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Robin M, Surjous L, Belbèze J, Bonnardel L, Lamas C, Silva J, Peres V, Corcos M. Four attachment-based categories of emotion regulation in adolescent psychic troubles. Front Psychol 2023; 14:1133980. [PMID: 37275718 PMCID: PMC10237043 DOI: 10.3389/fpsyg.2023.1133980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 04/06/2023] [Indexed: 06/07/2023] Open
Abstract
Introduction Emotion regulation is altered in many psychiatric disorders in adolescence, but the understanding of mechanisms that underlie this alteration is still poor. Methods The PERCEPT study explores alexithymia, empathy, facial emotion recognition (FER) and defence mechanisms in a sample of adolescents in psychiatric care (n = 61, 74% of girls, mean age = 15.03 y.o.), in relation with participants' attachment styles. Results Results revealed correlations between attachment dimensions and all of the emotion regulation variables, suggesting that attachment modalities have functional links with emotional regulation at its different levels: FER accuracy was inversely correlated with avoidant attachment, while affective empathy, difficulty in identifying feelings (alexithymia) and immature as well as neurotic defence mechanisms were positively correlated with anxious attachment. Moreover, attachment categories delineated distinct emotional perception profiles. In particular, preoccupied attachment included adolescents with the highest levels of facial emotion perception (sensitivity and accuracy) and of affective empathy, whereas detached attachment included adolescents with the lowest levels of these variables. Neurotic defence mechanisms and difficulty to identify feelings were correlated with preoccupied attachment; immature defence mechanisms and difficulty to describe feelings to others characterized fearful attachment. Discussion These results suggest that attachment categories underlie emotion regulation processes in psychiatric disorders in adolescence. Theoretical and clinical implications are discussed.
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Affiliation(s)
- Marion Robin
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France
- CESP, INSERM U1178, Paris-Saclay University, Villejuif, France
| | - Luc Surjous
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France
- Paris Cité University, Paris, France
| | - Jean Belbèze
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France
- Paris Cité University, Paris, France
| | - Lucile Bonnardel
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France
| | - Claire Lamas
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France
| | - Jérôme Silva
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France
| | - Victoire Peres
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France
| | - Maurice Corcos
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France
- Paris Cité University, Paris, France
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Saleem A, Harmata G, Jain S, Voss MW, Fiedorowicz JG, Williams AJ, Shaffer JJ, Richards JG, Barsotti EJ, Sathyaputri L, Schmitz SL, Christensen GE, Long JD, Xu J, Wemmie JA, Magnotta VA. Functional connectivity of the cerebellar vermis in bipolar disorder and associations with mood. Front Psychiatry 2023; 14:1147540. [PMID: 37215681 PMCID: PMC10196126 DOI: 10.3389/fpsyt.2023.1147540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 04/12/2023] [Indexed: 05/24/2023] Open
Abstract
Purpose Studies of the neural underpinnings of bipolar type I disorder have focused on the emotional control network. However, there is also growing evidence for cerebellar involvement, including abnormal structure, function, and metabolism. Here, we sought to assess functional connectivity of the cerebellar vermis with the cerebrum in bipolar disorder and to assess whether connectivity might depend on mood. Methods This cross-sectional study enrolled 128 participants with bipolar type I disorder and 83 control comparison participants who completed a 3 T magnetic resonance imaging (MRI) study, which included anatomical as well as resting state Blood Oxygenation Level Dependent (BOLD) imaging. Functional connectivity of the cerebellar vermis to all other brain regions was assessed. Based on quality control metrics of the fMRI data, 109 participants with bipolar disorder and 79 controls were included in the statistical analysis comparing connectivity of the vermis. In addition, the data was explored for the potential impacts of mood, symptom burden, and medication in those with bipolar disorder. Results Functional connectivity between the cerebellar vermis and the cerebrum was found to be aberrant in bipolar disorder. The connectivity of the vermis was found to be greater in bipolar disorder to regions involved in motor control and emotion (trending), while reduced connectivity was observed to a region associated with language production. In the participants with bipolar disorder, past depression symptom burden affected connectivity; however, no effects of medication were observed. Functional connectivity between the cerebellar vermis and all other regions revealed an inverse association with current mood ratings. Conclusion Together the findings may suggest that the cerebellum plays a compensatory role in bipolar disorder. The proximity of the cerebellar vermis to the skull may make this region a potential target for treatment with transcranial magnetic stimulation.
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Affiliation(s)
- Arshaq Saleem
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, United States
| | - Gail Harmata
- Department of Radiology, University of Iowa, Iowa City, IA, United States
| | - Shivangi Jain
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, United States
| | - Michelle W. Voss
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, United States
| | - Jess G. Fiedorowicz
- The Ottawa Hospital, Ottawa Hospital Research Institute, University of Ottawa Brain and Mind Research Institute, Ottawa, ON, Canada
| | | | - Joseph J. Shaffer
- Department of Radiology, University of Iowa, Iowa City, IA, United States
- Department of Biosciences, Kansas City University, Kansas City, MO, United States
| | | | | | - Leela Sathyaputri
- Department of Psychiatry, University of Iowa, Iowa City, IA, United States
- Embracing the World, Elburn, IL, United States
| | - Samantha L. Schmitz
- Department of Psychiatry, University of Iowa, Iowa City, IA, United States
- College of Osteopathic Medicine, Des Moines University, Des Moines, IA, United States
| | - Gary E. Christensen
- Department of Electrical and Computer Engineering, University of Iowa, Iowa City, IA, United States
- Department of Radiation Oncology, University of Iowa, Iowa City, IA, United States
| | - Jeffrey D. Long
- Department of Psychiatry, University of Iowa, Iowa City, IA, United States
- Department of Biostatistics, University of Iowa, Iowa City, IA, United States
| | - Jia Xu
- Department of Radiology, University of Iowa, Iowa City, IA, United States
| | - John A. Wemmie
- Department of Psychiatry, University of Iowa, Iowa City, IA, United States
- Veterans Affairs Medical Center, Iowa City, IA, United States
- Department of Molecular Physiology and Biophysics, University of Iowa, Iowa City, IA, United States
- Department of Neurosurgery, University of Iowa, Iowa City, IA, United States
| | - Vincent A. Magnotta
- Department of Radiology, University of Iowa, Iowa City, IA, United States
- Department of Psychiatry, University of Iowa, Iowa City, IA, United States
- Department of Biomedical Engineering, University of Iowa, Iowa City, IA, United States
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3
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Long X, Li L, Wang X, Cao Y, Wu B, Roberts N, Gong Q, Kemp GJ, Jia Z. Gray matter alterations in adolescent major depressive disorder and adolescent bipolar disorder. J Affect Disord 2023; 325:550-563. [PMID: 36669567 DOI: 10.1016/j.jad.2023.01.049] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 12/24/2022] [Accepted: 01/11/2023] [Indexed: 01/19/2023]
Abstract
BACKGROUND Gray matter volume (GMV) alterations in several emotion-related brain areas are implicated in mood disorders, but findings have been inconsistent in adolescents with major depressive disorder (MDD) or bipolar disorder (BD). METHODS We conducted a comprehensive meta-analysis of 35 region-of-interest (ROI) and 18 whole-brain voxel-based morphometry (VBM) MRI studies in adolescent MDD and adolescent BD, and indirectly compared the results in the two groups. The effects of age, sex, and other demographic and clinical scale scores were explored using meta-regression analysis. RESULTS In the ROI meta-analysis, right putamen volume was decreased in adolescents with MDD, while bilateral amygdala volume was decreased in adolescents with BD compared to healthy controls (HC). In the whole-brain VBM meta-analysis, GMV was increased in right middle frontal gyrus and decreased in left caudate in adolescents with MDD compared to HC, while in adolescents with BD, GMV was increased in left superior frontal gyrus and decreased in limbic regions compared with HC. MDD vs BD comparison revealed volume alteration in the prefrontal-limbic system. LIMITATION Different clinical features limit the comparability of the samples, and small sample size and insufficient clinical details precluded subgroup analysis or meta-regression analyses of these variables. CONCLUSIONS Distinct patterns of GMV alterations in adolescent MDD and adolescent BD could help to differentiate these two populations and provide potential diagnostic biomarkers.
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Affiliation(s)
- Xipeng Long
- Department of Nuclear Medicine, West China Hospital of Sichuan University, No. 37 GuoXue Xiang, Chengdu 610041, Sichuan, PR China; Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, PR China
| | - Lei Li
- Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, PR China; Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, PR China
| | - Xiuli Wang
- Department of Clinical Psychiatry, the Fourth People's Hospital of Chengdu, Chengdu 610041, Sichuan, PR China
| | - Yuan Cao
- Department of Nuclear Medicine, West China Hospital of Sichuan University, No. 37 GuoXue Xiang, Chengdu 610041, Sichuan, PR China
| | - Baolin Wu
- Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, PR China; Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, PR China
| | - Neil Roberts
- The Queens Medical Research Institute (QMRI), School of Clinical Sciences, University of Edinburgh, Edinburgh, UK
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, PR China; Department of Radiology, West China Xiamen Hospital of Sichuan University, 699Jinyuan Xi Road, Jimei District, 361021 Xiamen, Fujian, PR China
| | - Graham J Kemp
- Liverpool Magnetic Resonance Imaging Center (LiMRIC) and Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Zhiyun Jia
- Department of Nuclear Medicine, West China Hospital of Sichuan University, No. 37 GuoXue Xiang, Chengdu 610041, Sichuan, PR China; Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, PR China.
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Saleem A, Harmata G, Jain S, Voss MW, Fiedorowicz JG, Williams A, Shaffer JJ, Richards JG, Barsotti EJ, Sathyaputri L, Schmitz SL, Christensen GE, Long JD, Xu J, Wemmie JA, Magnotta VA. Functional Connectivity of the Cerebellar Vermis in Bipolar Disorder and Associations with Mood. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.02.02.526878. [PMID: 36778335 PMCID: PMC9915674 DOI: 10.1101/2023.02.02.526878] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Purpose Studies of the neural underpinnings of bipolar type I disorder have focused on the emotional control network. However, there is also growing evidence for cerebellar involvement, including abnormal structure, function, and metabolism. Here, we sought to assess functional connectivity of the cerebellum with the cerebrum in bipolar disorder and to assess whether any effects might depend on mood. Methods This cross-sectional study enrolled 128 participants with bipolar type I disorder and 83 control comparison participants who completed a 3T MRI scan, which included anatomical imaging as well as resting state BOLD imaging. Functional connectivity of the cerebellar vermis to all other brain regions was assessed. Based on quality control metrics of the fMRI data, 109 participants with bipolar disorder and 79 controls were used to in the statistical analysis comparing connectivity of the vermis as well as associations with mood. Potential impacts of medications were also explored. Results Functional connectivity of the cerebellar vermis in bipolar disorder was found to differ significantly between brain regions known to be involved in the control of emotion, motor function, and language. While connections with emotion and motor control areas were significantly stronger in bipolar disorder, connection to a region associated language production was significantly weaker. In the participants with bipolar disorder, ratings of depression and mania were inversely associated with vermis functional connectivity. No effect of medications on these connections were observed. Conclusion Together the findings suggest cerebellum may play a compensatory role in bipolar disorder and when it can no longer fulfill this role, depression and mania develop. The proximity of the cerebellar vermis to the skull may make this region a potential target for treatment with transcranial magnetic stimulation.
