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Novák T, Kostýlková L, Bareš M, Renková V, Hejzlar M, Renka J, Baumann S, Laskov O, Klírová M. Right ventrolateral and left dorsolateral 10 Hz transcranial magnetic stimulation as an add-on treatment for bipolar I and II depression: a double-blind, randomised, three-arm, sham-controlled study. World J Biol Psychiatry 2024; 25:304-316. [PMID: 38785073 DOI: 10.1080/15622975.2024.2357110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 05/15/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVES Despite the clinical importance of bipolar depression (BDE), effective treatment options are still limited. Transcranial magnetic stimulation (rTMS) has proven of moderate efficacy in major depression, but the evidence remains inconclusive for BDE. METHODS A 4-week, double-blind, randomised, parallel-group, sham-controlled study (trial ID ISRCTN77188420) explored the benefits of 10 Hz MRI-guided right ventrolateral (RVL) rTMS and left dorsolateral (LDL) rTMS as add-on treatments for BDE. Outcome measures included changes in the Montgomery-Åsberg Depression Rating Scale (MADRS) score, self-assessment, response and remission rates, and side effects. RESULTS Sixty patients were randomly assigned to study groups, and forty-six completed the double-blind phase. The mean change from baseline to Week 4 in MADRS was greater in both active groups compared to the sham, yet differences did not achieve significance (RVL vs sham: -4.50, 95%CI -10.63 to 1.64, p = 0.3; LDL vs sham: -4.07, 95%CI -10.24 to 2.10, p = 0.4). None of the other outcome measures yielded significant results. CONCLUSIONS While not demonstrating the superiority of either 10 Hz rTMS over sham, with the limited sample size, we can not rule out a moderate yet clinically meaningful effect. Further well-powered studies are essential to elucidate the role of rTMS in managing BDE.
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Affiliation(s)
- Tomáš Novák
- National Institute of Mental Health, Klecany, Czech Republic
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Lenka Kostýlková
- National Institute of Mental Health, Klecany, Czech Republic
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Martin Bareš
- National Institute of Mental Health, Klecany, Czech Republic
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | | | - Martin Hejzlar
- National Institute of Mental Health, Klecany, Czech Republic
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jiří Renka
- National Institute of Mental Health, Klecany, Czech Republic
| | - Silvie Baumann
- National Institute of Mental Health, Klecany, Czech Republic
| | - Olga Laskov
- National Institute of Mental Health, Klecany, Czech Republic
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Monika Klírová
- National Institute of Mental Health, Klecany, Czech Republic
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
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Wu Y, Su YA, Zhu L, Li J, Si T. Advances in functional MRI research in bipolar disorder: from the perspective of mood states. Gen Psychiatr 2024; 37:e101398. [PMID: 38292862 PMCID: PMC10826570 DOI: 10.1136/gpsych-2023-101398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 12/20/2023] [Indexed: 02/01/2024] Open
Abstract
Bipolar disorder is characterised by recurrent and alternating episodes of mania/hypomania and depression. Current breakthroughs in functional MRI techniques have uncovered the functional neuroanatomy of bipolar disorder. However, the pathophysiology underlying mood instability, mood switching and the development of extreme mood states is less well understood. This review presents a comprehensive overview of current evidence from functional MRI studies from the perspective of mood states. We first summarise the disrupted brain activation patterns and functional connectivity that have been reported in bipolar disorder, irrespective of the mood state. We next focus on research that solely included patients in a single mood state for a better understanding of the pathophysiology of bipolar disorder and research comparing patients with different mood states to dissect mood state-related effects. Finally, we briefly summarise current theoretical models and conclude this review by proposing potential avenues for future research. A comprehensive understanding of the pathophysiology with consideration of mood states could not only deepen our understanding of how acute mood episodes develop at a neurophysiological level but could also facilitate the identification of biological targets for personalised treatment and the development of new interventions for bipolar disorder.
