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Shamabadi A, Karimi H, Cattarinussi G, Moghaddam HS, Akhondzadeh S, Sambataro F, Schiena G, Delvecchio G. Neuroimaging Correlates of Treatment Response to Transcranial Magnetic Stimulation in Bipolar Depression: A Systematic Review. Brain Sci 2023; 13:brainsci13050801. [PMID: 37239273 DOI: 10.3390/brainsci13050801] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/10/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
Transcranial magnetic stimulation (TMS) has become a promising strategy for bipolar disorder (BD). This study reviews neuroimaging findings, indicating functional, structural, and metabolic brain changes associated with TMS in BD. Web of Science, Embase, Medline, and Google Scholar were searched without any restrictions for studies investigating neuroimaging biomarkers, through structural magnetic resonance imaging (MRI), diffusion tensor imaging (DTI), functional MRI (fMRI), magnetic resonance spectroscopy (MRS), positron emission tomography (PET), and single photon emission computed tomography (SPECT), in association with response to TMS in patients with BD. Eleven studies were included (fMRI = 4, MRI = 1, PET = 3, SPECT = 2, and MRS = 1). Important fMRI predictors of response to repetitive TMS (rTMS) included higher connectivity of emotion regulation and executive control regions. Prominent MRI predictors included lower ventromedial prefrontal cortex connectivity and lower superior frontal and caudal middle frontal volumes. SPECT studies found hypoconnectivity of the uncus/parahippocampal cortex and right thalamus in non-responders. The post-rTMS changes using fMRI mostly showed increased connectivity among the areas neighboring the coil. Increased blood perfusion was reported post-rTMS in PET and SPECT studies. Treatment response comparison between unipolar depression and BD revealed almost equal responses. Neuroimaging evidence suggests various correlates of response to rTMS in BD, which needs to be further replicated in future studies.
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Affiliation(s)
- Ahmad Shamabadi
- Psychiatric Research Center, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Tehran M9HV+R6Q, Iran
- School of Medicine, Tehran University of Medical Sciences, Tehran P94V+8MF, Iran
| | - Hanie Karimi
- Psychiatric Research Center, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Tehran M9HV+R6Q, Iran
- School of Medicine, Tehran University of Medical Sciences, Tehran P94V+8MF, Iran
| | - Giulia Cattarinussi
- Department of Neuroscience (DNS), Padua Neuroscience Center, University of Padova, 35131 Padua, Italy
| | - Hossein Sanjari Moghaddam
- Psychiatric Research Center, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Tehran M9HV+R6Q, Iran
| | - Shahin Akhondzadeh
- Psychiatric Research Center, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Tehran M9HV+R6Q, Iran
| | - Fabio Sambataro
- Department of Neuroscience (DNS), Padua Neuroscience Center, University of Padova, 35131 Padua, Italy
| | - Giandomenico Schiena
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Giuseppe Delvecchio
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
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Long X, Li L, Wang X, Cao Y, Wu B, Roberts N, Gong Q, Kemp GJ, Jia Z. Gray matter alterations in adolescent major depressive disorder and adolescent bipolar disorder. J Affect Disord 2023; 325:550-563. [PMID: 36669567 DOI: 10.1016/j.jad.2023.01.049] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 12/24/2022] [Accepted: 01/11/2023] [Indexed: 01/19/2023]
Abstract
BACKGROUND Gray matter volume (GMV) alterations in several emotion-related brain areas are implicated in mood disorders, but findings have been inconsistent in adolescents with major depressive disorder (MDD) or bipolar disorder (BD). METHODS We conducted a comprehensive meta-analysis of 35 region-of-interest (ROI) and 18 whole-brain voxel-based morphometry (VBM) MRI studies in adolescent MDD and adolescent BD, and indirectly compared the results in the two groups. The effects of age, sex, and other demographic and clinical scale scores were explored using meta-regression analysis. RESULTS In the ROI meta-analysis, right putamen volume was decreased in adolescents with MDD, while bilateral amygdala volume was decreased in adolescents with BD compared to healthy controls (HC). In the whole-brain VBM meta-analysis, GMV was increased in right middle frontal gyrus and decreased in left caudate in adolescents with MDD compared to HC, while in adolescents with BD, GMV was increased in left superior frontal gyrus and decreased in limbic regions compared with HC. MDD vs BD comparison revealed volume alteration in the prefrontal-limbic system. LIMITATION Different clinical features limit the comparability of the samples, and small sample size and insufficient clinical details precluded subgroup analysis or meta-regression analyses of these variables. CONCLUSIONS Distinct patterns of GMV alterations in adolescent MDD and adolescent BD could help to differentiate these two populations and provide potential diagnostic biomarkers.
