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Wu YK, Su YA, Li L, Zhu LL, Li K, Li JT, Mitchell PB, Yan CG, Si TM. Brain functional changes across mood states in bipolar disorder: from a large-scale network perspective. Psychol Med 2024; 54:763-774. [PMID: 38084586 DOI: 10.1017/s0033291723002453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
BACKGROUND Exploring the neural basis related to different mood states is a critical issue for understanding the pathophysiology underlying mood switching in bipolar disorder (BD), but research has been scarce and inconsistent. METHODS Resting-state functional magnetic resonance imaging data were acquired from 162 patients with BD: 33 (hypo)manic, 64 euthymic, and 65 depressive, and 80 healthy controls (HCs). The differences of large-scale brain network functional connectivity (FC) between the four groups were compared and correlated with clinical characteristics. To validate the generalizability of our findings, we recruited a small longitudinal independent sample of BD patients (n = 11). In addition, we examined topological nodal properties across four groups as exploratory analysis. RESULTS A specific strengthened pattern of network FC, predominantly involving the default mode network (DMN), was observed in (hypo)manic patients when compared with HCs and bipolar patients in other mood states. Longitudinal observation revealed an increase in several network FCs in patients during (hypo)manic episode. Both samples evidenced an increase in the FC between the DMN and ventral attention network, and between the DMN and limbic network (LN) related to (hypo)mania. The altered network connections were correlated with mania severity and positive affect. Bipolar depressive patients exhibited decreased FC within the LN compared with HCs. The exploratory analysis also revealed an increase in degree in (hypo)manic patients. CONCLUSIONS Our findings identify a distributed pattern of large-scale network disturbances in the unique context of (hypo)mania and thus provide new evidence for our understanding of the neural mechanism of BD.
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Affiliation(s)
- Yan-Kun Wu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Yun-Ai Su
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Le Li
- Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Center for Cognitive Science of Language, Beijing Language and Culture University, Beijing, China
| | - Lin-Lin Zhu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Ke Li
- PLA Strategic Support Force Characteristic Medical Center, Beijing, China
| | - Ji-Tao Li
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Philip B Mitchell
- School of Psychiatry, University of New South Wales, Sydney, Australia
- Black Dog Institute, Prince of Wales Hospital, Sydney, Australia
| | - Chao-Gan Yan
- Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Tian-Mei Si
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
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2
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Wu Y, Su YA, Zhu L, Li J, Si T. Advances in functional MRI research in bipolar disorder: from the perspective of mood states. Gen Psychiatr 2024; 37:e101398. [PMID: 38292862 PMCID: PMC10826570 DOI: 10.1136/gpsych-2023-101398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 12/20/2023] [Indexed: 02/01/2024] Open
Abstract
Bipolar disorder is characterised by recurrent and alternating episodes of mania/hypomania and depression. Current breakthroughs in functional MRI techniques have uncovered the functional neuroanatomy of bipolar disorder. However, the pathophysiology underlying mood instability, mood switching and the development of extreme mood states is less well understood. This review presents a comprehensive overview of current evidence from functional MRI studies from the perspective of mood states. We first summarise the disrupted brain activation patterns and functional connectivity that have been reported in bipolar disorder, irrespective of the mood state. We next focus on research that solely included patients in a single mood state for a better understanding of the pathophysiology of bipolar disorder and research comparing patients with different mood states to dissect mood state-related effects. Finally, we briefly summarise current theoretical models and conclude this review by proposing potential avenues for future research. A comprehensive understanding of the pathophysiology with consideration of mood states could not only deepen our understanding of how acute mood episodes develop at a neurophysiological level but could also facilitate the identification of biological targets for personalised treatment and the development of new interventions for bipolar disorder.
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Affiliation(s)
- Yankun Wu
- Department of Clinical Psychopharmacology, Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Yun-Ai Su
- Department of Clinical Psychopharmacology, Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Linlin Zhu
- Department of Clinical Psychopharmacology, Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Jitao Li
- Department of Clinical Psychopharmacology, Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Tianmei Si
- Department of Clinical Psychopharmacology, Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
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Martino M, Magioncalda P. A three-dimensional model of neural activity and phenomenal-behavioral patterns. Mol Psychiatry 2023:10.1038/s41380-023-02356-w. [PMID: 38114633 DOI: 10.1038/s41380-023-02356-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 11/16/2023] [Accepted: 11/27/2023] [Indexed: 12/21/2023]
Abstract
How phenomenal experience and behavior are related to neural activity in physiology and psychopathology represents a fundamental question in neuroscience and psychiatry. The phenomenal-behavior patterns may be deconstructed into basic dimensions, i.e., psychomotricity, affectivity, and thought, which might have distinct neural correlates. This work provides a data overview on the relationship of these phenomenal-behavioral dimensions with brain activity across physiological and pathological conditions (including major depressive disorder, bipolar disorder, schizophrenia, attention-deficit/hyperactivity disorder, anxiety disorders, addictive disorders, Parkinson's disease, Tourette syndrome, Alzheimer's disease, and frontotemporal dementia). Accordingly, we propose a three-dimensional model of neural activity and phenomenal-behavioral patterns. In this model, neural activity is organized into distinct units in accordance with connectivity patterns and related input/output processing, manifesting in the different phenomenal-behavioral dimensions. (1) An external neural unit, which involves the sensorimotor circuit/brain's sensorimotor network and is connected with the external environment, processes external inputs/outputs, manifesting in the psychomotor dimension (processing of exteroception/somatomotor activity). External unit hyperactivity manifests in psychomotor excitation (hyperactivity/hyperkinesia/catatonia), while external unit hypoactivity manifests in psychomotor inhibition (retardation/hypokinesia/catatonia). (2) An internal neural unit, which involves the interoceptive-autonomic circuit/brain's salience network and is connected with the internal/body environment, processes internal inputs/outputs, manifesting in the affective dimension (processing of interoception/autonomic activity). Internal unit hyperactivity manifests in affective excitation (anxiety/dysphoria-euphoria/panic), while internal unit hypoactivity manifests in affective inhibition (anhedonia/apathy/depersonalization). (3) An associative neural unit, which involves the brain's associative areas/default-mode network and is connected with the external/internal units (but not with the environment), processes associative inputs/outputs, manifesting in the thought dimension (processing of ideas). Associative unit hyperactivity manifests in thought excitation (mind-wandering/repetitive thinking/psychosis), while associative unit hypoactivity manifests in thought inhibition (inattention/cognitive deficit/consciousness loss). Finally, these neural units interplay and dynamically combine into various neural states, resulting in the complex phenomenal experience and behavior across physiology and neuropsychiatric disorders.
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Affiliation(s)
- Matteo Martino
- Graduate Institute of Mind Brain and Consciousness, Taipei Medical University, Taipei, Taiwan.
| | - Paola Magioncalda
- Graduate Institute of Mind Brain and Consciousness, Taipei Medical University, Taipei, Taiwan.
- International Master/Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
- Department of Radiology, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan.
- Department of Medical Research, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan.
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4
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Estudillo-Guerra MA, Linnman C, Galvez V, Chapa-Koloffon G, Pacheco-Barrios K, Morales-Quezada L, Flores Ramos M. Is brain perfusion correlated to switching mood states and cognitive impairment in bipolar disorder type I? A longitudinal study using perfusion imaging approach. Front Psychiatry 2023; 14:1244134. [PMID: 37860170 PMCID: PMC10582948 DOI: 10.3389/fpsyt.2023.1244134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 09/13/2023] [Indexed: 10/21/2023] Open
Abstract
Type I Bipolar disorder (BD-I) is a neuropsychiatric disorder characterized by manic or mixed-featured episodes, impaired cognitive functioning, and persistent work and social functioning impairment. This study aimed to investigate within-subject; (i) differences in brain perfusion using Single-photon emission computed tomography (SPECT) between manic and euthymic states in BD-I patients; (ii) explore potential associations between altered brain perfusion and cognitive status; and (iii) examine the relationship between cerebral perfusion and mania symptom ratings. Seventeen adult patients diagnosed with BD-I in a manic episode were recruited, and clinical assessments, cognitive tests, and brain perfusion studies were conducted at baseline (mania state) and a follow-up visit 6 months later. The results showed cognitive impairment during the manic episode, which persisted during the euthymic state at follow-up. However, no significant changes in brain perfusion were observed between the manic and euthymic states. During mania, trends toward decreased perfusion in the left cerebellum and right superior parietal lobule were noted. Additionally, trends indicated a higher perfusion imbalance in the left superior and middle frontal gyrus during mania and the right superior and middle frontal gyrus during euthymia. No significant correlations existed between brain perfusion, mania symptom ratings, and cognitive performance, indicating that symptomatology might represent more than neural hemodynamics. These findings suggest that cognitive impairment may persist in BD-I patients and highlight the need for therapeutic interventions targeting cognitive deficits. More extensive studies with extended follow-up periods are warranted further to investigate brain perfusion and cognitive functioning in BD-I patients.