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Affiliation(s)
- Arshaq Saleem
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, 52242
| | - Gail Harmata
- Department of Radiology, University of Iowa, Iowa City, IA, 52242
| | - Shivangi Jain
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, 52242
| | - Michelle W. Voss
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, 52242
| | - Jess G. Fiedorowicz
- The Ottawa Hospital, Ottawa Hospital Research Institute, University of Ottawa Brain & Mind Research Institute, Ottawa ON Canada K1H 8L6
| | - Aislinn Williams
- Department of Psychiatry, University of Iowa, Iowa City, IA, 52242
| | | | | | | | - Leela Sathyaputri
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, 52242
| | - Samantha L. Schmitz
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, 52242
| | - Gary E. Christensen
- Department of Electrical and Computer Engineering, University of Iowa, Iowa City, IA, 52242,Department of Radiation Oncology, University of Iowa, Iowa City, IA, 52242
| | - Jeffrey D. Long
- Department of Psychiatry, University of Iowa, Iowa City, IA, 52242,Department of Biostatistics, University of Iowa, Iowa City, IA, 52242
| | - Jia Xu
- Department of Radiology, University of Iowa, Iowa City, IA, 52242
| | - John A. Wemmie
- Department of Psychiatry, University of Iowa, Iowa City, IA, 52242,Veterans Affairs Medical Center, Iowa City, Iowa, USA,Department of Molecular Physiology and Biophysics, University of Iowa, Iowa City, Iowa, USA,Department of Neurosurgery, University of Iowa, Iowa City, IA, 52242
| | - Vincent A. Magnotta
- Department of Radiology, University of Iowa, Iowa City, IA, 52242,Department of Psychiatry, University of Iowa, Iowa City, IA, 52242,Department of Biomedical Engineering, University of Iowa, Iowa City, IA, 52242
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5
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Goldman DA, Sankar A, Rich A, Kim JA, Pittman B, Constable RT, Scheinost D, Blumberg HP. A graph theory neuroimaging approach to distinguish the depression of bipolar disorder from major depressive disorder in adolescents and young adults. J Affect Disord 2022; 319:15-26. [PMID: 36103935 PMCID: PMC9669784 DOI: 10.1016/j.jad.2022.09.016] [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: 07/25/2022] [Revised: 09/03/2022] [Accepted: 09/09/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Markers to differentiate depressions of bipolar disorder (BD-Dep) from depressions of major depressive disorder (MDD-Dep), and for more targeted treatments, are critically needed to decrease current high rates of misdiagnosis that can lead to ineffective or potentially deleterious treatments. Distinguishing, and specifically treating the depressions, during the adolescent/young adult epoch is especially important to decrease illness progression and improve prognosis, and suicide, as it is the epoch when suicide thoughts and behaviors often emerge. With differences in functional connectivity patterns reported when BD-Dep and MDD-Dep have been studied separately, this study used a graph theory approach aimed to identify functional connectivity differences in their direct comparison. METHODS Functional magnetic resonance imaging whole-brain functional connectivity (Intrinsic Connectivity Distribution, ICD) measures were compared across adolescents/young adults with BD-Dep (n = 28), MDD-Dep (n = 20) and HC (n = 111). Follow-up seed-based connectivity was conducted on regions of significant ICD differences. Relationships with demographic and clinical measures were assessed. RESULTS Compared to the HC group, both the BD-Dep and MDD-Dep groups exhibited left-sided frontal, insular, and medial temporal ICD increases. The BD-Dep group had additional right-sided ICD increases in frontal, basal ganglia, and fusiform areas. In seed-based analyses, the BD-Dep group exhibited increased interhemispheric functional connectivity between frontal areas not seen in the MDD-Dep group. LIMITATIONS Modest sample size; medications not studied systematically. CONCLUSIONS This study supports bilateral and interhemispheric functional dysconnectivity as features of BD-Dep that may differentiate it from MDD-Dep in adolescents/young adults and serve as a target for early diagnosis and treatment strategies.
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Affiliation(s)
- Danielle A Goldman
- Interdepartmental Neuroscience Program, Yale School of Medicine, New Haven, CT 06511, United States of America; Department of Psychiatry, Yale School of Medicine, New Haven, CT 06511, United States of America
| | - Anjali Sankar
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06511, United States of America; Department of Neurology and Neurobiology Research Unit, Copenhagen University Hospital, Copenhagen, Denmark
| | - Alexandra Rich
- Interdepartmental Neuroscience Program, Yale School of Medicine, New Haven, CT 06511, United States of America
| | - Jihoon A Kim
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06511, United States of America
| | - Brian Pittman
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06511, United States of America
| | - R Todd Constable
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT 06511, United States of America
| | - Dustin Scheinost
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT 06511, United States of America
| | - Hilary P Blumberg
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06511, United States of America; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT 06511, United States of America; Child Study Center, Yale School of Medicine, New Haven, CT 06511, United States of America.
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Nimarko AF, Fischer AS, Hagan KE, Gorelik AJ, Lu Y, Young CJ, Singh MK. Neural Correlates of Positive Emotion Processing That Distinguish Healthy Youths at Familial Risk for Bipolar Versus Major Depressive Disorder. J Am Acad Child Adolesc Psychiatry 2021; 60:887-901. [PMID: 32738282 PMCID: PMC7855111 DOI: 10.1016/j.jaac.2020.07.890] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 06/17/2020] [Accepted: 07/23/2020] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Familial risk for bipolar disorder (BD) or major depressive disorder (MDD) may lead to differential emotion processing signatures, resulting in unique neural vulnerability. METHOD Healthy offspring of a parent with BD (n = 29, "BD-risk") or MDD (n = 44, "MDD-risk") and healthy control youths without any personal or family psychopathology (n = 28, "HC") aged 8 to 17 years (13.64 ± 2.59 years) completed an implicit emotion-perception functional magnetic resonance imaging task. Whole-brain voxelwise and psychophysiological interaction analyses examined neural differences in activation and connectivity during emotion processing. Regression modeling tested for neural associations with behavioral strengths and difficulties and conversion to psychopathology at follow-up (3.71 ± 1.91 years). RESULTS BD-risk youth showed significantly reduced bilateral putamen activation, and decreased connectivity between the left putamen and the left ventral anterior cingulate cortex (vACC) and the right posterior cingulate cortex (PCC) during positive-valence emotion processing compared to MDD-risk and HC (Z >2.3; p <.001). Decreased left putamen-right PCC connectivity correlated with subsequent peer problems in BD-risk (β = -2.90; p <.05) and MDD-risk (β = -3.64; p < .05) groups. Decreased left (β = -0.09; p < .05) and right putamen activation (β = -0.07; p = .04) were associated with conversion to a mood or anxiety disorder in BD-risk youths. Decreased left putamen-right PCC connectivity was associated with a higher risk of conversion in BD-risk (HR = 8.28 , p < .01) and MDD-risk (HR = 2.31, p = .02) groups. CONCLUSION Reduced putamen activation and connectivity during positive emotion processing appear to distinguish BD-risk youths from MDD-risk and HC youths, and may represent a marker of vulnerability.
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Affiliation(s)
| | | | | | | | - Yvonne Lu
- Stanford University School of Medicine, California
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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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Wakschlag LS, Perlman SB, Blair RJ, Leibenluft E, Briggs-Gowan MJ, Pine DS. The Neurodevelopmental Basis of Early Childhood Disruptive Behavior: Irritable and Callous Phenotypes as Exemplars. Am J Psychiatry 2018; 175:114-130. [PMID: 29145753 PMCID: PMC6075952 DOI: 10.1176/appi.ajp.2017.17010045] [Citation(s) in RCA: 119] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The arrival of the Journal's 175th anniversary occurs at a time of recent advances in research, providing an ideal opportunity to present a neurodevelopmental roadmap for understanding, preventing, and treating psychiatric disorders. Such a roadmap is particularly relevant for early-childhood-onset neurodevelopmental conditions, which emerge when experience-dependent neuroplasticity is at its peak. Employing a novel developmental specification approach, this review places recent neurodevelopmental research on early childhood disruptive behavior within the historical context of the Journal. The authors highlight irritability and callous behavior as two core exemplars of early disruptive behavior. Both phenotypes can be reliably differentiated from normative variation as early as the first years of life. Both link to discrete pathophysiology: irritability with disruptions in prefrontal regulation of emotion, and callous behavior with abnormal fear processing. Each phenotype also possesses clinical and predictive utility. Based on a nomologic net of evidence, the authors conclude that early disruptive behavior is neurodevelopmental in nature and should be reclassified as an early-childhood-onset neurodevelopmental condition in DSM-5. Rapid translation from neurodevelopmental discovery to clinical application has transformative potential for psychiatric approaches of the millennium. [AJP at 175: Remembering Our Past As We Envision Our Future November 1938: Electroencephalographic Analyses of Behavior Problem Children Herbert Jasper and colleagues found that brain abnormalities revealed by EEG are a potential causal factor in childhood behavioral disorders. (Am J Psychiatry 1938; 95:641-658 )].
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Affiliation(s)
- Lauren S Wakschlag
- From the Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences, and the Institute for Policy Research, Northwestern University, Chicago; the Department of Psychiatry, University of Pittsburgh, Pittsburgh; the Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebr.; the Department of Psychiatry, University of Connecticut, Farmington, Conn.; and the National Institute of Mental Health, Bethesda, Md
| | - Susan B Perlman
- From the Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences, and the Institute for Policy Research, Northwestern University, Chicago; the Department of Psychiatry, University of Pittsburgh, Pittsburgh; the Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebr.; the Department of Psychiatry, University of Connecticut, Farmington, Conn.; and the National Institute of Mental Health, Bethesda, Md
| | - R James Blair
- From the Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences, and the Institute for Policy Research, Northwestern University, Chicago; the Department of Psychiatry, University of Pittsburgh, Pittsburgh; the Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebr.; the Department of Psychiatry, University of Connecticut, Farmington, Conn.; and the National Institute of Mental Health, Bethesda, Md
| | - Ellen Leibenluft
- From the Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences, and the Institute for Policy Research, Northwestern University, Chicago; the Department of Psychiatry, University of Pittsburgh, Pittsburgh; the Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebr.; the Department of Psychiatry, University of Connecticut, Farmington, Conn.; and the National Institute of Mental Health, Bethesda, Md
| | - Margaret J Briggs-Gowan
- From the Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences, and the Institute for Policy Research, Northwestern University, Chicago; the Department of Psychiatry, University of Pittsburgh, Pittsburgh; the Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebr.; the Department of Psychiatry, University of Connecticut, Farmington, Conn.; and the National Institute of Mental Health, Bethesda, Md
| | - Daniel S Pine
- From the Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences, and the Institute for Policy Research, Northwestern University, Chicago; the Department of Psychiatry, University of Pittsburgh, Pittsburgh; the Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebr.; the Department of Psychiatry, University of Connecticut, Farmington, Conn.; and the National Institute of Mental Health, Bethesda, Md
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9
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Lopez-Larson MP, Shah LM, Weeks HR, King JB, Mallik AK, Yurgelun-Todd DA, Anderson JS. Abnormal Functional Connectivity Between Default and Salience Networks in Pediatric Bipolar Disorder. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2017; 2:85-93. [PMID: 29560889 PMCID: PMC6422527 DOI: 10.1016/j.bpsc.2016.10.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 10/06/2016] [Accepted: 10/07/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Pediatric bipolar disorder (PBD) (occurring prior to 18 years of age) is a developmental brain disorder that is among the most severe and disabling psychiatric conditions affecting youth. Despite increasing evidence that brain connectivity is atypical in adults with bipolar disorder, it is not clear how brain connectivity may be altered in youths with PBD. METHODS This cross-sectional resting-state functional magnetic resonance imaging study included 80 participants recruited over 4 years: 32 youths with PBD, currently euthymic (13 males; 15.1 years old), and 48 healthy control (HC) subjects (27 males; 14.5 years old). Functional connectivity between eight major intrinsic connectivity networks, along with connectivity measurements between 333 brain regions, was compared between PBD and HC subjects. Additionally, connectivity differences were evaluated between PBD and HC samples in negatively correlated connections, as defined by 839 subjects of the Human Connectome Project dataset. RESULTS We found increased inter- but not intranetwork functional connectivity in PBD between the default mode and salience networks (p = .0017). Throughout the brain, atypical connections showed failure to develop anticorrelation with age during adolescence in PBD but not HC samples among connections that exhibit negative correlation in adulthood. CONCLUSIONS Youths with PBD demonstrate reduced anticorrelation between default mode and salience networks. Further evaluation of the interaction between these networks is needed in development and with other mood states such as depression and mania to clarify if this atypical connectivity is a PBD trait biomarker.
