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Primavera D, Aviles Gonzalez C, Perra A, Kalcev G, Cantone E, Cossu G, Holzinger A, Carta MG, Sancassiani F. Virtual Reality Cognitive Remediation in Older Adults with Bipolar Disorder: The Effects on Cognitive Performance and Depression in a Feasibility Randomized Controlled Trial. Healthcare (Basel) 2024; 12:1753. [PMID: 39273777 PMCID: PMC11394966 DOI: 10.3390/healthcare12171753] [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: 08/12/2024] [Revised: 08/27/2024] [Accepted: 08/29/2024] [Indexed: 09/15/2024] Open
Abstract
INTRODUCTION Dementia, depression, and cardiovascular disease are major public health concerns for older adults, requiring early intervention. This study investigates whether a virtual reality cognitive remediation program (VR-CR) can improve cognitive function and depressive symptoms in older adults, and determines the necessary sample size for future studies. Integrated VR and CR interventions have shown promising outcomes in older adults with neurodegenerative and mental health disorders. METHODS This secondary analysis of a randomized controlled trial involves adults aged 58-75 years with bipolar disorder, excluding those with acute episodes, epilepsy, or severe eye diseases. The experimental group received standard treatment plus VR-CR, while the control group received only standard treatment. RESULTS No baseline differences were found between the experimental and control groups. No significant improvement was observed in the overall cognitive function test (p = 0.897) or in depressive symptoms (p = 0.322). A phase III efficacy study requires a sample size of 28 participants (alpha = 0.05, beta = 0.20). CONCLUSIONS VR-CR can potentially treat depressive symptoms in adults and older adults, but the results support conducting phase III studies to further investigate these outcomes. However, the improvement in cognitive performance in the elderly is less pronounced than in younger individuals.
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Affiliation(s)
- Diego Primavera
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Cagliari, Italy
| | - Cesar Aviles Gonzalez
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Cagliari, Italy
- Department of Nursing, Universidad Popular del Cesar, Valledupar 200001, Colombia
| | - Alessandra Perra
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Cagliari, Italy
| | - Goce Kalcev
- The National Alliance for Neuromuscular Diseases and Neuroscience GANGLION Skopje, 1000 Skopje, North Macedonia
| | - Elisa Cantone
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Cagliari, Italy
| | - Giulia Cossu
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Cagliari, Italy
| | - Anita Holzinger
- Department at Medical, University of Wien, Spitalgasse 23, 1090 Wien, Austria
| | - Mauro Giovanni Carta
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Cagliari, Italy
| | - Federica Sancassiani
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Cagliari, Italy
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Carta MG, Kurotschka PK, Machado S, Erfurth A, Sancassiani F, Perra A, Tusconi M, Cossu G, Aviles Gonzalez CI, Primavera D. A Virtual Reality Cognitive Stimulation Program as an Effective Tool Against Residual/Prodromal Depressive Symptoms in Bipolar Disorders. J Clin Med 2024; 13:4714. [PMID: 39200856 PMCID: PMC11355462 DOI: 10.3390/jcm13164714] [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: 06/26/2024] [Revised: 08/08/2024] [Accepted: 08/10/2024] [Indexed: 09/02/2024] Open
Abstract
Background: Bipolar disorder (BD) is a severe psychiatric illness characterized by a chronic course and recurrent episodes, including residual depressive symptoms even during euthymic phases. These symptoms, although not meeting criteria for a depressive episode, are linked to relapse risk and impaired social functioning. This study aims to assess whether Virtual Reality Cognitive Remediation Training reduces depressive symptoms below the clinical threshold in individuals with BD. Methods: This post hoc analysis focuses on the secondary outcome (PHQ9) of a randomized-controlled trial. Participants were recruited from the Center of Liaison Psychiatry and Psychosomatics in Italy. The experimental group received Virtual Reality Cognitive Remediation, while the control group received standard treatment Results: Data from 39 individuals in the experimental group and 25 in the control group were analyzed. A greater reduction in PHQ-9 scores (>9) was observed in the experimental group (71.8% to 48.7%) compared to the control group. Significant improvements in total PHQ-9 scores and specific symptoms were noted in the experimental group compared to the control group. Conclusions: The study highlights the significant impact of virtual reality intervention on reducing depressive symptoms in bipolar disorder. This promising outcome underscores the potential preventive role of cognitive stimulation in relapse prevention. The intervention could offer valuable benefits for both treatment and prevention strategies in bipolar disorder.
