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Hibar DP, Westlye LT, Doan NT, Jahanshad N, Cheung JW, Ching CRK, Versace A, Bilderbeck AC, Uhlmann A, Mwangi B, Krämer B, Overs B, Hartberg CB, Abé C, Dima D, Grotegerd D, Sprooten E, Bøen E, Jimenez E, Howells FM, Delvecchio G, Temmingh H, Starke J, Almeida JRC, Goikolea JM, Houenou J, Beard LM, Rauer L, Abramovic L, Bonnin M, Ponteduro MF, Keil M, Rive MM, Yao N, Yalin N, Najt P, Rosa PG, Redlich R, Trost S, Hagenaars S, Fears SC, Alonso-Lana S, van Erp TGM, Nickson T, Chaim-Avancini TM, Meier TB, Elvsåshagen T, Haukvik UK, Lee WH, Schene AH, Lloyd AJ, Young AH, Nugent A, Dale AM, Pfennig A, McIntosh AM, Lafer B, Baune BT, Ekman CJ, Zarate CA, Bearden CE, Henry C, Simhandl C, McDonald C, Bourne C, Stein DJ, Wolf DH, Cannon DM, Glahn DC, Veltman DJ, Pomarol-Clotet E, Vieta E, Canales-Rodriguez EJ, Nery FG, Duran FLS, Busatto GF, Roberts G, Pearlson GD, Goodwin GM, Kugel H, Whalley HC, Ruhe HG, Soares JC, Fullerton JM, Rybakowski JK, Savitz J, Chaim KT, Fatjó-Vilas M, Soeiro-de-Souza MG, Boks MP, Zanetti MV, Otaduy MCG, Schaufelberger MS, Alda M, Ingvar M, Phillips ML, Kempton MJ, Bauer M, Landén M, Lawrence NS, van Haren NEM, Horn NR, Freimer NB, Gruber O, Schofield PR, Mitchell PB, Kahn RS, Lenroot R, Machado-Vieira R, Ophoff RA, Sarró S, Frangou S, Satterthwaite TD, Hajek T, Dannlowski U, Malt UF, Arolt V, Gattaz WF, Drevets WC, Caseras X, Agartz I, Thompson PM, Andreassen OA. Cortical abnormalities in bipolar disorder: an MRI analysis of 6503 individuals from the ENIGMA Bipolar Disorder Working Group. Mol Psychiatry 2018; 23:932-942. [PMID: 28461699 PMCID: PMC5668195 DOI: 10.1038/mp.2017.73] [Citation(s) in RCA: 422] [Impact Index Per Article: 70.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 02/04/2017] [Accepted: 02/10/2017] [Indexed: 12/13/2022]
Abstract
Despite decades of research, the pathophysiology of bipolar disorder (BD) is still not well understood. Structural brain differences have been associated with BD, but results from neuroimaging studies have been inconsistent. To address this, we performed the largest study to date of cortical gray matter thickness and surface area measures from brain magnetic resonance imaging scans of 6503 individuals including 1837 unrelated adults with BD and 2582 unrelated healthy controls for group differences while also examining the effects of commonly prescribed medications, age of illness onset, history of psychosis, mood state, age and sex differences on cortical regions. In BD, cortical gray matter was thinner in frontal, temporal and parietal regions of both brain hemispheres. BD had the strongest effects on left pars opercularis (Cohen's d=-0.293; P=1.71 × 10-21), left fusiform gyrus (d=-0.288; P=8.25 × 10-21) and left rostral middle frontal cortex (d=-0.276; P=2.99 × 10-19). Longer duration of illness (after accounting for age at the time of scanning) was associated with reduced cortical thickness in frontal, medial parietal and occipital regions. We found that several commonly prescribed medications, including lithium, antiepileptic and antipsychotic treatment showed significant associations with cortical thickness and surface area, even after accounting for patients who received multiple medications. We found evidence of reduced cortical surface area associated with a history of psychosis but no associations with mood state at the time of scanning. Our analysis revealed previously undetected associations and provides an extensive analysis of potential confounding variables in neuroimaging studies of BD.
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Affiliation(s)
- D P Hibar
- Imaging Genetics Center, Mark and Mary Stevens Institute for Neuroimaging & Informatics, University of Southern California, Marina del Rey, CA, USA,Janssen Research & Development, San Diego, CA, USA
| | - L T Westlye
- NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway,Department of Psychology, University of Oslo, Oslo, Norway
| | - N T Doan
- NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - N Jahanshad
- Imaging Genetics Center, Mark and Mary Stevens Institute for Neuroimaging & Informatics, University of Southern California, Marina del Rey, CA, USA
| | - J W Cheung
- Imaging Genetics Center, Mark and Mary Stevens Institute for Neuroimaging & Informatics, University of Southern California, Marina del Rey, CA, USA
| | - C R K Ching
- Imaging Genetics Center, Mark and Mary Stevens Institute for Neuroimaging & Informatics, University of Southern California, Marina del Rey, CA, USA,Neuroscience Interdepartmental Graduate Program, University of California, Los Angeles, Los Angeles, CA, USA
| | - A Versace
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - A C Bilderbeck
- University Department of Psychiatry and Oxford Health NHS Foundation Trust, University of Oxford, Oxford, UK
| | - A Uhlmann
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa,MRC Unit on Anxiety and Stress Disorders, Groote Schuur Hospital (J-2), University of Cape Town, Cape Town, South Africa
| | - B Mwangi
- UT Center of Excellence on Mood Disorders, Department of Psychiatry & Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - B Krämer
- Section for Experimental Psychopathology and Neuroimaging, Department of General Psychiatry, Heidelberg University, Heidelberg, Germany
| | - B Overs
- Neuroscience Research Australia, Sydney, NSW, Australia
| | - C B Hartberg
- NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - C Abé
- Department of Clinical Neuroscience, Osher Centre, Karolinska Institutet, Stockholm, Sweden
| | - D Dima
- Department of Psychology, City University London, London, UK,Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - D Grotegerd
- Department of Psychiatry, University of Münster, Münster, Germany
| | - E Sprooten
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - E Bøen
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - E Jimenez
- Hospital Clinic, IDIBAPS, University of Barcelona, CIBERSAM, Barcelona, Spain
| | - F M Howells
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - G Delvecchio
- IRCCS "E. Medea" Scientific Institute, San Vito al Tagliamento, Italy
| | - H Temmingh
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - J Starke
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - J R C Almeida
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - J M Goikolea
- Hospital Clinic, IDIBAPS, University of Barcelona, CIBERSAM, Barcelona, Spain
| | - J Houenou
- INSERM U955 Team 15 ‘Translational Psychiatry’, University Paris East, APHP, CHU Mondor, Fondation FondaMental, Créteil, France,NeuroSpin, UNIACT Lab, Psychiatry Team, CEA Saclay, Gif Sur Yvette, France
| | - L M Beard
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - L Rauer