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Affiliation(s)
- Melissa P Lopez-Larson
- The Brain Institute, U.S. Department of Veterans Affairs, Salt Lake City, Utah; University of Utah, University of Utah Medical School, U.S. Department of Veterans Affairs, Salt Lake City, Utah.
| | - Lubdha M Shah
- The Brain Institute, U.S. Department of Veterans Affairs, Salt Lake City, Utah; Department of Radiology, U.S. Department of Veterans Affairs, Salt Lake City, Utah; University of Utah, University of Utah Medical School, U.S. Department of Veterans Affairs, Salt Lake City, Utah
| | - Howard R Weeks
- University of Utah, University of Utah Medical School, U.S. Department of Veterans Affairs, Salt Lake City, Utah
| | - Jace B King
- The Brain Institute, U.S. Department of Veterans Affairs, Salt Lake City, Utah; Department of Radiology, U.S. Department of Veterans Affairs, Salt Lake City, Utah; Interdepartmental Program in Neuroscience, U.S. Department of Veterans Affairs, Salt Lake City, Utah
| | - Atul K Mallik
- Department of Radiology, U.S. Department of Veterans Affairs, Salt Lake City, Utah
| | - Deborah A Yurgelun-Todd
- The Brain Institute, U.S. Department of Veterans Affairs, Salt Lake City, Utah; Interdepartmental Program in Neuroscience, U.S. Department of Veterans Affairs, Salt Lake City, Utah; University of Utah, University of Utah Medical School, U.S. Department of Veterans Affairs, Salt Lake City, Utah; VISN 19 MIRECC, U.S. Department of Veterans Affairs, Salt Lake City, Utah
| | - Jeffrey S Anderson
- The Brain Institute, U.S. Department of Veterans Affairs, Salt Lake City, Utah; Department of Radiology, U.S. Department of Veterans Affairs, Salt Lake City, Utah; Interdepartmental Program in Neuroscience, U.S. Department of Veterans Affairs, Salt Lake City, Utah; Department of Bioengineering, U.S. Department of Veterans Affairs, Salt Lake City, Utah; University of Utah, University of Utah Medical School, U.S. Department of Veterans Affairs, Salt Lake City, Utah
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10
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Stoddard J, Gotts SJ, Brotman MA, Lever S, Hsu D, Zarate C, Ernst M, Pine DS, Leibenluft E. Aberrant intrinsic functional connectivity within and between corticostriatal and temporal-parietal networks in adults and youth with bipolar disorder. Psychol Med 2016; 46:1509-1522. [PMID: 26924633 PMCID: PMC6996294 DOI: 10.1017/s0033291716000143] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Major questions remain regarding the dysfunctional neural circuitry underlying the pathophysiology of bipolar disorder (BD) in both youths and adults. In both age groups, studies implicate abnormal intrinsic functional connectivity among prefrontal, limbic and striatal areas. METHOD We collected resting-state functional magnetic resonance imaging (fMRI) data from youths and adults (ages 10-50 years) with BD (n = 39) and healthy volunteers (HV; n = 78). We identified brain regions with aberrant intrinsic functional connectivity in BD by first comparing voxel-wise mean global connectivity and then conducting correlation analyses. We used k-means clustering and multidimensional scaling to organize all detected regions into networks. RESULTS Across the brain, we detected areas of dysconnectivity in both youths and adults with BD relative to HV. There were no significant age-group × diagnosis interactions. When organized by interregional connectivity, the areas of dysconnectivity in patients with BD comprised two networks: one of temporal and parietal areas involved in late stages of visual processing, and one of corticostriatal areas involved in attention, cognitive control and response generation. CONCLUSIONS These data suggest that two networks show abnormal intrinsic functional connectivity in BD. Regions in these networks have been implicated previously in BD. We observed similar dysconnectivity in youths and adults with BD. These findings provide guidance for refining models of network-based dysfunction in BD.
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Affiliation(s)
- J. Stoddard
- Department of Health and Human Services, Section on Bipolar Spectrum Disorders, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - S. J. Gotts
- Department of Health and Human Services, Section on Cognitive Neuropsychology, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - M. A. Brotman
- Department of Health and Human Services, Section on Bipolar Spectrum Disorders, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - S. Lever
- Department of Health and Human Services, Section on Bipolar Spectrum Disorders, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - D. Hsu
- School of Medicine, Emory University, Atlanta, GA, USA
| | - C. Zarate
- Department of Health and Human Services, Section on the Neurobiology and Treatment of Mood Disorders, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - M. Ernst
- Department of Health and Human Services, Section on Development and Affective Neuroscience, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - D. S. Pine
- Department of Health and Human Services, Section on Development and Affective Neuroscience, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - E. Leibenluft
- Department of Health and Human Services, Section on Bipolar Spectrum Disorders, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
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11
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A voxel-based morphometry study of gray matter correlates of facial emotion recognition in bipolar disorder. Psychiatry Res 2015; 233:158-64. [PMID: 26123449 DOI: 10.1016/j.pscychresns.2015.05.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Revised: 11/07/2014] [Accepted: 05/17/2015] [Indexed: 01/23/2023]
Abstract
Facial emotion recognition (FER) is one of the many cognitive deficits reported in bipolar disorder (BD) patients. The aim of this study was to investigate neuroanatomical correlates of FER impairments in BD type I (BD-I). Participants comprised 21 euthymic BD-I patients without Axis I DSM IV-TR comorbidities and 21 healthy controls who were assessed using magnetic resonance imaging and the Penn Emotion Recognition Test (ER40). Preprocessing of images used DARTEL (diffeomorphic anatomical registration through exponentiated Lie algebra) for optimized voxel-based morphometry in SPM8. Compared with healthy subjects, BD-I patients performed poorly in on the ER40 and had reduced gray matter volume (GMV) in the left orbitofrontal cortex, superior portion of the temporal pole and insula. In the BD-I group, the statistical maps indicated a direct correlation between FER on the ER40 and right middle cingulate gyrus GMV. Our findings are consistent with the previous studies regarding the overlap of multiple brain networks of social cognition and BD neurobiology, particularly components of the anterior-limbic neural network.
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12
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Manelis A, Ladouceur CD, Graur S, Monk K, Bonar LK, Hickey MB, Dwojak AC, Axelson D, Goldstein BI, Goldstein TR, Bebko G, Bertocci MA, Hafeman DM, Gill MK, Birmaher B, Phillips ML. Altered amygdala-prefrontal response to facial emotion in offspring of parents with bipolar disorder. Brain 2015; 138:2777-90. [PMID: 26112339 DOI: 10.1093/brain/awv176] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Accepted: 04/26/2015] [Indexed: 12/23/2022] Open
Abstract
This study aimed to identify neuroimaging measures associated with risk for, or protection against, bipolar disorder by comparing youth offspring of parents with bipolar disorder versus youth offspring of non-bipolar parents versus offspring of healthy parents in (i) the magnitude of activation within emotional face processing circuitry; and (ii) functional connectivity between this circuitry and frontal emotion regulation regions. The study was conducted at the University of Pittsburgh Medical Centre. Participants included 29 offspring of parents with bipolar disorder (mean age = 13.8 years; 14 females), 29 offspring of non-bipolar parents (mean age = 13.8 years; 12 females) and 23 healthy controls (mean age = 13.7 years; 11 females). Participants were scanned during implicit processing of emerging happy, sad, fearful and angry faces and shapes. The activation analyses revealed greater right amygdala activation to emotional faces versus shapes in offspring of parents with bipolar disorder and offspring of non-bipolar parents than healthy controls. Given that abnormally increased amygdala activation during emotion processing characterized offspring of both patient groups, and that abnormally increased amygdala activation has often been reported in individuals with already developed bipolar disorder and those with major depressive disorder, these neuroimaging findings may represent markers of increased risk for affective disorders in general. The analysis of psychophysiological interaction revealed that offspring of parents with bipolar disorder showed significantly more negative right amygdala-anterior cingulate cortex functional connectivity to emotional faces versus shapes, but significantly more positive right amygdala-left ventrolateral prefrontal cortex functional connectivity to happy faces (all P-values corrected for multiple tests) than offspring of non-bipolar parents and healthy controls. Taken together with findings of increased amygdala-ventrolateral prefrontal cortex functional connectivity, and decreased amygdala-anterior cingulate cortex functional connectivity previously shown in individuals with bipolar disorder, these connectivity patterns in offspring of parents with bipolar disorder may be risk markers for, rather than markers conferring protection against, bipolar disorder in youth. The patterns of activation and functional connectivity remained unchanged after removing medicated participants and those with current psychopathology from analyses. This is the first study to demonstrate that abnormal functional connectivity patterns within face emotion processing circuitry distinguish offspring of parents with bipolar disorder from those of non-bipolar parents and healthy controls.
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Affiliation(s)
- Anna Manelis
- 1 Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Cecile D Ladouceur
- 1 Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Simona Graur
- 1 Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kelly Monk
- 1 Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Lisa K Bonar
- 1 Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mary Beth Hickey
- 1 Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Amanda C Dwojak
- 1 Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - David Axelson
- 2 Department of Psychiatry, Nationwide Children's Hospital and The Ohio State College of Medicine, Columbus, Ohio, USA
| | - Benjamin I Goldstein
- 3 Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Faculty of Medicine, Toronto, Ontario, Canada
| | - Tina R Goldstein
- 1 Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Genna Bebko
- 1 Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Michele A Bertocci
- 1 Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Danella M Hafeman
- 1 Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mary Kay Gill
- 1 Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Boris Birmaher
- 1 Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mary L Phillips
- 1 Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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13
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Whalley HC, Sussmann JE, Romaniuk L, Stewart T, Kielty S, Lawrie SM, Hall J, McIntosh AM. Dysfunction of emotional brain systems in individuals at high risk of mood disorder with depression and predictive features prior to illness. Psychol Med 2015; 45:1207-1218. [PMID: 25229638 DOI: 10.1017/s0033291714002256] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Abnormalities of emotion-related brain circuitry, including cortico-thalamic-limbic regions underpin core symptoms of bipolar disorder (BD) and major depressive disorder (MDD). It is unclear whether these abnormalities relate to symptoms of the disorder, are present in unaffected relatives, or whether they can predict future illness. METHOD The Bipolar Family Study (BFS) is a prospective longitudinal study that has examined individuals at familial risk of mood disorder and healthy controls on three occasions, 2 years apart. The current study concerns imaging data from the second assessment; 51 controls and 81 high-risk (HR) individuals performing an emotional memory task. The latter group was divided into 61 HR individuals who were well, and 20 who met diagnostic criteria for MDD. At the time of the third assessment a further 11 HR individuals (from the Well group) had developed MDD. The current analyses focused on (i) differences between groups based on diagnostic status at the time of the scan, and (ii) predictors of future illness, comparing the 11 HR individuals who became unwell after the second scanning assessment to those who remained well. RESULTS All groups demonstrated typical emotional modulation of memory and associated brain activations. For analysis (i) the HR MDD group demonstrated increased thalamic activation v. HR Well. (ii) HR Well individuals who subsequently became ill showed increased activation of thalamus, insula and anterior cingulate compared to those who remained well. CONCLUSIONS These findings suggest evidence for specific changes related to the presence of illness and evidence that changes in brain function in cortico-thalamic-limbic regions precede clinical illness.
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Affiliation(s)
- H C Whalley
- Division of Psychiatry,University of Edinburgh,Edinburgh,UK
| | - J E Sussmann
- Division of Psychiatry,University of Edinburgh,Edinburgh,UK
| | - L Romaniuk
- Division of Psychiatry,University of Edinburgh,Edinburgh,UK
| | - T Stewart
- Division of Psychiatry,University of Edinburgh,Edinburgh,UK
| | - S Kielty
- Division of Psychiatry,University of Edinburgh,Edinburgh,UK
| | - S M Lawrie
- Division of Psychiatry,University of Edinburgh,Edinburgh,UK
| | - J Hall
- Division of Psychiatry,University of Edinburgh,Edinburgh,UK
| | - A M McIntosh
- Division of Psychiatry,University of Edinburgh,Edinburgh,UK
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14
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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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15
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Stoddard J, Hsu D, Reynolds R, Brotman MA, Ernst M, Pine DS, Leibenluft E, Dickstein DP. Aberrant amygdala intrinsic functional connectivity distinguishes youths with bipolar disorder from those with severe mood dysregulation. Psychiatry Res 2015; 231:120-5. [PMID: 25544024 PMCID: PMC4370426 DOI: 10.1016/j.pscychresns.2014.11.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Revised: 10/31/2014] [Accepted: 11/06/2014] [Indexed: 12/26/2022]
Abstract
It remains unclear the degree to which youths with episodic mania (bipolar disorder; BD) vs. those with chronic, severe irritability (severe mood dysregulation, SMD) should be placed in similar or distinct diagnostic groups. Addressing this clinically meaningful question requires greater understanding of the neural alterations underlying both disorders. We evaluated resting state functional magnetic resonance imaging data of 53 youths (14 BD, 20 healthy volunteers (HV), and 19 SMD, ages 9-18.5 years). Seed regions of interest were the bilateral basolateral, superficial and centromedial amygdala, defined using the Juelich probabilistic atlas. We found a significant between-group difference in functional connectivity between the left basolateral amygdala and the medial aspect of the left frontal pole plus the posterior cingulate/precuneus. This finding was driven by hyperconnectivity among BD vs. HV or SMD youths. As with earlier data, these findings suggest that the pathophysiology of BD and SMD may differ.