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Affiliation(s)
- Mauro Giovanni Carta
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Cagliari, Italy; (M.G.C.); (F.S.); (A.P.); (G.C.); (C.I.A.G.)
| | - Peter K. Kurotschka
- Department of General Practice, University Hospital Würzburg, 97070 Würzburg, Germany;
| | - Sergio Machado
- Center of Neuroscience, Neurodiversity Institute, Queimados 26325-010, Brazil;
- Institute of Psychiatry-IPUB, Federal University of Rio de Janeiro, Rio de Janeiro 22290-140, Brazil
| | - Andreas Erfurth
- 6th Psychiatric Department, Otto-Wagner-Spital, 1140 Vienna, Austria;
| | - Federica Sancassiani
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Cagliari, Italy; (M.G.C.); (F.S.); (A.P.); (G.C.); (C.I.A.G.)
| | - Alessandra Perra
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Cagliari, Italy; (M.G.C.); (F.S.); (A.P.); (G.C.); (C.I.A.G.)
| | - Massimo Tusconi
- Azienda Ospedaliero Universitaria di Cagliari, 09042 Cagliari, Italy;
| | - Giulia Cossu
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Cagliari, Italy; (M.G.C.); (F.S.); (A.P.); (G.C.); (C.I.A.G.)
| | - Cesar Ivan Aviles Gonzalez
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Cagliari, Italy; (M.G.C.); (F.S.); (A.P.); (G.C.); (C.I.A.G.)
| | - Diego Primavera
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Cagliari, Italy; (M.G.C.); (F.S.); (A.P.); (G.C.); (C.I.A.G.)
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Primavera D, Migliaccio GM, Garau V, Orrù G, Scano A, Perra A, Pinna S, Tusconi M, Carta MG, Sancassiani F. Improving Quality of Life in Bipolar Disorders with an Immersive Virtual Reality Remediation Training Randomized Controlled Trial (RCT). J Clin Med 2024; 13:3886. [PMID: 38999451 PMCID: PMC11242424 DOI: 10.3390/jcm13133886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Revised: 06/26/2024] [Accepted: 06/29/2024] [Indexed: 07/14/2024] Open
Abstract
Background: Health-related quality of life (H-QoL) is a critical measure in bipolar disorder (BD). Recent trials using virtual reality (VR) have shown potential in improving H-QoL. However, VR's effect on the H-QoL of people with BD needs to be further explored. Methods: This study involved a secondary analysis of a feasibility randomized controlled trial, focusing on "quality of life". Participants (aged 18-75) diagnosed with bipolar disorder were randomized into two groups. The experimental group used the CEREBRUM VR app, while the control group received the usual care. Quality of life was assessed using the Short-Form Health Survey (SF-12). Results: A total of 39 individuals in the experimental group and 25 in the control group represent the final samples. The results showed a greater improvement in the SF-12 total score in the experimental group (8.7%) compared to the control group (F = 66.851 p < 0.0001), specifically in the dimension of physical activity limitation, emotional impact, concentration, pain, calmness, energy levels, discouragement, and social activities. Conclusions: This study demonstrated an improvement in QoL for individuals with BD following a VR intervention. As a feasibility study, this secondary outcome needs to be confirmed by further phase III studies. If confirmed, VR could offer valuable rehabilitation tools and insights into the pathogenesis and treatment of BD.
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Affiliation(s)
- Diego Primavera
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato Blocco I (CA), 09042 Cagliari, Italy
| | - Gian Mario Migliaccio
- Department Human Sciences and Promotion of the Quality of Life, San Raffaele Open University, 00118 Rome, Italy
| | - Valentino Garau
- School of Dentistry, University of Cagliari, 09042 Cagliari, Italy
| | - Germano Orrù
- Department of Surgical Sciences, University of Cagliari, Cittadella Universitaria, Blocco I, Asse Didattico Medicina P2, Monserrato (CA), 09042 Cagliari, Italy
| | - Alessandra Scano
- Department of Surgical Sciences, University of Cagliari, Cittadella Universitaria, Blocco I, Asse Didattico Medicina P2, Monserrato (CA), 09042 Cagliari, Italy
| | - Alessandra Perra
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato Blocco I (CA), 09042 Cagliari, Italy
| | - Samantha Pinna
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato Blocco I (CA), 09042 Cagliari, Italy
| | | | - Mauro Giovanni Carta
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato Blocco I (CA), 09042 Cagliari, Italy
| | - Federica Sancassiani
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato Blocco I (CA), 09042 Cagliari, Italy
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Zhang G, Xiao Q, Wang C, Gao W, Su L, Lu G, Zhong Y. The Different Impact of Depressive or Manic First-episode on Pediatric Bipolar Disorder Patients: Evidence From Resting-state fMRI. Neuroscience 2023; 526:185-195. [PMID: 37385333 DOI: 10.1016/j.neuroscience.2023.06.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 06/14/2023] [Accepted: 06/16/2023] [Indexed: 07/01/2023]
Abstract
Bipolar disorder may begin as depression or mania, which can affect the treatment and prognosis of bipolar disorder. However, the physiological and pathological differences of pediatric bipolar disorder (PBD) patients with different onset symptoms are not clear. The purpose of this study was to investigate the differences of clinical, cognitive function and intrinsic brain networks in PBD patients with first-episode depression and first-episode mania. A total of 63 participants, including 43 patients and 20 healthy controls, underwent resting-state fMRI scans. PBD patients were classified as first-episode depressive and first-episode manic based on their first-episode symptoms. Cognitive tests were used to measure attention and memory of all participants. Independent component analysis (ICA) was used to extract the salience network (SN), default-mode network (DMN), central executive network (ECN) and limbic network (LN) for each participant. Spearman rank correlation analysis was performed between abnormal activation and clinical and cognitive measures. The results showed that there were differences in cognitive functions such as attention and visual memory between first-episode depression and mania, as well as differences activation in anterior cingulate cortex (ACC), posterior cingulate cortex (PCC), precuneus, inferior parietal cortex and parahippocampus. And significant associations of brain activity with clinical assessments or cognition were found in different patients. In conclusion, we found differential impairments in cognitive and brain network activation in first-episode depressive and first-episode manic PBD patients, and correlations were found between these impairments. These evidences may shed light on the different developmental paths of bipolar disorder.
