09/06/2019] [Indexed: 12/22/2022] Open
Abstract
Bipolar disorder (BD) has been linked to disrupted structural and functional connectivity between prefrontal networks and limbic brain regions. Studies of patients with pediatric bipolar disorder (PBD) can help elucidate the developmental origins of altered structural connectivity underlying BD and provide novel insights into the aetiology of BD. Here we compare the network properties of whole-brain structural connectomes of euthymic PBD patients with psychosis, a variant of PBD, and matched healthy controls. Our results show widespread changes in the structural connectivity of PBD patients with psychosis in both cortical and subcortical networks, notably affecting the orbitofrontal cortex, frontal gyrus, amygdala, hippocampus and basal ganglia. Graph theoretical analysis revealed that PBD connectomes have fewer hubs, weaker rich club organization, different modular fingerprint and inter-modular communication, compared to healthy participants. The relationship between network features and neurocognitive and psychotic scores was also assessed, revealing trends of association between patients’ IQ and affective psychotic symptoms with the local efficiency of the orbitofrontal cortex. Our findings reveal that PBD with psychosis is associated with significant widespread changes in structural network topology, thus strengthening the hypothesis of a reduced capacity for integrative processing of information across brain regions. Localised network changes involve core regions for emotional processing and regulation, as well as memory and executive function, some of which show trends of association with neurocognitive faculties and symptoms. Together, our findings provide the first comprehensive characterisation of the alterations in local and global structural brain connectivity and network topology, which may contribute to the deficits in cognition and emotion processing and regulation found in PBD.
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Affiliation(s)
- Henrique M Fernandes
- Center for Music in the Brain (MIB), Aarhus University, Aarhus, Denmark. .,Department of Psychiatry, University of Oxford, Oxford, UK. .,Center of Functionally Integrative Neuroscience (CFIN), Aarhus University, Aarhus, Denmark.
| | - Joana Cabral
- Center for Music in the Brain (MIB), Aarhus University, Aarhus, Denmark.,Department of Psychiatry, University of Oxford, Oxford, UK.,Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
| | - Tim J van Hartevelt
- Center for Music in the Brain (MIB), Aarhus University, Aarhus, Denmark.,Department of Psychiatry, University of Oxford, Oxford, UK
| | | | - Carsten Gleesborg
- Center of Functionally Integrative Neuroscience (CFIN), Aarhus University, Aarhus, Denmark.,Sino-Danish Center for Education and Research (SDC), Aarhus, Denmark
| | - Arne Møller
- Center of Functionally Integrative Neuroscience (CFIN), Aarhus University, Aarhus, Denmark
| | - Gustavo Deco
- Theoretical and Computational Neuroscience Group, Center of Brain and Cognition, Universitat Pompeu Fabra, Barcelona, Spain.,Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - Peter C Whybrow
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, USA
| | - Predrag Petrovic
- Cognitive Neurophysiology Research Group, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Anthony C James
- Department of Psychiatry, University of Oxford, Oxford, UK.,Highfield Unit, Warneford Hospital, Oxford, UK
| | - Morten L Kringelbach
- Center for Music in the Brain (MIB), Aarhus University, Aarhus, Denmark.,Department of Psychiatry, University of Oxford, Oxford, UK.,Center of Functionally Integrative Neuroscience (CFIN), Aarhus University, Aarhus, Denmark.,Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
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15
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Toma S, Islam AH, Metcalfe AWS, Mitchell RHB, Fiksenbaum L, MacIntosh BJ, Goldstein BI. Cortical Volume and Thickness Across Bipolar Disorder Subtypes in Adolescents: A Preliminary Study. J Child Adolesc Psychopharmacol 2019; 29:141-151. [PMID: 30359542 DOI: 10.1089/cap.2017.0137] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Neuroimaging studies of adults with bipolar disorder (BD) have identified several BD subtype distinctions, including greater deficits in prefrontal gray matter volumes in BD-I (bipolar I disorder) compared to BD-II (bipolar II disorder). We sought to investigate BD subtype differences in brain structure among adolescents and young adults. METHODS Forty-four youth with BD (14 BD-I, 16 BD-II, and 14 BD-not otherwise specified [NOS], mean age 17) underwent 3T-MRI and images were analyzed using FreeSurfer software. Cortical volume and thickness were analyzed for region of interest (ROI): ventrolateral prefrontal cortex, ventromedial prefrontal cortex, anterior cingulate cortex (ACC), subgenual cingulate cortex, and amygdala, controlling for age, sex, and total intracranial volume. ROIs were selected as found to be implicated in BD in prior studies. A whole brain vertex-wise exploratory analysis was also performed. Uncorrected results are presented. RESULTS There were group differences in ACC thickness (F = 3.88, p = 0.03, η2 = 0.173 uncorrected), which was reduced in BD-II in comparison to BD-I (p = 0.027 uncorrected) and BD-NOS (p = 0.019 uncorrected). These results did not survive correction for multiple comparisons and no other group differences were observed. The exploratory vertex-wise analysis found a similar pattern of lower cortical thickness in BD-II in the left and right superior frontal gyrus and left caudal middle frontal gyrus. CONCLUSIONS This study found reduced cortical thickness for youth with BD-II, relative to BD-I, in regions associated with cognitive control. Further neurostructural differences between subtypes may emerge later during the course of illness.
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Affiliation(s)
- Simina Toma
- 1 Centre for Youth Bipolar Disorder , Sunnybrook Health Sciences Centre, Toronto, Canada .,2 Department of Psychiatry, University of Toronto , Toronto, Canada
| | - Alvi H Islam
- 1 Centre for Youth Bipolar Disorder , Sunnybrook Health Sciences Centre, Toronto, Canada .,2 Department of Psychiatry, University of Toronto , Toronto, Canada
| | - Arron W S Metcalfe
- 1 Centre for Youth Bipolar Disorder , Sunnybrook Health Sciences Centre, Toronto, Canada .,3 Brain Sciences , Sunnybrook Health Sciences Centre, Toronto, Canada .,4 Heart and Stroke Foundation Canadian Partnership for Stroke Recovery , Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Rachel H B Mitchell
- 1 Centre for Youth Bipolar Disorder , Sunnybrook Health Sciences Centre, Toronto, Canada .,2 Department of Psychiatry, University of Toronto , Toronto, Canada
| | - Lisa Fiksenbaum
- 1 Centre for Youth Bipolar Disorder , Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Bradley J MacIntosh
- 3 Brain Sciences , Sunnybrook Health Sciences Centre, Toronto, Canada .,4 Heart and Stroke Foundation Canadian Partnership for Stroke Recovery , Sunnybrook Health Sciences Centre, Toronto, Canada .,5 Department of Medical Biophysics, University of Toronto , Toronto, Canada .,6 Department of Physical Sciences, Sunnybrook Health Sciences Centre , Toronto, Canada
| | - Benjamin I Goldstein
- 1 Centre for Youth Bipolar Disorder , Sunnybrook Health Sciences Centre, Toronto, Canada .,2 Department of Psychiatry, University of Toronto , Toronto, Canada .,4 Heart and Stroke Foundation Canadian Partnership for Stroke Recovery , Sunnybrook Health Sciences Centre, Toronto, Canada .,7 Department of Pharmacology, University of Toronto , Toronto, Canada
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16
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Omega-3 Polyunsaturated Fatty Acid Deficiency and Progressive Neuropathology in Psychiatric Disorders: A Review of Translational Evidence and Candidate Mechanisms. Harv Rev Psychiatry 2019; 27:94-107. [PMID: 30633010 PMCID: PMC6411441 DOI: 10.1097/hrp.0000000000000199] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Meta-analytic evidence indicates that mood and psychotic disorders are associated with both omega-3 polyunsaturated fatty acid (omega-3 PUFA) deficits and progressive regional gray and white matter pathology. Although the association between omega-3 PUFA insufficiency and progressive neuropathological processes remains speculative, evidence from translational research suggests that omega-3 PUFA insufficiency may represent a plausible and modifiable risk factor not only for enduring neurodevelopmental abnormalities in brain structure and function, but also for increased vulnerability to neurodegenerative processes. Recent evidence from human neuroimaging studies suggests that lower omega-3 PUFA intake/status is associated with accelerated gray matter atrophy in healthy middle-aged and elderly adults, particularly in brain regions consistently implicated in mood and psychotic disorders, including the amygdala, anterior cingulate, hippocampus, prefrontal cortex, and temporal cortex. Human neuroimaging evidence also suggests that both low omega-3 PUFA intake/status and psychiatric disorders are associated with reductions in white matter microstructural integrity and increased rates of white matter hyperintensities. Preliminary evidence suggests that increasing omega-3 PUFA status is protective against gray matter atrophy and deficits in white matter microstructural integrity in patients with mood and psychotic disorders. Plausible mechanisms mediating this relationship include elevated pro-inflammatory signaling, increased synaptic regression, and reductions in cerebral perfusion. Together these associations encourage additional neuroimaging research to directly investigate whether increasing omega-3 PUFA status can mitigate neuropathological processes in patients with, or at high risk for, psychiatric disorders.
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17
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Zhao L, Chang H, Zhou DS, Cai J, Fan W, Tang W, Tang W, Li X, Liu W, Liu F, He Y, Bai Y, Sun Y, Dai J, Li L, Xiao X, Zhang C, Li M. Replicated associations of FADS1, MAD1L1, and a rare variant at 10q26.13 with bipolar disorder in Chinese population. Transl Psychiatry 2018; 8:270. [PMID: 30531795 PMCID: PMC6286364 DOI: 10.1038/s41398-018-0337-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 10/07/2018] [Accepted: 11/13/2018] [Indexed: 12/12/2022] Open
Abstract
Genetic analyses of psychiatric illnesses, such as bipolar disorder (BPD), have revealed essential information regarding the underlying pathological mechanisms. While such studies in populations of European ancestry have achieved prominent success, understanding the genetic risk factors of these illnesses (especially BPD) in Chinese population remains an urgent task. Given the lack of genome-wide association study (GWAS) of BPD in Chinese population from Mainland China, replicating the previously reported GWAS hits in distinct populations will provide valuable information for future GWAS analysis in Han Chinese. In the present study, we have recruited 1146 BPD cases and 1956 controls from Mainland China for genetic analyses, as well as 65 Han Chinese brain amygdala tissues for mRNA expression analyses. Using this clinical sample, one of the largest Han Chinese BPD samples till now, we have conducted replication analyses of 21 single nucleotide polymorphisms (SNPs) extracted from previous GWAS of distinct populations. Among the 21 tested SNPs, 16 showed the same direction of allelic effects in our samples compared with previous studies; 6 SNPs achieved nominal significance (p < 0.05) at one-tailed test, and 2 additional SNPs showed marginal significance (p < 0.10). Aside from replicating previously reported BPD risk SNPs, we herein also report several intriguing findings: (1) the SNP rs174576 was associated with BPD in our Chinese sample and in the overall global meta-analysis, and was significantly correlated with FADS1 mRNA in diverse public RNA-seq datasets as well as our in house collected Chinese amygdala samples; (2) two (partially) independent SNPs in MAD1L1 were both significantly associated with BPD in our Chinese sample, which was also supported by haplotype analysis; (3) a rare SNP rs78089757 in 10q26.13 region was a genome-wide significant variant for BPD in East Asians, and this SNP was near monomorphic in Europeans. In sum, these results confirmed several significant BPD risk genes. We hope this Chinese BPD case-control sample and the current brain amygdala tissues (with continuous increasing sample size in the near future) will provide helpful resources in elucidating the genetic and molecular basis of BPD in this major world population.
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Affiliation(s)
- Lijuan Zhao
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences and Yunnan Province, Kunming Institute of Zoology, Kunming, Yunnan, China
- Kunming College of Life Science, University of Chinese Academy of Sciences, Kunming, Yunnan, China
| | - Hong Chang
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences and Yunnan Province, Kunming Institute of Zoology, Kunming, Yunnan, China
| | - Dong-Sheng Zhou
- Department of Psychiatry, Ningbo Kangning Hospital, Ningbo, Zhejiang, China
| | - Jun Cai
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weixing Fan
- Jinhua Second Hospital, Jinhua, Zhejiang, China
| | - Wei Tang
- Wenzhou Kangning Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Wenxin Tang
- Hangzhou Seventh People's Hospital, Hangzhou, Zhejiang, China
| | - Xingxing Li
- Department of Psychiatry, Ningbo Kangning Hospital, Ningbo, Zhejiang, China
| | - Weiqing Liu
- Department of Psychiatry, the First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Fang Liu
- Department of Psychiatry, the First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Yuanfang He
- Department of Psychiatry, the First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Yan Bai
- Department of Psychiatry, the First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Yan Sun
- Wuhan Institute for Neuroscience and Neuroengineering, South-Central University for Nationalities, Wuhan, Hubei, China
- Chinese Brain Bank Center, Wuhan, Hubei, China
| | - Jiapei Dai
- Wuhan Institute for Neuroscience and Neuroengineering, South-Central University for Nationalities, Wuhan, Hubei, China
- Chinese Brain Bank Center, Wuhan, Hubei, China
| | - Lingyi Li
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences and Yunnan Province, Kunming Institute of Zoology, Kunming, Yunnan, China
| | - Xiao Xiao
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences and Yunnan Province, Kunming Institute of Zoology, Kunming, Yunnan, China.
| | - Chen Zhang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Ming Li
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences and Yunnan Province, Kunming Institute of Zoology, Kunming, Yunnan, China.