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Affiliation(s)
- Joel Stoddard
- Section on Bipolar Spectrum Disorders, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA.
| | - Derek Hsu
- Section on Bipolar Spectrum Disorders, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | - Rick Reynolds
- Scientific and Statistical Computing Core, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | - Melissa A. Brotman
- Section on Bipolar Spectrum Disorders, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | - Monique Ernst
- Section on Development and Affective Neuroscience, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | - Daniel S. Pine
- Section on Development and Affective Neuroscience, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | - Ellen Leibenluft
- Section on Bipolar Spectrum Disorders, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | - Daniel P. Dickstein
- PediMIND Program, Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
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16
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Tseng WL, Bones BL, Kayser RR, Olsavsky AK, Fromm SJ, Pine DS, Leibenluft E, Brotman MA. An fMRI study of emotional face encoding in youth at risk for bipolar disorder. Eur Psychiatry 2015; 30:94-8. [PMID: 25172156 PMCID: PMC10656053 DOI: 10.1016/j.eurpsy.2014.05.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 05/09/2014] [Accepted: 05/20/2014] [Indexed: 11/30/2022] Open
Abstract
Face memory deficits may be a bipolar disorder (BD) endophenotype. BD (n=27) and unaffected youth at risk (n=13) exhibited middle frontal gyrus hypoactivation during successful vs. unsuccessful encoding. Parahippocampal gyrus dysfunction was found in BD and at-risk youth (vs. low-risk, n=37). Middle occipital gyrus hypoactivation was only present in BD.
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Affiliation(s)
- 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.
| | - B L Bones
- Georgetown University School of Medicine, Washington, DC, USA
| | - R R Kayser
- Georgetown University School of Medicine, Washington, DC, USA
| | - A K Olsavsky
- UCLA Semel Institute for Neuroscience and Human Behavior, 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
| | - 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
| | - 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
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17
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Hafeman D, Bebko G, Bertocci MA, Fournier JC, Bonar L, Perlman SB, Travis M, Gill MK, Diwadkar VA, Sunshine JL, Holland SK, Kowatch RA, Birmaher B, Axelson D, Horwitz SM, Arnold LE, Fristad MA, Frazier TW, Youngstrom EA, Findling RL, Drevets W, Phillips ML. Abnormal deactivation of the inferior frontal gyrus during implicit emotion processing in youth with bipolar disorder: attenuated by medication. J Psychiatr Res 2014; 58:129-36. [PMID: 25151338 PMCID: PMC4381734 DOI: 10.1016/j.jpsychires.2014.07.023] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 07/21/2014] [Accepted: 07/24/2014] [Indexed: 12/28/2022]
Abstract
Previous neuroimaging studies of youth with bipolar disorder (BD) have identified abnormalities in emotion regulation circuitry. Using data from the Longitudinal Assessment of Manic Symptoms Cohort (a clinical sample recruited for behavioral and emotional dysregulation), we examined the impact of BD and medication on activation in these regions. Functional neuroimaging data were obtained from 15 youth with BD who currently were unmedicated with a mood stabilizer or antipsychotic (U-BD), 19 youth with medicated BD (M-BD), a non-bipolar clinical sample with high rates of disruptive behavioral disorders (non-BD, n = 59), and 29 healthy controls (HC) while they were shown task-irrelevant morphing emotional faces and shapes. Whole brain analysis was used to identify clusters that showed differential activation to emotion vs. shapes across group. To assess pair-wise comparisons and potential confounders, mean activation data were extracted only from clusters within regions previously implicated in emotion regulation (including amygdala and ventral prefrontal regions). A cluster in the right inferior frontal gyrus (IFG) showed group differences to emotion vs. shapes (159 voxels, corrected p < .05). Within this cluster, U-BD youth showed decreased activation relative to HC (p = .007) and non-BD (p = .004) youth. M-BD also showed decreased activation in this cluster relative to HC and non-BD youth, but these differences were attenuated. Results were specific to negative emotions, and not found with happy faces. IFG findings were not explained by other medications (e.g. stimulants) or diagnoses. Compared to both HC and a non-BD sample, U-BD is associated with abnormally decreased right IFG activation to negative emotions.
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Affiliation(s)
- Danella Hafeman
- Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh
| | - Genna Bebko
- Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh
| | - Michele A. Bertocci
- Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh
| | - Jay C. Fournier
- Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh
| | - Lisa Bonar
- Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh
| | - Susan B. Perlman
- Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh
| | - Michael Travis
- Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh
| | - Mary Kay Gill
- Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh
| | | | | | - Scott K Holland
- Cincinnati Children's Hospital Medical Center, University of Cincinnati
| | | | - Boris Birmaher
- Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh
| | | | | | | | | | | | | | - Robert L. Findling
- University Hospitals Case Medical Center/Case Western Reserve University,Psychiatry, Johns Hopkins University
| | - Wayne Drevets
- Janssen Pharmaceuticals Research & Development, of Johnson&Johnson
| | - Mary L. Phillips
- Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh,Psychological Medicine, Cardiff University
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18
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Pavuluri M, May A. Differential Treatment of Pediatric Bipolar Disorder and Attention-Deficit/Hyperactivity Disorder. Psychiatr Ann 2014. [DOI: 10.3928/00485713-20141003-06] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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19
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Bozorg B, Tehrani-Doost M, Shahrivar Z, Fata L, Mohamadzadeh A. Facial emotion recognition in adolescents with bipolar disorder. IRANIAN JOURNAL OF PSYCHIATRY 2014; 9:20-4. [PMID: 25561944 PMCID: PMC4277603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECT Bipolar disorder (BD) is associated with abnormalities in emotional competence. One of the main aspects of this competency is emotion recognition which is presented in the face. This study aimed to evaluate facial emotion recognition in adolescents with bipolar disorder when they are free of acute symptoms. METHOD Thirty patients diagnosed with BD aged 12 to 18 were selected from a large sample of consecutive admitted adolescents in Roozbeh hospital. They were compared with 30 matched normal developing adolescents who were recruited from mainstream schools at Tehran. All participants were evaluated using a facial emotion recognition task. The participants needed to recognize happy, sad, angry and neutral facial expressions The ANOVA was used to analyze the differences between the two groups in terms of emotion recognition variables. RESULTS The patients with BD showed a significant deficit in recognizing emotions in general (p=.01) which was prominent in the angry faces. Their response time to recognize the facial expressions was longer compared to the normal individuals. This difference was significant in recognizing the happy and neutral faces (p<0.05). CONCLUSION This study suggests an inaccurate recognition of facial expressions in adolescents with BD, particularly for anger, as well as slowness in detecting emotions especially happiness.
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Affiliation(s)
- Bonnie Bozorg
- Clinical Psychologist, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Tehrani-Doost
- Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Shahrivar
- Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran
| | - Ladan Fata
- Clinical Psychologist, Tehran University of Medical Sciences Tehran, Iran
| | - Azar Mohamadzadeh
- Cognitive Psychologist, Tehran University of Medical Sciences. Tehran, Iran
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20
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Lee MS, Anumagalla P, Talluri P, Pavuluri MN. Meta-analyses of developing brain function in high-risk and emerged bipolar disorder. Front Psychiatry 2014; 5:141. [PMID: 25404919 PMCID: PMC4217331 DOI: 10.3389/fpsyt.2014.00141] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 09/24/2014] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES Identifying early markers of brain function among those at high risk (HR) for pediatric bipolar disorder (PBD) could serve as a screening measure when children and adolescents present with subsyndromal clinical symptoms prior to the conversion to bipolar disorder. Studies on the offspring of patients with bipolar disorder who are genetically at HR have each been limited in establishing a biomarker, while an analytic review in summarizing the findings offers an improvised opportunity toward that goal. METHODS An activation likelihood estimation (ALE) meta-analysis of mixed cognitive and emotional activities using the GingerALE software from the BrainMap Project was completed. The meta-analysis of all fMRI studies contained a total of 29 reports and included PBD, HR, and typically developing (TD) groups. RESULTS The HR group showed significantly greater activation relative to the TD group in the right DLPFC-insular-parietal-cerebellar regions. Similarly, the HR group exhibited greater activity in the right DLPFC and insula as well as the left cerebellum compared to patients with PBD. Patients with PBD, relative to TD, showed greater activation in regions of the right amygdala, parahippocampal gyrus, medial PFC, left ventral striatum, and cerebellum and lower activation in the right VLPFC and the DLPFC. CONCLUSION The HR population showed increased activity, presumably indicating greater compensatory deployment, in relation to both the TD and the PBD, in the key cognition and emotion-processing regions, such as the DLPFC, insula, and parietal cortex. In contrast, patients with PBD, relative to HR and TD, showed decreased activity, which could indicate a decreased effort in multiple PFC regions in addition to widespread subcortical abnormalities, which are suggestive of a more entrenched disease process.
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Affiliation(s)
- Moon-Soo Lee
- Pediatric Brain Research and Intervention Center, University of Illinois at Chicago , Chicago, IL , USA ; College of Medicine, Korea University , Seoul , South Korea
| | - Purnima Anumagalla
- Pediatric Brain Research and Intervention Center, University of Illinois at Chicago , Chicago, IL , USA
| | - Prasanth Talluri
- Pediatric Brain Research and Intervention Center, University of Illinois at Chicago , Chicago, IL , USA
| | - Mani N Pavuluri
- Pediatric Brain Research and Intervention Center, University of Illinois at Chicago , Chicago, IL , USA
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Xu K, Liu H, Li H, Tang Y, Womer F, Jiang X, Chen K, Zhou Y, Jiang W, Luo X, Fan G, Wang F. Amplitude of low-frequency fluctuations in bipolar disorder: a resting state fMRI study. J Affect Disord 2014; 152-154:237-42. [PMID: 24120087 DOI: 10.1016/j.jad.2013.09.017] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 08/08/2013] [Accepted: 09/17/2013] [Indexed: 01/08/2023]
Abstract
OBJECTIVES The spontaneous low frequency fluctuations (LFF) of blood oxygenation level-dependent (BOLD) signal in resting state have been identified as a biological measure of baseline spontaneous activity in the brain. Increasingly, studies of spontaneous resting state functional connectivity have demonstrated neural network abnormalities in bipolar disorder (BD). This study used the amplitude of low frequency fluctuations (ALFF) to explore the regional functional changes in BD during resting state. METHODS Twenty-nine BD participants and 29 matched healthy controls (HC) were recruited to undergo resting-state functional magnetic resonance imaging scan on a 3.0T magnetic resonance imaging system. The ALFF of BOLD signal in gray matter for each participant was calculated, and then was compared between BD and HC using ALFF maps. RESULTS Compared to the HC group, the BD group showed increased ALFF in ventral prefrontal cortex, dorsal lateral prefrontal cortex, frontal eye field, insula, and putamen with extension into the ventral striatum, as well as decreased ALFF in the lingual gyrus (p<0.05, corrected). LIMITATIONS Although we observed differences in ALFF between BD and HC, we cannot conclusively state that these differences are caused by the pathophysiology of BD since most of BD participants were being treated with medications at the time of scanning. CONCLUSIONS Our results revealed altered regional brain activity in BD during resting state. The affected regions have been associated with BD pathophysiology. This suggests that methods using ALFF method may potentially be useful in further studies of this disorder.
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Affiliation(s)
- Ke Xu
- Department of Radiology, The First Affiliated Hospital, China Medical University, 155 Nanjing North Street, Shenyang, Liaoning 110001, PR China
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22
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Diler RS, Renner Cardoso de Almeida J, Ladouceur C, Birmaher B, Axelson D, Phillips M. Neural activity to intense positive versus negative stimuli can help differentiate bipolar disorder from unipolar major depressive disorder in depressed adolescents: a pilot fMRI study. Psychiatry Res 2013; 214:277-84. [PMID: 24080517 PMCID: PMC3856642 DOI: 10.1016/j.pscychresns.2013.06.013] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Revised: 06/04/2013] [Accepted: 06/27/2013] [Indexed: 01/07/2023]
Abstract
Failure to distinguish bipolar depression (BDd) from the unipolar depression of major depressive disorder (UDd) in adolescents has significant clinical consequences. We aimed to identify differential patterns of functional neural activity in BDd versus UDd and employed two (fearful and happy) facial expression/ gender labeling functional magnetic resonance imaging (fMRI) experiments to study emotion processing in 10 BDd (8 females, mean age=15.1 ± 1.1) compared to age- and gender-matched 10 UDd and 10 healthy control (HC) adolescents who were age- and gender-matched to the BDd group. BDd adolescents, relative to UDd, showed significantly lower activity to both intense happy (e.g., insula and temporal cortex) and intense fearful faces (e.g., frontal precentral cortex). Although the neural regions recruited in each group were not the same, both BDd and UDd adolescents, relative to HC, showed significantly lower neural activity to intense happy and mild happy faces, but elevated neural activity to mild fearful faces. Our results indicated that patterns of neural activity to intense positive and negative emotional stimuli can help differentiate BDd from UDd in adolescents.