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Affiliation(s)
- Gui Zhang
- School of Psychology, Nanjing Normal University, Nanjing 210097, China
| | - Qian Xiao
- Mental Health Centre of Xiangya Hospital, Central South University, Changsha 410008, Hunan, China
| | - Chun Wang
- Department of Psychiatry, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing 210029, Jiangsu, China
| | - Weijia Gao
- Children's Hospital affiliated to the Medical College of Zhejiang University, Hangzhou 310003, Zhejiang, China
| | - Linyan Su
- Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Guangming Lu
- Department of Medical Imaging, Jinling Hospital, Nanjing University School of Medicine, 210093 Nanjing, Jiangsu, China
| | - Yuan Zhong
- School of Psychology, Nanjing Normal University, Nanjing 210097, China.
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Simonetti A, Lijffijt M, Kurian S, Saxena J, Janiri D, Mazza M, Carriero G, Moccia L, Mwangi B, Swann AC, Soares JC. Neuroanatomical Correlates of the Late Positive Potential in Youth with Pediatric Bipolar Disorder. Curr Neuropharmacol 2023; 21:1617-1630. [PMID: 37056060 PMCID: PMC10472816 DOI: 10.2174/1570159x21666230413104536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 02/22/2023] [Accepted: 02/23/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND The late positive potential (LPP) could be a marker of emotion dysregulation in youth with pediatric bipolar disorder (PBD). However, the neuroanatomical correlates of the LPP are still not clarified. OBJECTIVE To provide cortical and deep gray matter correlates of the LPP in youth, specifically, youth with PBD. METHODS Twenty-four 7 to 17 years-old children with PBD and 28 healthy controls (HC) underwent cortical thickness and deep gray matter volumes measurements through magnetic resonance imaging and LPP measurement elicited by passively viewing emotional faces through electroencephalography. T-tests compared group differences in LPP, cortical thickness, and deep gray matter volumes. Linear regressions tested the relationship between LPP amplitude and cortical thickness/deep gray matter volumes. RESULTS PBD had a more pronounced LPP amplitude for happy faces and a thinner cortex in prefrontal areas than HC. While considering both groups, a higher LPP amplitude was associated with a thicker cortex across occipital and frontal lobes, and with a smaller right globus pallidus volume. In addition, a higher LPP amplitude for happy faces was associated with smaller left caudate and left globus pallidus volumes across both groups. Finally, the LPP amplitude correlated negatively with right precentral gyrus thickness across youth with PBD, but positively across HC. CONCLUSION Neural correlates of LPP in youth included fronto-occipital areas that have been associated also with emotion processing and control. The opposite relationship between BPD and HC of LPP amplitude and right precentral gyrus thickness might explain the inefficacy of the emotional control system in PBD.