- CAS Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai, China.
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18
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Teixeira AL, Colpo GD, Fries GR, Bauer IE, Selvaraj S. Biomarkers for bipolar disorder: current status and challenges ahead. Expert Rev Neurother 2018; 19:67-81. [PMID: 30451546 DOI: 10.1080/14737175.2019.1550361] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Bipolar disorder (BD) is a chronic psychiatric disorder marked by clinical and pathophysiological heterogeneity. There is a high expectation that personalized approaches can improve the management of patients with BD. For that, identification and validation of potential biomarkers are fundamental. Areas covered: This manuscript will critically review the current status of different biomarkers for BD, including peripheral, genetic, neuroimaging, and neurophysiological candidates, discussing the challenges to move the field forward. Expert commentary: There are no lab or complementary tests currently recommended for the diagnosis or management of patients with BD. Panels composed by multiple biomarkers will probably contribute to stratifying patients according to their clinical stage, therapeutic response, and prognosis.
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Affiliation(s)
- Antonio L Teixeira
- a Department of Psychiatry & Behavioral Sciences , McGovern Medical School, UT Health , Houston , TX , USA.,b Laboratório Interdisciplinar de Investigação Médica, Faculdade de Medicina , Universidade Federal de Minas Gerais (UFMG) , Belo Horizonte , Brazil
| | - Gabriela D Colpo
- a Department of Psychiatry & Behavioral Sciences , McGovern Medical School, UT Health , Houston , TX , USA
| | - Gabriel R Fries
- a Department of Psychiatry & Behavioral Sciences , McGovern Medical School, UT Health , Houston , TX , USA
| | - Isabelle E Bauer
- a Department of Psychiatry & Behavioral Sciences , McGovern Medical School, UT Health , Houston , TX , USA
| | - Sudhakar Selvaraj
- a Department of Psychiatry & Behavioral Sciences , McGovern Medical School, UT Health , Houston , TX , USA
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19
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Cazala F, Suchting R, Zeni CP, Bauer IE, Mwangi B, Wu MJ, Passos IC, Spiker DE, Zunta-Soares GB, Soares JC. Effects of valproate on brain volumes in pediatric bipolar disorder: A preliminary study. Psychiatry Res Neuroimaging 2018; 278:65-68. [PMID: 29907438 DOI: 10.1016/j.pscychresns.2018.05.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 04/30/2018] [Accepted: 05/11/2018] [Indexed: 10/14/2022]
Abstract
Sodium valproate (VPA) has well-established neuroprotective effects and is recommended as treatment in bipolar disorder patients. The neural effects of VPA in pediatric bipolar disorder (PBD) have yet to be established. This preliminary study explored the effects of VPA on brain structure in PBD. Fourteen PBD patients (10 males; mean = 13.43 ± 3.05 years old) underwent a structural MRI before and after a 6-week VPA treatment period. Bayesian linear mixed modeling explored seven brain region volumes as a function of dichotomous pre/post time. Results showed a decrease in amygdala volume over time. These findings need to be confirmed by large-scale, longitudinal studies.
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Affiliation(s)
- Fadwa Cazala
- School of Medicine, The University of Texas Health Science Center at Houston, USA.
| | - Robert Suchting
- School of Medicine, The University of Texas Health Science Center at Houston, USA
| | - Cristian P Zeni
- School of Medicine, The University of Texas Health Science Center at Houston, USA
| | - Isabelle E Bauer
- School of Medicine, The University of Texas Health Science Center at Houston, USA
| | - Benson Mwangi
- School of Medicine, The University of Texas Health Science Center at Houston, USA
| | - Mon-Ju Wu
- School of Medicine, The University of Texas Health Science Center at Houston, USA
| | - Ives Cavalcante Passos
- Department of Psychiatry, Laboratory of Molecular Psychiatry, Universidade Federal do Rio Grande do Sul (UFRGS), Brazil
| | - Danielle E Spiker
- School of Medicine, The University of Texas Health Science Center at Houston, USA
| | | | - Jair C Soares
- School of Medicine, The University of Texas Health Science Center at Houston, USA
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20
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Mitchell RH, Metcalfe AW, Islam AH, Toma S, Patel R, Fiksenbaum L, Korczak D, MacIntosh BJ, Goldstein BI. Sex differences in brain structure among adolescents with bipolar disorder. Bipolar Disord 2018; 20:448-458. [PMID: 29956452 DOI: 10.1111/bdi.12663] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Bipolar disorder (BD) is twice as prevalent amongst female as amongst male adolescents. Thus far, little is known regarding the neurostructural substrates underlying this disparity. We therefore examined sex differences in neurostructural magnetic resonane imaging (MRI) phenotypes amongst adolescents with BD. METHODS T1-weighted structural MRI was acquired from 44 BD (25 female [F] and 19 male [M]) and 58 (28 F and 30 M) healthy control (HC) adolescents (13-21 years old). Whole-brain and region-of-interest (ROI) analyses examined structural volume and cortical thickness using FreeSurfer. ROIs included the ventrolateral prefrontal cortex (vlPFC), anterior cingulate cortex (ACC), amygdala and hippocampus. General linear models evaluated sex-by-diagnosis interactions, controlling for age and intracranial volume. RESULTS Whole-brain analysis revealed sex-by-diagnosis interactions in the left supramarginal gyrus (SMG) (P = .02, η2 = 0.02) and right inferior parietal lobule (IPL) volumes (P = .04, η2 = 0.01). Sex differences in HCs were found in the SMG (M > F) and IPL (F > M). In BD, sex differences were reversed and of smaller magnitude in the SMG (M < F) and of greater magnitude in the IPL (F > M), driven by trends towards smaller SMG and IPL in BD vs HC male participants (P = .05 and .14). Whole-brain analyses for cortical thickness, and ROI analyses for volume and cortical thickness, were not significant. CONCLUSIONS Normative sex differences may be disrupted in adolescent BD in the SMG and IPL, heteromodal association network hubs responsible for higher order integration of cognitive and emotional processing. Unexpectedly, these findings may inform our understanding of aberrant brain structure in adolescent BD male patients, rather than female patients. Future work should focus on replication, as well as the impact of puberty status and sex hormones on measures of brain structure and function.
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Affiliation(s)
- Rachel Hb Mitchell
- Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Canada
| | - Arron Ws Metcalfe
- Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, Canada
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Canada
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Alvi H Islam
- Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Pharmacology, University of Toronto, Toronto, Canada
| | - Simina Toma
- Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Ronak Patel
- Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Lisa Fiksenbaum
- Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Daphne Korczak
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Department of Psychiatry, Hospital for Sick Children, Toronto, Canada
| | - Bradley J MacIntosh
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Canada
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, Canada
- Physical Sciences, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Canada
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Pharmacology, University of Toronto, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
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21
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Cabeen RP, Laidlaw DH, Ruggieri A, Dickstein DP. Preliminary mapping of the structural effects of age in pediatric bipolar disorder with multimodal MR imaging. Psychiatry Res 2018; 273:54-62. [PMID: 29361347 PMCID: PMC5815932 DOI: 10.1016/j.pscychresns.2017.12.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 12/31/2017] [Accepted: 12/31/2017] [Indexed: 10/18/2022]
Abstract
This study investigates multimodal structural MR imaging biomarkers of development trajectories in pediatric bipolar disorder. T1-weighted and diffusion-weighted MR imaging was conducted to investigate cross-sectional group differences with age between typically developing controls (N = 26) and youths diagnosed with bipolar disorder (N = 26). Region-based analysis was used to examine cortical thickness of gray matter and diffusion tensor parameters in superficial white matter, and tractography-based analysis was used to examine deep white matter fiber bundles. Patients and controls showed significantly different maturation trajectories across brain areas; however, the magnitude of differences varied by region. The rate of cortical thinning with age was greater in patients than controls in the left frontal pole. While controls showed increasing fractional anisotropy (FA) and axial diffusivity (AD) with age, patients showed an opposite trend of decreasing FA and AD with age in fronto-temporal-striatal regions located in both superficial and deep white matter. The findings support fronto-temporal-striatal alterations in the developmental trajectories of youths diagnosed with bipolar disorder, and further, show the value of multimodal computational techniques in the assessment of neuropsychiatric disorders. These preliminary results warrant further investigation into longitudinal changes and the effects of treatment in the brain areas identified in this study.
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Affiliation(s)
- Ryan P Cabeen
- Laboratory of Neuro Imaging, USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA.
| | - David H Laidlaw
- Department of Computer Science, Brown University, Providence, RI, USA
| | - Amanda Ruggieri
- Pediatric Mood, Imaging & NeuroDevelopment Program, Bradley Hospital, Alpert Medical School of Brown University, Providence, RI, USA
| | - Daniel P Dickstein
- Pediatric Mood, Imaging & NeuroDevelopment Program, Bradley Hospital, Alpert Medical School of Brown University, Providence, RI, USA
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22
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Abstract
Bipolar disorder (BD) is a severe, recurrent mood disorder, associated with a significant morbidity and mortality, with high rates of suicides and medical comorbidities. There is a high risk of mood disorders among the first-degree relatives of patients with BD. In the current clinical practice, the diagnosis of BD is made by history taking, interview and behavioural observations, thereby lacking an objective, biological validation. This approach may result in underdiagnosis, misdiagnosis and eventually poorer outcomes. Due to the heterogeneity of BD, the possibility of developing a single, specific biomarker is still remote; however, there is a set of promising biomarkers which may serve as predictive, prognostic or treatment markers in the future. The review presents a critical appraisal and update on some of the most promising candidates for biomarkers, namely, neuroimaging markers, peripheral biomarkers and genetic markers, including a brief discussion on cognitive endophenotypes as indicative of genetic risk. The lessons learnt from other fields and specialties in medicine need to be applied to psychiatry to translate the knowledge from ‘bench to bedside’ by means of clinically useful biomarkers. Overall, the biomarkers may help in pushing the shift towards personalized medicine for psychiatric patients.
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Affiliation(s)
- Rajesh Sagar
- Department of Psychiatry, All Institute of Medical Sciences, New Delhi, India
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23
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Eggins PS, Hatton SN, Hermens DF, Hickie IB, Lagopoulos J. Subcortical volumetric differences between clinical stages of young people with affective and psychotic disorders. Psychiatry Res Neuroimaging 2018; 271:8-16. [PMID: 29216557 DOI: 10.1016/j.pscychresns.2017.11.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 11/20/2017] [Accepted: 11/20/2017] [Indexed: 11/19/2022]
Abstract
The aim of this study was to investigate differences in subcortical and hippocampal volumes between healthy controls, young people at an early stage of affective and psychotic disorders and those in more advanced stages, to identify markers associated with functional outcomes and illness severity. Young people presenting to youth mental health services with admixtures of depressive, manic and psychotic symptoms (n = 141), and healthy counterparts (n = 49), aged 18-25 were recruited. Participants underwent magnetic resonance imaging, clinical assessments and were rated as to their current clinical stage. Eighty-four patients were classified at the attenuated syndrome stage (Stage 1b) and 57 were classified as having discrete and persistent disorders (Stage 2+). Automated segmentation was performed using NeuroQuant® to determine volumes of subcortical and hippocampus structures which were compared between groups and correlated with clinical and functional outcomes. Compared to healthy controls, Stage 2+ patients showed significantly reduced right amygdala volumes. Whereas Stage 1b patients showed significantly reduced left caudate volumes compared to healthy controls. Smaller left caudate volume correlated with greater psychological distress and impaired functioning. This study shows a clinical application for an automated program to identify and track subcortical changes evident in young people with emerging psychopathology.
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Affiliation(s)
- Peta S Eggins
- Clinical Research Unit, Brain and Mind Centre, University of Sydney, Australia.
| | - Sean N Hatton
- Clinical Research Unit, Brain and Mind Centre, University of Sydney, Australia
| | - Daniel F Hermens
- Clinical Research Unit, Brain and Mind Centre, University of Sydney, Australia
| | - Ian B Hickie
- Clinical Research Unit, Brain and Mind Centre, University of Sydney, Australia
| | - Jim Lagopoulos
- Clinical Research Unit, Brain and Mind Centre, University of Sydney, Australia
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24
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Akbaş S, Nahir M, Pirzirenli ME, Dündar C, Ceyhan M, Sarısoy G, Şahin B. Quantitative analysis of the amygdala, thalamus and hippocampus on magnetic resonance images in paediatric bipolar disorders and compared with the children of bipolar parents and healthy control. Psychiatry Res Neuroimaging 2017; 270:61-67. [PMID: 29065344 DOI: 10.1016/j.pscychresns.2017.08.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 06/29/2017] [Accepted: 08/29/2017] [Indexed: 12/28/2022]
Abstract
MR imaging studies in paediatric bipolar disorder have particularly focused on the amygdala and hippocampus, subcortical structures, and to a lesser extent on the thalamus. The purpose of this study was to perform structural analysis of the regions of interest (ROI) associated with mood regulation. In this study 18 children (between the ages of 12-18) were matched according to their age and sex and were divided into three groups. These were: a paediatric bipolar disorder group, risk group and a healthy control group. The structured diagnostic interviews were performed with children and their parents. T1 weighted MR images in the sagittal plane with a thickness of 1mm were taken from the subjects. Automatic structural brain analysis was performed, and the volume and volume fraction (VF) of the ROIs were obtained. Brain size in the patients with paediatric bipolar disorder (742.4 ± 110.1cm3) was significantly smaller than the healthy control group (880.7 ± 73.8cm3) (p≤0.05). MRI analysis between the paediatric bipolar disorder, risk group and healthy control group revealed no difference between them in terms of amygdala, thalamus or hippocampal volumes. In this study, there was no difference between the volumes of amygdala, thalamus or hippocampus.