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Affiliation(s)
- Maria Anayali Estudillo-Guerra
- Clínica de Trastornos del Afecto, Instituto Nacional de Psiquiatría “Ramón de la Fuente”, Mexico City, Mexico
- Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Clas Linnman
- Spaulding Neuroimaging Laboratory, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, MA, United States
| | - Victor Galvez
- Laboratorio de Neurociencias Cognitivas y Desarrollo, Escuela de Psicología, Universidad Panamericana, Mexico City, Mexico
| | | | - Kevin Pacheco-Barrios
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Vicerrectorado de Investigación, Unidad de Investigación Para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru
| | - Leon Morales-Quezada
- Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Monica Flores Ramos
- Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico
- Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
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5
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Lynch CJ, Elbau I, Ng T, Ayaz A, Zhu S, Manfredi N, Johnson M, Wolk D, Power JD, Gordon EM, Kay K, Aloysi A, Moia S, Caballero-Gaudes C, Victoria LW, Solomonov N, Goldwaser E, Zebley B, Grosenick L, Downar J, Vila-Rodriguez F, Daskalakis ZJ, Blumberger DM, Williams N, Gunning FM, Liston C. Expansion of a frontostriatal salience network in individuals with depression. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.08.09.551651. [PMID: 37645792 PMCID: PMC10461904 DOI: 10.1101/2023.08.09.551651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Hundreds of neuroimaging studies spanning two decades have revealed differences in brain structure and functional connectivity in depression, but with modest effect sizes, complicating efforts to derive mechanistic pathophysiologic insights or develop biomarkers. 1 Furthermore, although depression is a fundamentally episodic condition, few neuroimaging studies have taken a longitudinal approach, which is critical for understanding cause and effect and delineating mechanisms that drive mood state transitions over time. The emerging field of precision functional mapping using densely-sampled longitudinal neuroimaging data has revealed unexpected, functionally meaningful individual differences in brain network topology in healthy individuals, 2-5 but these approaches have never been applied to individuals with depression. Here, using precision functional mapping techniques and 11 datasets comprising n=187 repeatedly sampled individuals and >21,000 minutes of fMRI data, we show that the frontostriatal salience network is expanded two-fold in most individuals with depression. This effect was replicable in multiple samples, including large-scale, group-average data (N=1,231 subjects), and caused primarily by network border shifts affecting specific functional systems, with three distinct modes of encroachment occurring in different individuals. Salience network expansion was unexpectedly stable over time, unaffected by changes in mood state, and detectable in children before the subsequent onset of depressive symptoms in adolescence. Longitudinal analyses of individuals scanned up to 62 times over 1.5 years identified connectivity changes in specific frontostriatal circuits that tracked fluctuations in specific symptom domains and predicted future anhedonia symptoms before they emerged. Together, these findings identify a stable trait-like brain network topology that may confer risk for depression and mood-state dependent connectivity changes in frontostriatal circuits that predict the emergence and remission of depressive symptoms over time.
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6
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Abé C, Liberg B, Klahn AL, Petrovic P, Landén M. Mania-related effects on structural brain changes in bipolar disorder - a narrative review of the evidence. Mol Psychiatry 2023; 28:2674-2682. [PMID: 37147390 PMCID: PMC10615759 DOI: 10.1038/s41380-023-02073-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 04/12/2023] [Accepted: 04/14/2023] [Indexed: 05/07/2023]
Abstract
Cross-sectional neuroimaging studies show that bipolar disorder is associated with structural brain abnormalities, predominantly observed in prefrontal and temporal cortex, cingulate gyrus, and subcortical regions. However, longitudinal studies are needed to elucidate whether these abnormalities presage disease onset or are consequences of disease processes, and to identify potential contributing factors. Here, we narratively review and summarize longitudinal structural magnetic resonance imaging studies that relate imaging outcomes to manic episodes. First, we conclude that longitudinal brain imaging studies suggest an association of bipolar disorder with aberrant brain changes, including both deviant decreases and increases in morphometric measures. Second, we conclude that manic episodes have been related to accelerated cortical volume and thickness decreases, with the most consistent findings occurring in prefrontal brain areas. Importantly, evidence also suggests that in contrast to healthy controls, who in general show age-related cortical decline, brain metrics remain stable or increase during euthymic periods in bipolar disorder patients, potentially reflecting structural recovering mechanisms. The findings stress the importance of preventing manic episodes. We further propose a model of prefrontal cortical trajectories in relation to the occurrence of manic episodes. Finally, we discuss potential mechanisms at play, remaining limitations, and future directions.
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Affiliation(s)
- Christoph Abé
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Quantify Research, Stockholm, Sweden
| | - Benny Liberg
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Anna Luisa Klahn
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Chemistry and Molecular Biology, University of Gothenburg, Gothenburg, Sweden
| | - Predrag Petrovic
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Center for Cognitive and Computational Neuropsychiatry, Karolinska Institutet, Stockholm, Sweden
- Center for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
| | - Mikael Landén
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
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7
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Riedel P, Lee J, Watson CG, Jimenez AM, Reavis EA, Green MF. Reorganization of the functional connectome from rest to a visual perception task in schizophrenia and bipolar disorder. Psychiatry Res Neuroimaging 2022; 327:111556. [PMID: 36327867 PMCID: PMC10611423 DOI: 10.1016/j.pscychresns.2022.111556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 09/13/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022]
Abstract
Functional connectome organization is altered in schizophrenia (SZ) and bipolar disorder (BD). However, it remains unclear whether network reorganization during a task relative to rest is also altered in these disorders. This study examined connectome organization in patients with SZ (N = 43) and BD (N = 42) versus healthy controls (HC; N = 39) using fMRI data during a visual object-perception task and at rest. Graph analyses were conducted for the whole-brain network using indices selected a priori: three reflecting network segregation (clustering coefficient, local efficiency, modularity), two reflecting integration (characteristic path length, global efficiency). Group differences were limited to network segregation and were more evident in SZ (clustering coefficient, modularity) than in BD (clustering coefficient) compared to HC. State differences were found across groups for segregation (local efficiency) and integration (characteristic path length). There was no group-by-state interaction for any graph index. In summary, aberrant network organization compared to HC was confirmed, and was more evident in SZ than in BD. Yet, reorganization was largely intact in both disorders. These findings help to constrain models of dysconnection in SZ and BD, suggesting that the extent of functional dysconnectivity in these disorders tends to persist across changes in mental state.
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Affiliation(s)
- Philipp Riedel
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, 760 Westwood Plaza, Los Angeles, CA 90024, USA; Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Würzburger Straße 35, Dresden 01187, Germany.
| | - Junghee Lee
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, 760 Westwood Plaza, Los Angeles, CA 90024, USA; Desert Pacific Mental Illness Research, Education, and Clinical Center, Greater Los Angeles VA Healthcare System, Bldg. 210, 11301 Wilshire Blvd, Los Angeles, CA 90073, USA; Department of Psychiatry and Behavioral Neurobiology, School of Medicine, The University of Alabama at Birmingham, SC 560, 1720 2nd Ave S, Birmingham, AL 35294-0017, USA
| | - Christopher G Watson
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Amy M Jimenez
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, 760 Westwood Plaza, Los Angeles, CA 90024, USA; Desert Pacific Mental Illness Research, Education, and Clinical Center, Greater Los Angeles VA Healthcare System, Bldg. 210, 11301 Wilshire Blvd, Los Angeles, CA 90073, USA
| | - Eric A Reavis
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, 760 Westwood Plaza, Los Angeles, CA 90024, USA; Desert Pacific Mental Illness Research, Education, and Clinical Center, Greater Los Angeles VA Healthcare System, Bldg. 210, 11301 Wilshire Blvd, Los Angeles, CA 90073, USA
| | - Michael F Green
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, 760 Westwood Plaza, Los Angeles, CA 90024, USA; Desert Pacific Mental Illness Research, Education, and Clinical Center, Greater Los Angeles VA Healthcare System, Bldg. 210, 11301 Wilshire Blvd, Los Angeles, CA 90073, USA
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8
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Chen P, Chen G, Zhong S, Chen F, Ye T, Gong J, Tang G, Pan Y, Luo Z, Qi Z, Huang L, Wang Y. Thyroid hormones disturbances, cognitive deficits and abnormal dynamic functional connectivity variability of the amygdala in unmedicated bipolar disorder. J Psychiatr Res 2022; 150:282-291. [PMID: 35429738 DOI: 10.1016/j.jpsychires.2022.03.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 03/16/2022] [Accepted: 03/21/2022] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Accumulating evidence suggests that hypothalamus-pituitary-thyroid (HPT) axis dysfunction is relevant to the neuropsychological and pathophysiology functions of bipolar disorder (BD). However, no research has investigated the inter-relationships among thyroid hormones disturbance, neurocognitive deficits, and aberrant brain function (particularly in the amygdala) in patients with BD. MATERIALS AND METHODS Data of dynamic resting-state functional connectivity (rs-dFC) were gathered from 59 patients with unmedicated BD II during depressive episodes and 52 healthy controls (HCs). Four seeds were selected (the bilateral lateral amygdala and the bilateral medial amygdala). The sliding-window analysis was applied to investigate dynamic functional connectivity (dFC). Additionally, the serum thyroid hormone (free tri-iodothyronine (FT3), total tri-iodothyronine (TT3), free thyroxin (FT4), total thyroxin (TT4) and thyroid-stimulating hormone (TSH)) levels, and cognitive scores on the MATRICS Consensus Cognitive Battery (MCCB) in patients and HCs were detected. RESULTS The BD group exhibited increased dFC variability between the left medial amygdala and right medial prefrontal cortex (mPFC) when compared with the HC group. Additionally, the BD group showed lower FT3, TT3, and TSH level, higher FT4 level, and poorer cognitive score. Moreover, a significant negative correlation was observed between the dFC variability of the left medial amygdala-right mPFC and TSH level, or reasoning and problem solving of MCCB score in BD group. Multiple regression analysis showed that the TSH level × dFC variability of the medial amygdala-mPFC was an independent predictor for cognitive processing speed in BD group. CONCLUSIONS This study revealed patients with BD II depression had excessive variability in dFC between the medial amygdala and mPFC. Moreover, both HPT axis dysfunction and abnormal dFC of the amygdala-mPFC might be implicated in cognitive impairment in the early stages of BD.