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Affiliation(s)
- Alessio Simonetti
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, 77030, USA
- Department of Neuroscience, Section of Psychiatry; Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy
| | - Marijn Lijffijt
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, 77030, USA
- Michael E. DeBakey VA Medical Center, Houston, TX, 77030, USA
| | - Sherin Kurian
- Department of Psychiatry, Texas Children’s Hospital, Houston, TX, 77030, USA
| | - Johanna Saxena
- Department of Psychiatry, Texas Children’s Hospital, Houston, TX, 77030, USA
| | - Delfina Janiri
- Department of Neuroscience, Section of Psychiatry; Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Marianna Mazza
- Department of Neuroscience, Section of Psychiatry; Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy
| | - Giulio Carriero
- Department of Neuroscience, Section of Psychiatry; Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy
| | - Lorenzo Moccia
- Department of Neuroscience, Section of Psychiatry; Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy
| | - Benson Mwangi
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, Houston, TX, 77030, USA
| | - Alan C. Swann
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, 77030, USA
- Michael E. DeBakey VA Medical Center, Houston, TX, 77030, USA
| | - Jair C. Soares
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, Houston, TX, 77030, USA
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Grigorian A, Kennedy KG, Luciw NJ, MacIntosh BJ, Goldstein BI. Obesity and Cerebral Blood Flow in the Reward Circuitry of Youth With Bipolar Disorder. Int J Neuropsychopharmacol 2022; 25:448-456. [PMID: 35092432 PMCID: PMC9211014 DOI: 10.1093/ijnp/pyac011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/13/2022] [Accepted: 01/27/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Bipolar disorder (BD) is associated with elevated body mass index (BMI) and increased rates of obesity. Obesity among individuals with BD is associated with more severe course of illness. Motivated by previous research on BD and BMI in youth as well as brain findings in the reward circuit, the current study investigates differences in cerebral blood flow (CBF) in youth BD with and without comorbid overweight/obesity (OW/OB). METHODS Participants consisted of youth, ages 13-20 years, including BD with OW/OB (BDOW/OB; n = 25), BD with normal weight (BDNW; n = 55), and normal-weight healthy controls (HC; n = 61). High-resolution T1-weighted and pseudo-continuous arterial spin labeling images were acquired using 3 Tesla magnetic resonance imaging. CBF differences were assessed using both region of interest and whole-brain voxel-wise approaches. RESULTS Voxel-wise analysis revealed significantly higher CBF in reward-associated regions in the BDNW group relative to the HC and BDOW/OB groups. CBF did not differ between the HC and BDOW/OB groups. There were no significant region of interest findings. CONCLUSIONS The current study identified distinct CBF levels relating to BMI in BD in the reward circuit, which may relate to underlying differences in cerebral metabolism, compensatory effects, and/or BD severity. Future neuroimaging studies are warranted to examine for changes in the CBF-OW/OB link over time and in relation to treatment.
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Affiliation(s)
- Anahit Grigorian
- Centre for Youth Bipolar Disorder, Department of Child and Youth Psychiatry, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Kody G Kennedy
- Centre for Youth Bipolar Disorder, Department of Child and Youth Psychiatry, Centre for Addiction and Mental Health, Toronto, Ontario, Canada,Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Nicholas J Luciw
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Bradley J MacIntosh
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada,Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, Toronto, Ontario, Canada,Hurvitz Brain Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Benjamin I Goldstein
- Correspondence: Benjamin I. Goldstein, MD, PhD, Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON, Canada, M6J 1H4 ()
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Whitmore A, Hudson S, West AE. Adapting psychosocial treatment to target parenting stress and parent–child relationships associated with transdiagnostic emotional and behavioural dysregulation in a culturally diverse population. CLIN PSYCHOL-UK 2021. [DOI: 10.1080/13284207.2021.1883403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Alina Whitmore
- Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | - Sharon Hudson
- Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, CA, USA
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Amy E. West
- Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, CA, USA
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Kurtz M, Mohring P, Förster K, Bauer M, Kanske P. Deficits in explicit emotion regulation in bipolar disorder: a systematic review. Int J Bipolar Disord 2021; 9:15. [PMID: 33937951 PMCID: PMC8089068 DOI: 10.1186/s40345-021-00221-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 02/11/2021] [Indexed: 12/20/2022] Open
Abstract
Background This study aimed to compile and synthesize studies investigating explicit emotion regulation in patients with bipolar disorder and individuals at risk of developing bipolar disorder. The importance of explicit emotion regulation arises from its potential role as a marker for bipolar disorders in individuals at risk and its potent role in therapy for bipolar disorder patients. Methods To obtain an exhaustive compilation of studies dealing specifically with explicit emotion regulation in bipolar disorder, we conducted a systematic literature search in four databases. In the 15 studies we included in our review, the emotion-regulation strategies maintenance, distraction, and reappraisal (self-focused and situation-focused) were investigated partly on a purely behavioral level and partly in conjunction with neural measures. The samples used in the identified studies included individuals at increased risk of bipolar disorder, patients with current affective episodes, and patients with euthymic mood state. Results In summary, the reviewed studies' results indicate impairments in explicit emotion regulation in individuals at risk for bipolar disorder, patients with manic and depressive episodes, and euthymic patients. These deficits manifest in subjective behavioral measures as well as in neural aberrations. Further, our review reveals a discrepancy between behavioral and neural findings regarding explicit emotion regulation in individuals at risk for bipolar disorders and euthymic patients. While these groups often do not differ significantly in behavioral measures from healthy and low-risk individuals, neural differences are mainly found in frontostriatal networks. Conclusion We conclude that these neural aberrations are a potentially sensitive measure of the probability of occurrence and recurrence of symptoms of bipolar disorders and that strengthening this frontostriatal route is a potentially protective measure for individuals at risk and patients who have bipolar disorders.