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Affiliation(s)
- Xipeng Long
- Department of Nuclear Medicine, West China Hospital of Sichuan University, No. 37 GuoXue Xiang, Chengdu 610041, Sichuan, PR China; Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, PR China
| | - Lei Li
- Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, PR China; Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, PR China
| | - Xiuli Wang
- Department of Clinical Psychiatry, the Fourth People's Hospital of Chengdu, Chengdu 610041, Sichuan, PR China
| | - Yuan Cao
- Department of Nuclear Medicine, West China Hospital of Sichuan University, No. 37 GuoXue Xiang, Chengdu 610041, Sichuan, PR China
| | - Baolin Wu
- Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, PR China; Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, PR China
| | - Neil Roberts
- The Queens Medical Research Institute (QMRI), School of Clinical Sciences, University of Edinburgh, Edinburgh, UK
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, PR China; Department of Radiology, West China Xiamen Hospital of Sichuan University, 699Jinyuan Xi Road, Jimei District, 361021 Xiamen, Fujian, PR China
| | - Graham J Kemp
- Liverpool Magnetic Resonance Imaging Center (LiMRIC) and Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Zhiyun Jia
- Department of Nuclear Medicine, West China Hospital of Sichuan University, No. 37 GuoXue Xiang, Chengdu 610041, Sichuan, PR China; Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, PR China.
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Hu B, Cha J, Fullerton JM, Hesam-Shariati S, Nakamura K, Nurnberger JI, Anand A. Genetic and environment effects on structural neuroimaging endophenotype for bipolar disorder: a novel molecular approach. Transl Psychiatry 2022; 12:137. [PMID: 35379780 DOI: 10.1038/s41398-022-01892-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 03/03/2022] [Accepted: 03/10/2022] [Indexed: 12/15/2022] Open
Abstract
We investigated gene-environment effects on structural brain endophenotype in bipolar disorder (BD) using a novel method of combining polygenic risk scores with epigenetic signatures since traditional methods of examining the family history and trauma effects have significant limitations. The study enrolled 119 subjects, including 55 BD spectrum (BDS) subjects diagnosed with BD or major depressive disorder (MDD) with subthreshold BD symptoms and 64 non-BDS subjects comprising 32 MDD subjects without BD symptoms and 32 healthy subjects. The blood samples underwent genome-wide genotyping and methylation quantification. We derived polygenic risk score (PRS) and methylation profile score (MPS) as weighted summations of risk single nucleotide polymorphisms and methylation probes, respectively, which were considered as molecular measures of genetic and environmental risks for BD. Linear regression was used to relate PRS, MPS, and their interaction to 44 brain structure measures quantified from magnetic resonance imaging (MRI) on 47 BDS subjects, and the results were compared with those based on family history and childhood trauma. After multiplicity corrections using false discovery rate (FDR), MPS was found to be negatively associated with the volume of the medial geniculate thalamus (FDR = 0.059, partial R2 = 0.208). Family history, trauma scale, and PRS were not associated with any brain measures. PRS and MPS show significant interactions on whole putamen (FDR = 0.09, partial R2 = 0.337). No significant gene-environment interactions were identified for the family history and trauma scale. PRS and MPS generally explained greater proportions of variances of the brain measures (range of partial R2 = [0.008, 0.337]) than the clinical risk factors (range = [0.004, 0.228]).
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Abstract
Transdiagnostic approach has a long history in neuroimaging, predating its recent ascendance as a paradigm for new psychiatric nosology. Various psychiatric disorders have been compared for commonalities and differences in neuroanatomical features and activation patterns, with different aims and rationales. This review covers both structural and functional neuroimaging publications with direct comparison of different psychiatric disorders, including schizophrenia, bipolar disorder, major depressive disorder, autism spectrum disorder, obsessive-compulsive disorder, attention-deficit/hyperactivity disorder, conduct disorder, anorexia nervosa, and bulimia nervosa. Major findings are systematically presented along with specific rationales for each comparison.
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Affiliation(s)
- Serge A Mitelman
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA; Department of Psychiatry, Division of Child and Adolescent Psychiatry, Elmhurst Hospital Center, 79-01 Broadway, Elmhurst, NY 11373, USA.