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Affiliation(s)
- Seher Akbaş
- Department of Child and Adolescent Psychiatry, Erenkoy Mental Health and Neurology Training and Research Hospital, Istanbul, Turkey.
| | - Mert Nahir
- Ondokuz Mayıs University Faculty of Medicine Department of Anatomy, Turkey
| | | | - Cihat Dündar
- Ondokuz Mayıs University Faculty of Medicine Department of Public Health, Turkey
| | - Meltem Ceyhan
- Ondokuz Mayıs University Faculty of Medicine Department of Radiology, Turkey
| | - Gökhan Sarısoy
- Ondokuz Mayıs University Faculty of Medicine Department of Psychiatry, Turkey
| | - Bünyamin Şahin
- Ondokuz Mayıs University Faculty of Medicine Department of Anatomy, Turkey
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25
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Goldstein BI, Birmaher B, Carlson GA, DelBello MP, Findling RL, Fristad M, Kowatch RA, Miklowitz DJ, Nery FG, Perez‐Algorta G, Van Meter A, Zeni CP, Correll CU, Kim H, Wozniak J, Chang KD, Hillegers M, Youngstrom EA. The International Society for Bipolar Disorders Task Force report on pediatric bipolar disorder: Knowledge to date and directions for future research. Bipolar Disord 2017; 19:524-543. [PMID: 28944987 PMCID: PMC5716873 DOI: 10.1111/bdi.12556] [Citation(s) in RCA: 124] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 08/14/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Over the past two decades, there has been tremendous growth in research regarding bipolar disorder (BD) among children and adolescents (ie, pediatric BD [PBD]). The primary purpose of this article is to distill the extant literature, dispel myths or exaggerated assertions in the field, and disseminate clinically relevant findings. METHODS An international group of experts completed a selective review of the literature, emphasizing areas of consensus, identifying limitations and gaps in the literature, and highlighting future directions to mitigate these gaps. RESULTS Substantial, and increasingly international, research has accumulated regarding the phenomenology, differential diagnosis, course, treatment, and neurobiology of PBD. Prior division around the role of irritability and of screening tools in diagnosis has largely abated. Gold-standard pharmacologic trials inform treatment of manic/mixed episodes, whereas fewer data address bipolar depression and maintenance/continuation treatment. Adjunctive psychosocial treatment provides a forum for psychoeducation and targets primarily depressive symptoms. Numerous neurocognitive and neuroimaging studies, and increasing peripheral biomarker studies, largely converge with prior findings from adults with BD. CONCLUSIONS As data have accumulated and controversy has dissipated, the field has moved past existential questions about PBD toward defining and pursuing pressing clinical and scientific priorities that remain. The overall body of evidence supports the position that perceptions about marked international (US vs elsewhere) and developmental (pediatric vs adult) differences have been overstated, although additional research on these topics is warranted. Traction toward improved outcomes will be supported by continued emphasis on pathophysiology and novel therapeutics.
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Affiliation(s)
- Benjamin I Goldstein
- Centre for Youth Bipolar DisorderSunnybrook Health Sciences CentreTorontoCanada,Departments of Psychiatry and PharmacologyUniversity of TorontoTorontoCanada
| | - Boris Birmaher
- Department of PsychiatryUniversity of Pittsburgh School of MedicinePittsburghPAUSA
| | - Gabrielle A Carlson
- Department of PsychiatryStony Brook University School of MedicineStony BrookNYUSA
| | - Melissa P DelBello
- Department of Psychiatry & Behavioral NeuroscienceUniversity of CincinnatiCincinnatiOHUSA
| | - Robert L Findling
- Department of Psychiatry & Behavioral SciencesThe Johns Hopkins UniversityBaltimoreMDUSA
| | - Mary Fristad
- Ohio State University Wexner Medical Center/Nationwide Children's HospitalColumbusOHUSA
| | - Robert A Kowatch
- Ohio State University Wexner Medical Center/Nationwide Children's HospitalColumbusOHUSA
| | | | - Fabiano G Nery
- Department of Psychiatry & Behavioral NeuroscienceUniversity of CincinnatiCincinnatiOHUSA
| | | | - Anna Van Meter
- Ferkauf Graduate School of PsychologyYeshiva UniversityBronxNYUSA
| | | | - Christoph U Correll
- The Zucker Hillside HospitalDepartment of PsychiatryNorthwell HealthGlen OaksNYUSA,Department of Psychiatry and Molecular MedicineHofstra Northwell School of MedicineHempsteadNYUSA
| | - Hyo‐Won Kim
- Department of PsychiatryUniversity of Ulsan College of MedicineAsan Medical CenterSeoulKorea
| | - Janet Wozniak
- Clinical and Research Program in Pediatric PsychopharmacologyMassachusetts General HospitalHarvard Medical SchoolBostonMAUSA
| | - Kiki D Chang
- Department of PsychiatryStanford UniversityPalo AltoCAUSA
| | - Manon Hillegers
- Department of Child and Adolescent Psychiatry and PsychologyErasmus Medical Center‐SophiaRotterdamThe Netherlands
| | - Eric A Youngstrom
- Department of Psychology and NeuroscienceUniversity of North CarolinaChapel HillNCUSA
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26
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Sandu AL, Artiges E, Galinowski A, Gallarda T, Bellivier F, Lemaitre H, Granger B, Ringuenet D, Tzavara ET, Martinot JL, Paillère Martinot ML. Amygdala and regional volumes in treatment-resistant versus nontreatment-resistant depression patients. Depress Anxiety 2017; 34:1065-1071. [PMID: 28792656 DOI: 10.1002/da.22675] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 04/22/2017] [Accepted: 06/29/2017] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Although treatment-resistant and nontreatment-resistant depressed patients show structural brain anomalies relative to healthy controls, the difference in regional volumetry between these two groups remains undocumented. METHODS A whole-brain voxel-based morphometry (VBM) analysis of regional volumes was performed in 125 participants' magnetic resonance images obtained on a 1.5 Tesla scanner; 41 had treatment-resistant depression (TRD), 40 nontreatment-resistant depression (non-TRD), and 44 were healthy controls. The groups were comparable for age and gender. Bipolar/unipolar features as well as pharmacological treatment classes were taken into account as covariates. RESULTS TRD patients had higher gray matter (GM) volume in the left and right amygdala than non-TRD patients. No difference was found between the TRD bipolar and the TRD unipolar patients, or between the non-TRD bipolar and non-TRD unipolar patients. An exploratory analysis showed that lithium-treated patients in both groups had higher GM volume in the superior and middle frontal gyri in both hemispheres. CONCLUSIONS Higher GM volume in amygdala detected in TRD patients might be seen in perspective with vulnerability to chronicity, revealed by medication resistance.
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Affiliation(s)
- Anca-Larisa Sandu
- Institut National de la Santé et de la Recherche Médicale, INSERM Unit 1000 "Neuroimaging & Psychiatry", University Paris Sud-Paris Saclay, University Paris Descartes Service Hospitalier Frédéric Joliot, Orsay, France.,Aberdeen Biomedical Imaging Centre, Lilian Sutton Building, University of Aberdeen, Aberdeen, UK
| | - Eric Artiges
- Institut National de la Santé et de la Recherche Médicale, INSERM Unit 1000 "Neuroimaging & Psychiatry", University Paris Sud-Paris Saclay, University Paris Descartes Service Hospitalier Frédéric Joliot, Orsay, France.,Department of Psychiatry 91G16, Orsay Hospital, Orsay, France
| | - André Galinowski
- Institut National de la Santé et de la Recherche Médicale, INSERM Unit 1000 "Neuroimaging & Psychiatry", University Paris Sud-Paris Saclay, University Paris Descartes Service Hospitalier Frédéric Joliot, Orsay, France
| | | | - Frank Bellivier
- APHP Department of Psychiatry, Fernand Widal Hospital, Paris, France
| | - Hervé Lemaitre
- Institut National de la Santé et de la Recherche Médicale, INSERM Unit 1000 "Neuroimaging & Psychiatry", University Paris Sud-Paris Saclay, University Paris Descartes Service Hospitalier Frédéric Joliot, Orsay, France
| | - Bernard Granger
- APHP Department of Psychiatry, Tarnier Hospital and University Paris Descartes, Paris, France
| | - Damien Ringuenet
- Service de Psychiatrie et Addictologie, Hôpital Paul Brousse, APHP Villejuif, France
| | - Eleni T Tzavara
- Institut National de la Santé et de la Recherche Médicale, INSERM Unit 1000 "Neuroimaging & Psychiatry", University Paris Sud-Paris Saclay, University Paris Descartes Service Hospitalier Frédéric Joliot, Orsay, France.,APHP Department of Psychiatry, Tarnier Hospital and University Paris Descartes, Paris, France.,Institut National de la Santé et de la Recherche Médicale, INSERM Unit 1130, UPMC, Paris, France
| | - Jean-Luc Martinot
- Institut National de la Santé et de la Recherche Médicale, INSERM Unit 1000 "Neuroimaging & Psychiatry", University Paris Sud-Paris Saclay, University Paris Descartes Service Hospitalier Frédéric Joliot, Orsay, France.,INSERM Unit 1000 at Maison de Solenn, Paris, France
| | - Marie-Laure Paillère Martinot
- Institut National de la Santé et de la Recherche Médicale, INSERM Unit 1000 "Neuroimaging & Psychiatry", University Paris Sud-Paris Saclay, University Paris Descartes Service Hospitalier Frédéric Joliot, Orsay, France.,INSERM Unit 1000 at Maison de Solenn, Paris, France.,AP-HP Adolescents Psychopathology and Medicine Department, Maison de Solenn, Cochin Hospital and University Paris Descartes, Paris, France
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27
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Islam AH, Metcalfe AWS, MacIntosh BJ, Korczak DJ, Goldstein BI. Greater body mass index is associated with reduced frontal cortical volumes among adolescents with bipolar disorder. J Psychiatry Neurosci 2017; 43:170041. [PMID: 29077553 PMCID: PMC5837884 DOI: 10.1503/jpn.170041] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 07/05/2017] [Accepted: 09/05/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Higher body mass index (BMI) and obesity is common among youth with bipolar disorder (BD) and is associated with greater psychiatric illness severity, including suicidality. Obesity has been associated with frontal, temporal and subcortical volumetric reductions in adults with BD. We examined the neurostructural correlates of BMI in adolescents early in their course of BD. METHODS We processed T1-weighted images of adolescents with BD and psychiatrically healthy controls using FreeSurfer to derive a priori region of interest (ROI) volumes/cortical thickness for the frontal lobe (FL), prefrontal cortex (PFC) and orbitofrontal cortex (OFC) as well as volumes for the amygdala and hippocampus. General linear models assessed the association between BMI and the ROIs, controlling for age, sex and intracranial volume. We also conducted exploratory within-BD group and whole brain vertex-wise analyses. RESULTS We included 40 adolescents with BD and 48 controls in our analyses. In addition to a main effect of BMI on the ROIs, there were significant diagnosis × BMI interaction effects on FL volumes. In the BD group only, BMI was negatively associated with FL, OFC and PFC cortical thickness. Whole brain analysis of BMI-volume correlations revealed 2 significant interaction clusters: 1 in the medial OFC and 1 in the caudal anterior cingulate cortex, with BD showing a stronger negative correlation. LIMITATIONS Reliance on BMI rather than a more nuanced measure of obesity may have influenced the findings. CONCLUSION Our results suggest that elevated BMI among adolescents with BD is associated with frontal neurostructural differences that are not observed in controls. Prospective studies examining the direction of the observed associations and the effect of BMI optimization on brain structure in adolescents with BD are warranted.