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Affiliation(s)
- Yankun Wu
- Department of Clinical Psychopharmacology, Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Yun-Ai Su
- Department of Clinical Psychopharmacology, Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Linlin Zhu
- Department of Clinical Psychopharmacology, Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Jitao Li
- Department of Clinical Psychopharmacology, Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Tianmei Si
- Department of Clinical Psychopharmacology, Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
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Li D, Hao J, Hao J, Cui X, Niu Y, Xiang J, Wang B. Enhanced Dynamic Laterality Based on Functional Subnetworks in Patients with Bipolar Disorder. Brain Sci 2023; 13:1646. [PMID: 38137094 PMCID: PMC10741828 DOI: 10.3390/brainsci13121646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/07/2023] [Accepted: 11/10/2023] [Indexed: 12/24/2023] Open
Abstract
An ocean of studies have pointed to abnormal brain laterality changes in patients with bipolar disorder (BD). Determining the altered brain lateralization will help us to explore the pathogenesis of BD. Our study will fill the gap in the study of the dynamic changes of brain laterality in BD patients and thus provide new insights into BD research. In this work, we used fMRI data from 48 BD patients and 48 normal controls (NC). We constructed the dynamic laterality time series by extracting the dynamic laterality index (DLI) at each sliding window. We then used k-means clustering to partition the laterality states and the Arenas-Fernandez-Gomez (AFG) community detection algorithm to determine the number of states. We characterized subjects' laterality characteristics using the mean laterality index (MLI) and laterality fluctuation (LF). Compared with NC, in all windows and state 1, BD patients showed higher MLI in the attention network (AN) of the right hemisphere, and AN in the left hemisphere showed more frequent laterality fluctuations. AN in the left hemisphere of BD patients showed higher MLI in all windows and state 3 compared to NC. In addition, in the AN of the right hemisphere in state 1, higher MLI in BD patients was significantly associated with patient symptoms. Our study provides new insights into the understanding of BD neuropathology in terms of brain dynamic laterality.
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Affiliation(s)
- Dandan Li
- College of Computer Science and Technology, Taiyuan University of Technology, Jinzhong 030600, China; (J.H.)
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Zeng C, Liao S, Pu W. Trait and state-related characteristics of thalamo-cortical circuit disruption in bipolar disorder: a prospective cross-sectional study. Front Psychiatry 2023; 14:1067819. [PMID: 37304427 PMCID: PMC10250647 DOI: 10.3389/fpsyt.2023.1067819] [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: 10/12/2022] [Accepted: 05/09/2023] [Indexed: 06/13/2023] Open
Abstract
Objective The purpose of this study is to investigate the shared and distinct thalamic-cortical circuit between bipolar depression and remission, as well as to investigate the trait and state-related characteristics of the abnormal thalamic-cortical circuit in bipolar disorder. Methods Resting-state functional magnetic resonance imaging was performed on 38 bipolar depression patients, 40 bipolar remission patients, and 39 gender-matched healthy controls (rsfMRI). The thalamic subregions were used as seed points to draw the functional connectivity of the entire brain, and then the shared and distinct thalamic-cortical circuits between bipolar depression and remission were compared. Results When compared to the healthy group, both groups of patients had significantly lower functional connectivity between the rostral temporal thalamus and the lingual gyrus, the posterior parietal thalamus, the precuneus/cerebellum, and the occipital thalamus and the precuneus; however, functional connectivity between the premotor thalamus and the superior medial frontal was significantly lower in depression. Conclusion This study discovered that both bipolar depression and remission had abnormal sensorimotor-thalamic functional connectivity, implying that it is a trait-related characteristic of bipolar disorder; however, the decline in prefrontal-thalamic connectivity exists specifically in bipolar depression, implying that it is a state-related characteristic of bipolar disorder.