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Affiliation(s)
- Pan Chen
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China; Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, 510630, China
| | - Guanmao Chen
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China; Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, 510630, China
| | - Shuming Zhong
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - Feng Chen
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China; Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, 510630, China
| | - Tao Ye
- Clinical Laboratory Center, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - JiaYing Gong
- Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, 510630, China; Department of Radiology, Six Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510655, China
| | - Guixian Tang
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China; Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, 510630, China
| | - Youling Pan
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China; Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, 510630, China
| | - Zhenye Luo
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China; Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, 510630, China
| | - Zhangzhang Qi
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China; Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, 510630, China
| | - Li Huang
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China; Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, 510630, China
| | - Ying Wang
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China; Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, 510630, China.
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9
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Goldman DA, Sankar A, Colic L, Villa L, Kim JA, Pittman B, Constable RT, Scheinost D, Blumberg HP. A graph theory-based whole brain approach to assess mood state differences in adolescents and young adults with bipolar disorder. Bipolar Disord 2022; 24:412-423. [PMID: 34665907 PMCID: PMC9016085 DOI: 10.1111/bdi.13144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 09/21/2021] [Accepted: 10/14/2021] [Indexed: 01/05/2023]
Abstract
OBJECTIVES Identifying hubs of brain dysfunction in adolescents and young adults with Bipolar I Disorder (BDAYA ) could provide targets for early detection, prevention, and treatment. Previous neuroimaging studies across mood states of BDAYA are scarce and often examined limited brain regions potentially prohibiting detection of other important regions. We used a data-driven whole-brain Intrinsic Connectivity Distribution (ICD) approach to investigate dysconnectivity hubs across mood states in BDAYA . METHODS Functional magnetic resonance imaging whole-brain ICD data were investigated for differences across four groups: BDAYA -depressed (n = 22), BDAYA -euthymic (n = 45), BDAYA -elevated (n = 24), and healthy controls (HC, n = 111). Clusters of ICD differences were assessed for regional dysconnectivity and mood symptom relationships. Analyses were also performed for BDAYA overall (vs. HC) ICD differences persisting across mood states. RESULTS ICD was higher in the BDAYA- depressed group than other groups in bilateral ventral/rostral/dorsal prefrontal cortex (PFC) and right lenticular nucleus (LN) (pcorrected <0.05). In BDAYA -depressed, functional connectivity (FC) was increased between these regions with their contralateral homologues and PFC-medial temporal FC was more negative (p < 0.005). PFC-related findings correlated with depression scores (p < 0.05). The overall BDAYA group showed ICD increases in more ventral left PFC and right cerebellum, present across euthymia and acute mood states. CONCLUSIONS This ICD approach supports a PFC hub of inter- and intra-hemispheric frontotemporal dysconnectivity in BDAYA with potential trait features and disturbances of higher magnitude during depression. Hubs were also revealed in LN and cerebellum, less common foci of BD research. The hubs are potential targets for early interventions to detect, prevent, and treat BD.
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Affiliation(s)
- Danielle A Goldman
- Interdepartmental Neuroscience Program, Yale University School of Medicine, New Haven, CT 06511,Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06511
| | - Anjali Sankar
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06511,Department of Neurology and Neurobiology Research Unit, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lejla Colic
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06511,Department of Psychiatry and Psychotherapy, University Hospital Jena, Jena, Germany
| | - Luca Villa
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06511,Department of Psychiatry, University of Oxford, UK
| | - Jihoon A Kim
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06511
| | - Brian Pittman
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06511
| | - R Todd Constable
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT 06511
| | - Dustin Scheinost
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT 06511
| | - Hilary P Blumberg
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06511,Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT 06511,Child Study Center, Yale University School of Medicine, New Haven, CT 06511
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10
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Tracing the psychopathology of bipolar disorder to the functional architecture of intrinsic brain activity and its neurotransmitter modulation: a three-dimensional model. Mol Psychiatry 2022; 27:793-802. [PMID: 33414499 DOI: 10.1038/s41380-020-00982-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/22/2020] [Accepted: 12/01/2020] [Indexed: 12/17/2022]
Abstract
Bipolar disorder (BD) shows complex alterations in psychomotor, affective, and thought dimensions, as described by Kraepelin in his fundamental model of manic-depressive illness. In turn, the expression of behavioral/phenomenological dimensions is traceable to intrinsic brain activity. We reported a data overview on intrinsic brain functioning and its changes in BD. Accordingly, we proposed a three-dimensional model of the relationship between brain functioning and behavioral/phenomenological patterns, along with its application to BD. In this model, intrinsic brain activity is organized in distinct units in accordance to connectivity patterns and related setting of input/output processing, underlying the different behavioral/phenomenological dimensions. An external unit (mainly involving the sensorimotor network) is connected with the external environment and sets the exteroceptive input/somatomotor output processing, underlying the psychomotor dimension. An internal unit (mainly involving the salience network) is connected to the internal/body environment and sets the interoceptive input/visceromotor output processing, underlying the affective dimension. Finally, an associative unit (mainly involving the default-mode network) is not connected with the environment and sets the processing of associative inputs/outputs, underlying the thought dimension. In each unit, neurotransmitter signaling couples the subcortical-cortical loop, which modulates the network activity levels, in turn setting input/output processing and related expression levels of the behavioral/phenomenological dimension. Different combinations in neurotransmitter signaling favor network balancing into distinct functional brain states, which manifest in different combinations of excitation or inhibition in psychomotricity, affectivity, and thought, resulting in the manic, depressive, and mixed states of BD. Our working model might provide a coherent framework for tracing the complex BD psychopathology to core functional brain alterations.
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11
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A unified model of the pathophysiology of bipolar disorder. Mol Psychiatry 2022; 27:202-211. [PMID: 33859358 DOI: 10.1038/s41380-021-01091-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/17/2021] [Accepted: 03/29/2021] [Indexed: 02/02/2023]
Abstract
This work provides an overview of the most consistent alterations in bipolar disorder (BD), attempting to unify them in an internally coherent working model of the pathophysiology of BD. Data on immune-inflammatory changes, structural brain abnormalities (in gray and white matter), and functional brain alterations (from neurotransmitter signaling to intrinsic brain activity) in BD were reviewed. Based on the reported data, (1) we hypothesized that the core pathological alteration in BD is a damage of the limbic network that results in alterations of neurotransmitter signaling. Although heterogeneous conditions can lead to such damage, we supposed that the main pathophysiological mechanism is traceable to an immune/inflammatory-mediated alteration of white matter involving the limbic network connections, which destabilizes the neurotransmitter signaling, such as dopamine and serotonin signaling. Then, (2) we suggested that changes in such neurotransmitter signaling (potentially triggered by heterogeneous stressors onto a structurally-damaged limbic network) lead to phasic (and often recurrent) reconfigurations of intrinsic brain activity, from abnormal subcortical-cortical coupling to changes in network activity. We suggested that the resulting dysbalance between networks, such as sensorimotor networks, salience network, and default-mode network, clinically manifest in combined alterations of psychomotricity, affectivity, and thought during the manic and depressive phases of BD. Finally, (3) we supposed that an additional contribution of gray matter alterations and related cognitive deterioration characterize a clinical-biological subgroup of BD. This model may provide a general framework for integrating the current data on BD and suggests novel specific hypotheses, prompting for a better understanding of the pathophysiology of BD.
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12
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Song Y, Yang J, Chang M, Wei Y, Yin Z, Zhu Y, Zhou Y, Zhou Y, Jiang X, Wu F, Kong L, Xu K, Wang F, Tang Y. Shared and distinct functional connectivity of hippocampal subregions in schizophrenia, bipolar disorder, and major depressive disorder. Front Psychiatry 2022; 13:993356. [PMID: 36186868 PMCID: PMC9515660 DOI: 10.3389/fpsyt.2022.993356] [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: 07/13/2022] [Accepted: 08/19/2022] [Indexed: 11/13/2022] Open
Abstract
Schizophrenia (SZ), bipolar disorder (BD), and major depressive disorder (MDD) share etiological and pathophysiological characteristics. Although neuroimaging studies have reported hippocampal alterations in SZ, BD, and MDD, little is known about how different hippocampal subregions are affected in these conditions because such subregions, namely, the cornu ammonis (CA), dentate gyrus (DG), and subiculum (SUB), have different structural foundations and perform different functions. Here, we hypothesize that different hippocampal subregions may reflect some intrinsic features among the major psychiatric disorders, such as SZ, BD, and MDD. By investigating resting functional connectivity (FC) of each hippocampal subregion among 117 SZ, 103 BD, 96 MDD, and 159 healthy controls, we found similarly and distinctly changed FC of hippocampal subregions in the three disorders. The abnormal functions of middle frontal gyrus might be the core feature of the psychopathological mechanisms of SZ, BD, and MDD. Anterior cingulate cortex and inferior orbital frontal gyrus might be the shared abnormalities of SZ and BD, and inferior orbital frontal gyrus is also positively correlated with depression and anxiety symptoms in SZ and BD. Caudate might be the unique feature of SZ and showed a positive correlation with the cognitive function in SZ. Middle temporal gyrus and supplemental motor area are the differentiating features of BD. Our study provides evidence for the different functions of different hippocampal subregions in psychiatric pathology.