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Affiliation(s)
- Alvi H Islam
- From the Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, Ont., Canada (Islam, Metcalfe, Goldstein); the Department of Psychiatry, University of Toronto, Toronto, Ont., Canada (Korczak, Goldstein); the Hurvitz Brain Sciences, Sunnybrook Research Institute, Toronto, Ont., Canada (Metcalfe, MacIntosh); the Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, Toronto, Ont., Canada (Metcalfe, MacIntosh, Goldstein); the Hospital for Sick Children, Toronto, Ont., Canada (Korczak); the Department of Medical Biophysics, University of Toronto, Toronto, Ont., Canada (MacIntosh); the Department of Physical Sciences, Sunnybrook Health Sciences Centre, Toronto, Ont., Canada (MacIntosh); and the Department of Pharmacology, University of Toronto, Toronto, Ont., Canada (Goldstein)
| | - Arron W S Metcalfe
- From the Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, Ont., Canada (Islam, Metcalfe, Goldstein); the Department of Psychiatry, University of Toronto, Toronto, Ont., Canada (Korczak, Goldstein); the Hurvitz Brain Sciences, Sunnybrook Research Institute, Toronto, Ont., Canada (Metcalfe, MacIntosh); the Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, Toronto, Ont., Canada (Metcalfe, MacIntosh, Goldstein); the Hospital for Sick Children, Toronto, Ont., Canada (Korczak); the Department of Medical Biophysics, University of Toronto, Toronto, Ont., Canada (MacIntosh); the Department of Physical Sciences, Sunnybrook Health Sciences Centre, Toronto, Ont., Canada (MacIntosh); and the Department of Pharmacology, University of Toronto, Toronto, Ont., Canada (Goldstein)
| | - Bradley J MacIntosh
- From the Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, Ont., Canada (Islam, Metcalfe, Goldstein); the Department of Psychiatry, University of Toronto, Toronto, Ont., Canada (Korczak, Goldstein); the Hurvitz Brain Sciences, Sunnybrook Research Institute, Toronto, Ont., Canada (Metcalfe, MacIntosh); the Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, Toronto, Ont., Canada (Metcalfe, MacIntosh, Goldstein); the Hospital for Sick Children, Toronto, Ont., Canada (Korczak); the Department of Medical Biophysics, University of Toronto, Toronto, Ont., Canada (MacIntosh); the Department of Physical Sciences, Sunnybrook Health Sciences Centre, Toronto, Ont., Canada (MacIntosh); and the Department of Pharmacology, University of Toronto, Toronto, Ont., Canada (Goldstein)
| | - Daphne J Korczak
- From the Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, Ont., Canada (Islam, Metcalfe, Goldstein); the Department of Psychiatry, University of Toronto, Toronto, Ont., Canada (Korczak, Goldstein); the Hurvitz Brain Sciences, Sunnybrook Research Institute, Toronto, Ont., Canada (Metcalfe, MacIntosh); the Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, Toronto, Ont., Canada (Metcalfe, MacIntosh, Goldstein); the Hospital for Sick Children, Toronto, Ont., Canada (Korczak); the Department of Medical Biophysics, University of Toronto, Toronto, Ont., Canada (MacIntosh); the Department of Physical Sciences, Sunnybrook Health Sciences Centre, Toronto, Ont., Canada (MacIntosh); and the Department of Pharmacology, University of Toronto, Toronto, Ont., Canada (Goldstein)
| | - Benjamin I Goldstein
- From the Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, Ont., Canada (Islam, Metcalfe, Goldstein); the Department of Psychiatry, University of Toronto, Toronto, Ont., Canada (Korczak, Goldstein); the Hurvitz Brain Sciences, Sunnybrook Research Institute, Toronto, Ont., Canada (Metcalfe, MacIntosh); the Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, Toronto, Ont., Canada (Metcalfe, MacIntosh, Goldstein); the Hospital for Sick Children, Toronto, Ont., Canada (Korczak); the Department of Medical Biophysics, University of Toronto, Toronto, Ont., Canada (MacIntosh); the Department of Physical Sciences, Sunnybrook Health Sciences Centre, Toronto, Ont., Canada (MacIntosh); and the Department of Pharmacology, University of Toronto, Toronto, Ont., Canada (Goldstein)
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28
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Naiberg MR, Hatch JK, Selkirk B, Fiksenbaum L, Yang V, Black S, Kertes PJ, Goldstein BI. Retinal photography: A window into the cardiovascular-brain link in adolescent bipolar disorder. J Affect Disord 2017; 218:227-237. [PMID: 28477501 DOI: 10.1016/j.jad.2017.04.066] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 04/21/2017] [Accepted: 04/28/2017] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The burden of cardiovascular disease in bipolar disorder (BD) exceeds what can be explained by traditional cardiovascular risk factors (CVRFs), lifestyle, and/or medications. Moreover, neurocognitive deficits are a core feature of BD, and are also related to CVRFs. We examined retinal vascular photography, a proxy for cerebral microvasculature, in relation to CVRFs, peripheral microvascular function, and neurocognition among BD adolescents. METHODS Subjects were 30 adolescents with BD and 32 healthy controls (HC). Retinal photography was conducted using a Topcon TRC 50 DX, Type IA camera, following pupil dilation. Retinal arteriolar and venular caliber was measured, from which the arterio-venular ratio (AVR) was computed. All measures were conducted masked to participant diagnosis. Peripheral arterial tonometry measured endothelial function. Neurocognition was assessed using the Cambridge Neuropsychological Tests Automated Battery. RESULTS AVR was not significantly different between groups (Cohen's d=0.18, p=0.103). Higher diastolic blood pressure (BP) was associated with lower (worse) AVR in BD (r=-0.441, p=0.015) but not HC (r=-0.192, p=0.293). Similarly, in the BD group only, higher (better) endothelial function was associated with higher AVR (r=0.375, p=0.041). Hierarchical regression models confirmed that, independent of covariates, retinal vascular caliber was significantly associated with diastolic BP and endothelial function in BD. Within the BD group, mood scores were significantly negatively correlated with AVR (β=-0.451, p=0.044). LIMITATIONS This study's limitations include a small sample size, a cross-sectional study design, and a heterogeneous sample. CONCLUSION Retinal photography may offer unique insights regarding the cardiovascular and neurocognitive burden of BD. Larger longitudinal studies are warranted.
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Affiliation(s)
- Melanie R Naiberg
- Sunnybrook Health Sciences Centre, Centre for Youth Bipolar Disorder, Toronto, Canada; University of Toronto, Department of Pharmacology and Toxicology, Toronto, Canada; Univeristy of Toronto, Department of Neurology, Toronto, Canada
| | - Jessica K Hatch
- Sunnybrook Health Sciences Centre, Centre for Youth Bipolar Disorder, Toronto, Canada; University of Toronto, Department of Pharmacology and Toxicology, Toronto, Canada; Univeristy of Toronto, Department of Neurology, Toronto, Canada
| | - Beth Selkirk
- The John and Liz Tory Eye Centre, Sunnybrook Health Sciences Centre, Department of Ophthalmology and Vision Sciences, Toronto, Canada; Univeristy of Toronto, Department of Neurology, Toronto, Canada
| | - Lisa Fiksenbaum
- Sunnybrook Health Sciences Centre, Centre for Youth Bipolar Disorder, Toronto, Canada; Univeristy of Toronto, Department of Neurology, Toronto, Canada
| | - Victor Yang
- Sunnybrook Research Institute, Hurvitz Brain Sciences Research Program, Toronto, Canada; University of Toronto, Department of Neurosurgery, Toronto, Canada; Univeristy of Toronto, Department of Neurology, Toronto, Canada
| | - Sandra Black
- Sunnybrook Research Institute, Hurvitz Brain Sciences Research Program, Toronto, Canada; University of Toronto, Department of Neurosurgery, Toronto, Canada; Sunnybrook Health Sciences Centre, Department of Medicine (Neurology), Toronto, Canada; Univeristy of Toronto, Department of Neurology, Toronto, Canada
| | - Peter J Kertes
- The John and Liz Tory Eye Centre, Sunnybrook Health Sciences Centre, Department of Ophthalmology and Vision Sciences, Toronto, Canada; University of Toronto, Ophthalmology and Vision Sciences, Toronto, Canada; Univeristy of Toronto, Department of Neurology, Toronto, Canada
| | - Benjamin I Goldstein
- Sunnybrook Health Sciences Centre, Centre for Youth Bipolar Disorder, Toronto, Canada; University of Toronto, Department of Pharmacology and Toxicology, Toronto, Canada; Univeristy of Toronto, Department of Neurology, Toronto, Canada.
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Emotion regulation as a transdiagnostic factor in the development of internalizing and externalizing psychopathology: Current and future directions. Dev Psychopathol 2017; 28:927-946. [PMID: 27739387 DOI: 10.1017/s0954579416000638] [Citation(s) in RCA: 262] [Impact Index Per Article: 37.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
In response to rapidly growing rates of comorbidity among psychiatric disorders, clinical scientists have become interested in identifying transdiagnostic processes that can help explain dysfunction across diagnostic categories (e.g., Kring & Sloan, 2009). One factor that has received a great deal of attention is that of emotion regulation, namely, the ability to modulate the intensity and/or duration of emotional states (e.g., Cicchetti, Ackerman, & Izard, 1995; Gross, 1998). Recent theoretical and empirical work has begun to emphasize the role that emotion regulation plays in the temporal comorbidity between internalizing and externalizing conditions (e.g., Aldao & De Los Reyes, 2015; De Los Reyes & Aldao, 2015; Drabick & Kendall, 2010; Jarrett & Ollendick, 2008; Patrick & Hajcak, 2016). However, close inspection of this work reveals two very pertinent areas of growth: (a) this literature is characterized by mixed findings that are likely explained, in part, by methodological heterogeneity; and (b) emotion regulation tends to be studied in relatively narrow terms. To address these issues, we provide a series of recommendations for facilitating cross-study comparisons and leveraging multifaceted approaches to studying emotion regulation processes within a developmental psychopathology framework. We hope that our perspective can enhance the organization and growth of this very important area of inquiry, and ultimately result in more effective prevention and treatment programs.
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30
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Arjmand S, Behzadi M, Stephens GJ, Ezzatabadipour S, Seifaddini R, Arjmand S, Shabani M. A Brain on a Roller Coaster: Can the Dopamine Reward System Act as a Protagonist to Subdue the Ups and Downs of Bipolar Disorder? Neuroscientist 2017; 24:423-439. [DOI: 10.1177/1073858417714226] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
One of the most interesting but tenebrous parts of the bipolar disorder (BD) story is the switch between (hypo)mania and depression, which can give bipolar patients a thrilling, but somewhat perilous, ‘ride’. Numerous studies have pointed out that there are some recognizable differences (either state-dependent or state-independent) in several brain regions of people with BD, including components of the brain’s reward system. Understanding the underpinning mechanisms of high and low mood statuses in BD has potential, not only for the development of highly specific and selective pharmaceutical agents, but also for better treatment approaches and psychological interventions to manage BD and, thus, give patients a safer ride. Herein, we review evidence that supports involvement of the reward system in the pathophysiology of mood swings, with the main focus on the mesocorticolimbic dopaminergic neural circuitry. Principally using findings from neuroimaging studies, we aim to signpost readers as to how mood alterations may affect different areas of the reward system and how antipsychotic drugs can influence the activity of these brain areas. Finally, we critically evaluate the hypothesis that the mesocorticolimbic dopamine reward system may act as a functional rheostat for different mood states.
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Affiliation(s)
- Shokouh Arjmand
- Kerman Neuroscience Research Center, Neuropharmacology Institute, Kerman University of Medical Sciences, Kerman, Iran
| | - Mina Behzadi
- Kerman Neuroscience Research Center, Neuropharmacology Institute, Kerman University of Medical Sciences, Kerman, Iran
| | - Gary J. Stephens
- School of Pharmacy, Reading University, Whiteknights, Reading, UK
| | - Sara Ezzatabadipour
- Kerman Neuroscience Research Center, Neuropharmacology Institute, Kerman University of Medical Sciences, Kerman, Iran
| | - Rostam Seifaddini
- Neurology Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Shahrad Arjmand
- Department of Psychology, Shahid Bahonar University of Kerman, Kerman, Iran
| | - Mohammad Shabani
- Kerman Neuroscience Research Center, Neuropharmacology Institute, Kerman University of Medical Sciences, Kerman, Iran
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31
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Kim E, Garrett A, Boucher S, Park MH, Howe M, Sanders E, Kelley RG, Reiss AL, Chang KD, Singh MK. Inhibited Temperament and Hippocampal Volume in Offspring of Parents with Bipolar Disorder. J Child Adolesc Psychopharmacol 2017; 27:258-265. [PMID: 27768380 DOI: 10.1089/cap.2016.0086] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Prior studies have suggested that inhibited temperament may be associated with an increased risk for developing anxiety or mood disorder, including bipolar disorder. However, the neurobiological basis for this increased risk is unknown. The aim of this study was to examine temperament in symptomatic and asymptomatic child offspring of parents with bipolar disorder (OBD) and to investigate whether inhibited temperament is associated with aberrant hippocampal volumes compared with healthy control (HC) youth. METHODS The OBD group consisted of 45 youth, 24 of whom had current psychiatric symptoms (OBD+s) and 21 without any psychiatric symptoms (OBD-s), and were compared with 24 HC youth. Temperament characteristics were measured by using the Revised Dimensions of Temperament Survey. Magnetic resonance imaging was used to measure hippocampal volumes. The association between temperament and hippocampal volumes was tested by using multiple regression analysis. RESULTS Compared with the OBD-s group, the OBD+s group had significantly more inhibited temperament traits, less flexibility, more negative mood, and less regular rhythm in their daily routines. In contrast, the OBD-s group was more likely to approach novel situations compared with OBD+s or HC groups. Within the OBD+s group, a more inhibited temperament was associated with smaller right hippocampal volumes. CONCLUSIONS In this study, symptomatic OBD were characterized by an inhibited temperament that was inversely correlated with hippocampal volume. Additional longitudinal studies are needed to determine whether inverse correlations between hippocampal volume and inhibited temperament represent early markers of risk for later developing bipolar disorder.