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Affiliation(s)
- Rasim Somer Diler
- University of Pittsburgh, Department of Psychiatry, Pittsburgh, PA, USA.
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23
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Reduced inferior frontal gyrus activation during response inhibition to emotional stimuli in youth at high risk of bipolar disorder. Biol Psychiatry 2013; 74:55-61. [PMID: 23245750 DOI: 10.1016/j.biopsych.2012.11.004] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Revised: 10/15/2012] [Accepted: 11/06/2012] [Indexed: 01/02/2023]
Abstract
BACKGROUND Functional brain imaging of young people at increased genetic risk for bipolar disorder provides a means of identifying potential endophenotypes for this condition. Dysfunctional neural mechanisms for the cognitive control of emotion are implicated in the genetic predisposition to bipolar disorder, with aberrant activity in frontocortical, striatal, and limbic brain regions previously reported in subjects with established bipolar disorder during inhibitory and emotion processing tasks. METHODS Functional brain activity during inhibition of emotional material in young people at increased genetic risk for bipolar disorder was investigated using a facial-emotion go/no-go task during functional magnetic resonance imaging. Data from 47 genetically high-risk individuals aged 18 to 30 years with at least one first-degree relative with bipolar disorder were compared with 49 control subjects (within the same age range but without a family history of bipolar disorder or other severe mental illness). RESULTS Whole-brain corrected analyses revealed a highly specific and significant lack of recruitment of the inferior frontal gyrus when inhibiting responses to fearful faces in the high-risk participants compared with control subjects (p = .011, family-wise error, peak voxel). CONCLUSIONS Impaired inhibitory function of the inferior frontal cortex may represent a trait marker of vulnerability to bipolar disorder. That this finding was revealed during inhibition of emotional material further implicates dysregulated frontolimbic brain networks as a potential neurocognitive endophenotype for bipolar disorder and provides evidence for pre-existing functional disturbances in those at high genetic risk for bipolar disorder.
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Adleman NE, Kayser RR, Olsavsky AK, Bones BL, Muhrer EJ, Fromm SJ, Pine DS, Zarate C, Leibenluft E, Brotman MA. Abnormal fusiform activation during emotional-face encoding assessed with functional magnetic resonance imaging. Psychiatry Res 2013; 212:161-3. [PMID: 23541333 PMCID: PMC3717571 DOI: 10.1016/j.pscychresns.2013.01.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Revised: 01/11/2013] [Accepted: 01/20/2013] [Indexed: 11/18/2022]
Abstract
This functional magnetic resonance imaging study shows that children and adults with bipolar disorder (BD), compared with healthy subjects, exhibit impaired memory for emotional faces and abnormal fusiform activation during encoding. Fusiform activation abnormalities in BD were correlated with mania severity and may therefore represent a trait and state BD biomarker.
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Affiliation(s)
- Nancy E Adleman
- 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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Seymour KE, Pescosolido MF, Reidy BL, Galvan T, Kim KL, Young M, Dickstein DP. Emotional face identification in youths with primary bipolar disorder or primary attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 2013; 52:537-546.e3. [PMID: 23622855 PMCID: PMC4418014 DOI: 10.1016/j.jaac.2013.03.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 02/28/2013] [Accepted: 03/15/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Bipolar disorder (BD) and attention-deficit/hyperactivity disorder (ADHD) are often comorbid or confounded; therefore, we evaluated emotional face identification to better understand brain/behavior interactions in children and adolescents with either primary BD, primary ADHD, or typically developing controls (TDC). METHOD Participants included individuals 7 to 17 years of age (overall sample mean age 12.40 ± 3.01 years), with "narrow-phenotype" pediatric BD (n = 30) or ADHD (n = 38), or typically developing controls (TDC) with no psychiatric disorders themselves or in their first-degree relatives (n = 41). In the BD group, comorbid diagnoses were allowed; however, youth in the ADHD group were excluded for comorbid mood or anxiety disorders. Patient groups were not excluded for psychotropic medication use. Emotional face identification was assessed using the computerized Diagnostic Analysis of Non-Verbal Accuracy (DANVA). RESULTS Participants with BD made significantly more identification errors on child happy faces than either TDCs (p = .03) or participants with ADHD (p = .01). Furthermore, youth with BD (0.33 ± 0.55) were more likely than youth with ADHD (0.11 ± 0.31) to make errors on low-intensity child happy faces (p = .05) but not high-intensity happy faces (p = NS). Participants with BD and ADHD made significantly more total errors in child face labeling than did TDCs, although participants with BD and ADHD did not differ from one another. CONCLUSION Our data suggest that youths with BD have specific alterations in emotional face identification of happy faces, an important finding that supports theories that response to positively valenced emotional stimuli may be especially salient in BD. Clinical trial registration information-Brain Imaging and Computer Games in Children With Either Bipolar Disorder, ADHD, Anxiety or Healthy Controls (BBPP); http://clinicaltrials.gov/; NCT01570426.
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Affiliation(s)
- Karen E Seymour
- Bradley Hospital's Pediatric Mood, Imaging, and NeuroDevelopmental (PediMIND) Program and the Alpert Medical School of Brown University, RI 02915, USA.
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Collin L, Bindra J, Raju M, Gillberg C, Minnis H. Facial emotion recognition in child psychiatry: a systematic review. RESEARCH IN DEVELOPMENTAL DISABILITIES 2013; 34:1505-1520. [PMID: 23475001 DOI: 10.1016/j.ridd.2013.01.008] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 01/13/2013] [Accepted: 01/17/2013] [Indexed: 06/01/2023]
Abstract
This review focuses on facial affect (emotion) recognition in children and adolescents with psychiatric disorders other than autism. A systematic search, using PRISMA guidelines, was conducted to identify original articles published prior to October 2011 pertaining to face recognition tasks in case-control studies. Used in the qualitative synthesis were: 2 studies on schizophrenia, 18 on mood disorders, 16 on anxiety disorders, 4 on eating disorders, 14 on ADHD and 9 on conduct disorder. Our review suggests that there are abnormalities in facial emotion recognition in a wide range of child psychiatric disorders and that these are likely to have a negative effect on both family and peer relationships. Scope for further research has been identified.
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Affiliation(s)
- Lisa Collin
- NHS Greater Glasgow and Clyde, United Kingdom
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27
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Frey BN, Andreazza AC, Houenou J, Jamain S, Goldstein BI, Frye MA, Leboyer M, Berk M, Malhi GS, Lopez-Jaramillo C, Taylor VH, Dodd S, Frangou S, Hall GB, Fernandes BS, Kauer-Sant'Anna M, Yatham LN, Kapczinski F, Young LT. Biomarkers in bipolar disorder: a positional paper from the International Society for Bipolar Disorders Biomarkers Task Force. Aust N Z J Psychiatry 2013; 47:321-32. [PMID: 23411094 DOI: 10.1177/0004867413478217] [Citation(s) in RCA: 162] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Although the etiology of bipolar disorder remains uncertain, multiple studies examining neuroimaging, peripheral markers and genetics have provided important insights into the pathophysiologic processes underlying bipolar disorder. Neuroimaging studies have consistently demonstrated loss of gray matter, as well as altered activation of subcortical, anterior temporal and ventral prefrontal regions in response to emotional stimuli in bipolar disorder. Genetics studies have identified several potential candidate genes associated with increased risk for developing bipolar disorder that involve circadian rhythm, neuronal development and calcium metabolism. Notably, several groups have found decreased levels of neurotrophic factors and increased pro-inflammatory cytokines and oxidative stress markers. Together these findings provide the background for the identification of potential biomarkers for vulnerability, disease expression and to help understand the course of illness and treatment response. In other areas of medicine, validated biomarkers now inform clinical decision-making. Although the findings reviewed herein hold promise, further research involving large collaborative studies is needed to validate these potential biomarkers prior to employing them for clinical purposes. Therefore, in this positional paper from the ISBD-BIONET (biomarkers network from the International Society for Bipolar Disorders), we will discuss our view of biomarkers for these three areas: neuroimaging, peripheral measurements and genetics; and conclude the paper with our position for the next steps in the search for biomarkers for bipolar disorder.
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Affiliation(s)
- Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
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28
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Altered regional homogeneity in pediatric bipolar disorder during manic state: a resting-state fMRI study. PLoS One 2013. [PMID: 23526961 DOI: 10.1371/journal.pone.0057978.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
UNLABELLED Pediatric bipolar disorder (PBD) is a severely debilitating illness, which is characterized by episodes of mania and depression separated by periods of remission. Previous fMRI studies investigating PBD were mainly task-related. However, little is known about the abnormalities in PBD, especially during resting state. Resting state brain activity measured by fMRI might help to explore neurobiological biomarkers of the disorder. METHODS Regional homogeneity (ReHo) was examined with resting-state fMRI (RS-fMRI) on 15 patients with PBD in manic state, with 15 age-and sex-matched healthy youth subjects as controls. RESULTS Compared with the healthy controls, the patients with PBD showed altered ReHo in the cortical and subcortical structures. The ReHo measurement of the PBD group was negatively correlated with the score of Young Mania Rating Scale (YMRS) in the superior frontal gyrus. Positive correlations between the ReHo measurement and the score of YMRS were found in the hippocampus and the anterior cingulate cortex in the PBD group. CONCLUSIONS Altered regional brain activity is present in patients with PBD during manic state. This study presents new evidence for abnormal ventral-affective and dorsal-cognitive circuits in PBD during resting state and may add fresh insights into the pathophysiological mechanisms underlying PBD.
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29
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Xiao Q, Zhong Y, Lu D, Gao W, Jiao Q, Lu G, Su L. Altered regional homogeneity in pediatric bipolar disorder during manic state: a resting-state fMRI study. PLoS One 2013; 8:e57978. [PMID: 23526961 PMCID: PMC3590243 DOI: 10.1371/journal.pone.0057978] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Accepted: 01/29/2013] [Indexed: 12/21/2022] Open
Abstract
UNLABELLED Pediatric bipolar disorder (PBD) is a severely debilitating illness, which is characterized by episodes of mania and depression separated by periods of remission. Previous fMRI studies investigating PBD were mainly task-related. However, little is known about the abnormalities in PBD, especially during resting state. Resting state brain activity measured by fMRI might help to explore neurobiological biomarkers of the disorder. METHODS Regional homogeneity (ReHo) was examined with resting-state fMRI (RS-fMRI) on 15 patients with PBD in manic state, with 15 age-and sex-matched healthy youth subjects as controls. RESULTS Compared with the healthy controls, the patients with PBD showed altered ReHo in the cortical and subcortical structures. The ReHo measurement of the PBD group was negatively correlated with the score of Young Mania Rating Scale (YMRS) in the superior frontal gyrus. Positive correlations between the ReHo measurement and the score of YMRS were found in the hippocampus and the anterior cingulate cortex in the PBD group. CONCLUSIONS Altered regional brain activity is present in patients with PBD during manic state. This study presents new evidence for abnormal ventral-affective and dorsal-cognitive circuits in PBD during resting state and may add fresh insights into the pathophysiological mechanisms underlying PBD.