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Affiliation(s)
- Yanzhuo Song
- Department of Psychiatry, First Hospital of China Medical University, Shenyang, China
| | - Jingyu Yang
- Department of Psychiatry, First Hospital of China Medical University, Shenyang, China.,Early Intervention Unit, Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
| | - Miao Chang
- Department of Radiology, First Hospital of China Medical University, Shenyang, China
| | - Yange Wei
- Department of Psychiatry, First Hospital of China Medical University, Shenyang, China.,Early Intervention Unit, Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
| | - Zhiyang Yin
- Department of Psychiatry, First Hospital of China Medical University, Shenyang, China
| | - Yue Zhu
- Department of Psychiatry, First Hospital of China Medical University, Shenyang, China
| | - Yuning Zhou
- Department of Psychiatry, First Hospital of China Medical University, Shenyang, China
| | - Yifang Zhou
- Department of Psychiatry, First Hospital of China Medical University, Shenyang, China
| | - Xiaowei Jiang
- Department of Psychiatry, First Hospital of China Medical University, Shenyang, China.,Department of Radiology, First Hospital of China Medical University, Shenyang, China
| | - Feng Wu
- Department of Psychiatry, First Hospital of China Medical University, Shenyang, China
| | - Lingtao Kong
- Department of Psychiatry, First Hospital of China Medical University, Shenyang, China
| | - Ke Xu
- Department of Radiology, First Hospital of China Medical University, Shenyang, China
| | - Fei Wang
- Department of Psychiatry, First Hospital of China Medical University, Shenyang, China.,Early Intervention Unit, Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
| | - Yanqing Tang
- Department of Psychiatry, First Hospital of China Medical University, Shenyang, China
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13
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Dynamics of amygdala connectivity in bipolar disorders: a longitudinal study across mood states. Neuropsychopharmacology 2021; 46:1693-1701. [PMID: 34099869 PMCID: PMC8280117 DOI: 10.1038/s41386-021-01038-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 04/30/2021] [Accepted: 05/03/2021] [Indexed: 11/25/2022]
Abstract
Alterations in activity and connectivity of brain circuits implicated in emotion processing and emotion regulation have been observed during resting-state for different clinical phases of bipolar disorders (BD), but longitudinal investigations across different mood states in the same patients are still rare. Furthermore, measuring dynamics of functional connectivity patterns offers a powerful method to explore changes in the brain's intrinsic functional organization across mood states. We used a novel co-activation pattern (CAP) analysis to explore the dynamics of amygdala connectivity at rest in a cohort of 20 BD patients prospectively followed-up and scanned across distinct mood states: euthymia (20 patients; 39 sessions), depression (12 patients; 18 sessions), or mania/hypomania (14 patients; 18 sessions). We compared them to 41 healthy controls scanned once or twice (55 sessions). We characterized temporal aspects of dynamic fluctuations in amygdala connectivity over the whole brain as a function of current mood. We identified six distinct networks describing amygdala connectivity, among which an interoceptive-sensorimotor CAP exhibited more frequent occurrences during hypomania compared to other mood states, and predicted more severe symptoms of irritability and motor agitation. In contrast, a default-mode CAP exhibited more frequent occurrences during depression compared to other mood states and compared to controls, with a positive association with depression severity. Our results reveal distinctive interactions between amygdala and distributed brain networks in different mood states, and foster research on interoception and default-mode systems especially during the manic and depressive phase, respectively. Our study also demonstrates the benefits of assessing brain dynamics in BD.
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14
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Lippard ET, Weber W, Welge J, Adler CM, Fleck DE, Almeida J, DelBello MP, Strakowski SM. Variation in rostral anterior cingulate functional connectivity with amygdala and caudate during first manic episode distinguish bipolar young adults who do not remit following treatment. Bipolar Disord 2021; 23:500-508. [PMID: 33089593 PMCID: PMC8060357 DOI: 10.1111/bdi.13025] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 09/04/2020] [Accepted: 10/19/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Altered activity in the ventrolateral prefrontal and anterior cingulate cortices, as well as subcortical and amygdala projection sites, was previously reported during a first manic episode in youth with bipolar disorder and observed to be associated with treatment response. To extend these findings, we investigated functional connectivity among these regions in first-episode manic participants who remitted after 8 weeks of treatment compared to those who did not. METHODS Forty-two participants with bipolar disorder (60% female) during their first manic episode were recruited and received 8 weeks of treatment. Twenty-one remitted following treatment. Participants completed fMRI scans, at baseline and following 8 weeks of treatment, while performing a continuous performance task with emotional and neutral distractors. A healthy comparison group (n = 41) received fMRI evaluations at the same intervals. Differences in functional connectivity of the amygdala and caudate with the rostral anterior cingulate and ventrolateral prefrontal cortices at baseline (and changes in functional connectivity following treatment) were modeled between groups. RESULTS At baseline, non-remitters showed an increase in positive connectivity between right anterior cingulate and caudate and a loss of negative connectivity between right anterior cingulate and amygdala, compared to healthy participants. Individuals who remitted following treatment showed an increase in negative connectivity between amygdala and left anterior cingulate 8 weeks following treatment. CONCLUSIONS Results provide evidence of alterations in anterior cingulate amygdala and caudate functional connectivity in bipolar disorder non-remitters during a first manic episode and changes in anterior cingulate functional connectivity associated with remission suggesting targets to predict treatment response. Registered at ClinicalTrials.Gov; Functional and Neurochemical Brain Changes in First-episode Bipolar Mania. NCT00609193. URL: https://clinicaltrials.gov/ct2/show/NCT00609193?term=strakowskirank=1.
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Affiliation(s)
- Elizabeth T.C. Lippard
- Department of Psychiatry and Behavioral Sciences, Dell Medical School, University of Texas, Austin, TX, USA,Waggoner Center for Alcohol and Addiction Research, University of Texas, Austin, TX, USA,Institute for Neuroscience, University of Texas, Austin, TX, USA,Department of Psychology, University of Texas, Austin, TX, USA,Institute of Early Life Adversity Research, University of Texas, Austin, TX, USA
| | - Wade Weber
- Department of Psychiatry and Behavioral Sciences, Dell Medical School, University of Texas, Austin, TX, USA
| | - Jeffrey Welge
- Department of Psychiatry and Behavioral Neuroscience and Center for Imaging Research, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Caleb M. Adler
- Department of Psychiatry and Behavioral Neuroscience and Center for Imaging Research, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - David E. Fleck
- Department of Psychiatry and Behavioral Neuroscience and Center for Imaging Research, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jorge Almeida
- Department of Psychiatry and Behavioral Sciences, Dell Medical School, University of Texas, Austin, TX, USA
| | - Melissa P. DelBello
- Department of Psychiatry and Behavioral Neuroscience and Center for Imaging Research, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Stephen M. Strakowski
- Department of Psychiatry and Behavioral Sciences, Dell Medical School, University of Texas, Austin, TX, USA,Waggoner Center for Alcohol and Addiction Research, University of Texas, Austin, TX, USA,Institute for Neuroscience, University of Texas, Austin, TX, USA,Department of Psychology, University of Texas, Austin, TX, USA
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15
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Pope HG, Kanayama G, Hudson JI, Kaufman MJ. Review Article: Anabolic-Androgenic Steroids, Violence, and Crime: Two Cases and Literature Review. Am J Addict 2021; 30:423-432. [PMID: 33870584 DOI: 10.1111/ajad.13157] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 01/16/2021] [Accepted: 02/04/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Anabolic-androgenic steroid (AAS) use has become a major worldwide substance use disorder, affecting tens of millions of individuals. Importantly, it is now increasingly recognized that some individuals develop uncharacteristically violent or criminal behaviors when using AAS. We sought to summarize available information on this topic. METHODS We reviewed the published literature on AAS-induced behavioral effects and augmented this information with extensive observations from our clinical and forensic experience. RESULTS It is now generally accepted that some AAS users develop uncharacteristically violent or criminal behaviors while taking these drugs. Although these behaviors may partially reflect premorbid psychopathology, sociocultural factors, or expectational effects, accumulating evidence suggests that they are also attributable to biological effects of AAS themselves. The mechanism of these effects remains speculative, but preliminary data suggest a possible role for brain regions involved in emotional reactivity, such as the amygdala and regions involved in cognitive control, including the frontal cortex. For unknown reasons, these effects appear idiosyncratic; most AAS users display few behavioral effects, but a minority develops severe effects. CONCLUSION AND SCIENTIFIC SIGNIFICANCE Professionals encountering AAS users in clinical or forensic settings should be alert to the possibility of AAS-induced violence or criminality and should employ strategies to assess whether AAS is indeed a contributory factor in a given case. Further research is needed to elucidate the mechanism of AAS-induced violence and to explain why only a subset of AAS users appears vulnerable to these effects. (Am J Addict 2021;00:00-00).