- Section for Experimental Psychopathology and Neuroimaging, Department of General Psychiatry, Heidelberg University, Heidelberg, Germany
| | - L Abramovic
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M Bonnin
- Hospital Clinic, IDIBAPS, University of Barcelona, CIBERSAM, Barcelona, Spain
| | - M F Ponteduro
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - M Keil
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany
| | - M M Rive
- Program for Mood Disorders, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - N Yao
- Department of Psychiatry, Yale University, New Haven, CT, USA,Olin Neuropsychiatric Research Center, Institute of Living, Hartford Hospital, Hartford, CT, USA
| | - N Yalin
- Centre for Affective Disorders, King’s College London, London, UK
| | - P Najt
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - P G Rosa
- Department of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil,Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), University of São Paulo, São Paulo, Brazil
| | - R Redlich
- Department of Psychiatry, University of Münster, Münster, Germany
| | - S Trost
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany
| | - S Hagenaars
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
| | - S C Fears
- Department of Psychiatry, University of California, Los Angeles, Los Angeles, CA, USA,West Los Angeles Veterans Administration, Los Angeles, CA, USA
| | - S Alonso-Lana
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - T G M van Erp
- Department of Psychiatry and Human Behavior, University of California, Irvine, CA, USA
| | - T Nickson
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
| | - T M Chaim-Avancini
- Department of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil,Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), University of São Paulo, São Paulo, Brazil
| | - T B Meier
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA,Laureate Institute for Brain Research, Tulsa, OK, USA
| | - T Elvsåshagen
- NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - U K Haukvik
- NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Department of Adult Psychiatry, University of Oslo, Oslo, Norway
| | - W H Lee
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - A H Schene
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands,Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands
| | - A J Lloyd
- Academic Psychiatry and Northern Centre for Mood Disorders, Newcastle University/Northumberland Tyne & Wear NHS Foundation Trust, Newcastle, UK
| | - A H Young
- Centre for Affective Disorders, King’s College London, London, UK
| | - A Nugent
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - A M Dale
- MMIL, Department of Radiology, University of California San Diego, San Diego, CA, USA,Department of Cognitive Science, Neurosciences and Psychiatry, University of California, San Diego, San Diego, CA, USA
| | - A Pfennig
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - A M McIntosh
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
| | - B Lafer
- Department of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - B T Baune
- Department of Psychiatry, University of Adelaide, Adelaide, SA, Australia
| | - C J Ekman
- Department of Clinical Neuroscience, Osher Centre, Karolinska Institutet, Stockholm, Sweden
| | - C A Zarate
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - C E Bearden
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA,Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - C Henry
- INSERM U955 Team 15 ‘Translational Psychiatry’, University Paris East, APHP, CHU Mondor, Fondation FondaMental, Créteil, France,Institut Pasteur, Unité Perception et Mémoire, Paris, France
| | - C Simhandl
- Bipolar Center Wiener Neustadt, Wiener Neustadt, Austria
| | - C McDonald
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - C Bourne
- University Department of Psychiatry and Oxford Health NHS Foundation Trust, University of Oxford, Oxford, UK,Department of Psychology & Counselling, Newman University, Birmingham, UK
| | - D J Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa,MRC Unit on Anxiety and Stress Disorders, Groote Schuur Hospital (J-2), University of Cape Town, Cape Town, South Africa
| | - D H Wolf
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - D M Cannon
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - D C Glahn
- Department of Psychiatry, Yale University, New Haven, CT, USA,Olin Neuropsychiatric Research Center, Institute of Living, Hartford Hospital, Hartford, CT, USA
| | - D J Veltman
- Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
| | - E Pomarol-Clotet
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - E Vieta
- Hospital Clinic, IDIBAPS, University of Barcelona, CIBERSAM, Barcelona, Spain
| | - E J Canales-Rodriguez
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - F G Nery
- Department of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil,Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - F L S Duran
- Department of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil,Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), University of São Paulo, São Paulo, Brazil
| | - G F Busatto
- Department of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil,Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), University of São Paulo, São Paulo, Brazil
| | - G Roberts
- School of Psychiatry and Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - G D Pearlson
- Department of Psychiatry, Yale University, New Haven, CT, USA,Olin Neuropsychiatric Research Center, Institute of Living, Hartford Hospital, Hartford, CT, USA
| | - G M Goodwin
- University Department of Psychiatry and Oxford Health NHS Foundation Trust, University of Oxford, Oxford, UK
| | - H Kugel
- Department of Clinical Radiology, University of Münster, Münster, Germany
| | - H C Whalley
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
| | - H G Ruhe
- University Department of Psychiatry and Oxford Health NHS Foundation Trust, University of Oxford, Oxford, UK,Program for Mood Disorders, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands,Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - J C Soares
- UT Center of Excellence on Mood Disorders, Department of Psychiatry & Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - J M Fullerton
- Neuroscience Research Australia, Sydney, NSW, Australia,School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - J K Rybakowski
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - J Savitz
- Laureate Institute for Brain Research, Tulsa, OK, USA,Faculty of Community Medicine, The University of Tulsa, Tulsa, OK, USA
| | - K T Chaim
- Department of Radiology, University of São Paulo, São Paulo, Brazil,LIM44-Laboratory of Magnetic Resonance in Neuroradiology, University of São Paulo, São Paulo, Brazil