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Affiliation(s)
- Qian Xiao
- Key Laboratory of Psychiatry and Mental Health of Hunan Province, Mental Health Institute of The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yuan Zhong
- School of Psychology, Nanjing Normal University, Nanjing, Jiangsu, China
| | - Dali Lu
- Key Laboratory of Psychiatry and Mental Health of Hunan Province, Mental Health Institute of The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Weijia Gao
- Key Laboratory of Psychiatry and Mental Health of Hunan Province, Mental Health Institute of The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Qing Jiao
- Department of Medical Imaging, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu, China
| | - Guangming Lu
- Department of Medical Imaging, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu, China
| | - Linyan Su
- Key Laboratory of Psychiatry and Mental Health of Hunan Province, Mental Health Institute of The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
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Singh MK, Chang KD, Kelley RG, Cui X, Sherdell L, Howe ME, Gotlib IH, Reiss AL. Reward processing in adolescents with bipolar I disorder. J Am Acad Child Adolesc Psychiatry 2013; 52:68-83. [PMID: 23265635 PMCID: PMC3530159 DOI: 10.1016/j.jaac.2012.10.004] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2012] [Revised: 09/06/2012] [Accepted: 10/09/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Bipolar disorder (BD) is a debilitating psychiatric condition that commonly begins in adolescence, a developmental period that has been associated with increased reward seeking. Because youth with BD are especially vulnerable to negative risk-taking behaviors, understanding the neural mechanisms by which dysregulated affect interacts with the neurobehavioral processing of reward is clearly important. One way to clarify how manic symptoms evolve in BD is to "prime" the affect before presenting rewarding stimuli. The objective of this study was to investigate the neural effects of an affective priming task designed to positively induce mood before reward processing in adolescents with and without BD. METHOD Neural activity and behaviors during the anticipation of and response to monetary reward and loss after an affective prime were compared using functional magnetic resonance imaging in 13- to 18-year-old adolescents with a recent onset of BD-I (n = 24) and demographically matched healthy comparison youth (n = 24). RESULTS Compared with the healthy control youth, youth with BD had speeded reaction times and showed decreased activation in the thalamus and inferior temporal gyrus while anticipating gains after priming but increased activations in the middle frontal gyrus and parietal cortices while anticipating losses after priming. Youth with BD also showed less activation in the inferior parietal lobule, thalamus, and superior frontal gyrus while receiving losses after priming. CONCLUSIONS Aberrant prefrontal and subcortical activations during reward processing suggest mechanisms that may underlie disordered self-awareness during goal pursuit and motivation in BD. Longitudinal studies are needed to examine whether this pattern of neural activation predicts a poorer long-term outcome.
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Affiliation(s)
- Manpreet K Singh
- Stanford University School of Medicine, Stanford, CA 94305-5795, USA.
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31
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Bio DS, Soeiro de-Souza MG, Otaduy MCG, Machado-Vieira R, Moreno RA. The impact of limbic system morphology on facial emotion recognition in bipolar I disorder and healthy controls. Neuropsychiatr Dis Treat 2013; 9:743-51. [PMID: 23723706 PMCID: PMC3666908 DOI: 10.2147/ndt.s41896] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Impairments in facial emotion recognition (FER) have been reported in bipolar disorder (BD) subjects during all mood states. This study aims to investigate the impact of limbic system morphology on FER scores in BD subjects and healthy controls. MATERIAL AND METHODS Thirty-nine euthymic BD I (type I) subjects and 40 healthy controls were subjected to a battery of FER tests and examined with 3D structural imaging of the amygdala and hippocampus. RESULTS The volume of these structures demonstrated a differential pattern of influence on FER scores in BD subjects and controls. In our control sample, larger left and right amygdala demonstrated to be associated to less recognition of sadness faces. In BD group, there was no impact of amygdala volume on FER but we observed a negative impact of the left hippocampus volume in the recognition of happiness while the right hippocampus volume positively impacted on the scores of happiness. CONCLUSION Our results indicate that amygdala and hippocampus volumes have distinct effects on FER in BD subjects compared to controls. Knowledge of the neurobiological basis of the illness may help to provide further insights on the role of treatments and psychosocial interventions for BD. Further studies should explore how these effects of amygdala and hippocampus volumes on FER are associated with social networks and social network functioning.
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Schenkel LS, Passarotti AM, Sweeney JA, Pavuluri MN. Negative emotion impairs working memory in pediatric patients with bipolar disorder type I. Psychol Med 2012; 42:2567-77. [PMID: 22564881 PMCID: PMC3652422 DOI: 10.1017/s0033291712000797] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND We investigated affect recognition and the impact of emotional valence on working memory (using happy, angry, and neutral faces) in pediatric patients with bipolar disorder (BD) and healthy control (HC) subjects. METHOD Subjects (N=70) consisted of unmedicated patients with BD type I (BD I, n=23) and type II (BD II, n=16) and matched HC subjects (n=31). All subjects completed tasks of emotion recognition (Chicago Pediatric Emotional Acuity Task; Chicago PEAT) and working memory for happy, angry, and neutral faces (Affective N-Back Memory Task; ANMT). RESULTS Compared to HC subjects, BD patients performed significantly more poorly when identifying the intensity of happy and angry expressions on the Chicago PEAT, and demonstrated working-memory impairments regardless of the type of facial emotional stimuli. Pediatric BD patients displayed the most impaired accuracy and reaction time performance with negative facial stimuli relative to neutral stimuli, but did not display this pattern with positive stimuli. Only BD I patients displayed working-memory deficits, while both BD I and BD II patients displayed emotion-identification impairments. Results remained significant after controlling for co-morbid ADHD and mood state. CONCLUSIONS Both BD I and BD II youth demonstrate emotion-identification deficits. BD youth also demonstrate working-memory impairments for facial stimuli irrespective of emotional valence; however, working-memory deficits were the most pronounced with negative emotional stimuli. These deficits appear to be specific to BD I patients, and suggest therefore that a more severe form of illness is characterized by more severe social-cognitive impairment.
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Affiliation(s)
- L S Schenkel
- Department of Psychology, Rochester Institute of Technology, Rochester, NY, USA.
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33
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Soeiro-de-Souza MG, Otaduy MCG, Dias CZ, Bio DS, Machado-Vieira R, Moreno RA. The impact of the CACNA1C risk allele on limbic structures and facial emotions recognition in bipolar disorder subjects and healthy controls. J Affect Disord 2012; 141:94-101. [PMID: 22464935 DOI: 10.1016/j.jad.2012.03.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Accepted: 03/06/2012] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Impairments in facial emotion recognition (FER) have been reported in bipolar disorder (BD) during all mood states. FER has been the focus of functional magnetic resonance imaging studies evaluating differential activation of limbic regions. Recently, the α1-C subunit of the L-type voltage-gated calcium channel (CACNA1C) gene has been described as a risk gene for BD and its Met allele found to increase CACNA1C mRNA expression. In healthy controls, the CACNA1C risk (Met) allele has been reported to increase limbic system activation during emotional stimuli and also to impact on cognitive function. The aim of this study was to investigate the impact of CACNA1C genotype on FER scores and limbic system morphology in subjects with BD and healthy controls. MATERIAL AND METHODS Thirty-nine euthymic BD I subjects and 40 healthy controls were submitted to a FER recognition test battery and genotyped for CACNA1C. Subjects were also examined with a 3D 3-Tesla structural imaging protocol. RESULTS The CACNA1C risk allele for BD was associated to FER impairment in BD, while in controls nothing was observed. The CACNA1C genotype did not impact on amygdala or hippocampus volume neither in BD nor controls. LIMITATIONS Sample size. CONCLUSION The present findings suggest that a polymorphism in calcium channels interferes FER phenotype exclusively in BD and doesn't interfere on limbic structures morphology.
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Affiliation(s)
- Márcio Gerhardt Soeiro-de-Souza
- Mood disorders Unit (GRUDA), Department and Institute of Psychiatry, School of Medicine, University of Sao Paulo, GRUDA IPq-FMUSP, Brazil.
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Wang F, Bobrow L, Liu J, Spencer L, Blumberg HP. Corticolimbic functional connectivity in adolescents with bipolar disorder. PLoS One 2012; 7:e50177. [PMID: 23185566 PMCID: PMC3503984 DOI: 10.1371/journal.pone.0050177] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Accepted: 10/22/2012] [Indexed: 11/19/2022] Open
Abstract
Convergent evidence supports regional dysfunction within a corticolimbic neural system that subserves emotional processing and regulation in adolescents and adults with bipolar disorder (BD), with abnormalities prominent within the amygdala and its major anterior paralimbic cortical connection sites including ventral anterior cingulate, orbitofrontal, insular and temporopolar cortices. Recent studies of adults with BD demonstrate abnormalities in the functional connectivity between the amygdala and anterior paralimbic regions suggesting an important role for the connections between these regions in the development of the disorder. This study tests the hypothesis that these functional connectivity abnormalities are present in adolescents with BD. Fifty-seven adolescents, twenty-one with BD and thirty-six healthy comparison (HC) adolescents, participated in functional magnetic resonance imaging while processing emotional face stimuli. The BD and HC groups were compared in the strength of functional connectivity from amygdala to the anterior paralimbic cortical regions, and explored in remaining brain regions. Functional connectivity was decreased in the BD group, compared to the HC group, during processing of emotional faces in ventral anterior cingulate (VACC), orbitofrontal, insular and temporopolar cortices (p<0.005). Orbitofrontal and VACC findings for the happy condition, and additionally right insula for the neutral condition, survived multiple comparison correction. Exploratory analyses did not reveal additional regions of group differences. This study provides evidence for decreased functional connectivity between the amygdala and anterior paralimbic cortices in adolescents with BD. This suggests that amygdala-anterior paralimbic connectivity abnormalities are early features of BD that emerge at least by adolescence in the disorder.
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Affiliation(s)
- Fei Wang
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Laurel Bobrow
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Jie Liu
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Linda Spencer
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Hilary P. Blumberg
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, United States of America
- Child Study Center, Yale School of Medicine, New Haven, Connecticut, United States of America
- Department of Diagnostic Radiology, Yale School of Medicine, New Haven, Connecticut, United States of America
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Deveney CM, Connolly ME, Jenkins SE, Kim P, Fromm SJ, Brotman MA, Pine DS, Leibenluft E. Striatal dysfunction during failed motor inhibition in children at risk for bipolar disorder. Prog Neuropsychopharmacol Biol Psychiatry 2012; 38:127-33. [PMID: 22414616 PMCID: PMC3389139 DOI: 10.1016/j.pnpbp.2012.02.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Revised: 02/13/2012] [Accepted: 02/28/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND A better understanding of the neural underpinnings of bipolar disorder (BD) can be obtained by examining brain activity in symptom-free individuals at risk for BD. This study examined the neural correlates of motor inhibition in a sample of symptom-free youths at familial risk for BD. METHODS 19 euthymic youths with BD, 13 asymptomatic youths with a first-degree relative with BD, and 21 healthy comparison children completed the stop signal task in a 3 T scanner. RESULTS Children at familial risk for BD exhibited increased putamen activation during unsuccessful inhibition that distinguished them from both healthy and BD children. Youths with BD exhibited reduced activation of the right nucleus accumbens during unsuccessful inhibition as compared to the other participant groups. CONCLUSIONS Striatal activation patterns differ between youths at risk for BD and healthy comparison children during a motor inhibition task.
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Affiliation(s)
- Christen M Deveney
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD 20892-2670, USA.
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Garrett A, Reiss A, Howe M, Kelley R, Singh M, Adleman N, Karchemskiy A, Chang K. Abnormal amygdala and prefrontal cortex activation to facial expressions in pediatric bipolar disorder. J Am Acad Child Adolesc Psychiatry 2012; 51:821-31. [PMID: 22840553 PMCID: PMC3408885 DOI: 10.1016/j.jaac.2012.06.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Revised: 05/21/2012] [Accepted: 06/01/2012] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Previous functional magnetic resonance imaging (fMRI) studies in pediatric bipolar disorder (BD) have reported greater amygdala and less dorsolateral prefrontal cortex (DLPFC) activation to facial expressions compared to healthy controls. The current study investigates whether these differences are associated with the early or late phase of activation, suggesting different temporal characteristics of brain responses. METHOD A total of 20 euthymic adolescents with familial BD (14 male) and 21 healthy control subjects (13 male) underwent fMRI scanning during presentation of happy, sad, and neutral facial expressions. Whole-brain voxelwise analyses were conducted in SPM5, using a three-way analysis of variance (ANOVA) with factors group (BD and healthy control [HC]), facial expression (happy, sad, and neutral versus scrambled), and phase (early and late, corresponding to the first and second half of each block of faces). RESULTS There were no significant group differences in task performance, age, gender, or IQ. Significant activation from the main effect of group included greater DLPFC activation in the HC group, and greater amygdala/hippocampal activation in the BD group. The interaction of Group × Phase identified clusters in the superior temporal sulcus/insula and visual cortex, where activation increased from the early to late phase of the block for the BD but not the HC group. CONCLUSIONS These findings are consistent with previous studies that suggest deficient prefrontal cortex regulation of heightened amygdala response to emotional stimuli in pediatric BD. Increasing activation over time in superior temporal and visual cortices suggests difficulty processing or disengaging attention from emotional faces in BD.