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Affiliation(s)
- Harrison G Pope
- Biological Psychiatry Laboratory, McLean Hospital, Belmont, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Gen Kanayama
- Biological Psychiatry Laboratory, McLean Hospital, Belmont, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - James I Hudson
- Biological Psychiatry Laboratory, McLean Hospital, Belmont, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Marc J Kaufman
- Harvard Medical School, Boston, Massachusetts.,McLean Imaging Center, McLean Hospital, Belmont, Massachusetts
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16
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Bora E, Can G, Zorlu N, Ulas G, Inal N, Ozerdem A. Structural dysconnectivity in offspring of individuals with bipolar disorder: The effect of co-existing clinical-high-risk for bipolar disorder. J Affect Disord 2021; 281:109-116. [PMID: 33310660 DOI: 10.1016/j.jad.2020.11.122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 11/22/2020] [Accepted: 11/26/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Bipolar disorder (BD) might be associated in disturbances in brain networks. However, little is known about the abnormalities in structural brain connectivity which might be related to vulnerability to BD and predictive of the emergence of manic symptoms. No previous study has investigated the effect of subthreshold syndromes on structural dysconnectivity in offspring of parents with BD (BDoff). METHODS We investigated diffusion weighted images of 70 BDoff and 48 healthy controls (HC). Nineteen of the 70 BDoff had presented with subthreshold syndromes indicating a clinical high-risk (BDoff-CHR) and other 51 BDoff had no such history (BDoff-non-CHR). Global and regional network properties, rich club organization and inter-regional connectivity in BDoff and healthy controls were investigated using graph analytical methods and network-based-statistics (NBS). RESULTS Global properties of WM networks appeared to be intact in BDoff-CHR and BDoff-non-CHR. However, decreased regional connectivity in right occipito-parietal areas and cerebellum was a common feature of both BDoff groups. Importantly, decreased interregional connectivity between nodes in right and left prefrontal regions, nodes in right prefrontal lobe and right temporal lobe and nodes in left occipital area and left cerebellum were evident in BDoff-CHR but not BDoff-non-CHR. LIMITATIONS The cross-sectional nature of the study was the main consideration. CONCLUSION Decreased regional connectivity in right posterior brain regions might be related to vulnerability to BD. On the other hand, interregional dysconnectivity in anterior frontal and limbic regions and left posterior brain regions might be evident in individuals genetically at risk for developing BD who had experienced subthreshold mood symptoms.
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Affiliation(s)
- Emre Bora
- Dokuz Eylul University, Faculty of Medicine, Department of Psychiatry, Izmir, Turkey; Dokuz Eylul University, Institute of Neuroscience, Izmir, Turkey; Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne.
| | - Gunes Can
- Izmir Biomedicine and Genome Center, Dokuz Eylul University Health Campus, Izmir, Turkey
| | - Nabi Zorlu
- Department of Psychiatry, Faculty of Medicine, Ataturk Training and Research Hospital, Izmir Katip Celebi University, İzmir, Turkey
| | - Gozde Ulas
- Department of Child and Adolescent Psychiatry, Tepecik Research and Training Hospital, İzmir, Turkey
| | - Neslihan Inal
- Dokuz Eylul University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Izmir, Turkey
| | - Aysegul Ozerdem
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
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17
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Zeng C, Ross B, Xue Z, Huang X, Wu G, Liu Z, Tao H, Pu W. Abnormal Large-Scale Network Activation Present in Bipolar Mania and Bipolar Depression Under Resting State. Front Psychiatry 2021; 12:634299. [PMID: 33841204 PMCID: PMC8032940 DOI: 10.3389/fpsyt.2021.634299] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 02/16/2021] [Indexed: 01/14/2023] Open
Abstract
Introduction: Previous studies have primarily focused on the neuropathological mechanisms of the emotional circuit present in bipolar mania and bipolar depression. Recent studies applying resting-state functional magnetic resonance imaging (fMRI) have raise the possibility of examining brain-wide networks abnormality between the two oppositional emotion states, thus this study aimed to characterize the different functional architecture represented in mania and depression by employing group-independent component analysis (gICA). Materials and Methods: Forty-one bipolar depressive patients, 20 bipolar manic patients, and 40 healthy controls (HCs) were recruited and received resting-state fMRI scans. Group-independent component analysis was applied to the brain network functional connectivity analysis. Then, we calculated the correlation between the value of between-group differences and clinical variables. Results: Group-independent component analysis identified 15 components in all subjects, and ANOVA showed that functional connectivity (FC) differed significantly in the default mode network, central executive network, and frontoparietal network across the three groups. Further post-hoc t-tests showed a gradient descent of activity-depression > HC > mania-in all three networks, with the differences between depression and HCs, as well as between depression and mania, surviving after family wise error (FWE) correction. Moreover, central executive network and frontoparietal network activities were positively correlated with Hamilton depression rating scale (HAMD) scores and negatively correlated with Young manic rating scale (YMRS) scores. Conclusions: Three brain networks heighten activity in depression, but not mania; and the discrepancy regions mainly located in prefrontal, which may imply that the differences in cognition and emotion between the two states is associated with top-down regulation in task-independent networks.
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Affiliation(s)
- Can Zeng
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Brendan Ross
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Zhimin Xue
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xiaojun Huang
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Guowei Wu
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Zhening Liu
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Haojuan Tao
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Weidan Pu
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China
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18
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Beyer DKE, Horn L, Klinker N, Freund N. Risky decision-making following prefrontal D1 receptor manipulation. Transl Neurosci 2021; 12:432-443. [PMID: 34760299 PMCID: PMC8569284 DOI: 10.1515/tnsci-2020-0187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/13/2021] [Accepted: 09/13/2021] [Indexed: 12/15/2022] Open
Abstract
The prefrontal dopamine D1 receptor (D1R) is involved in cognitive processes. Viral overexpression of this receptor in rats further increases the reward-related behaviors and even its termination induces anhedonia and helplessness. In this study, we investigated the risky decision-making during D1R overexpression and its termination. Rats conducted the rodent version of the Iowa gambling task daily. In addition, the methyl CpG–binding protein-2 (MeCP2), one regulator connecting the dopaminergic system, cognitive processes, and mood-related behavior, was investigated after completion of the behavioral tasks. D1R overexpressing subjects exhibited maladaptive risky decision-making and risky decisions returned to control levels following termination of D1R overexpression; however, after termination, animals earned less reward compared to control subjects. In this phase, MeCP2-positive cells were elevated in the right amygdala. Our results extend the previously reported behavioral changes in the D1R-manipulated animal model to increased risk-taking and revealed differential MeCP2 expression adding further evidence for a bipolar disorder-like phenotype of this model.
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Affiliation(s)
- Dominik K. E. Beyer
- Division of Experimental and Molecular Psychiatry, Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr-University, 44801 Bochum, Germany
| | - Lisa Horn
- Division of Experimental and Molecular Psychiatry, Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr-University, 44801 Bochum, Germany
| | - Nadine Klinker
- Division of Experimental and Molecular Psychiatry, Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr-University, 44801 Bochum, Germany
| | - Nadja Freund
- Division of Experimental and Molecular Psychiatry, Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr-University, 44801 Bochum, Germany
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19
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Fan Z, Yang J, Zeng C, Xi C, Wu G, Guo S, Xue Z, Liu Z, Tao H. Bipolar Mood State Reflected in Functional Connectivity of the Hate Circuit: A Resting-State Functional Magnetic Resonance Imaging Study. Front Psychiatry 2020; 11:556126. [PMID: 33192670 PMCID: PMC7652934 DOI: 10.3389/fpsyt.2020.556126] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 08/28/2020] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Previous studies suggested bipolar disorder caused an aberrant alteration in the insular, putamen, and left superior frontal gyrus, which are the main components of the hate circuit. However, the relationship between the hate circuit and the pathophysiologic substrate underlying different phases of bipolar disorder remain unclear. In this study, we aimed to identify group differences of resting-state functional connectivity within the hate circuit in healthy controls (HCs) and bipolar patients in different mood states. METHODS Resting-state functional magnetic resonance imaging of the brain were acquired from 54 HCs and 81 patients with bipolar disorder including 20 with bipolar mania (BM), 35 with bipolar depression (BD), and 26 with bipolar euthymia (BE). We selected bilateral insula (L.INS and R.INS), bilateral putamen (L.PUT and R.PUT), and left superior frontal gyrus (L.SFGd) as seed regions, and conducted the seed-based functional connectivity analysis to identify group differences of connectivity strength within the hate circuit. Spearman correlations were performed to evaluate the relationship between the hate circuit and manic/depressive symptoms. RESULTS Significant group differences of connectivity strength within the hate circuit were found in links of the R.INS-L.SFGd, R.PUT-L.SFGd, and L.INS- R.PUT after false discovery rate was corrected. The BM group showed an opposite hate circuit pattern to BD, BE, and HCs. The BD group showed decreased hate circuit connectivity in the L.INS-R.PUT compared with the BE group. No significant difference was detected among BD, BE, and HCs. Furthermore, functional connectivity of the R.INS-L.SFGd and R.PUT-L.SFGd were positively correlated with manic symptoms, while the L.INS- R.PUT was negatively correlated with depressive symptoms. CONCLUSIONS Our preliminary findings suggest that altered functional connectivity of the hate circuit in different mood phases may be related to state markers and underpin the neuropathological basis of bipolar disorder.