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Affiliation(s)
- Eunjoo Kim
- 1 Department of Psychiatry and Institute of Behavioral Sciences, Yonsei University College of Medicine, Seoul, Korea
| | - Amy Garrett
- 2 Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine , Stanford, California
| | - Spencer Boucher
- 2 Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine , Stanford, California
| | - Min-Hyeon Park
- 3 Department of Psychiatry, The Catholic University of Korea , Seoul St. Mary's Hospital, Seoul, Korea
| | - Meghan Howe
- 2 Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine , Stanford, California
| | - Erica Sanders
- 2 Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine , Stanford, California
| | - Ryan G Kelley
- 2 Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine , Stanford, California
| | - Allan L Reiss
- 2 Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine , Stanford, California
| | - Kiki D Chang
- 2 Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine , Stanford, California
| | - Manpreet K Singh
- 2 Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine , Stanford, California
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32
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López-Jaramillo C, Vargas C, Díaz-Zuluaga AM, Palacio JD, Castrillón G, Bearden C, Vieta E. Increased hippocampal, thalamus and amygdala volume in long-term lithium-treated bipolar I disorder patients compared with unmedicated patients and healthy subjects. Bipolar Disord 2017; 19:41-49. [PMID: 28239952 DOI: 10.1111/bdi.12467] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 10/12/2016] [Accepted: 01/04/2017] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Magnetic resonance imaging (MRI) studies in bipolar I disorder (BD-I) suggest that lithium is associated with increased volumes of cortico-limbic structures. However, more rigorous control of confounding factors is needed to obtain further support for this hypothesis. The aim of the present study was to assess differences in brain volumes among long-term lithium-treated BD-I patients, unmedicated BD-I patients, and healthy controls. METHODS This was a cross-sectional study with 32 euthymic BD-I patients (16 on lithium monotherapy for a mean of 180 months, and 16 receiving no medication for at least the 2 months prior to the study) and 20 healthy controls. Patients were euthymic (Hamilton Depression Rating Scale [HDRS] <6 and Young Mania Rating Scale [YMRS] <7) and had not taken psychotropic medications other than lithium for at least 6 months. Brain images were acquired on a 1.5 Tesla MRI (Phillips, Amsterdam, The Netherlands) and segmented to generate volumetric measures of cortical and subcortical brain areas, ventricles and global brain. RESULTS Significant differences were found in the volumes of the left amygdala (P=.0003), right amygdala (P=.030), left hippocampus (P=.022), left thalamus (P=.022), and right thalamus (P=.019) in long-term lithium-treated BD-I patients, compared to unmedicated patients and controls, after multivariable adjustment. No differences were observed in global brain volume or in ventricular size among the three groups. Likewise, there was no correlation between serum lithium levels and the increase in size in the described brain areas. CONCLUSIONS The structural differences found among the three groups, and specifically those between long-term lithium-treated and unmedicated BD-I patients, indicate increased limbic structure volumes in lithium-treated patients.
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Affiliation(s)
- Carlos López-Jaramillo
- Research Group in Psychiatry GIPSI, Department of Psychiatry, Faculty of Medicine, Universidad de Antioquia, Medellin, Colombia
| | - Cristian Vargas
- Research Group in Psychiatry GIPSI, Department of Psychiatry, Faculty of Medicine, Universidad de Antioquia, Medellin, Colombia
| | - Ana M Díaz-Zuluaga
- Research Group in Psychiatry GIPSI, Department of Psychiatry, Faculty of Medicine, Universidad de Antioquia, Medellin, Colombia
| | - Juan David Palacio
- Research Group in Psychiatry GIPSI, Department of Psychiatry, Faculty of Medicine, Universidad de Antioquia, Medellin, Colombia
| | - Gabriel Castrillón
- Research Group, Instituto de Alta Tecnología Médica IATM, Medellin, Colombia
| | - Carrie Bearden
- Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA, USA
| | - Eduard Vieta
- Department of Psychiatry, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
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33
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Polyunsaturated fatty acids and recurrent mood disorders: Phenomenology, mechanisms, and clinical application. Prog Lipid Res 2017; 66:1-13. [PMID: 28069365 DOI: 10.1016/j.plipres.2017.01.001] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 12/20/2016] [Accepted: 01/05/2017] [Indexed: 01/25/2023]
Abstract
A body of evidence has implicated dietary deficiency in omega-3 polyunsaturated fatty acids (n-3 PUFA), including eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), in the pathophysiology and etiology of recurrent mood disorders including major depressive disorder (MDD) and bipolar disorder. Cross-national and cross-sectional evidence suggests that greater habitual intake of n-3 PUFA is associated with reduced risk for developing mood symptoms. Meta-analyses provide strong evidence that patients with mood disorders exhibit low blood n-3 PUFA levels which are associated with increased risk for the initial development of mood symptoms in response to inflammation. While the etiology of this n-3 PUFA deficit may be multifactorial, n-3 PUFA supplementation is sufficient to correct this deficit and may also have antidepressant effects. Rodent studies suggest that n-3 PUFA deficiency during perinatal development can recapitulate key neuropathological, neurochemical, and behavioral features associated with mood disorders. Clinical neuroimaging studies suggest that low n-3 PUFA biostatus is associated with abnormalities in cortical structure and function also observed in mood disorders. Collectively, these findings implicate dietary n-3 PUFA insufficiency, particularly during development, in the pathophysiology of mood dysregulation, and support implementation of routine screening for and treatment of n-3 PUFA deficiency in patients with mood disorders.
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Hibar DP, Westlye LT, van Erp TGM, Rasmussen J, Leonardo CD, Faskowitz J, Haukvik UK, Hartberg CB, Doan NT, Agartz I, Dale AM, Gruber O, Krämer B, Trost S, Liberg B, Abé C, Ekman CJ, Ingvar M, Landén M, Fears SC, Freimer NB, Bearden CE, Sprooten E, Glahn DC, Pearlson GD, Emsell L, Kenney J, Scanlon C, McDonald C, Cannon DM, Almeida J, Versace A, Caseras X, Lawrence NS, Phillips ML, Dima D, Delvecchio G, Frangou S, Satterthwaite TD, Wolf D, Houenou J, Henry C, Malt UF, Bøen E, Elvsåshagen T, Young AH, Lloyd AJ, Goodwin GM, Mackay CE, Bourne C, Bilderbeck A, Abramovic L, Boks MP, van Haren NEM, Ophoff RA, Kahn RS, Bauer M, Pfennig A, Alda M, Hajek T, Mwangi B, Soares JC, Nickson T, Dimitrova R, Sussmann JE, Hagenaars S, Whalley HC, McIntosh AM, Thompson PM, Andreassen OA. Subcortical volumetric abnormalities in bipolar disorder. Mol Psychiatry 2016; 21:1710-1716. [PMID: 26857596 PMCID: PMC5116479 DOI: 10.1038/mp.2015.227] [Citation(s) in RCA: 317] [Impact Index Per Article: 39.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 12/08/2015] [Accepted: 12/11/2015] [Indexed: 11/29/2022]
Abstract
Considerable uncertainty exists about the defining brain changes associated with bipolar disorder (BD). Understanding and quantifying the sources of uncertainty can help generate novel clinical hypotheses about etiology and assist in the development of biomarkers for indexing disease progression and prognosis. Here we were interested in quantifying case-control differences in intracranial volume (ICV) and each of eight subcortical brain measures: nucleus accumbens, amygdala, caudate, hippocampus, globus pallidus, putamen, thalamus, lateral ventricles. In a large study of 1710 BD patients and 2594 healthy controls, we found consistent volumetric reductions in BD patients for mean hippocampus (Cohen's d=-0.232; P=3.50 × 10-7) and thalamus (d=-0.148; P=4.27 × 10-3) and enlarged lateral ventricles (d=-0.260; P=3.93 × 10-5) in patients. No significant effect of age at illness onset was detected. Stratifying patients based on clinical subtype (BD type I or type II) revealed that BDI patients had significantly larger lateral ventricles and smaller hippocampus and amygdala than controls. However, when comparing BDI and BDII patients directly, we did not detect any significant differences in brain volume. This likely represents similar etiology between BD subtype classifications. Exploratory analyses revealed significantly larger thalamic volumes in patients taking lithium compared with patients not taking lithium. We detected no significant differences between BDII patients and controls in the largest such comparison to date. Findings in this study should be interpreted with caution and with careful consideration of the limitations inherent to meta-analyzed neuroimaging comparisons.
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Affiliation(s)
- D P Hibar
- Imaging Genetics Center, University of Southern California, Los Angeles, CA, USA
| | - L T Westlye
- Division of Mental Health and Addiction, Norwegian Centre for Mental Disorders Research, KG Jebsen Centre for Psychosis Research, Oslo University Hospital, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - T G M van Erp
- Department of Psychiatry and Human Behavior, University of California, Irvine, CA, USA
| | - J Rasmussen
- Department of Psychiatry and Human Behavior, University of California, Irvine, CA, USA
| | - C D Leonardo
- Imaging Genetics Center, University of Southern California, Los Angeles, CA, USA
| | - J Faskowitz
- Imaging Genetics Center, University of Southern California, Los Angeles, CA, USA
| | - U K Haukvik
- Division of Mental Health and Addiction, Norwegian Centre for Mental Disorders Research, KG Jebsen Centre for Psychosis Research, Oslo University Hospital, Oslo, Norway
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - C B Hartberg
- Division of Mental Health and Addiction, Norwegian Centre for Mental Disorders Research, KG Jebsen Centre for Psychosis Research, Oslo University Hospital, Oslo, Norway
| | - N T Doan
- Division of Mental Health and Addiction, Norwegian Centre for Mental Disorders Research, KG Jebsen Centre for Psychosis Research, Oslo University Hospital, Oslo, Norway
| | - I Agartz
- Division of Mental Health and Addiction, Norwegian Centre for Mental Disorders Research, KG Jebsen Centre for Psychosis Research, Oslo University Hospital, Oslo, Norway
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - A M Dale
- MMIL, Department of Radiology, University of California, San Diego, CA, USA
- Department of Cognitive Science, Neurosciences and Psychiatry, University of California, San Diego, CA, USA
| | - O Gruber
- Center for Translational Research in Systems Neuroscience and Psychiatry, Department of Psychiatry and Psychotherapy, Georg August University Goettingen, Goettingen, Germany
- Section for Experimental Psychopathology and Neuroimaging, Department of General Psychiatry, Heidelberg University Hospital, Heidelberg, Germany
| | - B Krämer
- Center for Translational Research in Systems Neuroscience and Psychiatry, Department of Psychiatry and Psychotherapy, Georg August University Goettingen, Goettingen, Germany
| | - S Trost
- Center for Translational Research in Systems Neuroscience and Psychiatry, Department of Psychiatry and Psychotherapy, Georg August University Goettingen, Goettingen, Germany
| | - B Liberg
- Department of Clinical Neuroscience, Section of Psychiatry, Karolinska Institutet, Stockholm, Sweden
| | - C Abé
- Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden
| | - C J Ekman
- Department of Clinical Neuroscience, Section of Psychiatry, Karolinska Institutet, Stockholm, Sweden
| | - M Ingvar
- Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden
- Karolinska MR Research Center, Karolinska Institutet, Stockholm, Sweden
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - M Landén
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - S C Fears
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
- Center for Neurobehavioral Genetics, University of California, Los Angeles, CA, USA
| | - N B Freimer
- Center for Neurobehavioral Genetics, University of California, Los Angeles, CA, USA
| | - C E Bearden
- Center for Neurobehavioral Genetics, University of California, Los Angeles, CA, USA
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
- Department of Psychology, University of California, Los Angeles, CA, USA
| | - the Costa Rica/Colombia Consortium for Genetic Investigation of Bipolar Endophenotypes
- Imaging Genetics Center, University of Southern California, Los Angeles, CA, USA
- Division of Mental Health and Addiction, Norwegian Centre for Mental Disorders Research, KG Jebsen Centre for Psychosis Research, Oslo University Hospital, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
- Department of Psychiatry and Human Behavior, University of California, Irvine, CA, USA
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
- MMIL, Department of Radiology, University of California, San Diego, CA, USA
- Department of Cognitive Science, Neurosciences and Psychiatry, University of California, San Diego, CA, USA
- Center for Translational Research in Systems Neuroscience and Psychiatry, Department of Psychiatry and Psychotherapy, Georg August University Goettingen, Goettingen, Germany
- Section for Experimental Psychopathology and Neuroimaging, Department of General Psychiatry, Heidelberg University Hospital, Heidelberg, Germany
- Department of Clinical Neuroscience, Section of Psychiatry, Karolinska Institutet, Stockholm, Sweden
- Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden
- Karolinska MR Research Center, Karolinska Institutet, Stockholm, Sweden
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
- Center for Neurobehavioral Genetics, University of California, Los Angeles, CA, USA
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
- Department of Psychology, University of California, Los Angeles, CA, USA
- Department of Psychiatry, Yale University, New Haven, CT, USA
- Olin Neuropsychiatric Research Center, Institute of Living, Hartford, CT, USA
- Department of Neurobiology, Yale University School of Medicine, New Haven, CT, USA
- Clinical Neuroimaging Laboratory, College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
- Department of Psychiatry, Brown University, Providence, RI, USA
- Department of Psychiatry, University of Pittsburgh, Western Psychiatric Institute and Clinic, Pittsburgh, PA, USA
- MRC Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
- School of Psychology, University of Exeter, Exeter, UK
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Neurospin, Uniact, I2BM, CEA Saclay, Saclay, France
- Inserm, U955, Equipe 15 Psychiatrie génétique, Créteil, France
- Université Paris-Est, UMR-S955, UPEC, Créteil, France
- Department of Psychosomatic Medicine, Oslo University Hospital—Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Research and Education, Oslo University Hospital, Oslo, Norway
- Norwegian Research Network On Mood Disorders, Oslo, Norway
- Department of Neurology, Oslo University Hospital, Oslo, Norway
- Centre for Affective Disorders, King's College London, London, UK
- Academic Psychiatry and Regional Affective Disorders Service, Newcastle University, Newcastle, UK
- Department of Psychiatry, University of Oxford, Oxford, UK
- Department of Psychology and Counselling, Newman University, Birmingham, UK
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, UK
- Department of Psychiatry, University Medical Centre Utrecht - Brain Centre Rudolf Magnus, Utrecht, The Netherlands