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Affiliation(s)
- Can Zeng
- Department of Psychology, Shaoguan University, Shaoguan, China
| | - SuQun Liao
- Department of Psychology, Shaoguan University, Shaoguan, China
| | - Weidan Pu
- Department of Clinical Psychology, The Third Xiangya Hospital, Central South University, Changsha, China
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Wen X, Han B, Li H, Dou F, Wei G, Hou G, Wu X. Unbalanced amygdala communication in major depressive disorder. J Affect Disord 2023; 329:192-206. [PMID: 36841299 DOI: 10.1016/j.jad.2023.02.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 02/06/2023] [Accepted: 02/19/2023] [Indexed: 02/27/2023]
Abstract
BACKGROUND Previous studies suggested an association between functional alteration of the amygdala and typical major depressive disorder (MDD) symptoms. Examining whether and how the interaction between the amygdala and regions/functional networks is altered in patients with MDD is important for understanding its neural basis. METHODS Resting-state functional magnetic resonance imaging data were recorded from 67 patients with MDD and 74 age- and sex-matched healthy controls (HCs). A framework for large-scale network analysis based on seed mappings of amygdala sub-regions, using a multi-connectivity-indicator strategy (cross-correlation, total interdependencies (TI), Granger causality (GC), and machine learning), was employed. Multiple indicators were compared between the two groups. The altered indicators were ranked in a supporting-vector machine-based procedure and associated with the Hamilton Rating Scale for Depression scores. RESULTS The amygdala connectivity with the default mode network and ventral attention network regions was enhanced and that with the somatomotor network, dorsal frontoparietal network, and putamen regions in patients with MDD was reduced. The machine learning analysis highlighted altered indicators that were most conducive to the classification between the two groups. LIMITATIONS Most patients with MDD received different pharmacological treatments. It is difficult to illustrate the medication state's effect on the alteration model because of its complex situation. CONCLUSION The results indicate an unbalanced interaction model between the amygdala and functional networks and regions essential for various emotional and cognitive functions. The model can help explain potential aberrancy in the neural mechanisms that underlie the functional impairments observed across various domains in patients with MDD.
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Affiliation(s)
- Xiaotong Wen
- Department of Psychology, Renmin University of China, Beijing 100872, China; Laboratory of the Department of Psychology, Renmin University of China, Beijing 100872, China; Interdisciplinary Platform of Philosophy and Cognitive Science, Renmin University of China, 100872, China.
| | - Bukui Han
- Department of Psychology, Renmin University of China, Beijing 100872, China; Laboratory of the Department of Psychology, Renmin University of China, Beijing 100872, China
| | - Huanhuan Li
- Department of Psychology, Renmin University of China, Beijing 100872, China; Laboratory of the Department of Psychology, Renmin University of China, Beijing 100872, China; Interdisciplinary Platform of Philosophy and Cognitive Science, Renmin University of China, 100872, China.
| | - Fengyu Dou
- Department of Psychology, Renmin University of China, Beijing 100872, China
| | - Guodong Wei
- Department of Psychology, Renmin University of China, Beijing 100872, China
| | - Gangqiang Hou
- Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen 518020, China
| | - Xia Wu
- School of Artificial Intelligence, Beijing Normal University, Beijing 100093, China
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Havlík M, Hlinka J, Klírová M, Adámek P, Horáček J. Towards causal mechanisms of consciousness through focused transcranial brain stimulation. Neurosci Conscious 2023; 2023:niad008. [PMID: 37089451 PMCID: PMC10120840 DOI: 10.1093/nc/niad008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 01/10/2023] [Accepted: 03/30/2023] [Indexed: 04/25/2023] Open
Abstract
Conscious experience represents one of the most elusive problems of empirical science, namely neuroscience. The main objective of empirical studies of consciousness has been to describe the minimal sets of neural events necessary for a specific neuronal state to become consciously experienced. The current state of the art still does not meet this objective but rather consists of highly speculative theories based on correlates of consciousness and an ever-growing list of knowledge gaps. The current state of the art is defined by the limitations of past stimulation techniques and the emphasis on the observational approach. However, looking at the current stimulation technologies that are becoming more accurate, it is time to consider an alternative approach to studying consciousness, which builds on the methodology of causal explanations via causal alterations. The aim of this methodology is to move beyond the correlates of consciousness and focus directly on the mechanisms of consciousness with the help of the currently focused brain stimulation techniques, such as geodesic transcranial electric neuromodulation. This approach not only overcomes the limitations of the correlational methodology but will also become another firm step in the following science of consciousness.