| | - M Fatjó-Vilas
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - M G Soeiro-de-Souza
- Department of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - M P Boks
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M V Zanetti
- Department of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil,Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), University of São Paulo, São Paulo, Brazil
| | - M C G Otaduy
- Department of Radiology, University of São Paulo, São Paulo, Brazil,LIM44-Laboratory of Magnetic Resonance in Neuroradiology, University of São Paulo, São Paulo, Brazil
| | - M S Schaufelberger
- Department of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil,Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), University of São Paulo, São Paulo, Brazil
| | - M Alda
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - M Ingvar
- Department of Clinical Neuroscience, Osher Centre, Karolinska Institutet, Stockholm, Sweden,Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - M L Phillips
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - M J Kempton
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - M Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - M Landén
- Department of Clinical Neuroscience, Osher Centre, Karolinska Institutet, Stockholm, Sweden,Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the Gothenburg University, Goteborg, Sweden
| | - N S Lawrence
- Department of Psychology, University of Exeter, Exeter, UK
| | - N E M van Haren
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - N R Horn
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - N B Freimer
- Center for Neurobehavioral Genetics, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
| | - O Gruber
- Section for Experimental Psychopathology and Neuroimaging, Department of General Psychiatry, Heidelberg University, Heidelberg, Germany
| | - P R Schofield
- Neuroscience Research Australia, Sydney, NSW, Australia,School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - P B Mitchell
- School of Psychiatry and Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - R S Kahn
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - R Lenroot
- Neuroscience Research Australia, Sydney, NSW, Australia,School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - R Machado-Vieira
- Department of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil,National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - R A Ophoff
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands,Center for Neurobehavioral Genetics, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
| | - S Sarró
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - S Frangou
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - T D Satterthwaite
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - T Hajek
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada,National Institute of Mental Health, Klecany, Czech Republic
| | - U Dannlowski
- Department of Psychiatry, University of Münster, Münster, Germany
| | - U F Malt
- Division of Clinical Neuroscience, Department of Research and Education, Oslo University Hospital, Oslo, Norway,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - V Arolt
- Department of Psychiatry, University of Münster, Münster, Germany
| | - W F Gattaz
- Department of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - W C Drevets
- Janssen Research & Development, Titusville, NJ, USA
| | - X Caseras
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - I Agartz
- NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - P M Thompson
- Imaging Genetics Center, Mark and Mary Stevens Institute for Neuroimaging & Informatics, University of Southern California, Marina del Rey, CA, USA
| | - O A Andreassen
- NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway,NORMENT, KG Jebsen Centre for Psychosis Research—TOP Study, Oslo University Hospital, Ullevål, Building 49, Kirkeveien 166, PO Box 4956, Nydalen, 0424, Oslo, Norway. E-mail:
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Hibar DP, Westlye LT, van Erp TGM, Rasmussen J, Leonardo CD, Faskowitz J, Haukvik UK, Hartberg CB, Doan NT, Agartz I, Dale AM, Gruber O, Krämer B, Trost S, Liberg B, Abé C, Ekman CJ, Ingvar M, Landén M, Fears SC, Freimer NB, Bearden CE, Sprooten E, Glahn DC, Pearlson GD, Emsell L, Kenney J, Scanlon C, McDonald C, Cannon DM, Almeida J, Versace A, Caseras X, Lawrence NS, Phillips ML, Dima D, Delvecchio G, Frangou S, Satterthwaite TD, Wolf D, Houenou J, Henry C, Malt UF, Bøen E, Elvsåshagen T, Young AH, Lloyd AJ, Goodwin GM, Mackay CE, Bourne C, Bilderbeck A, Abramovic L, Boks MP, van Haren NEM, Ophoff RA, Kahn RS, Bauer M, Pfennig A, Alda M, Hajek T, Mwangi B, Soares JC, Nickson T, Dimitrova R, Sussmann JE, Hagenaars S, Whalley HC, McIntosh AM, Thompson PM, Andreassen OA. Subcortical volumetric abnormalities in bipolar disorder. Mol Psychiatry 2016; 21:1710-1716. [PMID: 26857596 PMCID: PMC5116479 DOI: 10.1038/mp.2015.227] [Citation(s) in RCA: 310] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 12/08/2015] [Accepted: 12/11/2015] [Indexed: 11/29/2022]
Abstract
Considerable uncertainty exists about the defining brain changes associated with bipolar disorder (BD). Understanding and quantifying the sources of uncertainty can help generate novel clinical hypotheses about etiology and assist in the development of biomarkers for indexing disease progression and prognosis. Here we were interested in quantifying case-control differences in intracranial volume (ICV) and each of eight subcortical brain measures: nucleus accumbens, amygdala, caudate, hippocampus, globus pallidus, putamen, thalamus, lateral ventricles. In a large study of 1710 BD patients and 2594 healthy controls, we found consistent volumetric reductions in BD patients for mean hippocampus (Cohen's d=-0.232; P=3.50 × 10-7) and thalamus (d=-0.148; P=4.27 × 10-3) and enlarged lateral ventricles (d=-0.260; P=3.93 × 10-5) in patients. No significant effect of age at illness onset was detected. Stratifying patients based on clinical subtype (BD type I or type II) revealed that BDI patients had significantly larger lateral ventricles and smaller hippocampus and amygdala than controls. However, when comparing BDI and BDII patients directly, we did not detect any significant differences in brain volume. This likely represents similar etiology between BD subtype classifications. Exploratory analyses revealed significantly larger thalamic volumes in patients taking lithium compared with patients not taking lithium. We detected no significant differences between BDII patients and controls in the largest such comparison to date. Findings in this study should be interpreted with caution and with careful consideration of the limitations inherent to meta-analyzed neuroimaging comparisons.