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Medizinische Fakultät, Technische Universität Dresden, Dresden, Germany
- Department of Psychiatry, Dalhousie University, Halifax, Canada
- National Institute of Mental Health, Klecany, Czech Republic
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, UT Houston Medical School, Houston, TX, USA
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
| | - E Sprooten
- Department of Psychiatry, Yale University, New Haven, CT, USA
- Olin Neuropsychiatric Research Center, Institute of Living, Hartford, CT, USA
| | - D C Glahn
- Department of Psychiatry, Yale University, New Haven, CT, USA
- Olin Neuropsychiatric Research Center, Institute of Living, Hartford, CT, USA
| | - G D Pearlson
- Department of Psychiatry, Yale University, New Haven, CT, USA
- Olin Neuropsychiatric Research Center, Institute of Living, Hartford, CT, USA
- Department of Neurobiology, Yale University School of Medicine, New Haven, CT, USA
| | - L Emsell
- Clinical Neuroimaging Laboratory, College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - J Kenney
- Clinical Neuroimaging Laboratory, College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - C Scanlon
- Clinical Neuroimaging Laboratory, College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - C McDonald
- Clinical Neuroimaging Laboratory, College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - D M Cannon
- Clinical Neuroimaging Laboratory, College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - J Almeida
- Department of Psychiatry, Brown University, Providence, RI, USA
| | - A Versace
- Department of Psychiatry, University of Pittsburgh, Western Psychiatric Institute and Clinic, Pittsburgh, PA, USA
| | - X Caseras
- MRC Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - N S Lawrence
- School of Psychology, University of Exeter, Exeter, UK
| | - M L Phillips
- MRC Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - D Dima
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - G Delvecchio
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - S Frangou
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - T D Satterthwaite
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - D Wolf
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - J Houenou
- Neurospin, Uniact, I2BM, CEA Saclay, Saclay, France
- Inserm, U955, Equipe 15 Psychiatrie génétique, Créteil, France
| | - C Henry
- Inserm, U955, Equipe 15 Psychiatrie génétique, Créteil, France
- Université Paris-Est, UMR-S955, UPEC, Créteil, France
| | - U F Malt
- Department of Psychosomatic Medicine, Oslo University Hospital—Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Research and Education, Oslo University Hospital, Oslo, Norway
| | - E Bøen
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
- Department of Psychosomatic Medicine, Oslo University Hospital—Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Norwegian Research Network On Mood Disorders, Oslo, Norway
| | - T Elvsåshagen
- Division of Mental Health and Addiction, Norwegian Centre for Mental Disorders Research, KG Jebsen Centre for Psychosis Research, Oslo University Hospital, Oslo, Norway
- Department of Psychosomatic Medicine, Oslo University Hospital—Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - A H Young
- Centre for Affective Disorders, King's College London, London, UK
| | - A J Lloyd
- Academic Psychiatry and Regional Affective Disorders Service, Newcastle University, Newcastle, UK
| | - G M Goodwin
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - C E Mackay
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - C Bourne
- Department of Psychiatry, University of Oxford, Oxford, UK
- Department of Psychology and Counselling, Newman University, Birmingham, UK
| | - A Bilderbeck
- Department of Psychiatry, University of Oxford, Oxford, UK
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, UK
| | - L Abramovic
- Department of Psychiatry, University Medical Centre Utrecht - Brain Centre Rudolf Magnus, Utrecht, The Netherlands
| | - M P Boks
- Department of Psychiatry, University Medical Centre Utrecht - Brain Centre Rudolf Magnus, Utrecht, The Netherlands
| | - N E M van Haren
- Department of Psychiatry, University Medical Centre Utrecht - Brain Centre Rudolf Magnus, Utrecht, The Netherlands
| | - R A Ophoff
- Center for Neurobehavioral Genetics, University of California, Los Angeles, CA, USA
- Department of Psychiatry, University Medical Centre Utrecht - Brain Centre Rudolf Magnus, Utrecht, The Netherlands
| | - R S Kahn
- Department of Psychiatry, University Medical Centre Utrecht - Brain Centre Rudolf Magnus, Utrecht, The Netherlands
| | - M Bauer
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Medizinische Fakultät, Technische Universität Dresden, Dresden, Germany
| | - A Pfennig
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Medizinische Fakultät, Technische Universität Dresden, Dresden, Germany
| | - M Alda
- Department of Psychiatry, Dalhousie University, Halifax, Canada
| | - T Hajek
- Department of Psychiatry, Dalhousie University, Halifax, Canada
- National Institute of Mental Health, Klecany, Czech Republic
| | - B Mwangi
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, UT Houston Medical School, Houston, TX, USA
| | - J C Soares
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, UT Houston Medical School, Houston, TX, USA
| | - T Nickson
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
| | - R Dimitrova
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
| | - J E Sussmann
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
| | - S Hagenaars
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
| | - H C Whalley
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
| | - A M McIntosh
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
| | - P M Thompson
- Imaging Genetics Center, University of Southern California, Los Angeles, CA, USA
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - O A Andreassen
- Division of Mental Health and Addiction, Norwegian Centre for Mental Disorders Research, KG Jebsen Centre for Psychosis Research, Oslo University Hospital, Oslo, Norway
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Diler RS. Neuroimaging can help identify biomarkers of early onset bipolar disorder. ACTA ACUST UNITED AC 2016. [DOI: 10.5455/bcp.20120214113908] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Rasim Somer Diler
- University of Pittsburgh, Western Psychiatric Institute and Clinic, Medical Director, Inpatient Child & Adolescent Bipolar Services, BFT 539, 3811 O'Hara Street, Pittsburgh, PA 15213 Tel: Fax:
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Berghorst LH, Kumar P, Greve DN, Deckersbach T, Ongur D, Dutra S, Pizzagalli DA. Stress and reward processing in bipolar disorder: a functional magnetic resonance imaging study. Bipolar Disord 2016; 18:602-611. [PMID: 27870507 PMCID: PMC5234857 DOI: 10.1111/bdi.12444] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 09/30/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES A link between negative life stress and the onset of mood episodes in bipolar disorder (BD) has been established, but processes underlying such a link remain unclear. Growing evidence suggests that stress can negatively affect reward processing and related neurobiological substrates, indicating that a dysregulated reward system may provide a partial explanation. The aim of this study was to test the impact of stress on reward-related neural functioning in BD. METHODS Thirteen euthymic or mildly depressed individuals with BD and 15 controls performed a Monetary Incentive Delay (MID) task while undergoing functional magnetic resonance imaging during no-stress and stress (negative psychosocial stressor involving poor performance feedback and threat of monetary deductions) conditions. RESULTS In hypothesis-driven region-of-interest analyses, a significant group-by-condition interaction emerged in the amygdala during reward anticipation. Relative to controls, while anticipating a potential reward, subjects with BD were characterized by amygdalar hyperactivation in the no-stress condition but hypoactivation during stress. Moreover, relative to controls, subjects with BD had significantly larger amygdala volumes. After controlling for structural differences, the effects of stress on amygdalar function remained, whereas groups no longer differed during the no-stress condition. During reward consumption, a group-by-condition interaction emerged in the putamen due to increased putamen activation in response to rewards in participants with BD during stress, but an opposite pattern in controls. CONCLUSIONS Overall, findings highlight possible impairments in using reward-predicting cues to adaptively engage in goal-directed actions in BD, combined with stress-induced hypersensitivity to reward consumption. Potential clinical implications are discussed.
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Affiliation(s)
| | - Poornima Kumar
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA,Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Doug N Greve
- Department of Radiology, Massachusetts General Hospital, Charlestown, MA
| | - Thilo Deckersbach
- Department of Psychiatry, Harvard Medical School, Boston, MA,Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Dost Ongur
- Department of Psychiatry, Harvard Medical School, Boston, MA,Schizophrenia and Bipolar Disorder Research Program, McLean Hospital, Belmont, MA, USA
| | - Sunny Dutra
- Department of Psychology, Yale University, New Haven, CT
| | - Diego A Pizzagalli
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA,Department of Psychiatry, Harvard Medical School, Boston, MA,McLean Imaging Center, McLean Hospital, Belmont, MA, USA
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Welge JA, Saliba LJ, Strawn JR, Eliassen JC, Patino LR, Adler CM, Weber W, Schneider MR, Barzman DH, Strakowski SM, DelBello MP, McNamara RK. Neurofunctional Differences Among Youth With and at Varying Risk for Developing Mania. J Am Acad Child Adolesc Psychiatry 2016; 55:980-989. [PMID: 27806866 DOI: 10.1016/j.jaac.2016.08.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 06/06/2016] [Accepted: 09/01/2016] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To examine prefrontal and amygdala activation during emotional processing in youth with or at varying risk for developing mania to identify candidate central prodromal risk biomarkers. METHOD Four groups of medication-free adolescents (10-20 years old) participated: adolescents with first-episode bipolar I disorder (BP-I; n = 32), adolescents with a parent with bipolar disorder and a depressive disorder (at-risk depressed [ARD]; n = 32), healthy adolescents with a parent with bipolar disorder (at-risk healthy [ARH]; n = 32), and healthy adolescents with no personal or family history of psychiatric illness (healthy comparison [HC]; n = 32). Participants underwent functional magnetic resonance imaging while performing a continuous performance task with emotional and neutral distracters. Region-of-interest analyses were performed for the bilateral amygdala and for subregions of the ventrolateral prefrontal cortex and anterior cingulate cortex. RESULTS Overall, no group differences in bilateral amygdala and ventrolateral prefrontal cortex (Brodmann area [BA] 45/47) activation during emotional or neutral stimuli were observed. The BP-I group exhibited lower right pregenual anterior cingulate cortex activation compared with the HC group, and activation in the left BA 44 was greater in the ARH and ARD groups compared with the HC group. BP-I and ARD groups exhibited blunted activation in the right BA 10 compared with the ARH group. CONCLUSION During emotional processing, amygdala and ventrolateral prefrontal cortex (BA 45/47) activation does not differ in youth with or at increasing risk for BP-I. However, blunted pregenual anterior cingulate cortex activation in first-episode mania could represent an illness biomarker, and greater prefrontal BA 10 and BA 44 activations in at-risk youth could represent a biomarker of risk or resilience warranting additional investigation in prospective longitudinal studies.
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Affiliation(s)
- Jeffrey A Welge
- Division of Bipolar Disorders Research, University of Cincinnati College of Medicine, Cincinnati
| | - Lawrence J Saliba
- Division of Bipolar Disorders Research, University of Cincinnati College of Medicine, Cincinnati
| | - Jeffrey R Strawn
- Division of Bipolar Disorders Research, University of Cincinnati College of Medicine, Cincinnati
| | - James C Eliassen
- Center for Imaging Research, University of Cincinnati College of Medicine
| | - L Rodrigo Patino
- Division of Bipolar Disorders Research, University of Cincinnati College of Medicine, Cincinnati
| | - Caleb M Adler
- Division of Bipolar Disorders Research, University of Cincinnati College of Medicine, Cincinnati; Center for Imaging Research, University of Cincinnati College of Medicine
| | - Wade Weber
- Division of Bipolar Disorders Research, University of Cincinnati College of Medicine, Cincinnati
| | - Marguerite Reid Schneider
- Medical Scientist Training Program, Graduate Program in Neuroscience, University of Cincinnati College of Medicine
| | - Drew H Barzman
- Division of Bipolar Disorders Research, University of Cincinnati College of Medicine, Cincinnati
| | - Stephen M Strakowski
- Division of Bipolar Disorders Research, University of Cincinnati College of Medicine, Cincinnati; Center for Imaging Research, University of Cincinnati College of Medicine
| | - Melissa P DelBello
- Division of Bipolar Disorders Research, University of Cincinnati College of Medicine, Cincinnati
| | - Robert K McNamara
- Division of Bipolar Disorders Research, University of Cincinnati College of Medicine, Cincinnati.
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Benarous X, Consoli A, Milhiet V, Cohen D. Early interventions for youths at high risk for bipolar disorder: a developmental approach. Eur Child Adolesc Psychiatry 2016; 25:217-33. [PMID: 26395448 DOI: 10.1007/s00787-015-0773-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Indexed: 10/23/2022]
Abstract
In recent decades, ongoing research programmes on primary prevention and early identification of bipolar disorder (BD) have been developed. The aim of this article is to review the principal forms of evidence that support preventive interventions for BD in children and adolescents and the main challenges associated with these programmes. We performed a literature review of the main computerised databases (MEDLINE, PUBMED) and a manual search of the literature relevant to prospective and retrospective studies of prodromal symptoms, premorbid stages, risk factors, and early intervention programmes for BD. Genetic and environmental risk factors of BD were identified. Most of the algorithms used to measure the risk of developing BD and the early interventions programmes focused on the familial risk. The prodromal signs varied greatly and were age dependent. During adolescence, depressive episodes associated with genetic or environmental risk factors predicted the onset of hypomanic/manic episodes over subsequent years. In prepubertal children, the lack of specificity of clinical markers and difficulties in mood assessment were seen as impeding preventive interventions at these ages. Despite encouraging results, biomarkers have not thus far been sufficiently validated in youth samples to serve as screening tools for prevention. Additional longitudinal studies in youths at high risk of developing BD should include repeated measures of putative biomarkers. Staging models have been developed as an integrative approach to specify the individual level of risk based on clinical (e.g. prodromal symptoms and familial history of BD) and non-clinical (e.g. biomarkers and neuroimaging) data. However, there is still a lack of empirically validated studies that measure the benefits of using these models to design preventive intervention programmes.