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Affiliation(s)
- Marek Havlík
- Center for Advanced Studies of Brain and Consciousness, National Institute of Mental Health, Topolová 748, Klecany 250 67, Czech Republic
| | - Jaroslav Hlinka
- Center for Advanced Studies of Brain and Consciousness, National Institute of Mental Health, Topolová 748, Klecany 250 67, Czech Republic
- Department of Complex Systems, Institute of Computer Science of the Czech Academy of Sciences, Pod Vodárenskou věží 271/2, Prague 182 07, Czech Republic
| | - Monika Klírová
- Center for Advanced Studies of Brain and Consciousness, National Institute of Mental Health, Topolová 748, Klecany 250 67, Czech Republic
- Third Faculty of Medicine, Charles University, Ruská 87, Prague 10 100 00, Czech Republic
| | - Petr Adámek
- Center for Advanced Studies of Brain and Consciousness, National Institute of Mental Health, Topolová 748, Klecany 250 67, Czech Republic
- Third Faculty of Medicine, Charles University, Ruská 87, Prague 10 100 00, Czech Republic
| | - Jiří Horáček
- Center for Advanced Studies of Brain and Consciousness, National Institute of Mental Health, Topolová 748, Klecany 250 67, Czech Republic
- Third Faculty of Medicine, Charles University, Ruská 87, Prague 10 100 00, Czech Republic
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Pallidal volume reduction and prefrontal-striatal-thalamic functional connectivity disruption in pediatric bipolar disorders. J Affect Disord 2022; 301:281-288. [PMID: 35031334 DOI: 10.1016/j.jad.2022.01.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/14/2021] [Accepted: 01/10/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND As a crucial node of the corticolimbic model, the striatum has been demonstrated in modulating emotional cues in pediatric bipolar disorders (PBD), the striatal distinction in structure and function between PBD-I and PBD-II remains unclear. METHODS MRI data of 36 patients in PBD-I, 22 patients in PBD-II and 19 age-gender matched healthy controls (HCs) were processed. Here, we investigated structural and functional alterations of 8 subregions of striatum (bilateral nucleus accumbens, caudate, putamen and globus pallidus) by analyzing MRI data. RESULTS We found volume reduction of the right pallidum, the significant positive correlation between the number of episodes and the functional connectivity between left pallidum and right caudate in PBD-I patients, abrupted prefrontal-striatal-thalamic functional connectivity in PBD-I group and decreased functional connectivity in PBD-II relative to HCs and PBD-I. LIMITATIONS Future studies should enroll more subjects and adopt a longitudinal perspective, which could help to discover striatum structural or functional alterations during subject-specific clinical progress in different states. CONCLUSIONS Results of the present study confirmed that structural and functional abnormality of striatum may be helpful in identifying PBD clinical types as distinctive biomarkers. The interruptions of the prefrontal-striatal-thalamic circuits may provide advantageous evidence for expounding the role of striatum in bipolar disorders etiology. Thus, potential mechanisms of dysfunction striatum need to be formulated and reconceptualized with multimodal neuroimaging studies in future.