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Affiliation(s)
- Amy Garrett
- Center for Interdisciplinary Brain Sciences Research and the Pediatric Bipolar Disorders Program at Stanford University
| | - Allan Reiss
- Center for Interdisciplinary Brain Sciences Research at Stanford University
| | - Meghan Howe
- Pediatric Bipolar Disorders Program at Stanford University
| | - Ryan Kelley
- Center for Interdisciplinary Brain Sciences Research and the Pediatric Bipolar Disorders Program at Stanford University
| | - Manpreet Singh
- Pediatric Bipolar Disorders Program at Stanford University
| | | | - Asya Karchemskiy
- Center for Interdisciplinary Brain Sciences Research at Stanford University
| | - Kiki Chang
- Pediatric Bipolar Disorders Program at Stanford University
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Abstract
OBJECTIVE Recent theories regarding the neuropathology of bipolar disorder suggest that both neurodevelopmental and neurodegenerative processes may play a role. While magnetic resonance imaging has provided significant insight into the structural, functional, and connectivity abnormalities associated with bipolar disorder, research assessing longitudinal changes has been more limited. However, such research is essential to elucidate the pathophysiology of the disorder. The aim of our review is to examine the extant literature for developmental and progressive structural and functional changes in individuals with and at risk for bipolar disorder. METHODS We conducted a literature review using MEDLINE and the following search terms: bipolar disorder, risk, child, adolescent, bipolar offspring, MRI, fMRI, DTI, PET, SPECT, cross-sectional, longitudinal, progressive, and developmental. Further relevant articles were identified by cross-referencing with identified manuscripts. CONCLUSIONS There is some evidence for developmental and progressive neurophysiological alterations in bipolar disorder, but the interpretation of correlations between neuroimaging findings and measures of illness exposure or age in cross-sectional studies must be performed with care. Prospective longitudinal studies placed in the context of normative developmental and atrophic changes in neural structures and pathways thought to be involved in bipolar disorder are needed to improve our understanding of the neurodevelopmental underpinnings and progressive changes associated with bipolar disorder.
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Affiliation(s)
- Marguerite Reid Schneider
- Physician Scientist Training Program, Neuroscience Graduate Program Department, University of Cincinnati College of Medicine, Cincinnati, OH 45219-0516, USA
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Soeiro-de-Souza MG, Bio DS, David DP, Rodrigues dos Santos D, Kerr DS, Gattaz WF, Machado-Vieira R, Moreno RA. COMT Met (158) modulates facial emotion recognition in bipolar I disorder mood episodes. J Affect Disord 2012; 136:370-6. [PMID: 22222175 DOI: 10.1016/j.jad.2011.11.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Revised: 10/25/2011] [Accepted: 11/14/2011] [Indexed: 10/14/2022]
Abstract
BACKGROUND One of the many cognitive deficits reported in bipolar disorder (BD) patients is facial emotion recognition (FER), which has recently been associated with dopaminergic catabolism. Catechol-O-methyltransferase (COMT) is one of the main enzymes involved in the metabolic degradation of dopamine (DA) in the prefrontal cortex (PFC). The COMT gene polymorphism rs4680 (Val158Met) Met allele is associated with decreased activity of this enzyme in healthy controls. The objective of this study was to evaluate the influence of Val158Met on FER during manic and depressive episodes in BD patients and in healthy controls. MATERIALS AND METHODS 64 BD type I patients (39 in manic and 25 in depressive episodes) and 75 healthy controls were genotyped for COMT rs4680 and assessed for FER using the Ekman 60 Faces (EK60) and Emotion Hexagon (Hx) tests. RESULTS Bipolar manic patients carrying the Met allele recognized fewer surprised faces, while depressed patients with the Met allele recognized fewer "angry" and "happy" faces. Healthy homozygous subjects with the Met allele had higher FER scores on the Hx total score, as well as on "disgust" and "angry" faces than other genotypes. CONCLUSION This is the first study suggesting that COMT rs4680 modulates FER differently during BD episodes and in healthy controls. This provides evidence that PFC DA is part of the neurobiological mechanisms of social cognition. Further studies on other COMT polymorphisms that include euthymic BD patients are warranted. Clinicaltrials.gov identifier: NCT00969.
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Affiliation(s)
- Márcio Gerhardt Soeiro-de-Souza
- Mood Disorders Unit (GRUDA), Department and Institute of Psychiatry, School of Medicine, University of São Paulo (IPq HC-FMUSP), Brazil.
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Brand JG, Goldberg TE, Gunawardane N, Gopin CB, Powers RL, Malhotra AK, Burdick KE. Emotional bias in unaffected siblings of patients with bipolar I disorder. J Affect Disord 2012; 136:1053-8. [PMID: 22209123 PMCID: PMC3380628 DOI: 10.1016/j.jad.2011.11.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Accepted: 11/14/2011] [Indexed: 11/27/2022]
Abstract
BACKGROUND Bipolar disorder (BPD) research has identified a number of neurocognitive deficits as potential vulnerability markers; however, very few studies have focused on patterns of performance on affective processing tasks (e.g. affective Go/No-Go tasks) which may be more closely tied to the pathophysiology of the illness. We previously reported that stable BPD patients demonstrate a response bias toward negative affective stimuli as compared with healthy controls and schizophrenia patients. The goal of the current study was to expand upon these prior findings to investigate these patterns in the unaffected siblings of BPD patients. METHODS An affective Go/No-Go test was used to evaluate inhibitory response to negatively-valenced, positively-valenced, and neutral stimuli in 20 unaffected siblings of bipolar I patients versus 20 healthy controls. Accuracy (d') and response bias (beta) served as dependent variables in a series of repeated measures ANCOVAs. RESULTS We found a non-significant main effect for group when comparing accuracy performance (d') on the affective Go/No-Go of unaffected siblings versus healthy controls. However, very similar to the pattern that we previously reported in stable BPD patients, unaffected siblings showed a response bias (beta) toward negatively-valenced stimuli versus healthy controls [F=3.81; p=0.03]. LIMITATIONS Small sample size. CONCLUSIONS The current results extend our recent work which suggested that stable bipolar patients attend more readily to negative target stimuli than do schizophrenic or healthy subjects. These data, indicating that unaffected siblings also demonstrate an affective processing bias, implicate this task as a potential endophenotype in BPD.
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Affiliation(s)
- Jesse G. Brand
- University of Virginia Health System; Charlottesville, VA
| | - Terry E. Goldberg
- The Zucker Hillside Hospital-North Shore Long Island Jewish Health System; Glen Oaks, NY
- Albert Einstein College of Medicine; Bronx, NY
- The Feinstein Institute for Medical Research; Manhasset, NY
| | | | - Chaya B. Gopin
- The Zucker Hillside Hospital-North Shore Long Island Jewish Health System; Glen Oaks, NY
| | - Robyn L. Powers
- The Zucker Hillside Hospital-North Shore Long Island Jewish Health System; Glen Oaks, NY
| | - Anil K. Malhotra
- The Zucker Hillside Hospital-North Shore Long Island Jewish Health System; Glen Oaks, NY
- Albert Einstein College of Medicine; Bronx, NY
- The Feinstein Institute for Medical Research; Manhasset, NY
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Dickstein DP, Leibenluft E. Beyond dogma: from diagnostic controversies to data about pediatric bipolar disorder and children with chronic irritability and mood dysregulation. THE ISRAEL JOURNAL OF PSYCHIATRY AND RELATED SCIENCES 2012; 49:52-61. [PMID: 22652929 PMCID: PMC4482115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
From the mid-1990s through the present, studies have demonstrated a significant rise in the numbers of children and adolescents diagnosed with bipolar disorder (BD). Why is this? The present manuscript reviews several possibilities, most notably ambiguity in the diagnostic criteria for mania and how they may apply to children with functionally-impairing irritability. Furthermore, we discuss ongoing phenomenological and affective neuroscience research approaches to address those children most on the fringes of our current psychiatric nosology. In summary, these studies suggest that BD youths may be distinguished on some measures from those with chronic irritability and severe mood dysregulation, although the two groups also have some shared deficits.
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Affiliation(s)
- Daniel P. Dickstein
- Pediatric Mood, Imaging, & NeuroDevelopment Program, Bradley Hospital, Alpert Medical School of Brown University, East Providence, Rhode Island, U.S.A
| | - Ellen Leibenluft
- Section on Bipolar Spectrum Disorders, Emotion and Development Branch, National Institute of Mental Health (NIMH), Bethesda, Maryland, U.S.A
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Wegbreit E, Ellis JA, Nandam A, Fitzgerald JM, Passarotti AM, Pavuluri MN, Stevens MC. Amygdala functional connectivity predicts pharmacotherapy outcome in pediatric bipolar disorder. Brain Connect 2011; 1:411-22. [PMID: 22432455 PMCID: PMC3604767 DOI: 10.1089/brain.2011.0035] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
The aim of this study was to determine functional connectivity among patients with pediatric bipolar disorder (PBD) who are responders to pharmacotherapy and those who are nonresponders, and learn how they differ from healthy controls (HC) while performing a task that engages affective and cognitive neural systems. PBD participants (n = 34; 13.4 ± 2.3 years) were defined as responders if there was ≥ 50% improvement in Young Mania Rating Scale (YMRS) scores (n = 22) versus nonresponders with < 50% improvement (n = 12) with one of three mood stabilizing medications (divalproex, risperidone, or lamotrigine). HC (n = 14; 14.2 ± 3.1 years) participants also were scanned at baseline and follow-up. During functional magnetic resonance imaging, participants performed a color-matching task in which they had to match the color of positive, negative, or neutral words with colored dots. Independent component analysis was used to identify functionally connected networks across the whole brain, which were subsequently interrogated using region-of-interest analyses to test for group differences. A frontolimbic network was identified that showed impaired functional integration in PBD relative to HC when participants viewed negatively valenced words. PBD medication responders showed greater connectivity of the amygdala into the network before and after treatment compared with nonresponders, with responders showing a pattern more similar to HC than to nonresponders. Regardless of medication type, the degree of amygdala functional connectivity predicted medication response as well as the improvement in YMRS scores across responders and nonresponders. These findings suggest that increased functional integration of the amygdala within the frontolimbic network might be a biomarker of general mood stabilizer medication responsivity in bipolar disorder.
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Affiliation(s)
- Ezra Wegbreit
- Pediatric Brain Research and Intervention Center, Department of Psychiatry, Colbeth Clinic, University of Illinois at Chicago, Chicago, Illinois 60608, USA
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Differential patterns of abnormal activity and connectivity in the amygdala-prefrontal circuitry in bipolar-I and bipolar-NOS youth. J Am Acad Child Adolesc Psychiatry 2011; 50:1275-89.e2. [PMID: 22115148 PMCID: PMC3268077 DOI: 10.1016/j.jaac.2011.09.023] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Revised: 09/20/2011] [Accepted: 09/27/2011] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The functioning of neural systems supporting emotion processing and regulation in youth with bipolar disorder not otherwise specified (BP-NOS) remains poorly understood. We sought to examine patterns of activity and connectivity in youth with BP-NOS relative to youth with bipolar disorder type I (BP-I) and healthy controls (HC). METHOD Participants (18 BP-I youth, 16 BP-NOS youth, and 18 HC) underwent functional magnetic resonance imaging while performing two emotional-face gender labeling tasks (happy/neutral, fearful/neutral). Analyses focused on a priori neural regions supporting emotion processing (amygdala) and emotion regulation (ventromedial prefrontal cortex (VMPFC), dorsolateral prefrontal cortex (DLPFC). Connectivity analyses used VMPFC as a seed region. RESULTS During the happy-face task, BP-I youth had greater amygdala, VMPFC, and DLPFC activity to happy faces whereas BP-NOS youth had reduced VMPFC and DLPFC activity to neutral faces relative to HC, and reduced amygdala, VMPFC, and DLPFC activity to neutral faces versus BP-I. During the fearful-face task, BP-I youth had reduced DLPFC activity to fearful faces whereas BP-NOS youth had reduced DLPFC activity to neutral faces relative to HC. BP-NOS youth showed greater VMPFC-DLPFC connectivity to happy faces relative to HC and BP-I youth. BP-I youth showed reduced VMPFC-amygdala connectivity to fearful faces relative to HC and BP-NOS youth. CONCLUSIONS This is the first study to document differential patterns of abnormal neural activity in, and connectivity between, neural regions supporting emotion processing and regulation in BP-NOS versus BP-I youth. Findings suggest that despite similarities in symptom presentation, there are differential patterns of abnormal neural functioning in BP-NOS and BP-I relative to HC, which might reflect an "intermediate state" in the course of BP-I illness. Future longitudinal studies are needed to relate these findings with future conversion to BP-I/II.