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Affiliation(s)
- D P Hibar
- Imaging Genetics Center, University of Southern California, Los Angeles, CA, USA
| | - L T Westlye
- Division of Mental Health and Addiction, Norwegian Centre for Mental Disorders Research, KG Jebsen Centre for Psychosis Research, Oslo University Hospital, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - T G M van Erp
- Department of Psychiatry and Human Behavior, University of California, Irvine, CA, USA
| | - J Rasmussen
- Department of Psychiatry and Human Behavior, University of California, Irvine, CA, USA
| | - C D Leonardo
- Imaging Genetics Center, University of Southern California, Los Angeles, CA, USA
| | - J Faskowitz
- Imaging Genetics Center, University of Southern California, Los Angeles, CA, USA
| | - U K Haukvik
- Division of Mental Health and Addiction, Norwegian Centre for Mental Disorders Research, KG Jebsen Centre for Psychosis Research, Oslo University Hospital, Oslo, Norway
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - C B Hartberg
- Division of Mental Health and Addiction, Norwegian Centre for Mental Disorders Research, KG Jebsen Centre for Psychosis Research, Oslo University Hospital, Oslo, Norway
| | - N T Doan
- Division of Mental Health and Addiction, Norwegian Centre for Mental Disorders Research, KG Jebsen Centre for Psychosis Research, Oslo University Hospital, Oslo, Norway
| | - I Agartz
- Division of Mental Health and Addiction, Norwegian Centre for Mental Disorders Research, KG Jebsen Centre for Psychosis Research, Oslo University Hospital, Oslo, Norway
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - A M Dale
- MMIL, Department of Radiology, University of California, San Diego, CA, USA
- Department of Cognitive Science, Neurosciences and Psychiatry, University of California, San Diego, CA, USA
| | - O Gruber
- Center for Translational Research in Systems Neuroscience and Psychiatry, Department of Psychiatry and Psychotherapy, Georg August University Goettingen, Goettingen, Germany
- Section for Experimental Psychopathology and Neuroimaging, Department of General Psychiatry, Heidelberg University Hospital, Heidelberg, Germany
| | - B Krämer
- Center for Translational Research in Systems Neuroscience and Psychiatry, Department of Psychiatry and Psychotherapy, Georg August University Goettingen, Goettingen, Germany
| | - S Trost
- Center for Translational Research in Systems Neuroscience and Psychiatry, Department of Psychiatry and Psychotherapy, Georg August University Goettingen, Goettingen, Germany
| | - B Liberg
- Department of Clinical Neuroscience, Section of Psychiatry, Karolinska Institutet, Stockholm, Sweden
| | - C Abé
- Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden
| | - C J Ekman
- Department of Clinical Neuroscience, Section of Psychiatry, Karolinska Institutet, Stockholm, Sweden
| | - M Ingvar
- Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden
- Karolinska MR Research Center, Karolinska Institutet, Stockholm, Sweden
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - M Landén
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - S C Fears
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
- Center for Neurobehavioral Genetics, University of California, Los Angeles, CA, USA
| | - N B Freimer
- Center for Neurobehavioral Genetics, University of California, Los Angeles, CA, USA
| | - C E Bearden
- Center for Neurobehavioral Genetics, University of California, Los Angeles, CA, USA
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
- Department of Psychology, University of California, Los Angeles, CA, USA
| | - the Costa Rica/Colombia Consortium for Genetic Investigation of Bipolar Endophenotypes
- Imaging Genetics Center, University of Southern California, Los Angeles, CA, USA
- Division of Mental Health and Addiction, Norwegian Centre for Mental Disorders Research, KG Jebsen Centre for Psychosis Research, Oslo University Hospital, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
- Department of Psychiatry and Human Behavior, University of California, Irvine, CA, USA
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
- MMIL, Department of Radiology, University of California, San Diego, CA, USA
- Department of Cognitive Science, Neurosciences and Psychiatry, University of California, San Diego, CA, USA
- Center for Translational Research in Systems Neuroscience and Psychiatry, Department of Psychiatry and Psychotherapy, Georg August University Goettingen, Goettingen, Germany
- Section for Experimental Psychopathology and Neuroimaging, Department of General Psychiatry, Heidelberg University Hospital, Heidelberg, Germany
- Department of Clinical Neuroscience, Section of Psychiatry, Karolinska Institutet, Stockholm, Sweden
- Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden
- Karolinska MR Research Center, Karolinska Institutet, Stockholm, Sweden
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
- Center for Neurobehavioral Genetics, University of California, Los Angeles, CA, USA
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
- Department of Psychology, University of California, Los Angeles, CA, USA
- Department of Psychiatry, Yale University, New Haven, CT, USA
- Olin Neuropsychiatric Research Center, Institute of Living, Hartford, CT, USA
- Department of Neurobiology, Yale University School of Medicine, New Haven, CT, USA
- Clinical Neuroimaging Laboratory, College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
- Department of Psychiatry, Brown University, Providence, RI, USA
- Department of Psychiatry, University of Pittsburgh, Western Psychiatric Institute and Clinic, Pittsburgh, PA, USA
- MRC Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
- School of Psychology, University of Exeter, Exeter, UK
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Neurospin, Uniact, I2BM, CEA Saclay, Saclay, France
- Inserm, U955, Equipe 15 Psychiatrie génétique, Créteil, France
- Université Paris-Est, UMR-S955, UPEC, Créteil, France
- Department of Psychosomatic Medicine, Oslo University Hospital—Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Research and Education, Oslo University Hospital, Oslo, Norway
- Norwegian Research Network On Mood Disorders, Oslo, Norway
- Department of Neurology, Oslo University Hospital, Oslo, Norway
- Centre for Affective Disorders, King's College London, London, UK
- Academic Psychiatry and Regional Affective Disorders Service, Newcastle University, Newcastle, UK
- Department of Psychiatry, University of Oxford, Oxford, UK
- Department of Psychology and Counselling, Newman University, Birmingham, UK
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, UK
- Department of Psychiatry, University Medical Centre Utrecht - Brain Centre Rudolf Magnus, Utrecht, The Netherlands
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Medizinische Fakultät, Technische Universität Dresden, Dresden, Germany
- Department of Psychiatry, Dalhousie University, Halifax, Canada
- National Institute of Mental Health, Klecany, Czech Republic
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, UT Houston Medical School, Houston, TX, USA