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Chen J, Rashid B, Yu Q, Liu J, Lin D, Du Y, Sui J, Calhoun VD. Variability in Resting State Network and Functional Network Connectivity Associated With Schizophrenia Genetic Risk: A Pilot Study. Front Neurosci 2018; 12:114. [PMID: 29545739 PMCID: PMC5838400 DOI: 10.3389/fnins.2018.00114] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 02/13/2018] [Indexed: 12/19/2022] Open
Abstract
Imaging genetics posits a valuable strategy for elucidating genetic influences on brain abnormalities in psychiatric disorders. However, association analysis between 2D genetic data (subject × genetic variable) and 3D first-level functional magnetic resonance imaging (fMRI) data (subject × voxel × time) has been challenging given the asymmetry in data dimension. A summary feature needs to be derived for the imaging modality to compute inter-modality association at subject level. In this work, we propose to use variability in resting state networks (RSNs) and functional network connectivity (FNC) as potential features for purpose of association analysis. We conducted a pilot study to investigate the proposed features in a dataset of 171 healthy controls and 134 patients with schizophrenia (SZ). We computed variability in RSN and FNC in a group independent component analysis framework and tested three types of variability metrics, namely Euclidean distance, Pearson correlation and Kullback-Leibler (KL) divergence. Euclidean distance and Pearson correlation metrics more effectively discriminated controls from patients than KL divergence. The group differences observed with variability in RSN and FNC were highly consistent, indicating patients presenting increased deviation from the cohort-common pattern of RSN and FNC than controls. The variability in RSN and FNC showed significant associations with network global efficiency, the more the deviation, the lower the efficiency. Furthermore, the RSN and FNC variability were found to associate with individual SZ risk SNPs as well as cumulative polygenic risk score for SZ. Collectively the current findings provide preliminary evidence for variability in RSN and FNC being promising imaging features that may find applications as biomarkers and in imaging genetic association analysis.
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Affiliation(s)
- Jiayu Chen
- Mind Research Network, Albuquerque, NM, United States
| | - Barnaly Rashid
- Mind Research Network, Albuquerque, NM, United States
- Harvard Medical School, Harvard University, Boston, MA, United States
| | - Qingbao Yu
- Mind Research Network, Albuquerque, NM, United States
| | - Jingyu Liu
- Mind Research Network, Albuquerque, NM, United States
- Department of Electrical Engineering, University of New Mexico, Albuquerque, NM, United States
| | - Dongdong Lin
- Mind Research Network, Albuquerque, NM, United States
| | - Yuhui Du
- Mind Research Network, Albuquerque, NM, United States
- School of Computer & Information Technology, Shanxi University, Taiyuan, China
| | - Jing Sui
- Mind Research Network, Albuquerque, NM, United States
- Brainnetome Center and National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Vince D. Calhoun
- Mind Research Network, Albuquerque, NM, United States
- Department of Electrical Engineering, University of New Mexico, Albuquerque, NM, United States
- Departments of Neurosciences and Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM, United States
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Akbaş S, Nahir M, Pirzirenli ME, Dündar C, Ceyhan M, Sarısoy G, Şahin B. Quantitative analysis of the amygdala, thalamus and hippocampus on magnetic resonance images in paediatric bipolar disorders and compared with the children of bipolar parents and healthy control. Psychiatry Res Neuroimaging 2017; 270:61-67. [PMID: 29065344 DOI: 10.1016/j.pscychresns.2017.08.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 06/29/2017] [Accepted: 08/29/2017] [Indexed: 12/28/2022]
Abstract
MR imaging studies in paediatric bipolar disorder have particularly focused on the amygdala and hippocampus, subcortical structures, and to a lesser extent on the thalamus. The purpose of this study was to perform structural analysis of the regions of interest (ROI) associated with mood regulation. In this study 18 children (between the ages of 12-18) were matched according to their age and sex and were divided into three groups. These were: a paediatric bipolar disorder group, risk group and a healthy control group. The structured diagnostic interviews were performed with children and their parents. T1 weighted MR images in the sagittal plane with a thickness of 1mm were taken from the subjects. Automatic structural brain analysis was performed, and the volume and volume fraction (VF) of the ROIs were obtained. Brain size in the patients with paediatric bipolar disorder (742.4 ± 110.1cm3) was significantly smaller than the healthy control group (880.7 ± 73.8cm3) (p≤0.05). MRI analysis between the paediatric bipolar disorder, risk group and healthy control group revealed no difference between them in terms of amygdala, thalamus or hippocampal volumes. In this study, there was no difference between the volumes of amygdala, thalamus or hippocampus.