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Zeng C, Ross B, Xue Z, Huang X, Wu G, Liu Z, Tao H, Pu W. Abnormal Large-Scale Network Activation Present in Bipolar Mania and Bipolar Depression Under Resting State. Front Psychiatry 2021; 12:634299. [PMID: 33841204 PMCID: PMC8032940 DOI: 10.3389/fpsyt.2021.634299] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 02/16/2021] [Indexed: 01/14/2023] Open
Abstract
Introduction: Previous studies have primarily focused on the neuropathological mechanisms of the emotional circuit present in bipolar mania and bipolar depression. Recent studies applying resting-state functional magnetic resonance imaging (fMRI) have raise the possibility of examining brain-wide networks abnormality between the two oppositional emotion states, thus this study aimed to characterize the different functional architecture represented in mania and depression by employing group-independent component analysis (gICA). Materials and Methods: Forty-one bipolar depressive patients, 20 bipolar manic patients, and 40 healthy controls (HCs) were recruited and received resting-state fMRI scans. Group-independent component analysis was applied to the brain network functional connectivity analysis. Then, we calculated the correlation between the value of between-group differences and clinical variables. Results: Group-independent component analysis identified 15 components in all subjects, and ANOVA showed that functional connectivity (FC) differed significantly in the default mode network, central executive network, and frontoparietal network across the three groups. Further post-hoc t-tests showed a gradient descent of activity-depression > HC > mania-in all three networks, with the differences between depression and HCs, as well as between depression and mania, surviving after family wise error (FWE) correction. Moreover, central executive network and frontoparietal network activities were positively correlated with Hamilton depression rating scale (HAMD) scores and negatively correlated with Young manic rating scale (YMRS) scores. Conclusions: Three brain networks heighten activity in depression, but not mania; and the discrepancy regions mainly located in prefrontal, which may imply that the differences in cognition and emotion between the two states is associated with top-down regulation in task-independent networks.
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Affiliation(s)
- Can Zeng
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Brendan Ross
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Zhimin Xue
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xiaojun Huang
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Guowei Wu
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Zhening Liu
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Haojuan Tao
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Weidan Pu
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China
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Ellard KK, Gosai AG, Bernstein EE, Kaur N, Sylvia LG, Camprodon JA, Dougherty DD, Nierenberg AA, Deckersbach T. Intrinsic functional neurocircuitry associated with treatment response to transdiagnostic CBT in bipolar disorder with anxiety. J Affect Disord 2018; 238:383-391. [PMID: 29909301 PMCID: PMC7980284 DOI: 10.1016/j.jad.2018.06.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 05/16/2018] [Accepted: 06/01/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Anxiety in bipolar disorder (BD) exacerbates emotion dysregulation and reduces treatment response. We recently conducted a pilot trial of transdiagnostic CBT to target anxiety and emotion dysregulation in BD adjunctive to pharmacotherapy. Reductions in depression and anxiety symptoms were significantly predicted by baseline levels of neuroticism and perceived affective control, as well as changes over time in emotion regulation skills. The present study investigates mechanism of treatment response by examining the relationship between baseline emotion regulation-related neural circuitry and trial outcomes. METHODS Nineteen patients completed baseline resting state fMRI scans prior to treatment randomization. Functional connectivity between the anterior insula (AI) and regions in the salience network (SN), default mode network (DMN), and executive control network (ECN) were examined as predictors of baseline and treatment-related changes in emotion regulation. RESULTS Greater improvements in emotion regulation were predicted by weaker right dorsal AI - right ventrolateral prefrontal cortex (VLPFC; SN) and stronger bilateral dorsal AI - bilateral amygdala functional connectivity. Baseline neuroticism was negatively correlated with right dorsal AI- inferior parietal lobule (ECN) functional connectivity, and baseline deficits in perceived affective control were positively associated with ventral AI - bilateral dACC (SN) connectivity. LIMITATIONS Small sample limits interpretability of treatment-specific effects. CONCLUSION Baseline functional connectivity of emotion-regulation related neural circuitry significantly predicted change in emotion regulation-related dimensions associated with anxiety and depression symptom reduction. Future studies are needed to determine if employing methods such as neuromodulation to rehabilitate relevant neural circuitry may improve ultimate treatment outcomes of transdiagnostic CBT for BD and anxiety.