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
| | - E Sprooten
- Department of Psychiatry, Yale University, New Haven, CT, USA
- Olin Neuropsychiatric Research Center, Institute of Living, Hartford, CT, USA
| | - D C Glahn
- Department of Psychiatry, Yale University, New Haven, CT, USA
- Olin Neuropsychiatric Research Center, Institute of Living, Hartford, CT, USA
| | - G D Pearlson
- Department of Psychiatry, Yale University, New Haven, CT, USA
- Olin Neuropsychiatric Research Center, Institute of Living, Hartford, CT, USA
- Department of Neurobiology, Yale University School of Medicine, New Haven, CT, USA
| | - L Emsell
- Clinical Neuroimaging Laboratory, College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - J Kenney
- Clinical Neuroimaging Laboratory, College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - C Scanlon
- Clinical Neuroimaging Laboratory, College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - C McDonald
- Clinical Neuroimaging Laboratory, College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - D M Cannon
- Clinical Neuroimaging Laboratory, College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - J Almeida
- Department of Psychiatry, Brown University, Providence, RI, USA
| | - A Versace
- Department of Psychiatry, University of Pittsburgh, Western Psychiatric Institute and Clinic, Pittsburgh, PA, USA
| | - X Caseras
- MRC Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - N S Lawrence
- School of Psychology, University of Exeter, Exeter, UK
| | - M L Phillips
- MRC Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - D Dima
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - G Delvecchio
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - S Frangou
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - T D Satterthwaite
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - D Wolf
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - J Houenou
- Neurospin, Uniact, I2BM, CEA Saclay, Saclay, France
- Inserm, U955, Equipe 15 Psychiatrie génétique, Créteil, France
| | - C Henry
- Inserm, U955, Equipe 15 Psychiatrie génétique, Créteil, France
- Université Paris-Est, UMR-S955, UPEC, Créteil, France
| | - U F Malt
- Department of Psychosomatic Medicine, Oslo University Hospital—Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Research and Education, Oslo University Hospital, Oslo, Norway
| | - E Bøen
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
- Department of Psychosomatic Medicine, Oslo University Hospital—Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Norwegian Research Network On Mood Disorders, Oslo, Norway
| | - T Elvsåshagen
- Division of Mental Health and Addiction, Norwegian Centre for Mental Disorders Research, KG Jebsen Centre for Psychosis Research, Oslo University Hospital, Oslo, Norway
- Department of Psychosomatic Medicine, Oslo University Hospital—Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - A H Young
- Centre for Affective Disorders, King's College London, London, UK
| | - A J Lloyd
- Academic Psychiatry and Regional Affective Disorders Service, Newcastle University, Newcastle, UK
| | - G M Goodwin
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - C E Mackay
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - C Bourne
- Department of Psychiatry, University of Oxford, Oxford, UK
- Department of Psychology and Counselling, Newman University, Birmingham, UK
| | - A Bilderbeck
- Department of Psychiatry, University of Oxford, Oxford, UK
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, UK
| | - L Abramovic
- Department of Psychiatry, University Medical Centre Utrecht - Brain Centre Rudolf Magnus, Utrecht, The Netherlands
| | - M P Boks
- Department of Psychiatry, University Medical Centre Utrecht - Brain Centre Rudolf Magnus, Utrecht, The Netherlands
| | - N E M van Haren
- Department of Psychiatry, University Medical Centre Utrecht - Brain Centre Rudolf Magnus, Utrecht, The Netherlands
| | - R A Ophoff
- Center for Neurobehavioral Genetics, University of California, Los Angeles, CA, USA
- Department of Psychiatry, University Medical Centre Utrecht - Brain Centre Rudolf Magnus, Utrecht, The Netherlands
| | - R S Kahn
- Department of Psychiatry, University Medical Centre Utrecht - Brain Centre Rudolf Magnus, Utrecht, The Netherlands
| | - M Bauer
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Medizinische Fakultät, Technische Universität Dresden, Dresden, Germany
| | - A Pfennig
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Medizinische Fakultät, Technische Universität Dresden, Dresden, Germany
| | - M Alda
- Department of Psychiatry, Dalhousie University, Halifax, Canada
| | - T Hajek
- Department of Psychiatry, Dalhousie University, Halifax, Canada
- National Institute of Mental Health, Klecany, Czech Republic
| | - B Mwangi
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, UT Houston Medical School, Houston, TX, USA
| | - J C Soares
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, UT Houston Medical School, Houston, TX, USA
| | - T Nickson
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
| | - R Dimitrova
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
| | - J E Sussmann
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
| | - S Hagenaars
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
| | - H C Whalley
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
| | - A M McIntosh
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
| | - P M Thompson
- Imaging Genetics Center, University of Southern California, Los Angeles, CA, USA
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - O A Andreassen
- Division of Mental Health and Addiction, Norwegian Centre for Mental Disorders Research, KG Jebsen Centre for Psychosis Research, Oslo University Hospital, Oslo, Norway
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Lancaster TM, Foley S, Tansey KE, Linden DEJ, Caseras X. CACNA1C risk variant is associated with increased amygdala volume. Eur Arch Psychiatry Clin Neurosci 2016; 266:269-75. [PMID: 26048451 DOI: 10.1007/s00406-015-0609-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 05/28/2015] [Indexed: 01/17/2023]
Abstract
Genome-wide association studies suggest that genetic variation within L-type calcium channel subunits confer risk to psychosis. The single nucleotide polymorphism at rs1006737 in CACNA1C has been associated with both schizophrenia and bipolar disorder and with several intermediate phenotypes that may serve as neurobiological antecedents, linking psychosis to genetic aetiology. Amongst others, it has been implicated in alterations in amygdala structure and function. In the present study, we show that the risk allele (A) is associated with increased amygdala volume in healthy individuals (n = 258). This observation reinforces a hypothesis that genetic variation may confer risk to psychosis via alterations in limbic structures. Further study of CACNA1C using intermediate phenotypes for psychosis will determine the mechanisms by which variation in this gene confers risk.