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Affiliation(s)
- Marcel Kurtz
- Clinical Psychology and Behavioral Neuroscience, Faculty of Psychology, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany.
| | - Pia Mohring
- Clinical Psychology and Behavioral Neuroscience, Faculty of Psychology, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany
| | - Katharina Förster
- Clinical Psychology and Behavioral Neuroscience, Faculty of Psychology, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, Medical Faculty, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Philipp Kanske
- Clinical Psychology and Behavioral Neuroscience, Faculty of Psychology, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany.,Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
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Berchio C, Küng AL, Kumar S, Cordera P, Dayer AG, Aubry JM, Michel CM, Piguet C. Eye-gaze processing in the broader bipolar phenotype revealed by electrical neuroimaging. Psychiatry Res Neuroimaging 2019; 291:42-51. [PMID: 31398614 DOI: 10.1016/j.pscychresns.2019.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 07/27/2019] [Accepted: 07/29/2019] [Indexed: 12/11/2022]
Abstract
Previous studies have documented atypical brain responses to faces in individuals with bipolar disorder (BD) and in their relatives. In view of previous findings of atypical face processing in youths at risk for BD, the aim of this study was to examine whether BD patients and offspring would show differential activation in networks of the social brain when processing eye-gaze. Data from 18 euthymic BD patients and 18 offspring, as well as 36 age-matched healthy controls, were collected using a delayed face-matching paradigm, event related potentials and electrical neuroimaging methods. The P200 component, which is implicated in facial cues decoding, differentiated the BD groups from their age-matched controls. P200 source reconstruction indicates impairments conveyed by eye-contact in a network involved in experiencing others' social intentions in BD patients (supplementary motor cortex, precentral gyrus, inferior parietal lobe), and the engagement of compensatory prefrontal mechanisms for modulating these functions in BD offspring. When viewing faces that had an averted gaze, BD patients and offspring showed a hypo-activation, compared to controls, particularly in regions involved in experiencing others' feelings (post-central gyrus in BD patients / ventral premotor cortex in offspring). Therefore, the neural mechanism for decoding shifts in eye-gaze may be a familial characteristic of BD.
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Affiliation(s)
- Cristina Berchio
- Department of Basic Neurosciences, Faculty of Medicine, University of Geneva, Geneva, Switzerland; Department of Mental Health and Psychiatry, Service of Psychiatric Specialties, Mood disorders unit University Hospitals of Geneva, Switzerland.
| | - Anne-Lise Küng
- Department of Mental Health and Psychiatry, Service of Psychiatric Specialties, Mood disorders unit University Hospitals of Geneva, Switzerland
| | - Samika Kumar
- Department of Psychology, University of California, Berkeley, CA, USA
| | - Paolo Cordera
- Department of Mental Health and Psychiatry, Service of Psychiatric Specialties, Mood disorders unit University Hospitals of Geneva, Switzerland
| | - Alexandre G Dayer
- Department of Basic Neurosciences, Faculty of Medicine, University of Geneva, Geneva, Switzerland; Department of Mental Health and Psychiatry, Service of Psychiatric Specialties, Mood disorders unit University Hospitals of Geneva, Switzerland; Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Jean-Michel Aubry
- Department of Mental Health and Psychiatry, Service of Psychiatric Specialties, Mood disorders unit University Hospitals of Geneva, Switzerland; Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Christoph M Michel
- Department of Basic Neurosciences, Faculty of Medicine, University of Geneva, Geneva, Switzerland; Biomedical Imaging Center (CIBM) Lausanne, Geneva, Switzerland
| | - Camille Piguet
- Department of Basic Neurosciences, Faculty of Medicine, University of Geneva, Geneva, Switzerland; Department of Mental Health and Psychiatry, Service of Psychiatric Specialties, Mood disorders unit University Hospitals of Geneva, Switzerland
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Affective processing bias in youth with primary bipolar disorder or primary attention-deficit/hyperactivity disorder. Eur Child Adolesc Psychiatry 2015; 24:1349-59. [PMID: 25724546 PMCID: PMC6518415 DOI: 10.1007/s00787-015-0686-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 01/28/2015] [Indexed: 10/23/2022]
Abstract
High rates of comorbidity and overlapping diagnostic criteria between pediatric bipolar disorder (BD) and attention-deficit/hyperactivity disorder (ADHD) contribute to diagnostic and treatment confusion. To advance what is known about both disorders, we compared effect of emotional stimuli on response control in children with primary BD, primary ADHD and typically developing controls (TDC). Participants included 7-17 year olds with either "narrow-phenotype" pediatric BD (n = 25), ADHD (n = 25) or TDC (n = 25). Groups were matched on participant age and FSIQ. The effect of emotional stimuli on response control was assessed using the Cambridge Neuropsychological Test Automated Battery Affective Go/No-Go task (CANTAB AGN). We found a group by target valence interaction on commission errors [F(2,71) = 5.34, p < 0.01, ƞ p (2) = 0.13] whereby ADHD, but not TDC participants, made more errors on negative than positive words [t(24) = -2.58, p < 0.05, r = 0.47]. In contrast, there was a nonsignificant trend for BD participants to make fewer errors on negative versus positive words compared to ADHD and TDC participants. Between-subjects effects showed that ADHD participants made more errors than TDC, but not BD participants. Our main finding advances what is known about the effect of emotional stimuli on response control in children with ADHD. Our results suggesting a positive affective processing bias in children with ADHD compliment emerging literature show that difficulties with emotional processing and regulation may be core features of ADHD. Further, given the observed pattern of results in children with ADHD compared to BD children, our behavioral results suggest the importance of examining differences in the brain-behavior mechanisms involved in affective processing in children with ADHD compared to BD children.