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Affiliation(s)
- Xavier Benarous
- Service de Psychiatrie de l'Enfant et de l'Adolescent, Université Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, AP-HP, 47-83, Boulevard de l'Hôpital, 75013, Paris, France.
| | - Angèle Consoli
- Service de Psychiatrie de l'Enfant et de l'Adolescent, Université Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, AP-HP, 47-83, Boulevard de l'Hôpital, 75013, Paris, France.,INSERM U-669, PSIGIAM, Paris, France
| | - Vanessa Milhiet
- Service de Psychiatrie de l'Enfant et de l'Adolescent, Université Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, AP-HP, 47-83, Boulevard de l'Hôpital, 75013, Paris, France
| | - David Cohen
- Service de Psychiatrie de l'Enfant et de l'Adolescent, Université Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, AP-HP, 47-83, Boulevard de l'Hôpital, 75013, Paris, France.,CNRS UMR 7222, Institut des Systèmes Intelligents et Robotiques, Paris, France
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Park MH, Garrett A, Boucher S, Howe M, Sanders E, Kim E, Singh M, Chang K. Amygdalar volumetric correlates of social anxiety in offspring of parents with bipolar disorder. Psychiatry Res 2015; 234:252-8. [PMID: 26472294 DOI: 10.1016/j.pscychresns.2015.09.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Revised: 09/17/2015] [Accepted: 09/25/2015] [Indexed: 10/23/2022]
Abstract
The prevalence of social anxiety disorder is high in offspring of parents with bipolar disorder (BD) and anxiety may be a significant risk factor in these youth for developing BD. We compared social anxiety symptoms between BD offspring with mood symptoms (high-risk group for developing BD I or II: HR) and healthy controls (HC). We also explored the correlations between the amygdalar volumes and social anxiety symptoms in the HR group with high social anxiety scores (HRHSA) due to the potential involvement of the amygdala in the pathophysiology of both BD and social anxiety. Youth participating in the study included 29h and 17HC of comparable age and gender. To assess social anxiety symptoms, we used the Multidimensional Anxiety Scale for Children (MASC) social anxiety subscale. The HR group's MASC social anxiety score was significantly higher than that of the HC group. Among the 29h, 17 subjects (58.6%) showed high social anxiety and they were classified as the HRHSA group. No significant difference was observed in amygdalar volume between the HRHSA and HC groups. However, there were significant negative correlations between amydalar volumes and MASC social anxiety score in the HRHSA group. These findings have implications for the link between amygdalar structure and both anxiety and mood control. This link may serve to implicate high social anxiety as a risk marker for future BD development.
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Affiliation(s)
- Min-Hyeon Park
- Department of Psychiatry, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, South Korea
| | - Amy Garrett
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Spencer Boucher
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Meghan Howe
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Erica Sanders
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Eunjoo Kim
- Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Manpreet Singh
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Kiki Chang
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
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Singh MK, Kelley RG, Chang KD, Gotlib IH. Intrinsic Amygdala Functional Connectivity in Youth With Bipolar I Disorder. J Am Acad Child Adolesc Psychiatry 2015; 54:763-70. [PMID: 26299298 PMCID: PMC4548854 DOI: 10.1016/j.jaac.2015.06.016] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 06/24/2015] [Accepted: 06/30/2015] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Bipolar disorder (BD) commonly begins during adolescence and may continue into adulthood. Studies in adults with BD suggest that disruptions in amygdalar neural circuitry explain the pathophysiology underlying the disorder. Importantly, however, amygdala subregion networks have not yet been examined in youth close to mania onset. The goal of this study was to compare resting state functional connectivity patterns in amygdala subregions in youth with bipolar I disorder with patterns in healthy controls. METHOD Centromedial, laterobasal, and superficial amygdala subdivisions were assessed during rest and examined in relation to clinical measures of mania in youth (14-20 years old) with bipolar I disorder who experienced only a single episode of mania (BD; n = 20) and age-matched healthy comparison youth without any personal or family history of DSM-IV Axis I disorders (HC; n = 23). RESULTS Relative to HC youth, youth with BD exhibited decreased connectivity between the laterobasal subdivision of the amygdala and the hippocampus and precentral gyrus, and increased connectivity between the laterobasal subdivision and the precuneus. Connectivity between the right laterobasal amygdala and right hippocampus was positively correlated with levels of anxiety in BD but not in HC youth, and connectivity between the right laterobasal amygdala and right precuneus was negatively correlated with insight about bipolar illness. CONCLUSION Youth with BD have abnormal amygdala resting state network connections to regions that are critical for emotional processing and self-awareness. Longitudinal studies are needed to determine whether these aberrant patterns in youth with BD can be altered with intervention and can influence the course of disorder.
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Inal-Emiroglu FN, Karabay N, Resmi H, Guleryuz H, Baykara B, Alsen S, Senturk-Pilan B, Akay A, Kose S. Correlations between amygdala volumes and serum levels of BDNF and NGF as a neurobiological markerin adolescents with bipolar disorder. J Affect Disord 2015; 182:50-6. [PMID: 25973783 DOI: 10.1016/j.jad.2015.04.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 02/10/2015] [Accepted: 04/08/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND The amygdala is repeatedly implicated as a critical component of the neurocircuitry regulating emotional valence. Studies have frequently reported reduced amygdala volumes in children and adolescents with bipolar disorder (BD). Brain derived neurotrophic factor (BDNF) and nerve growth factor (NGF) play critical roles in growth, differentiation, maintenance, and synaptic plasticity of neuronal systems in adolescent brain development. The aim of the present study was to assess amygdala volumesand its correlation with serum levels of NGF and BDNF in euthymic adolescents with BD and healthy controls. METHODS Using structural MRI, we compared the amygdala volumes of 30 euthymic subjects with BD with 23 healthy control subjects aged between 13 and 19 years during a naturalistic clinical follow-up. The boundaries of the amygdala were outlined manually. Serum BDNF and NGF levels were measured using sandwich-ELISA and compared between the study groups. RESULTS The right or left amygdala volume did not differ between the study groups.The right and left amygdala volumes were highly correlated with levels of BDNF in the combined BD group and the valproate-treated group.Both R and L amygdala volumes were correlated with BDNF levels in healthy controls. The left amygdala volumes were correlated with BDNF levels in the lithium-treated group. LIMITATIONS This cross-sectional study cannot inform longitudinal changes in brain structure. Further studies with larger sample sizes are needed to improve reliability. CONCLUSIONS The correlations between amygdala volumes and BDNF levels might be an early neuromarker for diagnosis and/or treatment response in adolescents with BD.
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Affiliation(s)
- F Neslihan Inal-Emiroglu
- Dokuz Eylul University Medical School, Child and Adolescent Psychiatry Department, Izmir, Turkey.
| | - Nuri Karabay
- Dokuz Eylul University Medical School, Radiology Department, Izmir, Turkey
| | - Halil Resmi
- Dokuz Eylul University Medical School, Medical Biochemistry Department, Izmir, Turkey
| | - Handan Guleryuz
- Dokuz Eylul University Medical School, Radiology Department, Izmir, Turkey
| | - Burak Baykara
- Dokuz Eylul University Medical School, Child and Adolescent Psychiatry Department, Izmir, Turkey
| | | | | | - Aynur Akay
- Dokuz Eylul University Medical School, Child and Adolescent Psychiatry Department, Izmir, Turkey
| | - Samet Kose
- University of Texas Medical School at Houston, Department of Psychiatry and Behavioral Sciences and Center for Neurobehavioral Research on Addiction (CNRA), Houston, TX, United States
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Correlation between Peripheral Levels of Brain-Derived Neurotrophic Factor and Hippocampal Volume in Children and Adolescents with Bipolar Disorder. Neural Plast 2015; 2015:324825. [PMID: 26075097 PMCID: PMC4444584 DOI: 10.1155/2015/324825] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 11/06/2014] [Accepted: 12/27/2014] [Indexed: 12/25/2022] Open
Abstract
Pediatric bipolar disorder (PBD) is a serious mental disorder that affects the development and emotional growth of affected patients. The brain derived neurotrophic factor (BDNF) is recognized as one of the possible markers of the framework and its evolution. Abnormalities in BDNF signaling in the hippocampus could explain the cognitive decline seen in patients with TB. Our aim with this study was to evaluate possible changes in hippocampal volume in children and adolescents with BD and associate them to serum BDNF. Subjects included 30 patients aged seven to seventeen years from the ProCAB (Program for Children and Adolescents with Bipolar Disorder). We observed mean right and left hippocampal volumes of 41910.55 and 41747.96 mm(3), respectively. No statistically significant correlations between peripheral BDNF levels and hippocampal volumes were found. We believe that the lack of correlation observed in this study is due to the short time of evolution of BD in children and adolescents. Besides studies with larger sample sizes to confirm the present findings and longitudinal assessments, addressing brain development versus a control group and including drug-naive patients in different mood states may help clarify the role of BDNF in the brain changes consequent upon BD.
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43
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Rosen HR, Rich BA. Neurocognitive Correlates of Emotional Stimulus Processing in Pediatric Bipolar Disorder: A Review. Postgrad Med 2015; 122:94-104. [PMID: 20675973 DOI: 10.3810/pgm.2010.07.2177] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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44
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Influence of DGKH variants on amygdala volume in patients with bipolar affective disorder and schizophrenia. Eur Arch Psychiatry Clin Neurosci 2015; 265:127-36. [PMID: 24958494 DOI: 10.1007/s00406-014-0513-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Accepted: 06/03/2014] [Indexed: 12/14/2022]
Abstract
The diacylglycerol kinase eta (DGKH) gene, first identified in a genome-wide association study, is one of the few replicated risk genes of bipolar affective disorder (BD). Following initial positive studies, it not only was found to be associated with BD but also implicated in the etiology of other psychiatric disorders featuring affective symptoms, rendering DGKH a cross-disorder risk gene. However, the (patho-)physiological role of the encoded enzyme is still elusive. In the present study, we investigated primarily the influence of a risk haplotype on amygdala volume in patients suffering from schizophrenia or BD as well as healthy controls and four single nucleotide polymorphisms conveying risk. There was a significant association of the DGKH risk haplotype with increased amygdala volume in BD, but not in schizophrenia or healthy controls. These findings add to the notion of a role of DGKH in the pathogenesis of BD.
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45
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All the world's a (clinical) stage: rethinking bipolar disorder from a longitudinal perspective. Mol Psychiatry 2015; 20:23-31. [PMID: 25048003 PMCID: PMC4303542 DOI: 10.1038/mp.2014.71] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 05/13/2014] [Accepted: 06/06/2014] [Indexed: 12/11/2022]
Abstract
Psychiatric disorders have traditionally been classified using a static, categorical approach. However, this approach falls short in facilitating understanding of the development, common comorbid diagnoses, prognosis and treatment of these disorders. We propose a 'staging' model of bipolar disorder that integrates genetic and neural information with mood and activity symptoms to describe how the disease progresses over time. From an early, asymptomatic, but 'at-risk' stage to severe, chronic illness, each stage is described with associated neuroimaging findings as well as strategies for mapping genetic risk factors. Integrating more biologic information relating to cardiovascular and endocrine systems, refining methodology for modeling dimensional approaches to disease and developing outcome measures will all be crucial in examining the validity of this model. Ultimately, this approach should aid in developing targeted interventions for each group that will reduce the significant morbidity and mortality associated with bipolar disorder.
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46
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Mwangi B, Spiker D, Zunta-Soares GB, Soares JC. Prediction of pediatric bipolar disorder using neuroanatomical signatures of the amygdala. Bipolar Disord 2014; 16:713-21. [PMID: 24917530 PMCID: PMC4234406 DOI: 10.1111/bdi.12222] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 03/31/2014] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Pediatric bipolar disorder is currently diagnosed based on signs and symptoms, and without objective diagnostic biomarkers. In the present study, we investigated the utility of structural neuroanatomical signatures of the amygdala to objectively differentiate individual subjects with pediatric bipolar disorder from matched healthy controls. METHODS Structural T1 -weighted neuroimaging scans were obtained from 16 children and adolescents with unmedicated DSM-IV bipolar disorder (11 males, five females) and 16 matched healthy controls (11 males, five females). Voxel-based gray matter morphometric features extracted from a bilateral region-of-interest within the amygdala were used to develop a multivariate pattern analysis model which was utilized in predicting novel or 'unseen' individual subjects as either bipolar disorder or healthy controls. RESULTS The model assigned 25 out of 32 subjects the correct label (bipolar disorder/healthy) translating to a 78.12% diagnostic accuracy, 81.25% sensitivity, 75.00% specificity, 76.47% positive predictive value, and 80.00% negative predictive value and an area under the receiver operating characteristic curve (ROC) of 0.81. The predictions were significant at p = 0.0014 (χ(2) test p-value). CONCLUSIONS These results reaffirm previous reports on the existence of neuroanatomical abnormalities in the amygdala of pediatric patients with bipolar disorder. Remarkably, the present study also demonstrates that neuroanatomical signatures of the amygdala can predict individual subjects with bipolar disorder with a relatively high specificity and sensitivity. To the best of our knowledge, this is the first study to present a proof-of-concept diagnostic marker of pediatric bipolar disorder based on structural neuroimaging scans of largely medication-naïve patients.