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Affiliation(s)
- Zebin Fan
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Mental Disorders, Changsha, China
- National Technology Institute on Mental Disorders, Changsha, China
| | - Jie Yang
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Mental Disorders, Changsha, China
- National Technology Institute on Mental Disorders, Changsha, China
| | - Can Zeng
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Mental Disorders, Changsha, China
- National Technology Institute on Mental Disorders, Changsha, China
| | - Chang Xi
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Mental Disorders, Changsha, China
- National Technology Institute on Mental Disorders, Changsha, China
| | - Guowei Wu
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Mental Disorders, Changsha, China
- National Technology Institute on Mental Disorders, Changsha, China
| | - Shuixia Guo
- Mathematics and Computer Science College, Hunan Normal University, Changsha, China
| | - Zhimin Xue
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Mental Disorders, Changsha, China
- National Technology Institute on Mental Disorders, Changsha, China
| | - Zhening Liu
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Mental Disorders, Changsha, China
- National Technology Institute on Mental Disorders, Changsha, China
| | - Haojuan Tao
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Mental Disorders, Changsha, China
- National Technology Institute on Mental Disorders, Changsha, China
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20
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Neuroanatomic and Functional Neuroimaging Findings. Curr Top Behav Neurosci 2020; 48:173-196. [PMID: 33040316 DOI: 10.1007/7854_2020_174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The search for brain morphology findings that could explain behavioral disorders has gone through a long path in the history of psychiatry. With the advance of brain imaging technology, studies have been able to identify brain morphology and neural circuits associated with the pathophysiology of mental illnesses, such as bipolar disorders (BD). Promising results have also shown the potential of neuroimaging findings in the identification of outcome predictors and response to treatment among patients with BD. In this chapter, we present brain imaging structural and functional findings associated with BD, as well as their hypothesized relationship with the pathophysiological aspects of that condition and their potential clinical applications.
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The Amygdala in Schizophrenia and Bipolar Disorder: A Synthesis of Structural MRI, Diffusion Tensor Imaging, and Resting-State Functional Connectivity Findings. Harv Rev Psychiatry 2020; 27:150-164. [PMID: 31082993 DOI: 10.1097/hrp.0000000000000207] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Frequently implicated in psychotic spectrum disorders, the amygdala serves as an important hub for elucidating the convergent and divergent neural substrates in schizophrenia and bipolar disorder, the two most studied groups of psychotic spectrum conditions. A systematic search of electronic databases through December 2017 was conducted to identify neuroimaging studies of the amygdala in schizophrenia and bipolar disorder, focusing on structural MRI, diffusion tensor imaging (DTI), and resting-state functional connectivity studies, with an emphasis on cross-diagnostic studies. Ninety-four independent studies were selected for the present review (49 structural MRI, 27 DTI, and 18 resting-state functional MRI studies). Also selected, and analyzed in a separate meta-analysis, were 33 volumetric studies with the amygdala as the region-of-interest. Reduced left, right, and total amygdala volumes were found in schizophrenia, relative to both healthy controls and bipolar subjects, even when restricted to cohorts in the early stages of illness. No volume abnormalities were observed in bipolar subjects relative to healthy controls. Shape morphometry studies showed either amygdala deformity or no differences in schizophrenia, and no abnormalities in bipolar disorder. In contrast to the volumetric findings, DTI studies of the uncinate fasciculus tract (connecting the amygdala with the medial- and orbitofrontal cortices) largely showed reduced fractional anisotropy (a marker of white matter microstructure abnormality) in both schizophrenia and bipolar patients, with no cross-diagnostic differences. While decreased amygdalar-orbitofrontal functional connectivity was generally observed in schizophrenia, varying patterns of amygdalar-orbitofrontal connectivity in bipolar disorder were found. Future studies can consider adopting longitudinal approaches with multimodal imaging and more extensive clinical subtyping to probe amygdalar subregional changes and their relationship to the sequelae of psychotic disorders.
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22
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Damme KSF, Alloy LB, Young CB, Kelley NJ, Chein J, Ng TH, Titone MK, Black CL, Nusslock R. Amygdala subnuclei volume in bipolar spectrum disorders: Insights from diffusion-based subsegmentation and a high-risk design. Hum Brain Mapp 2020; 41:3358-3369. [PMID: 32386113 PMCID: PMC7375099 DOI: 10.1002/hbm.25021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 04/06/2020] [Accepted: 04/13/2020] [Indexed: 12/31/2022] Open
Abstract
Amygdala abnormalities are widely documented in bipolar spectrum disorders (BSD). Amygdala volume typically is measured after BSD onset; thus, it is not known whether amygdala abnormalities predict BSD risk or relate to the disorder. Additionally, past literature often treated the amygdala as a homogeneous structure, and did not consider its distinct subnuclei and their differential connectivity to other brain regions. To address these issues, we used a behavioral high‐risk design and diffusion‐based subsegmentation to examine amygdala subnuclei among medication‐free individuals with, and at risk for, BSD. The behavioral high‐risk design (N = 114) included low‐risk (N = 37), high‐risk (N = 47), and BSD groups (N = 30). Diffusion‐based subsegmentation of the amygdala was conducted to determine whether amygdala volume differences related to particular subnuclei. Individuals with a BSD diagnosis showed greater whole, bilateral amygdala volume compared to Low‐Risk individuals. Examination of subnuclei revealed that the BSD group had larger volumes compared to the High‐Risk group in both the left medial and central subnuclei, and showed larger volume in the right lateral subnucleus compared to the Low‐Risk group. Within the BSD group, specific amygdala subnuclei volumes related to time since first episode onset and number of lifetime episodes. Taken together, whole amygdala volume analyses replicated past findings of enlargement in BSD, but did not detect abnormalities in the high‐risk group. Examination of subnuclei volumes detected differences in volume between the high‐risk and BSD groups that were missed in the whole amygdala volume. Results have implications for understanding amygdala abnormalities among individuals with, and at risk for, a BSD.
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Affiliation(s)
| | - Lauren B Alloy
- Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA
| | - Christina B Young
- Department of Psychology, Northwestern University, Evanston, Illinois, USA.,Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Nicholas J Kelley
- Department of Psychology, Northwestern University, Evanston, Illinois, USA.,School of Psychology, University of Southampton, Southampton, UK
| | - Jason Chein
- Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA
| | - Tommy H Ng
- Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA
| | - Madison K Titone
- Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA
| | - Chelsea L Black
- Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA.,Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Robin Nusslock
- Department of Psychology, Northwestern University, Evanston, Illinois, USA
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23
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Jimenez AM, Riedel P, Lee J, Reavis EA, Green MF. Linking resting-state networks and social cognition in schizophrenia and bipolar disorder. Hum Brain Mapp 2019; 40:4703-4715. [PMID: 31322784 DOI: 10.1002/hbm.24731] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 06/21/2019] [Accepted: 07/07/2019] [Indexed: 12/25/2022] Open
Abstract
Individuals with schizophrenia and bipolar disorder show alterations in functional neural connectivity during rest. However, resting-state network (RSN) disruptions have not been systematically compared between the two disorders. Further, the impact of RSN disruptions on social cognition, a key determinant of functional outcome, has not been studied. Forty-eight individuals with schizophrenia, 46 with bipolar disorder, and 48 healthy controls completed resting-state functional magnetic resonance imaging. An atlas-based approach was used to examine functional connectivity within nine RSNs across the cortex. RSN connectivity was assessed via nonparametric permutation testing, and associations with performance on emotion perception, mentalizing, and emotion management tasks were examined. Group differences were observed in the medial and lateral visual networks and the sensorimotor network. Individuals with schizophrenia demonstrated reduced connectivity relative to healthy controls in all three networks. Individuals with bipolar disorder demonstrated reduced connectivity relative to controls in the medial visual network and connectivity within this network was significantly positively correlated with emotion management. In healthy controls, connectivity within the medial and lateral visual networks positively correlated with mentalizing. No significant correlations were found for either visual network in schizophrenia. Results highlight the role of altered early visual processing in social cognitive deficits in both schizophrenia and bipolar disorder. However, individuals with bipolar disorder appear to compensate for disrupted visual network connectivity on social cognitive tasks, whereas those with schizophrenia do not. The current study adds clarity on the neurophysiology underlying social cognitive deficits that result in impaired functioning in serious mental illness.
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Affiliation(s)
- Amy M Jimenez
- Desert Pacific MIRECC, VA Greater Los Angeles Healthcare System, Los Angeles, California.,Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, California
| | - Philipp Riedel
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, California.,Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Dresden, Sachsen, Germany
| | - Junghee Lee
- Desert Pacific MIRECC, VA Greater Los Angeles Healthcare System, Los Angeles, California.,Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, California
| | - Eric A Reavis
- Desert Pacific MIRECC, VA Greater Los Angeles Healthcare System, Los Angeles, California.,Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, California
| | - Michael F Green
- Desert Pacific MIRECC, VA Greater Los Angeles Healthcare System, Los Angeles, California.,Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, California
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24
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Basavaraju R, Mehta UM, Pascual-Leone A, Thirthalli J. Elevated mirror neuron system activity in bipolar mania: Evidence from a transcranial magnetic stimulation study. Bipolar Disord 2019; 21:259-269. [PMID: 30422373 PMCID: PMC7610514 DOI: 10.1111/bdi.12723] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES The role of the "mirror neuron system" (MNS) in the pathophysiology of mood disorders is not well studied. Given its posited role in the often-impaired socio-emotional processes like intention detection, empathy, and imitation, we compared putative MNS-activity in patients with bipolar mania and healthy comparison subjects. We also examined the association between putative MNS-activity and hyper-imitative behaviors in patients. METHODS We studied 39 medication-free individuals diagnosed with mania and 45 healthy comparison subjects. TMS-evoked motor cortical reactivity was measured via single- and paired-pulse stimuli (assessing SICI-short and LICI-long interval intracortical inhibition) while subjects viewed a static image and goal-directed actions. Manic symptom severity and imitative behaviors were quantified using the Young's Mania Rating Scale and a modification of the Echolalia Questionnaire. RESULTS Two-way repeated measures analysis of variance demonstrated a significant group ×time interaction effect indicating greater facilitation of cortical reactivity during action-observation (putative MNS-activity) in the patient group as compared to the healthy group. While LICI-mediated MNS-activity had a significant association with manic symptom severity (r = 0.35, P = 0.038), SICI-mediated MNS-activity was significantly associated with incidental echolalia scores in a subgroup of 17 patients with incidental echolalia (r = 0.75, P < 0.001). CONCLUSIONS Our findings demonstrate that putative MNS-activity is heightened in mania, possibly because of disinhibition, and associated with behavioral consequences (incidental echolalia).