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Affiliation(s)
- T M Lancaster
- Neuroscience and Mental Health Research Institute, Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff, Wales, UK. .,Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, 70 Park Place, Cardiff, CF10 3AT, Wales, UK.
| | - S Foley
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, 70 Park Place, Cardiff, CF10 3AT, Wales, UK.,MRC Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff School of Medicine, Cardiff University, Cardiff, Wales, UK
| | - K E Tansey
- MRC Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff School of Medicine, Cardiff University, Cardiff, Wales, UK
| | - D E J Linden
- Neuroscience and Mental Health Research Institute, Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff, Wales, UK.,Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, 70 Park Place, Cardiff, CF10 3AT, Wales, UK.,MRC Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff School of Medicine, Cardiff University, Cardiff, Wales, UK
| | - X Caseras
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, 70 Park Place, Cardiff, CF10 3AT, Wales, UK.,MRC Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff School of Medicine, Cardiff University, Cardiff, Wales, UK
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Caseras X, Tansey KE, Foley S, Linden D. Association between genetic risk scoring for schizophrenia and bipolar disorder with regional subcortical volumes. Transl Psychiatry 2015; 5:e692. [PMID: 26645627 PMCID: PMC5068590 DOI: 10.1038/tp.2015.195] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 10/26/2015] [Indexed: 01/20/2023] Open
Abstract
Previous research has shown coincident abnormal regional brain volume in patients with schizophrenia (SCZ) and bipolar disorder (BD) compared with controls. Whether these abnormalities are genetically driven or explained by secondary effects of the disorder or environmental factors is unknown. We aimed to investigate the association between genetic risk scoring (GRS) for SCZ and BD with volume of brain areas previously shown to be different between these clinical groups and healthy controls. We obtained subcortical brain volume measures and GRS for SCZ and BD from a sample of 274 healthy volunteers (71.4% females, mean age 24.7 (s.d. 6.9)). Volume of the globus pallidus was associated with the shared GRS between SCZ and BD, and also with the independent GRS for each of these disorders. Volume of the amygdala was associated with the non-shared GRS between SCZ and BD, and with the independent GRS for BD. Our results for volume of the globus pallidus support the idea of SCZ and BD sharing a common underlying neurobiological abnormality associated with a common genetic risk for both these disorders. Results for volume of the amygdala, though, would suggest the existence of a distinct mechanism only associated with genetic risk for BD. Finally, the lack of association between genetic risk and volume of most subcortical structures suggests that the volumetric differences reported in patient-control comparisons may not be genetically driven, but a consequence of the disorder or co-occurring environmental factors.
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Affiliation(s)
- X Caseras
- MRC Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - K E Tansey
- MRC Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
- MRC Integrative Epidemiology Unit, School of Social and Community Medicine, Faculty of Medicine & Dentistry, University of Bristol, Bristol, UK
| | - S Foley
- MRC Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, Cardiff, UK
| | - D Linden
- MRC Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, Cardiff, UK
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Olatunji BO, Ferreira-Garcia R, Caseras X, Fullana MA, Wooderson S, Speckens A, Lawrence N, Giampietro V, Brammer MJ, Phillips ML, Fontenelle LF, Mataix-Cols D. Predicting response to cognitive behavioral therapy in contamination-based obsessive-compulsive disorder from functional magnetic resonance imaging. Psychol Med 2014; 44:2125-2137. [PMID: 24229474 DOI: 10.1017/s0033291713002766] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Although cognitive behavioral therapy (CBT) is an effective treatment for obsessive-compulsive disorder (OCD), few reliable predictors of treatment outcome have been identified. The present study examined the neural correlates of symptom improvement with CBT among OCD patients with predominantly contamination obsessions and washing compulsions, the most common OCD symptom dimension. METHOD Participants consisted of 12 OCD patients who underwent symptom provocation with contamination-related images during functional magnetic resonance imaging (fMRI) scanning prior to 12 weeks of CBT. RESULTS Patterns of brain activity during symptom provocation were correlated with a decrease on the Yale-Brown Obsessive Compulsive Scale (YBOCS) after treatment, even when controlling for baseline scores on the YBOCS and the Beck Depression Inventory (BDI) and improvement on the BDI during treatment. Specifically, activation in brain regions involved in emotional processing, such as the anterior temporal pole and amygdala, was most strongly associated with better treatment response. By contrast, activity in areas involved in emotion regulation, such as the dorsolateral prefrontal cortex, correlated negatively with treatment response mainly in the later stages within each block of exposure during symptom provocation. CONCLUSIONS Successful recruitment of limbic regions during exposure to threat cues in patients with contamination-based OCD may facilitate a better response to CBT, whereas excessive activation of dorsolateral prefrontal regions involved in cognitive control may hinder response to treatment. The theoretical implications of the findings and their potential relevance to personalized care approaches are discussed.