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Using neuroimaging to evaluate and guide pharmacological and psychotherapeutic treatments for mood disorders in children. CNS Spectr 2015; 20:359-68. [PMID: 25659836 DOI: 10.1017/s1092852914000819] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Mood disorders are increasing in childhood, and often require multimodal and comprehensive treatment plans to address a complex array of symptoms and associated morbidities. Pharmacotherapy, in combination with psychotherapeutic interventions, is essential for treatment and stabilization. Current evidence supports the use of a number of interventions in children and adolescents diagnosed with DSM-5 mood spectrum disorders, which are associated with impairments in prefrontal-striatal-limbic networks, which are key for emotional functioning and regulation. Yet, little is known about the neurobiological effects of interventions on the developing brain. This chapter provides a synopsis of the literature demonstrating the neural effects of psychotropic medications and psychotherapy in youth with depressive or bipolar spectrum disorders. Additional longitudinal and biological studies are warranted to characterize the effects of these interventions on all phases and stages of mood illness development in children and adolescents.
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12
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Bowyer SM, Gjini K, Zhu X, Kim L, Moran JE, Rizvi SU, Gumenyuk V, Tepley N, Boutros NN. Potential Biomarkers of Schizophrenia from MEG Resting-State Functional Connectivity Networks: Preliminary Data. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/jbbs.2015.51001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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13
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Neurocognitive impairments among youth with pediatric bipolar disorder: a systematic review of neuropsychological research. J Affect Disord 2014; 166:297-306. [PMID: 25012445 DOI: 10.1016/j.jad.2014.05.025] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 05/18/2014] [Accepted: 05/19/2014] [Indexed: 12/23/2022]
Abstract
BACKGROUND Pediatric bipolar disorder (PBD) has emerged as a field of research in which neuropsychological studies are continuously providing new empirical findings. Despite this, a comprehensive framework for neurocognitive impairments is still lacking, and most of the evidence remains unconnected. We addressed this question through a systematic review of neuropsychological research, with the aim of elucidating the main issues concerning this topic. METHOD A comprehensive search of databases (PubMed, PsycINFO) was performed. Published manuscripts between 1990 and January 2014 were identified. Overall, 124 studies fulfilled inclusion criteria. Methodological differences between studies required a descriptive review of findings. RESULTS Evidence indicates that verbal/visual-spatial memory, processing speed, working memory, and social cognition are neurocognitive domains impaired in PBD youth. Furthermore, these deficits are greater among those who suffer acute affective symptoms, PBD type I, and/or attention deficit hyperactivity disorder (ADHD) comorbidity. In addition, several neurocognitive deficits imply certain changes in prefrontal cortex activity and are somewhat associated with psychosocial and academic disabilities. Strikingly, these deficits are consistently similar to those encountered in ADHD as well as severe mood dysregulation (SMD). Besides, some neurocognitive impairments appear before the onset of the illness and tend to maintain stable across adolescence. Finally, any therapy has not yet demonstrated to be effective on diminishing these neurocognitive impairments. LIMITATIONS More prolonged follow-up studies aimed at delineating the course of treatment and the response to it are warranted. CONCLUSIONS Despite noteworthy research on the neurocognitive profile of PBD, our knowledge is still lagging behind evidence from adult counterparts.