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Affiliation(s)
- Benson Mwangi
- Department of Psychiatry and Behavioral Sciences; University of Texas Center of Excellence on Mood Disorders; UT Houston Medical School; Houston TX USA
| | - Danielle Spiker
- Department of Psychiatry and Behavioral Sciences; University of Texas Center of Excellence on Mood Disorders; UT Houston Medical School; Houston TX USA
| | - Giovana B Zunta-Soares
- Department of Psychiatry and Behavioral Sciences; University of Texas Center of Excellence on Mood Disorders; UT Houston Medical School; Houston TX USA
| | - Jair C Soares
- Department of Psychiatry and Behavioral Sciences; University of Texas Center of Excellence on Mood Disorders; UT Houston Medical School; Houston TX USA
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47
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Phillips ML, Swartz HA. A critical appraisal of neuroimaging studies of bipolar disorder: toward a new conceptualization of underlying neural circuitry and a road map for future research. Am J Psychiatry 2014; 171:829-43. [PMID: 24626773 PMCID: PMC4119497 DOI: 10.1176/appi.ajp.2014.13081008] [Citation(s) in RCA: 396] [Impact Index Per Article: 39.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE In this critical review, the authors appraise neuroimaging findings in bipolar disorder in emotion-processing, emotion-regulation, and reward-processing neural circuitry in order to synthesize the current knowledge of the neural underpinnings of bipolar disorder and provide a neuroimaging research road map for future studies. METHOD The authors examined findings from all major studies in bipolar disorder that used functional MRI, volumetric analysis, diffusion imaging, and resting-state techniques, integrating findings to provide a better understanding of larger-scale neural circuitry abnormalities in bipolar disorder. RESULTS Bipolar disorder can be conceptualized, in neural circuitry terms, as parallel dysfunction in prefrontal cortical (especially ventrolateral prefrontal cortical)-hippocampal-amygdala emotion-processing and emotion-regulation circuits bilaterally, together with an "overactive" left-sided ventral striatal-ventrolateral and orbitofrontal cortical reward-processing circuitry, resulting in characteristic behavioral abnormalities associated with bipolar disorder: emotional lability, emotional dysregulation, and heightened reward sensitivity. A potential structural basis for these functional abnormalities is gray matter volume decreases in the prefrontal and temporal cortices, the amygdala, and the hippocampus and fractional anisotropy decreases in white matter tracts connecting prefrontal and subcortical regions. CONCLUSIONS Neuroimaging studies of bipolar disorder clearly demonstrate abnormalities in neural circuits supporting emotion processing, emotion regulation, and reward processing, although there are several limitations to these studies. Future neuroimaging research in bipolar disorder should include studies adopting dimensional approaches; larger studies examining neurodevelopmental trajectories in youths with bipolar disorder or at risk for bipolar disorder; multimodal neuroimaging studies using integrated systems approaches; and studies using pattern recognition approaches to provide clinically useful individual-level data. Such studies will help identify clinically relevant biomarkers to guide diagnosis and treatment decision making for individuals with bipolar disorder.
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Brotman MA, Tseng WL, Olsavsky AK, Fromm SJ, Muhrer EJ, Rutenberg J, Deveney CM, Adleman NE, Zarate CA, Pine DS, Leibenluft E. Fronto-limbic-striatal dysfunction in pediatric and adult patients with bipolar disorder: impact of face emotion and attentional demands. Psychol Med 2014; 44:1639-1651. [PMID: 23930595 PMCID: PMC3922892 DOI: 10.1017/s003329171300202x] [Citation(s) in RCA: 40] [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] [Indexed: 12/21/2022]
Abstract
BACKGROUND Research in bipolar disorder (BD) implicates fronto-limbic-striatal dysfunction during face emotion processing but it is unknown how such dysfunction varies by task demands, face emotion and patient age. METHOD During functional magnetic resonance imaging (fMRI), 181 participants, including 62 BD (36 children and 26 adults) and 119 healthy comparison (HC) subjects (57 children and 62 adults), engaged in constrained and unconstrained processing of emotional (angry, fearful, happy) and non-emotional (neutral) faces. During constrained processing, subjects answered questions focusing their attention on the face; this was processed either implicitly (nose width rating) or explicitly (hostility; subjective fear ratings). Unconstrained processing consisted of passive viewing. RESULTS Pediatric BD rated neutral faces as more hostile than did other groups. In BD patients, family-wise error (FWE)-corrected region of interest (ROI) analyses revealed dysfunction in the amygdala, inferior frontal gyrus (IFG), anterior cingulate cortex (ACC) and putamen. Patients with BD showed amygdala hyperactivation during explicit processing (hostility ratings) of fearful faces and passive viewing of angry and neutral faces but IFG hypoactivation during implicit processing of neutral and happy faces. In the ACC and striatum, the direction of dysfunction varied by task demand: BD demonstrated hyperactivation during unconstrained processing of angry or neutral faces but hypoactivation during constrained processing (implicit or explicit) of angry, neutral or happy faces. CONCLUSIONS Findings suggest amygdala hyperactivation in BD while processing negatively valenced and neutral faces, regardless of attentional condition, and BD IFG hypoactivation during implicit processing. In the cognitive control circuit involving the ACC and putamen, BD neural dysfunction was sensitive to task demands.
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Affiliation(s)
- M. A. Brotman
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | - W.-L. Tseng
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | - A. K. Olsavsky
- Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA
| | - S. J. Fromm
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | - E. J. Muhrer
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | - J.G. Rutenberg
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | - C. M. Deveney
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | - N. E. Adleman
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | - C. A. Zarate
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | - D. S. Pine
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | - E. Leibenluft
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
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Lecardeur L, Benarous X, Milhiet V, Consoli A, Cohen D. [Management of bipolar 1 disorder in children and adolescents]. Encephale 2014; 40:143-53. [PMID: 24656684 DOI: 10.1016/j.encep.2014.02.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 02/17/2014] [Indexed: 11/15/2022]
Abstract
Lifetime prevalence of child and adolescent bipolar 1 disorder (BD1) is nearly 0.1 %. Even though it is not a frequent disorder in young people, there is an increased interest for this disorder at this age, because of the poor outcome, the severe functional impairments and the major risk of suicide. Diagnosis is complex in view of the more frequent comorbidities, the variability with an age-dependant clinical presentation, and the overlap in symptom presentation with other psychiatric disorders (e.g. disruptive disorders in prepubertal the child and schizophrenia in the adolescent). The presentation in adolescents is very similar to that in adults and in prepubertal children chronic persistent irritability and rapid mood oscillation are often at the foreground. For a while, such presentations were considered as BD-not otherwise specified (BD-NOS), which can explain the outburst of the prevalence of bipolar disorder in children in the US. Longitudinal studies that look for the outcome of such emotional dysregulations have not revealed an affiliation with bipolar disorder spectrum, but with depressive disorders in adulthood. The diagnosis of Disruptive Mood Dysregulation Disorder was proposed in the DSM-5 to identify these children and to prevent confusion with bipolar disorder. The goals of the pharmacological and psychosocial treatments are to control or ameliorate the symptoms, to avoid new episodes or recurrences, to improve psychosocial functioning and well-being, and to prevent suicide. In the US, lithium and four atypical antipsychotics have been approved by the FDA for 10 to 13-year-olds (risperidone, olanzapine, aripiprazole and quetiapine). In France, only lithium salts (after the age of 16) and aripiprazole (after the age of 13) are recommended. Psychosocial treatments, such as a familial or individual approach are developing.
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Affiliation(s)
- L Lecardeur
- Équipe mobile de soins intensifs, centre Esquirol, CHU de Caen, avenue Côte-de-Nacre, 14033 Caen, France; CNRS, UMR 6301 ISTCT, ISTS group, GIP CYCERON, 14074 Caen, France; CEA, DSV/I2BM, UMR 6301 ISTCT, 14074 Caen, France; Université de Caen Basse-Normandie, UMR 6301 ISTCT, 14074 Caen, France.
| | - X Benarous
- Service de psychiatrie de l'enfant et de l'adolescent, hôpital Pitié-Salpêtrière, AP-HP, 75651 Paris cedex 13, France
| | - V Milhiet
- Service de psychiatrie de l'enfant et de l'adolescent, hôpital Pitié-Salpêtrière, AP-HP, 75651 Paris cedex 13, France
| | - A Consoli
- Service de psychiatrie de l'enfant et de l'adolescent, hôpital Pitié-Salpêtrière, AP-HP, 75651 Paris cedex 13, France
| | - D Cohen
- Service de psychiatrie de l'enfant et de l'adolescent, hôpital Pitié-Salpêtrière, AP-HP, 75651 Paris cedex 13, France; CNRS UMR 7222, institut des systèmes intelligents et robotiques, université Pierre-et-Marie-Curie, 75252 Paris cedex 05, France
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50
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Deveney CM, Brotman MA, Thomas LA, Hinton KE, Muhrer EM, Reynolds RC, Adleman NE, Zarate CA, Pine DS, Leibenluft E. Neural response during explicit and implicit face processing varies developmentally in bipolar disorder. Soc Cogn Affect Neurosci 2014; 9:1984-92. [PMID: 24493839 DOI: 10.1093/scan/nsu014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Both children and adults with bipolar disorder (BD) exhibit face emotion labeling deficits and neural circuitry dysfunction in response to emotional faces. However, few studies have compared these groups directly to distinguish effects of age and diagnosis. Such studies are important to begin to elucidate the developmental trajectory of BD and facilitate its diagnosis, prevention and treatment. This functional magnetic resonance imaging study compares 41 individuals with BD (19 children; 22 adults) and 44 age-matched healthy individuals (25 children; 19 adults) when making explicit or implicit judgments about angry or happy face morphs across a range of emotion intensity. Linear trend analyses revealed that BD patients, irrespective of age, failed to recruit the amygdala in response to increasing angry face. This finding was no longer significant when the group was restricted to euthymic youth or those without comorbid attention deficit hyperactivity disorder although this may reflect low statistical power. Deficits in subgenual anterior cingulate modulation were observed in both patient groups but were related to implicit processing for child patients and explicit processing for adult patients. Abnormalities in face emotion labeling and the circuitry mediating it may be biomarkers of BD that are present across development.
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Affiliation(s)
- Christen M Deveney
- Emotion and Development Branch, Department of Health and Human Services, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA, Section on the Neurobiology and Treatment of Mood Disorders, Department of Health and Human Services, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA, and Scientific and Statistical Computing Core, Department of Health and Human Services, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA
| | - Melissa A Brotman
- Emotion and Development Branch, Department of Health and Human Services, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA, Section on the Neurobiology and Treatment of Mood Disorders, Department of Health and Human Services, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA, and Scientific and Statistical Computing Core, Department of Health and Human Services, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA
| | - Laura A Thomas
- Emotion and Development Branch, Department of Health and Human Services, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA, Section on the Neurobiology and Treatment of Mood Disorders, Department of Health and Human Services, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA, and Scientific and Statistical Computing Core, Department of Health and Human Services, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA
| | - Kendra E Hinton
- Emotion and Development Branch, Department of Health and Human Services, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA, Section on the Neurobiology and Treatment of Mood Disorders, Department of Health and Human Services, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA, and Scientific and Statistical Computing Core, Department of Health and Human Services, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA
| | - Eli M Muhrer
- Emotion and Development Branch, Department of Health and Human Services, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA, Section on the Neurobiology and Treatment of Mood Disorders, Department of Health and Human Services, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA, and Scientific and Statistical Computing Core, Department of Health and Human Services, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA
| | - Richard C Reynolds
- Emotion and Development Branch, Department of Health and Human Services, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA, Section on the Neurobiology and Treatment of Mood Disorders, Department of Health and Human Services, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA, and Scientific and Statistical Computing Core, Department of Health and Human Services, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA
| | - Nancy E Adleman
- Emotion and Development Branch, Department of Health and Human Services, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA, Section on the Neurobiology and Treatment of Mood Disorders, Department of Health and Human Services, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA, and Scientific and Statistical Computing Core, Department of Health and Human Services, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA
| | - Carlos A Zarate
- Emotion and Development Branch, Department of Health and Human Services, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA, Section on the Neurobiology and Treatment of Mood Disorders, Department of Health and Human Services, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA, and Scientific and Statistical Computing Core, Department of Health and Human Services, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA
| | - Daniel S Pine
- Emotion and Development Branch, Department of Health and Human Services, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA, Section on the Neurobiology and Treatment of Mood Disorders, Department of Health and Human Services, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA, and Scientific and Statistical Computing Core, Department of Health and Human Services, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA
| | - Ellen Leibenluft
- Emotion and Development Branch, Department of Health and Human Services, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA, Section on the Neurobiology and Treatment of Mood Disorders, Department of Health and Human Services, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA, and Scientific and Statistical Computing Core, Department of Health and Human Services, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA
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