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Affiliation(s)
- B O Olatunji
- Department of Psychology and Psychiatry,Vanderbilt University,Nashville, TN,USA
| | | | - X Caseras
- MRC Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neurosciences,Cardiff University,UK
| | - M A Fullana
- Departments of Psychology and Psychosis Studies, Institute of Psychiatry,King's College London,UK
| | - S Wooderson
- Department of Psychological Medicine, Institute of Psychiatry,King's College London,UK
| | - A Speckens
- Department of Primary and Community Care,Radboud University Nijmegen Medical Centre,Nijmegen,The Netherlands
| | - N Lawrence
- School of Psychology,University of Exeter,UK
| | - V Giampietro
- Department of Neuroimaging, Institute of Psychiatry,King's College London,UK
| | - M J Brammer
- Department of Neuroimaging, Institute of Psychiatry,King's College London,UK
| | - M L Phillips
- Department of Psychiatry,University of Pittsburgh School of Medicine,Pittsburgh, PA,USA
| | - L F Fontenelle
- Institute of Psychiatry,Federal University of Rio de Janeiro,Brazil
| | - D Mataix-Cols
- Departments of Psychology and Psychosis Studies, Institute of Psychiatry,King's College London,UK
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Lipp I, Murphy K, Wise RG, Caseras X. Understanding the contribution of neural and physiological signal variation to the low repeatability of emotion-induced BOLD responses. Neuroimage 2013; 86:335-42. [PMID: 24128735 PMCID: PMC3898985 DOI: 10.1016/j.neuroimage.2013.10.015] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 08/29/2013] [Accepted: 10/03/2013] [Indexed: 01/28/2023] Open
Abstract
Previous studies have reported low repeatability of BOLD activation measures during emotion processing tasks. It is not clear, however, whether low repeatability is a result of changes in the underlying neural signal over time, or due to insufficient reliability of the acquired BOLD signal caused by noise contamination. The aim of this study was to investigate the influence of “cleaning” the BOLD signal, by correcting for physiological noise and for differences in BOLD responsiveness, on measures of repeatability. Fifteen healthy volunteers were scanned on two different occasions, performing an emotion provocation task with faces (neutral, 50% fearful, 100% fearful) followed by a breath-hold paradigm to provide a marker of BOLD responsiveness. Repeatability of signal distribution (spatial repeatability) and repeatability of signal amplitude within two regions of interest (amygdala and fusiform gyrus) were estimated by calculating the intraclass correlation coefficient (ICC). Significant repeatability of signal amplitude was only found within the right amygdala during the perception of 50% fearful faces, but disappeared when physiological noise correction was performed. Spatial repeatability was higher within the fusiform gyrus than within the amygdala, and better at the group level than at the participant level. Neither physiological noise correction, nor consideration of BOLD responsiveness, assessed through the breath-holding, increased repeatability. The findings lead to the conclusion that low repeatability of BOLD response amplitude to emotional faces is more likely to be explained by the lack of stability in the underlying neural signal than by physiological noise contamination. Furthermore, reported repeatability might be a result of repeatability of task-correlated physiological variation rather than neural activity. This means that the emotion paradigm used in this study might not be useful for studies that require the BOLD response to be a stable measure of emotional processing, for example in the context of biomarkers. We investigated repeatability of BOLD responses during a widely used emotion task. Repeatability of signal amplitude was low in the amygdala and in the fusiform gyrus. Spatial repeatability was higher within the fusiform gyrus than within the amygdala. Physiological noise correction did not improve any of the repeatability measures. The BOLD response to this emotion task might not be useful as a biomarker.
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Affiliation(s)
- I Lipp
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, UK; MRC Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, UK
| | - K Murphy
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, UK
| | - R G Wise
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, UK
| | - X Caseras
- MRC Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, UK.
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Caseras X, Giampietro V, Lamas A, Brammer M, Vilarroya O, Carmona S, Rovira M, Torrubia R, Mataix-Cols D. The functional neuroanatomy of blood-injection-injury phobia: a comparison with spider phobics and healthy controls. Psychol Med 2010; 40:125-134. [PMID: 19435544 DOI: 10.1017/s0033291709005972] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Most neuroimaging studies of specific phobia have investigated the animal subtype. The blood-injection-injury (BII) subtype is characterized by a unique biphasic psychophysiological response, which could suggest a distinct neural substrate, but direct comparisons between phobia types are lacking. METHOD This study compared the neural responses during the presentation of phobia-specific stimuli in 12 BII phobics, 14 spider (SP) phobics and 14 healthy controls using functional magnetic resonance imaging (fMRI). RESULTS Subjective ratings showed that the experimental paradigm produced the desired symptom-specific effects. As in many previous studies, when viewing spider-related stimuli, SP phobics showed increased activation in dorsal anterior cingulate and anterior insula, compared to BII phobics and healthy controls. However, when viewing images of blood-injection-injuries, participants with BII phobia mainly showed increased activation in the thalamus and visual/attention areas (occipito-temporo-parietal cortex), compared with the other two groups. The degree of provoked anxiety and disgust by phobia-relevant images was strongly associated with activation in several common regions across the two phobia groups (thalamus, cerebellum, occipito-temporal regions) but only correlated with activation in the dorsal anterior cingulate gyrus and the anterior insula in the SP phobics. CONCLUSIONS These results suggest partially distinct neurobiological substrates of animal and BII phobias and support their current classification as two distinct subtypes in the DSM-IV-TR. Further research is needed to better understand the precise neurobiological mechanisms in BII phobia and particularly the fainting response.
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Affiliation(s)
- X Caseras
- Department of Psychiatry and Legal Medicine, Institute of Neurosciences, Autonomous University of Barcelona, Catalonia, Spain.
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Caseras X, Mataix-Cols D, Rimes KA, Giampietro V, Brammer M, Zelaya F, Chalder T, Godfrey E. The neural correlates of fatigue: an exploratory imaginal fatigue provocation study in chronic fatigue syndrome. Psychol Med 2008; 38:941-951. [PMID: 18447963 DOI: 10.1017/s0033291708003450] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Fatigue is the central symptom in chronic fatigue syndrome (CFS) and yet very little is known about its neural correlates. The aim of this study was to explore the functional brain response, using functional magnetic resonance imaging (fMRI), to the imaginal experience of fatigue in CFS patients and controls. METHOD We compared the blood oxygen level dependent (BOLD) responses of 12 CFS patients and 11 healthy controls to a novel fatigue provocation procedure designed to mimic real-life situations. A non-fatiguing anxiety-provoking condition was also included to control for the non-specific effects of negative affect. RESULTS During the provocation of fatigue, CFS patients reported feelings of both fatigue and anxiety and, compared to controls, they showed increased activation in the occipito-parietal cortex, posterior cingulate gyrus and parahippocampal gyrus, and decreased activation in dorsolateral and dorsomedial prefrontal cortices. The reverse pattern of findings was observed during the anxiety-provoking scenarios. CONCLUSIONS The results may suggest that, in CFS patients, the provocation of fatigue is associated with exaggerated emotional responses that patients may have difficulty suppressing. These findings are discussed in relation to the cognitive-behavioural model of CFS.
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Affiliation(s)
- X Caseras
- Unitat de Psicologia Mèdica, Institut de Neurociències, Universitat Autònoma de Barcelona, Catalonia, Spain.