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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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15
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Meaux E, Roux S, Batty M. Early visual ERPs are influenced by individual emotional skills. Soc Cogn Affect Neurosci 2013; 9:1089-98. [PMID: 23720573 DOI: 10.1093/scan/nst084] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Processing information from faces is crucial to understanding others and to adapting to social life. Many studies have investigated responses to facial emotions to provide a better understanding of the processes and the neural networks involved. Moreover, several studies have revealed abnormalities of emotional face processing and their neural correlates in affective disorders. The aim of this study was to investigate whether early visual event-related potentials (ERPs) are affected by the emotional skills of healthy adults. Unfamiliar faces expressing the six basic emotions were presented to 28 young adults while recording visual ERPs. No specific task was required during the recording. Participants also completed the Social Skills Inventory (SSI) which measures social and emotional skills. The results confirmed that early visual ERPs (P1, N170) are affected by the emotions expressed by a face and also demonstrated that N170 and P2 are correlated to the emotional skills of healthy subjects. While N170 is sensitive to the subject's emotional sensitivity and expressivity, P2 is modulated by the ability of the subjects to control their emotions. We therefore suggest that N170 and P2 could be used as individual markers to assess strengths and weaknesses in emotional areas and could provide information for further investigations of affective disorders.
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Affiliation(s)
- Emilie Meaux
- UMR Inserm U930, Université François Rabelais de Tours, CHRU de Tours, Centre Universitaire de Pédopsychiatrie, 37044 Tours Cedex 9, France
| | - Sylvie Roux
- UMR Inserm U930, Université François Rabelais de Tours, CHRU de Tours, Centre Universitaire de Pédopsychiatrie, 37044 Tours Cedex 9, France
| | - Magali Batty
- UMR Inserm U930, Université François Rabelais de Tours, CHRU de Tours, Centre Universitaire de Pédopsychiatrie, 37044 Tours Cedex 9, France
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16
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Whitney J, Joormann J, Gotlib IH, Kelley RG, Acquaye T, Howe M, Chang KD, Singh MK. Information processing in adolescents with bipolar I disorder. J Child Psychol Psychiatry 2012; 53:937-45. [PMID: 22390273 PMCID: PMC3429788 DOI: 10.1111/j.1469-7610.2012.02543.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cognitive models of bipolar I disorder (BD) may aid in identification of children who are especially vulnerable to chronic mood dysregulation. Information-processing biases related to memory and attention likely play a role in the development and persistence of BD among adolescents; however, these biases have not been extensively studied in youth with BD. METHODS We administered the self-referent encoding task and the dot-probe task to adolescents with bipolar I disorder (BD, n = 35) and a demographically similar healthy comparison group (HC, n = 25) at baseline, and at a 1-year follow-up in a subset of this cohort (n = 22 per group). RESULTS At both baseline and 1-year follow-up, there were significant interactions of group (BD, HC) and valence of stimulus (positive, negative adjective) on endorsement and recall of self-referent adjectives. HC adolescents endorsed and recalled more positive self-referent adjectives at baseline and follow-up while adolescents with BD endorsed and recalled more negative self-referent adjectives at baseline but not follow-up. Over time, depression symptomatology was associated with impaired memory for positive self-referent adjectives. There were no group differences in attentional bias at either time points. CONCLUSIONS Adolescents with BD exhibit bias away from endorsement and recall of positive adjectives, which remained stable over time and independent of mood state.
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Affiliation(s)
- Jane Whitney
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305-5719, USA.
| | - Jutta Joormann
- Department of Psychology, University of Miami, Coral Gables, FL
| | - Ian H. Gotlib
- Department of Psychology, Stanford University, Stanford, CA, USA
| | - Ryan G. Kelley
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA
| | - Tenah Acquaye
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA
| | - Meghan Howe
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA
| | - Kiki D. Chang
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA
| | - Manpreet K. Singh
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA
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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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Olsavsky AK, Brotman MA, Rutenberg JG, Muhrer EJ, Deveney CM, Fromm SJ, Towbin K, Pine DS, Leibenluft E. Amygdala hyperactivation during face emotion processing in unaffected youth at risk for bipolar disorder. J Am Acad Child Adolesc Psychiatry 2012; 51:294-303. [PMID: 22365465 PMCID: PMC3292775 DOI: 10.1016/j.jaac.2011.12.008] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Revised: 12/06/2011] [Accepted: 12/07/2011] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Youth at familial risk for bipolar disorder (BD) show deficits in face emotion processing, but the neural correlates of these deficits have not been examined. This preliminary study tests the hypothesis that, relative to healthy comparison (HC) subjects, both BD subjects and youth at risk for BD (i.e., those with a first-degree BD relative) will demonstrate amygdala hyperactivation when viewing fearful and happy faces. The at-risk youth were unaffected, in that they had no history of mood disorder. METHOD Amygdala activity was examined in 101 unrelated participants, 8 to 18 years old. Age, gender, and IQ-matched groups included BD (N = 32), unaffected at-risk (N = 13), and HC (N = 56). During functional magnetic resonance imaging, participants attended to emotional and nonemotional aspects of fearful and happy faces. RESULTS While rating their fear of fearful faces, both BD and unaffected at-risk subjects exhibited amygdala hyperactivity versus HC. There were no between-group differences in amygdala activity in response to happy faces. Post-hoc comparisons revealed that, in at-risk youth, familial risk status (offspring versus sibling), presence of Axis I diagnosis (n = 1 attention-deficit/hyperactivity disorder [ADHD], n = 1 social phobia), and history of medication exposure (n = 1) did not influence imaging findings. CONCLUSIONS We found amygdala hyperactivation in both unaffected at-risk and BD youth while rating their fear of fearful faces. These pilot data suggest that both face emotion labeling deficits and amygdala hyperactivity during face processing should receive further study as potential BD endophenotypes. Longitudinal studies should test whether amygdala hyperactivity to fearful faces predicts conversion to BD in at-risk youth.