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Affiliation(s)
- Kristen K Ellard
- Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, 50 Staniford Street, Suite 580, Boston, MA 02114, United States.
| | - Aishwarya G Gosai
- Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, 50 Staniford Street, Suite 580, Boston, MA 02114, United States
| | | | | | - Lousia G Sylvia
- Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, 50 Staniford Street, Suite 580, Boston, MA 02114, United States
| | - Joan A Camprodon
- Division of Neurotherapeutics, Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, United States
| | - Darin D Dougherty
- Division of Neurotherapeutics, Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, United States
| | - Andrew A Nierenberg
- Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, 50 Staniford Street, Suite 580, Boston, MA 02114, United States
| | - Thilo Deckersbach
- Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, 50 Staniford Street, Suite 580, Boston, MA 02114, United States
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Kesner L, Grygarová D, Fajnerová I, Lukavský J, Nekovářová T, Tintěra J, Zaytseva Y, Horáček J. Perception of direct vs. averted gaze in portrait paintings: An fMRI and eye-tracking study. Brain Cogn 2018; 125:88-99. [DOI: 10.1016/j.bandc.2018.06.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 06/07/2018] [Accepted: 06/08/2018] [Indexed: 11/30/2022]
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Alda M, Manchia M. Personalized management of bipolar disorder. Neurosci Lett 2017; 669:3-9. [PMID: 29208408 DOI: 10.1016/j.neulet.2017.12.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 11/29/2017] [Accepted: 12/01/2017] [Indexed: 12/15/2022]
Abstract
Bipolar disorder (BD) is one of the most serious psychiatric disorders. The rates of disability, the risk of suicide attempts and their high lethality, as well as frequent and severe psychiatric and medical comorbidities, put it among the major causes of mortality and disability worldwide. At the same time, many patients can do well when treated properly. In this review, we focus on those aspects of the clinical care that offer the potential of individualized approach, in the context of the recent technology driven advances in the comprehension of the neurobiological underpinnings of BD. We first review those clinical and biological factors that can help identifying individuals at high risk of developing BD. Among these are a family history of BD and/or completed suicide, prodromal symptoms (in childhood and/or adolescence) such as anxiety and mood lability, early onset, and poor response to antidepressants. Panels of genetic markers are also being studied to identify subjects at risk for BD. Further, neuroimaging studies have found an increased gray matter density in the right Inferior Frontal Gyrus (rIFG) as a possible risk marker of BD. We then examine clinical factors that influence the initiation, selection and possibly discontinuation of long-term treatment. Lastly, we discuss the risk of side effects in BD, and their relevance for treatment adherence and for treatment monitoring. In summary, we discuss how a personalized approach in BD can be implemented through the identification of specific clinical and molecular predictors. We show that the realization of a personalized management of BD is not only of a theoretical value, but has substantial clinical repercussions, resulting in a significant reduction of the long-term morbidity and mortality associated to BD.
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Affiliation(s)
- Martin Alda
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Mirko Manchia
- Section of Psychiatry, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy; Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada
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Abstract
The evolutionary success of Homo sapiens is attributed to the following two factors: the upright body posture (which freed our hands and allowed unconstrained operation of various objects) and intensive development of the frontal lobes, mainly the Broca area of the brain. Underlining the uniqueness of the human brain, we often forget about the fact that the frontal lobes – the most developed part of the brain – are at the same time our greatest weakness, exposed to the action of damaging factors in our evolving environment. Is depression the cost of evolution?