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Lázaro C, Caseras X, Baños JE. Postherpetic neuralgia: a descriptive analysis of patients seen in pain clinics. Reg Anesth Pain Med 2003; 28:315-20. [PMID: 12945025 DOI: 10.1016/s1098-7339(03)00178-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND OBJECTIVE Postherpetic neuralgia (PHN) is a common ailment that pain specialists must often cope with. The goal of the present survey is to investigate the pain characteristics of 119 PHN patients with persistent pain seen at different pain clinics. Methods information on demographic features, pain characteristics (MPQ-SV, VAS, VRS), and treatment was recorded by means of a standard case report form. RESULTS Gender, age, location, and treatment were consistent with previous reports. Antidepressant, antiepileptic, and analgesic drugs were the most commonly used by patients. The patients seen in pain clinics are probably a subset of severe cases of PHN, where delayed referral to these units plays an important role. The most frequent qualitative features of the disease were the McGill Pain Questionnaire-Spanish Version (MPQ-SV). These features may change in relation to illness evolution; electric shocklike pain and emotional distress were significantly higher after 6 months of evolution and age (those younger than 70 were more able to locate painful areas and to feel pain as pricking or sharp), and gender (men selected spatial pressure and traction pressure more frequently). None of the explored variables was relevant to predicting pain intensity. CONCLUSIONS This study reveals a subset of patients, mostly suffering from long-term PHN, where pain persists. The most frequent qualitative traits of PHN patients are described. Some variables were involved in modulation of pain characteristics in these patients. The effect of study design in interpretation of results is discussed.
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Affiliation(s)
- C Lázaro
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
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Lázaro C, Caseras X, Torrubia R, Baños JE. [Measurement of postoperative pain: analysis of the sensitivity of various self-evaluation instruments]. Rev Esp Anestesiol Reanim 2003; 50:230-6. [PMID: 12833796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
OBJECTIVES This study compared the sensitivity of two one-dimensional scales (a visual analog scale [VAS] and a verbal scale of pain intensity [VSPI]) and one multidimensional scale (McGill Pain Questionnaire-Spanish Version [MPQ-SV]) for detecting changes in pain after a variety of surgical procedures with postoperative analgesia provided by one of two methods. PATIENTS AND METHODS Forty-two patients who underwent abdominal surgery, hysterectomy, cesarean, inguinal herniorrhaphy, subcostal or medial laparoscopic cholecystectomy were studied. Postoperative analgesia consisted of 1 mg/Kg of intravenous pethidine every 4 h in group one (n = 20) and intramuscular diclofenac every 12 h in group two. Assessment was at 24 h and/or at 48 and 72 h using the VAS, the VSPI and the MPQ-SV. RESULTS All the scales were useful for assessing postoperative pain, giving estimates that were sensitive to variations in pain on days after the operation. The MPQ-SV was able to detect different pain-producing capacities for the surgical procedures more effectively than were the one-dimensional scales. The MPQ-SV was also able to discriminate the qualitative and quantitative differences among the mechanisms of action of opioid and nonsteroidal anti-inflammatory drugs, whereas the one-dimensional scales were unable to distinguish therapeutic approach. CONCLUSIONS All the scales were sensitive to changes in postoperative pain, but the MPQ-SV gave more precise information of differences between analgesic treatments and among operations.
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Affiliation(s)
- C Lázaro
- Departamento de Farmacología, de Terapéutica y de Toxicología, Facultad de Medicina, Universitat Autònoma de Barcelona.
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Caseras X, Àvila C, Torrubia R. The measurement of individual differences in Behavioural Inhibition and Behavioural Activation Systems: a comparison of personality scales. Personality and Individual Differences 2003. [DOI: 10.1016/s0191-8869(02)00084-3] [Citation(s) in RCA: 120] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Lázaro C, Caseras X, Whizar-Lugo VM, Wenk R, Baldioceda F, Bernal R, Ovalle A, Torrubia R, Baños JE. Psychometric properties of a Spanish version of the McGill Pain Questionnaire in several Spanish-speaking countries. Clin J Pain 2001; 17:365-74. [PMID: 11783818 DOI: 10.1097/00002508-200112000-00012] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Versions of the McGill Pain Questionnaire are available in a several languages and are used in clinical studies and sociocultural or ethnic comparisons of pain issues. However, there is a lack of studies that compare the validity and reliability of the instrument in the countries where it is used. The current study investigates the psychometric properties of a Spanish version of the McGill Pain Questionnaire in five Spanish-speaking countries. DESIGN The authors conducted a multicenter and transnational study with one investigator in each center. Patients were evaluated once with a Spanish version of the McGill Pain Questionnaire, a visual analog scale, and a verbal rating scale. SETTING The study was performed in pain clinics and acute pain units of four Latin American countries (Argentina, Costa Rica, Mexico, and Panama) and Spain. PATIENTS The study included 205 patients (84 with acute pain, 121 with chronic pain) from Latin America. Their data were compared with those of 282 Spanish patients. INTERVENTIONS The McGill Pain Questionnaire, visual analog scale, and verbal rating scale were administered once to all patients. The McGill Pain Questionnaire was administered again to patients from Latin America countries to ascertain descriptor comprehension. OUTCOME MEASURES Demographic data, McGill Pain Questionnaire parameters, and visual analog scale and a verbal rating scale scores were obtained from patients with chronic and acute pain. Psychometric properties of the Spanish version of the McGill Pain Questionnaire were established for each country by calculating the ordinal consistency by means of rank-scale correlation (Spearman test), intercategory correlation, and interparameter correlation (Pearson test). Concurrent validity was also calculated by comparing scores from the visual analog scale (Pearson test) and verbal rating scale (Spearman test) with questionnaire parameters (qualitative-to-quantitative comparisons). RESULTS The Spanish version of the McGill Pain Questionnaire maintained a high internal validity when tested in different countries. Ordinal consistency, intercategory, interparameter, and qualitative-to-quantitative parameter correlations were similar in all countries. Few descriptors were considered to be inappropriate or difficult to understand. CONCLUSIONS The psychometric properties of the Spanish version of the McGill Pain Questionnaire assessed in different Latin-American countries suggest that the questionnaire may be used to evaluate Spanish-speaking patients. The validity of this test should be extended with reliability studies to further establish its usefulness in the evaluation of pain.
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Affiliation(s)
- C Lázaro
- Department of Farmacologia, de Terapéutica i de Toxicologia, Universitat Autònoma de Barcelona, Bellaterra, Spain
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