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Affiliation(s)
- Aviva K. Olsavsky
- Section on Bipolar Spectrum Disorders, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, US Department of Health and Human Services, Bethesda, Maryland,David Geffen School of Medicine at the University of California Los Angeles
| | - Melissa A. Brotman
- Section on Bipolar Spectrum Disorders, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, US Department of Health and Human Services, Bethesda, Maryland
| | - Julia G. Rutenberg
- Section on Bipolar Spectrum Disorders, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, US Department of Health and Human Services, Bethesda, Maryland
| | - Eli J. Muhrer
- Section on Bipolar Spectrum Disorders, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, US Department of Health and Human Services, Bethesda, Maryland
| | - Christen M. Deveney
- Section on Bipolar Spectrum Disorders, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, US Department of Health and Human Services, Bethesda, Maryland
| | - Stephen J. Fromm
- Section on Bipolar Spectrum Disorders, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, US Department of Health and Human Services, Bethesda, Maryland
| | - Kenneth Towbin
- Section on Bipolar Spectrum Disorders, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, US Department of Health and Human Services, Bethesda, Maryland
| | - Daniel S. Pine
- Section on Bipolar Spectrum Disorders, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, US Department of Health and Human Services, Bethesda, Maryland
| | - Ellen Leibenluft
- Section on Bipolar Spectrum Disorders, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, US Department of Health and Human Services, Bethesda, Maryland
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Pavuluri MN, Passarotti AM, Fitzgerald JM, Wegbreit E, Sweeney JA. Risperidone and divalproex differentially engage the fronto-striato-temporal circuitry in pediatric mania: a pharmacological functional magnetic resonance imaging study. J Am Acad Child Adolesc Psychiatry 2012; 51:157-170.e5. [PMID: 22265362 PMCID: PMC3357915 DOI: 10.1016/j.jaac.2011.10.019] [Citation(s) in RCA: 35] [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] [Received: 02/25/2011] [Revised: 10/11/2011] [Accepted: 10/28/2011] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The current study examined the impact of risperidone and divalproex on affective and working memory circuitry in patients with pediatric bipolar disorder (PBD). METHOD This was a six-week, double-blind, randomized trial of risperidone plus placebo versus divalproex plus placebo for patients with mania (n = 21; 13.6 ± 2.5 years of age). Functional magnetic resonance imaging (fMRI) outcomes were measured using a block design, affective, N-back task with angry, happy, and neutral face stimuli at baseline and at 6-week follow-up. Matched healthy controls (HC; n = 15, 14.5 ± 2.8 years) were also scanned twice. RESULTS In post hoc analyses on the significant interaction in a 3×2×2 analysis of variance (ANOVA) that included patient groups and HC, the risperidone group showed greater activation after treatment in response to the angry face condition in the left subgenual anterior cingulate cortex (ACC) and striatum relative to the divalproex group. The divalproex group showed greater activation relative to the risperidone group in the left inferior frontal gyrus and right middle temporal gyrus. Over the treatment course, the risperidone group showed greater change in activation in the left ventral striatum than the divalproex group, and the divalproex group showed greater activation change in left inferior frontal gyrus and right middle temporal gyrus than the risperidone group. Furthermore, each patient group showed increased activation relative to HC in fronto-striato-temporal regions over time. The happy face condition was potentially less emotionally challenging in this study and did not elicit notable findings. CONCLUSIONS When patients performed a working memory task under emotional duress inherent in the paradigm, divalproex enhanced activation in a fronto-temporal circuit whereas risperidone increased activation in the dopamine (D₂) receptor-rich ventral striatum. Clinical trial registration information-Risperidone and Divalproex Sodium With MRI Assessment in Pediatric Bipolar; http://www.clinicaltrials.gov; NCT00176202.
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Affiliation(s)
- Mani N Pavuluri
- Pediatric Brain Research and Intervention Center, Institute for Juvenile Research, Colbeth Clinic, University of Illinois at Chicago, IL 60608, USA.
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