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Affiliation(s)
- Piotr Gałecki
- Department of Adult Psychiatry, Medical University of Łódź, Łódź, Poland
| | - Monika Talarowska
- Department of Adult Psychiatry, Medical University of Łódź, Łódź, Poland
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Wei S, Geng H, Jiang X, Zhou Q, Chang M, Zhou Y, Xu K, Tang Y, Wang F. Amygdala-prefrontal cortex resting-state functional connectivity varies with first depressive or manic episode in bipolar disorder. Neurosci Lett 2017; 641:51-55. [PMID: 28130184 DOI: 10.1016/j.neulet.2017.01.052] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 01/20/2017] [Accepted: 01/21/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Bipolar disorder (BD) is one of the most complex mental illnesses, characterized by interactive depressive and manic states that are 2 contrary symptoms of disease states. The bilateral amygdala and prefrontal cortex (PFC) appear to play critical roles in BD; however, abnormalities seem to manifest differently in the 2 states and may provide further insight into underlying mechanisms. METHODS Sixteen participants with first-episode depressive and 13 participants with first-episode manic states of bipolar disorder as well as 30 healthy control (HC) participants underwent resting-state functional magnetic resonance imaging (fMRI). Resting-state functional connectivity (rsFC) between the bilateral amygdala and PFC was compared among the 3 groups. RESULTS Compared with depressive state participants of the BD group, manic state participants of the BD group showed a significant decrease in rsFC between the amygdala and right orbital frontal cortex (p<0.05, corrected). In addition, rsFC between the amygdala and left middle frontal cortex was significantly decreased in depressive and manic state participants of the BD group when compared with the HC group (p<0.05, corrected). CONCLUSIONS Our findings suggest that mood state during the first episodes of BD may be related to abnormality in hemispheric lateralization. The abnormalities in amygdala- left PFC functional connectivity might present the trait feature for BD, while deficits in amygdala- right PFC functional connectivity might be specific to manic episode, compared to depressive episode.
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Affiliation(s)
- Shengnan Wei
- Brain Function Research Section, First Affiliated Hospital, China Medical University, Shenyang, Liaoning, PR China; Department of Radiology, First Affiliated Hospital, China Medical University, Shenyang, Liaoning, PR China
| | - Haiyang Geng
- Department of Radiology, First Affiliated Hospital, China Medical University, Shenyang, Liaoning, PR China
| | - Xiaowei Jiang
- Brain Function Research Section, First Affiliated Hospital, China Medical University, Shenyang, Liaoning, PR China; Department of Radiology, First Affiliated Hospital, China Medical University, Shenyang, Liaoning, PR China
| | - Qian Zhou
- Department of Psychiatry, First Affiliated Hospital, China Medical University, Shenyang, Liaoning, PR China
| | - Miao Chang
- Department of Radiology, First Affiliated Hospital, China Medical University, Shenyang, Liaoning, PR China
| | - Yifang Zhou
- Department of Psychiatry, First Affiliated Hospital, China Medical University, Shenyang, Liaoning, PR China; Department of Geriatric Medicine, First Affiliated Hospital, China Medical University, Shenyang, Liaoning, PR China
| | - Ke Xu
- Department of Radiology, First Affiliated Hospital, China Medical University, Shenyang, Liaoning, PR China
| | - Yanqing Tang
- Brain Function Research Section, First Affiliated Hospital, China Medical University, Shenyang, Liaoning, PR China; Department of Psychiatry, First Affiliated Hospital, China Medical University, Shenyang, Liaoning, PR China; Department of Geriatric Medicine, First Affiliated Hospital, China Medical University, Shenyang, Liaoning, PR China
| | - Fei Wang
- Brain Function Research Section, First Affiliated Hospital, China Medical University, Shenyang, Liaoning, PR China; Department of Radiology, First Affiliated Hospital, China Medical University, Shenyang, Liaoning, PR China; Department of Psychiatry, First Affiliated Hospital, China Medical University, Shenyang, Liaoning, PR China.
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Chase HW, Phillips ML. Elucidating neural network functional connectivity abnormalities in bipolar disorder: toward a harmonized methodological approach. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2016; 1:288-298. [PMID: 27453953 PMCID: PMC4956344 DOI: 10.1016/j.bpsc.2015.12.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Bipolar disorder (BD), a mood disorder characterized by emotional lability and dysregulation, is associated with alterations in functional connectivity, particularly as assessed using functional MRI. Here, we provide an overview of the extant literature, and themes that have emerged within it. We identified published research describing functional connectivity in BD using PubMed and follow-up searches. The most consistent evidence favors abnormally heightened functional connectivity between the amygdala and the lateral regions of the ventral prefrontal cortex (PFC), both during rest or emotional processing. Altered interactions between the amygdala and more medial PFC regions have been implicated in BD, but are less consistently related to core symptoms and are sometimes associated with mood state or psychosis. Interactions between medial and lateral ventral PFC have also been reported to be altered in BD, and may mediate estimates of amygdala/vlPFC connectivity. We also describe other themes, including an emerging literature examining reward circuitry, which has highlighted abnormal functional interactions between the ventral striatum and medial prefrontal cortex, as well as the advent of examining global network abnormalities in BD. Functional connectivity studies in BD have established altered interactions between PFC and the amygdala. To address the inconsistencies in the literature, we suggest avenues for the adoption of large scale, and network-based analysis of connectivity, the integration of structural connectivity and the acknowledgement of dynamic and context-related shifts in functional connectivity as a means of clarifying the abnormal neural circuitry in the disorder.