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Affiliation(s)
- Rakshathi Basavaraju
- Department of Psychiatry, National institute of Mental Health & Neurosciences (NIMHANS), Bangalore, india
| | - Urvakhsh M. Mehta
- Department of Psychiatry, National institute of Mental Health & Neurosciences (NIMHANS), Bangalore, india
| | - Alvaro Pascual-Leone
- Division of Cognitive Neurology, Berenson-Allen Center for Noninvasive Brain Stimulation, Beth israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Jagadisha Thirthalli
- Department of Psychiatry, National institute of Mental Health & Neurosciences (NIMHANS), Bangalore, india
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25
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Differentiating between bipolar and unipolar depression in functional and structural MRI studies. Prog Neuropsychopharmacol Biol Psychiatry 2019; 91:20-27. [PMID: 29601896 DOI: 10.1016/j.pnpbp.2018.03.022] [Citation(s) in RCA: 125] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 03/25/2018] [Accepted: 03/25/2018] [Indexed: 01/10/2023]
Abstract
Distinguishing depression in bipolar disorder (BD) from unipolar depression (UD) solely based on clinical clues is difficult, which has led to the exploration of promising neural markers in neuroimaging measures for discriminating between BD depression and UD. In this article, we review structural and functional magnetic resonance imaging (MRI) studies that directly compare UD and BD depression based on neuroimaging modalities including functional MRI studies on regional brain activation or functional connectivity, structural MRI on gray or white matter morphology, and pattern classification analyses using a machine learning approach. Numerous studies have reported distinct functional and structural alterations in emotion- or reward-processing neural circuits between BD depression and UD. Different activation patterns in neural networks including the amygdala, anterior cingulate cortex (ACC), prefrontal cortex (PFC), and striatum during emotion-, reward-, or cognition-related tasks have been reported between BD and UD. A stronger functional connectivity pattern in BD was pronounced in default mode and in frontoparietal networks and brain regions including the PFC, ACC, parietal and temporal regions, and thalamus compared to UD. Gray matter volume differences in the ACC, hippocampus, amygdala, and dorsolateral prefrontal cortex (DLPFC) have been reported between BD and UD, along with a thinner DLPFC in BD compared to UD. BD showed reduced integrity in the anterior part of the corpus callosum and posterior cingulum compared to UD. Several studies performed pattern classification analysis using structural and functional MRI data to distinguish between UD and BD depression using a supervised machine learning approach, which yielded a moderate level of accuracy in classification.
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26
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Lee I, Nielsen K, Nawaz U, Hall MH, Öngür D, Keshavan M, Brady R. Diverse pathophysiological processes converge on network disruption in mania. J Affect Disord 2019; 244:115-123. [PMID: 30340100 PMCID: PMC6785980 DOI: 10.1016/j.jad.2018.10.087] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 09/19/2018] [Accepted: 10/05/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Neuroimaging of psychiatric disease is challenged by the difficulty of establishing the causal role of neuroimaging abnormalities. Lesions that cause mania present a unique opportunity to understand how brain network disruption may cause mania in both lesions and in bipolar disorder. METHODS A literature search revealed 23 case reports with imaged lesions that caused mania in patients without history of bipolar disorder. We traced these lesions and examined resting-state functional Magnetic Resonance Imaging (rsfMRI) connectivity to these lesions and control lesions to find networks that would be disrupted specifically by mania-causing lesions. The results were then used as regions-of-interest to examine rsfMRI connectivity in patients with bipolar disorder (n = 16) who underwent imaging longitudinally across states of both mania and euthymia alongside a cohort of healthy participants scanned longitudinally. We then sought to replicate these results in independent cohorts of manic (n = 26) and euthymic (n = 21) participants with bipolar disorder. RESULTS Mania-inducing lesions overlap significantly in network connectivity. Mania-causing lesions selectively disrupt networks that include orbitofrontal cortex, dorsolateral prefrontal cortex, and temporal lobes. In bipolar disorder, the manic state was reflected in strong, significant, and specific disruption in network communication between these regions and regions implicated in bipolar pathophysiology: the amygdala and ventro-lateral prefrontal cortex. LIMITATIONS There was heterogeneity in the clinical characterization of mania causing lesions. CONCLUSIONS Lesions causing mania demonstrate shared and specific network disruptions. These disruptions are also observed in bipolar mania and suggest a convergence of multiple disorders on shared circuit dysfunction to cause mania.
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Affiliation(s)
- Ivy Lee
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Kathryn Nielsen
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA,Schizophrenia and Bipolar Disorder Program, McLean Hospital, Belmont, MA, USA
| | - Uzma Nawaz
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Mei-Hua Hall
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA,Schizophrenia and Bipolar Disorder Program, McLean Hospital, Belmont, MA, USA
| | - Dost Öngür
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA,Schizophrenia and Bipolar Disorder Program, McLean Hospital, Belmont, MA, USA
| | - Matcheri Keshavan
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Roscoe Brady
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Schizophrenia and Bipolar Disorder Program, McLean Hospital, Belmont, MA, USA.
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27
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Chee MW, Zhou J. Functional connectivity and the sleep-deprived brain. PROGRESS IN BRAIN RESEARCH 2019; 246:159-176. [DOI: 10.1016/bs.pbr.2019.02.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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28
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Vai B, Bertocchi C, Benedetti F. Cortico-limbic connectivity as a possible biomarker for bipolar disorder: where are we now? Expert Rev Neurother 2019; 19:159-172. [PMID: 30599797 DOI: 10.1080/14737175.2019.1562338] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The fronto-limbic network has been suggested as a key circuitry in the pathophysiology and maintenance of bipolar disorder. In the past decade, a disrupted connectivity within prefrontal-limbic structures was identified as a promising candidate biomarker for the disorder. Areas Covered: In this review, the authors examine current literature in terms of the structural, functional and effective connectivity in bipolar disorder, integrating recent findings of imaging genetics and machine learning. This paper profiles the current knowledge and identifies future perspectives to provide reliable and usable neuroimaging biomarkers for bipolar psychopathology in clinical practice. Expert Opinion: The replication and the translation of acquired knowledge into useful and usable tools represents one of the current greatest challenges in biomarker research applied to psychiatry.
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Affiliation(s)
- Benedetta Vai
- a Psychiatry & Clinical Psychobiology , Division of Neuroscience, Scientific Institute Ospedale San Raffaele , Milano , Italy.,b University Vita-Salute San Raffaele , Milano , Italy
| | - Carlotta Bertocchi
- a Psychiatry & Clinical Psychobiology , Division of Neuroscience, Scientific Institute Ospedale San Raffaele , Milano , Italy
| | - Francesco Benedetti
- a Psychiatry & Clinical Psychobiology , Division of Neuroscience, Scientific Institute Ospedale San Raffaele , Milano , Italy.,b University Vita-Salute San Raffaele , Milano , Italy
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29
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Poletti S, Riberto M, Vai B, Ghiglino D, Lorenzi C, Vitali A, Brioschi S, Locatelli C, Serretti A, Colombo C, Benedetti F. A Glutamate Transporter EAAT1 Gene Variant Influences Amygdala Functional Connectivity in Bipolar Disorder. J Mol Neurosci 2018; 65:536-545. [PMID: 30073554 DOI: 10.1007/s12031-018-1138-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 07/23/2018] [Indexed: 12/27/2022]
Abstract
Bipolar disorder (BD) is a severe illness characterized by recurrent depressive and manic episodes and by emotional dysregulation. Altered cortico-limbic connectivity could account for typical symptoms of the disorder such as mood instability, emotional dysregulation, and cognitive deficits. Functional connectivity positively associated with glutamatergic neurotransmission. The inactivation of glutamate is handled by a series of glutamate transporters, among them, the excitatory amino acid transporter 1 (EAAT1) which is modulated by a SNP rs2731880 (C/T) where the C allele leads to increased EAAT1 expression and glutamate uptake. We hypothesized that rs2731880 would affect cortico-limbic functional connectivity during an implicit affective processing task. Sixty-eight BD patients underwent fMRI scanning during implicit processing of fearful and angry faces. We explored the effect of rs2731880 on the strength of functional connectivity from the amygdalae to the whole brain. A significant activation in response to emotional processing was observed in two main clusters encompassing the right and left amygdala. Amygdalae to whole-brain functional connectivity analyses revealed a significant interaction between rs2731880 and the task (emotional stimuli vs geometric shapes) for the functional connections between the right amygdala and right subgenual anterior cingulate cortex. Post-hoc analyses revealed that T/T patients showed a significant negative connectivity between the amygdala and anterior cingulate cortex compared to C carriers. T/T subjects also performed significantly better in the face-matching task than rs2731880*C carriers. Our findings reveal an EAAT1 genotype-associated difference in cortico-limbic connectivity during affective regulation, possibly identifying a neurobiological underpinning of emotional dysfunction in BD.