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Neurocognitive performance in children and adolescents with bipolar disorder: a review. Eur Child Adolesc Psychiatry 2011; 20:433-50. [PMID: 21904806 DOI: 10.1007/s00787-011-0209-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2010] [Accepted: 07/28/2011] [Indexed: 10/17/2022]
Abstract
A number of studies have reported the evidence of cognitive deficits in adult bipolar patients. Recently, there has been a shift in research on neurocognitive performance in bipolar disorder (BD) towards examining younger age groups. A review of the literature on neurocognitive impairments in BD in childhood and adolescence was conducted. We searched systematically for studies in samples of age groups younger than 18 years of age in average that included either a healthy control group or normative data for the cognitive tests used. Twenty-one original articles were found and reviewed. Children and adolescents with BD show deficits in a variety of cognitive areas. The most consistent results were found for impairments in verbal memory. A majority of studies also indicated impairments in working memory. Similar pattern of neurocognitive impairment was found in children and adolescents as compared to adults suffering from BD. The neurocognitive deficits need to be recognized and incorporated into individual treatment programs.
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Fronto-limbic dysfunction in mania pre-treatment and persistent amygdala over-activity post-treatment in pediatric bipolar disorder. Psychopharmacology (Berl) 2011; 216:485-99. [PMID: 21390505 PMCID: PMC3174733 DOI: 10.1007/s00213-011-2243-2] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2010] [Accepted: 02/18/2011] [Indexed: 10/18/2022]
Abstract
RATIONALE Neural deficits at the interface of affect and cognition may improve with pharmacotherapy in pediatric bipolar disorder (PBD). OBJECTIVES We examined lamotrigine treatment impact on the neural interface of working memory and affect in PBD. METHODS Un-medicated, acutely ill, patients with mania and hypomania (n = 17), and healthy controls (HC; n = 13; mean age = 13.36 ± 2.55) performed an affective two-back functional magnetic resonance imaging task with blocks of angry vs neutral faces (i.e., angry face condition) or happy vs neutral faces (i.e., happy face condition) before treatment and at follow-up, after 8-week treatment with second-generation antipsychotics followed by 6 weeks of lamotrigine monotherapy. RESULTS At baseline, for the angry face condition, PBD, relative to HC, showed reduced activation in the left ventrolateral prefrontal cortex (VLPFC) and right caudate; for the happy face condition, PBD showed increased activation in bilateral PFC and right amygdala and middle temporal gyrus. Post-treatment, PBD showed greater activation in right amygdala relative to HC for both conditions. Patients, relative to HC, exhibited greater changes over time in the right VLPFC and amygdala, left subgenual anterior cingulate cortex and left caudate for the angry face condition, and in right middle temporal gyrus for the happy face condition. CONCLUSIONS Pharmacotherapy resulted in symptom improvement and normalization of higher cortical emotional and cognitive regions in patients relative to HC, suggesting that the VLPFC dysfunction may be state-specific in PBD. Amygdala was overactive in PBD, relative to HC, regardless of reduction in manic symptoms, and may be a trait marker of PBD.
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Neuroimaging-based markers of bipolar disorder: evidence from two meta-analyses. J Affect Disord 2011; 132:344-55. [PMID: 21470688 DOI: 10.1016/j.jad.2011.03.016] [Citation(s) in RCA: 168] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2010] [Revised: 02/14/2011] [Accepted: 03/03/2011] [Indexed: 12/26/2022]
Abstract
BACKGROUND Bipolar disorder (BD) is often misdiagnosed or tardily detected, leading to inadequate treatment and devastating consequences. The identification of objective biomarkers, such as functional and structural brain abnormalities of BD might improve diagnosis and help elucidate its pathophysiology. METHODS To identify neurobiological markers of BD, two meta-analyses, one of functional neuroimaging studies related to emotional processing and a second of structural whole-brain neuroimaging studies in BD were conducted in the present study. Conducting a literature search on studies published up to September 2009 we identified 28 studies that were eligible for the meta-analyses: 13 functional magnetic resonance imaging studies, related to emotional processing and 15 structural imaging studies using whole-brain voxel-based morphometry. Only studies comparing patients with bipolar disorder to healthy controls were considered. Data were extracted or converted to a single anatomical reference (Talairach space). The activation likelihood estimation technique was used to assess the voxel-wise correspondence of results between studies. RESULTS In patients with BD, decreased activation and diminution of gray matter were identified in a cortical-cognitive brain network that has been associated with the regulation of emotions. By contrast, patients with BD exhibited increased activation in ventral limbic brain regions that mediate the experience of emotions and generation of emotional responses. The present study provides evidence for functional and anatomical alterations in BD in brain networks associated with the experience and regulation of emotions. CONCLUSIONS These alterations support previously proposed neurobiological models of BD and might represent valid neurobiological markers of the disorder. The specificity of these results to unipolar depression remains to be explored.
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Wang F, Kalmar JH, Womer FY, Edmiston EE, Chepenik LG, Chen R, Spencer L, Blumberg HP. Olfactocentric paralimbic cortex morphology in adolescents with bipolar disorder. Brain 2011; 134:2005-12. [PMID: 21666263 DOI: 10.1093/brain/awr124] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
The olfactocentric paralimbic cortex plays a critical role in the regulation of emotional and neurovegetative functions that are disrupted in core features of bipolar disorder. Adolescence is thought to be a critical period in both the maturation of the olfactocentric paralimbic cortex and in the emergence of bipolar disorder pathology. Together, these factors implicate a central role for the olfactocentric paralimbic cortex in the development of bipolar disorder and suggest that abnormalities in this cortex may be expressed by adolescence in the disorder. We tested the hypothesis that differences in olfactocentric paralimbic cortex structure are a morphological feature in adolescents with bipolar disorder. Subjects included 118 adolescents (41 with bipolar disorder and 77 healthy controls). Cortical grey matter volume differences between adolescents with and without bipolar disorder were assessed with voxel-based morphometry analyses of high-resolution structural magnetic resonance imaging scans. Compared with healthy comparison adolescents, adolescents with bipolar disorder demonstrated significant volume decreases in olfactocentric paralimbic regions, including orbitofrontal, insular and temporopolar cortices. Findings in these regions survived small volume correction (P < 0.05, corrected). Volume decreases in adolescents with bipolar disorder were also noted in inferior prefrontal and superior temporal gyri and cerebellum. The findings suggest that abnormalities in the morphology of the olfactocentric paralimbic cortex may contribute to the bipolar disorder phenotype that emerges in adolescence. The morphological development of the olfactocentric paralimbic cortex has received little study. The importance of these cortices in emotional and social development, and support for a central role for these cortices in the development of bipolar disorder, suggest that study of the development of these cortices in health and in bipolar disorder is critically needed.
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Affiliation(s)
- Fei Wang
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06511, USA
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Lopez-Larson M, Breeze JL, Kennedy DN, Hodge SM, Tang L, Moore C, Giuliano AJ, Makris N, Caviness VS, Frazier JA. Age-related changes in the corpus callosum in early-onset bipolar disorder assessed using volumetric and cross-sectional measurements. Brain Imaging Behav 2011; 4:220-31. [PMID: 20686873 DOI: 10.1007/s11682-010-9101-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Corpus callosum (CC) area abnormalities have been reported in magnetic resonance imaging (MRI) studies of adults and youths with bipolar disorder (BPD), suggesting interhemispheric communication may be abnormal in BPD and may be present early in the course of illness and affect normal neuromaturation of this structure throughout the lifecycle. Neuroimaging scans from 44 youths with DSM-IV BPD and 22 healthy controls (HC) were analyzed using cross-sectional area measurements and a novel method of volumetric parcellation. Univariate analyses of variance were conducted on CC subregions using both volume and traditional area measurements. Youths with BPD had smaller middle and posterior callosal regions, and reduced typical age-related increases in CC size. The cross-sectional area and novel volumetric methodologies resulted in similar findings. Future longitudinal assessments of CC development would track the evolution of callosal abnormalities in youths with BPD and allow exploration of the functional significance of these findings.
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Vasa RA, Pine DS, Thorn JM, Nelson TE, Spinelli S, Nelson E, Maheu FS, Ernst M, Bruck M, Mostofsky SH. Enhanced right amygdala activity in adolescents during encoding of positively valenced pictures. Dev Cogn Neurosci 2011; 1:88-99. [PMID: 21127721 PMCID: PMC2993431 DOI: 10.1016/j.dcn.2010.08.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Revised: 08/04/2010] [Accepted: 08/05/2010] [Indexed: 11/19/2022] Open
Abstract
While studies among adults implicate the amygdala and interconnecting brain regions in encoding emotional stimuli, few studies have examined whether developmental changes occur within this emotional-memory network during adolescence. The present study examined whether adolescents and adults differentially engaged the amygdala and hippocampus during successful encoding of emotional pictures, with either positive or negative valence. Eighteen adults and twelve adolescents underwent event-related fMRI while encoding emotional pictures. Approximately 30 min later, outside the scanner, subjects were asked to recall the pictures seen during the scan. Age group differences in brain activity in the amygdala and hippocampus during encoding of the pictures that were later successfully and unsuccessfully recalled were separately compared for the positive and negative pictures. Adolescents, relative to adults, demonstrated enhanced activity in the right amygdala during encoding of positive pictures that were later recalled compared to not recalled. There were no age group differences in amygdala or hippocampal activity during successful encoding of negative pictures. The findings of preferential activity within the adolescent right amygdala during successful encoding of positive pictures may have implications for the increased reward and novelty seeking behavior, as well as elevated rates of psychopathology, observed during this distinct developmental period.
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Affiliation(s)
- Roma A Vasa
- Department of Psychiatry, Kennedy Krieger Institute, 716 North Broadway, Baltimore, MD 21205, United States.
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Rocca CCDA, Heuvel EVD, Caetano SC, Lafer B. Facial emotion recognition in bipolar disorder: a critical review. BRAZILIAN JOURNAL OF PSYCHIATRY 2010; 31:171-80. [PMID: 19578691 DOI: 10.1590/s1516-44462009000200015] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2009] [Accepted: 03/16/2009] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Literature review of the controlled studies in the last 18 years in emotion recognition deficits in bipolar disorder. METHOD A bibliographical research of controlled studies with samples larger than 10 participants from 1990 to June 2008 was completed in Medline, Lilacs, PubMed and ISI. Thirty-two papers were evaluated. RESULTS Euthymic bipolar disorder presented impairment in recognizing disgust and fear. Manic BD showed difficult to recognize fearful and sad faces. Pediatric bipolar disorder patients and children at risk presented impairment in their capacity to recognize emotions in adults and children faces. Bipolar disorder patients were more accurate in recognizing facial emotions than schizophrenic patients. DISCUSSION Bipolar disorder patients present impaired recognition of disgust, fear and sadness that can be partially attributed to mood-state. In mania, they have difficult to recognize fear and disgust. Bipolar disorder patients were more accurate in recognizing emotions than depressive and schizophrenic patients. Bipolar disorder children present a tendency to misjudge extreme facial expressions as being moderate or mild in intensity. CONCLUSION Affective and cognitive deficits in bipolar disorder vary according to the mood states. Follow-up studies re-testing bipolar disorder patients after recovery are needed in order to investigate if these abnormalities reflect a state or trait marker and can be considered an endophenotype. Future studies should aim at standardizing task and designs.
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Dickstein D. The diagnostic dilemma: why we need to change how we diagnose bipolar disorder in children. CEREBRUM : THE DANA FORUM ON BRAIN SCIENCE 2010; 2010:23. [PMID: 23447768 PMCID: PMC3574781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Bipolar disorder diagnosis has been rising dramatically in children for the past decade. In response to this increase, writes Daniel Dickstein, M.D., of Bradley Hospital and Brown University, researchers at the National Institute of Mental Health and elsewhere are reviewing the diagnostic criteria. In coming years, Dickstein argues, recognizing and diagnosing bipolar disorder in children should be based more on biological markers, such as brain structure and the use of neural circuits, than on the inconsistent diagnostic categories laid out in the Diagnostic and Statistical Manual of Mental Disorders.
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