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Affiliation(s)
- Henry W Chase
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Mary L Phillips
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
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15
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Kitamura MS, Watanabe K, Kitagawa N. Positive Emotion Facilitates Audiovisual Binding. Front Integr Neurosci 2016; 9:66. [PMID: 26834585 PMCID: PMC4724726 DOI: 10.3389/fnint.2015.00066] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 12/14/2015] [Indexed: 12/01/2022] Open
Abstract
It has been shown that positive emotions can facilitate integrative and associative information processing in cognitive functions. The present study examined whether emotions in observers can also enhance perceptual integrative processes. We tested 125 participants in total for revealing the effects of emotional states and traits in observers on the multisensory binding between auditory and visual signals. Participants in Experiment 1 observed two identical visual disks moving toward each other, coinciding, and moving away, presented with a brief sound. We found that for participants with lower depressive tendency, induced happy moods increased the width of the temporal binding window of the sound-induced bounce percept in the stream/bounce display, while no effect was found for the participants with higher depressive tendency. In contrast, no effect of mood was observed for a simple audiovisual simultaneity discrimination task in Experiment 2. These results provide the first empirical evidence of a dependency of multisensory binding upon emotional states and traits, revealing that positive emotions can facilitate the multisensory binding processes at a perceptual level.
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Affiliation(s)
- Miho S. Kitamura
- Faculty of Science and Engineering, Waseda UniversityTokyo, Japan
- NTT Communication Science Laboratories, NTT CorporationTokyo, Japan
| | - Katsumi Watanabe
- Faculty of Science and Engineering, Waseda UniversityTokyo, Japan
- Research Center for Advanced Science and Technology, The University of TokyoTokyo, Japan
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Connectomic markers of disease expression, genetic risk and resilience in bipolar disorder. Transl Psychiatry 2016; 6:e706. [PMID: 26731443 PMCID: PMC5068872 DOI: 10.1038/tp.2015.193] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 10/18/2015] [Accepted: 10/30/2015] [Indexed: 01/23/2023] Open
Abstract
Bipolar disorder (BD) is characterized by emotional dysregulation and cognitive deficits associated with abnormal connectivity between subcortical-primarily emotional processing regions-and prefrontal regulatory areas. Given the significant contribution of genetic factors to BD, studies in unaffected first-degree relatives can identify neural mechanisms of genetic risk but also resilience, thus paving the way for preventive interventions. Dynamic causal modeling (DCM) and random-effects Bayesian model selection were used to define and assess connectomic phenotypes linked to facial affect processing and working memory in a demographically matched sample of first-degree relatives carefully selected for resilience (n=25), euthymic patients with BD (n=41) and unrelated healthy controls (n=46). During facial affect processing, patients and relatives showed similarly increased frontolimbic connectivity; resilient relatives, however, evidenced additional adaptive hyperconnectivity within the ventral visual stream. During working memory processing, patients displayed widespread hypoconnectivity within the corresponding network. In contrast, working memory network connectivity in resilient relatives was comparable to that of controls. Our results indicate that frontolimbic dysfunction during affect processing could represent a marker of genetic risk to BD, and diffuse hypoconnectivity within the working memory network a marker of disease expression. The association of hyperconnectivity within the affect-processing network with resilience to BD suggests adaptive plasticity that allows for compensatory changes and encourages further investigation of this phenotype in genetic and early intervention studies.
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