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Affiliation(s)
- Sara Poletti
- Psychiatry and Clinical Psychobiology, Division of Neuroscience, Scientific Institute and University Vita-Salute San Raffaele, Milan, Italy.
| | - Martina Riberto
- Psychiatry and Clinical Psychobiology, Division of Neuroscience, Scientific Institute and University Vita-Salute San Raffaele, Milan, Italy
| | - Benedetta Vai
- Psychiatry and Clinical Psychobiology, Division of Neuroscience, Scientific Institute and University Vita-Salute San Raffaele, Milan, Italy
| | - Davide Ghiglino
- Psychiatry and Clinical Psychobiology, Division of Neuroscience, Scientific Institute and University Vita-Salute San Raffaele, Milan, Italy
| | - Cristina Lorenzi
- Psychiatry and Clinical Psychobiology, Division of Neuroscience, Scientific Institute and University Vita-Salute San Raffaele, Milan, Italy
| | - Alice Vitali
- Psychiatry and Clinical Psychobiology, Division of Neuroscience, Scientific Institute and University Vita-Salute San Raffaele, Milan, Italy
| | - Silvia Brioschi
- Psychiatry and Clinical Psychobiology, Division of Neuroscience, Scientific Institute and University Vita-Salute San Raffaele, Milan, Italy
| | - Clara Locatelli
- Psychiatry and Clinical Psychobiology, Division of Neuroscience, Scientific Institute and University Vita-Salute San Raffaele, Milan, Italy
| | - Alessandro Serretti
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Cristina Colombo
- Psychiatry and Clinical Psychobiology, Division of Neuroscience, Scientific Institute and University Vita-Salute San Raffaele, Milan, Italy
| | - Francesco Benedetti
- Psychiatry and Clinical Psychobiology, Division of Neuroscience, Scientific Institute and University Vita-Salute San Raffaele, Milan, Italy
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30
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Chen L, Wang Y, Niu C, Zhong S, Hu H, Chen P, Zhang S, Chen G, Deng F, Lai S, Wang J, Huang L, Huang R. Common and distinct abnormal frontal-limbic system structural and functional patterns in patients with major depression and bipolar disorder. NEUROIMAGE-CLINICAL 2018; 20:42-50. [PMID: 30069426 PMCID: PMC6067086 DOI: 10.1016/j.nicl.2018.07.002] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 06/02/2018] [Accepted: 07/03/2018] [Indexed: 12/16/2022]
Abstract
Major depressive disorder (MDD) and bipolar disorder (BD) are common severe affective diseases. Although previous neuroimaging studies have investigated brain abnormalities in MDD or BD, the structural and functional differences between these two disorders remain unclear. In this study, we adopted a multimodal approach, combining voxel-based morphometry (VBM) and functional connectivity (FC), to study the common and distinct structural and functional alterations in unmedicated MDD and BD patients. The VBM analysis revealed that both the MDD and BD patients showed decreased gray matter volume (GMV) in the left anterior cingulate cortex (ACC_L) and right hippocampus (HIP_R) compared with the healthy controls, and the MDD patients showed decreased GMV in the left superior frontal gyrus (SFG_L) and ACC_L compared with the BD patients. Furthermore, we took these clusters as seed regions to analyze the abnormal resting-state functional connectivity (RSFC) in the patients. We found that both the MDD and BD groups had decreased RSFC between the ACC_L and the left orbitofrontal cortex (OFC_L) and that the MDD group had decreased RSFC between the SFG_L and the HIP_L, compared with the healthy controls. Our results revealed that the MDD and BD patients were more similar than different in GMV and RSFC. These findings indicate that investigating the frontal-limbic system could be useful for understanding the underlying mechanisms of these two disorders. Both MDD and BD patients had reduced GMV in the ACC_L and HIP_R compared with HC. MDD patients had decreased GMV in the ACC_L and SFG_L compared with BD patients. Both BD and MDD patients had decreased ACC-OFC RSFC compared with HC. The MDD and BD patients were more similar than different in GMV and RSFC.
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Key Words
- ACC, anterior cingulate cortex
- Affective disorder
- CSF, cerebrospinal fluid
- DLPFC, dorsolateral prefrontal cortex
- Functional connectivity
- GM, gray matter
- GMV, gray matter volume
- HDRS, Hamilton Depression Rating Scale
- HIP, hippocampus
- Multimodal
- OFC, orbitofrontal cortex
- ORBmid, orbital part middle frontal gyrus
- ORBsup, orbital part superior frontal gyrus
- R-fMRI, Resting-state fMRI
- RSFC, resting-state functional connectivity
- SFG, superior frontal gyrus
- THA, thalamus
- VBM, voxel-based morphometry
- VLPFC, ventrolateral prefrontal cortex
- Voxel-based morphometry
- WM, white matter
- YMRS, Young Mania Rating Scale
- dmPFC, dorsomedial prefrontal cortex
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Affiliation(s)
- Lixiang Chen
- Center for the Study of Applied Psychology, Key Laboratory of Mental Health and Cognitive Science of Guangdong Province, School of Psychology, Institute for Brain Research and Rehabilitation, South China Normal University, Guangzhou 510631, China
| | - Ying Wang
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou 510630, China; Institute of Molecular and Functional Imaging, Jinan University, Guangzhou 510630, China.
| | - Chen Niu
- Center for the Study of Applied Psychology, Key Laboratory of Mental Health and Cognitive Science of Guangdong Province, School of Psychology, Institute for Brain Research and Rehabilitation, South China Normal University, Guangzhou 510631, China
| | - Shuming Zhong
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Huiqing Hu
- Center for the Study of Applied Psychology, Key Laboratory of Mental Health and Cognitive Science of Guangdong Province, School of Psychology, Institute for Brain Research and Rehabilitation, South China Normal University, Guangzhou 510631, China
| | - Ping Chen
- Center for the Study of Applied Psychology, Key Laboratory of Mental Health and Cognitive Science of Guangdong Province, School of Psychology, Institute for Brain Research and Rehabilitation, South China Normal University, Guangzhou 510631, China
| | - Shufei Zhang
- Center for the Study of Applied Psychology, Key Laboratory of Mental Health and Cognitive Science of Guangdong Province, School of Psychology, Institute for Brain Research and Rehabilitation, South China Normal University, Guangzhou 510631, China
| | - Guanmao Chen
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Feng Deng
- Center for the Study of Applied Psychology, Key Laboratory of Mental Health and Cognitive Science of Guangdong Province, School of Psychology, Institute for Brain Research and Rehabilitation, South China Normal University, Guangzhou 510631, China
| | - Sunkai Lai
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Junjing Wang
- Department of Applied Psychology, Guangdong University of Foreign Studies, Guangzhou 510006, China
| | - Li Huang
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Ruiwang Huang
- Center for the Study of Applied Psychology, Key Laboratory of Mental Health and Cognitive Science of Guangdong Province, School of Psychology, Institute for Brain Research and Rehabilitation, South China Normal University, Guangzhou 510631, China.
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31
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Li G, Liu P, Andari E, Zhang A, Zhang K. The Role of Amygdala in Patients With Euthymic Bipolar Disorder During Resting State. Front Psychiatry 2018; 9:445. [PMID: 30283367 PMCID: PMC6156348 DOI: 10.3389/fpsyt.2018.00445] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 08/29/2018] [Indexed: 12/20/2022] Open
Abstract
The current study aims to explore the functional changes of the amygdala in patients with euthymic Bipolar Disorder (BD) using resting state fMRI (rs-fMRI). Twenty-one euthymic patients with bipolar disorder and 28 healthy controls participated in this study. Two of the euthymic patients with BD and three of the healthy controls were excluded due to excessive head motion. We found that patients with euthymia (38.79 ± 12.03) show higher fALFF (fractional Amplitude of low-frequency fluctuation) value of the amygdala (t = 2.076, P = 0.044), and lower functional connectivity between the amygdala and supplementary motor area (p < 0.01, GRF corrected) than healthy controls (33.40 ± 8.21). However, euthymic patients did not show a differential activity in ReHo (Regional Homogeneity) and gray matter of the amygdala region as compared to healthy controls. Thus, despite the absence of clinical symptoms in euthymic patients with BD, the amygdala functional activity and its connectivity to other brain regions remain altered. Further investigation of negative emotions and social functioning in euthymic patients with BD are needed and can help pave the way for a better understanding of BD psychopathology.
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Affiliation(s)
- Gaizhi Li
- Shanxi Medical University, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Penghong Liu
- Shanxi Medical University, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Elissar Andari
- Department of Psychiatry and Behavioral Sciences, Center for Translational Social Neuroscience, Silvio O. Conte Center for Oxytocin and Social Cognition, Yerkes National Primate Research Center, Emory University School of Medicine, Atlanta, GA, United States
| | - Aixia Zhang
- Shanxi Medical University, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Kerang Zhang
- Shanxi Medical University, The First Hospital of Shanxi Medical University, Taiyuan, China
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