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Affiliation(s)
- Seher Akbaş
- Department of Child and Adolescent Psychiatry, Erenkoy Mental Health and Neurology Training and Research Hospital, Istanbul, Turkey.
| | - Mert Nahir
- Ondokuz Mayıs University Faculty of Medicine Department of Anatomy, Turkey
| | | | - Cihat Dündar
- Ondokuz Mayıs University Faculty of Medicine Department of Public Health, Turkey
| | - Meltem Ceyhan
- Ondokuz Mayıs University Faculty of Medicine Department of Radiology, Turkey
| | - Gökhan Sarısoy
- Ondokuz Mayıs University Faculty of Medicine Department of Psychiatry, Turkey
| | - Bünyamin Şahin
- Ondokuz Mayıs University Faculty of Medicine Department of Anatomy, Turkey
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7
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McCarthy J, Arrese D, McGlashan A, Rappaport B, Kraseski K, Conway F, Mule C, Tucker J. Sustained Attention and Visual Processing Speed in Children and Adolescents with Bipolar Disorder and other Psychiatric Disorders. Psychol Rep 2016; 95:39-47. [PMID: 15460356 DOI: 10.2466/pr0.95.1.39-47] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
To investigate the cognitive functioning of children and adolescents with bipolar illness, 112 child and adolescent psychiatric inpatients and day-hospital patients at a state psychiatric hospital were administered the Wechsler Intelligence Scale for Children–III (WISC–III) as part of an admission psychological assessment. There were 22 patients with Bipolar Disorder and 90 with other psychiatric disorders; all were between 8 and 17 years of age. The patients with Bipolar Disorder had a mean age of 14 yr., a mean Verbal IQ of 78, a mean Performance IQ of 76, and a mean Full Scale IQ of 75. When their WISC–III scores were compared with those who had Schizophrenia Spectrum disorders (Schizophrenia and Schizoaffective Disorder), Psychosis Not Otherwise Specified, Attention Deficit Hyperactivity Disorder, and Conduct Disorder and Oppositional Defiant Disorder, there were no significant between-group mean differences for Verbal IQ, but patients with Bipolar Disorder had a significantly lower mean Performance IQ than those with ADHD and those with Conduct Disorder and Oppositional Defiant Disorder. Contrary to the expectation that the patients with Bipolar Disorder might have better sustained attention (higher Digit Span scores) than those with Schizophrenia Spectrum disorders and worse visual processing speed (lower Coding scores) than the other diagnostic groups, the bipolar patients' Digit Span and Coding scores did not differ significantly from those of the other groups. The patients with Psychosis, Not Otherwise Specified had significantly lower mean Performance IQ, Full Scale IQ, and Coding than the ADHD and the Conduct Disorder and Oppositional Disorder groups.
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Affiliation(s)
- James McCarthy
- Queens Children's Psychiatric Center, Bellerose, NY 11426, USA
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8
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Nery FG, Gigante AD, Amaral JA, Fernandes FBF, Berutti M, Almeida KM, Carneiro CDG, Duran FLS, Otaduy MG, Leite CC, Busatto G, Lafer B. Gray matter volumes in patients with bipolar disorder and their first-degree relatives. Psychiatry Res 2015; 234:188-93. [PMID: 26459073 DOI: 10.1016/j.pscychresns.2015.09.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 07/24/2015] [Accepted: 09/01/2015] [Indexed: 01/15/2023]
Abstract
Bipolar disorder (BD) is highly heritable. First-degree relatives of BD patient have an increased risk to develop the disease. We investigated abnormalities in gray matter (GM) volumes in healthy first-degree relatives of BD patients to identify possible brain structural endophenotypes for the disorder. 3D T1-weighted magnetic resonance images were obtained from 25 DSM-IV BD type I patients, 23 unaffected relatives, and 27 healthy controls (HC). A voxel-based morphometry protocol was used to compare differences in GM volumes between groups. BD patients presented reduced GM volumes bilaterally in the thalamus compared with HC. Relatives presented no global or regional GM differences compared with HC. Our negative results do not support the role of GM volume abnormalities as endophenotypes for BD. Thalamic volume abnormalities may be associated the pathophysiology of the disease.
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Affiliation(s)
- Fabiano G Nery
- Bipolar Disorder Program, Department of Psychiatry, University of Sao Paulo Medical School, Sao Paulo, SP, Brazil; Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Alexandre Duarte Gigante
- Bipolar Disorder Program, Department of Psychiatry, University of Sao Paulo Medical School, Sao Paulo, SP, Brazil
| | - Jose A Amaral
- Bipolar Disorder Program, Department of Psychiatry, University of Sao Paulo Medical School, Sao Paulo, SP, Brazil
| | - Francy B F Fernandes
- Bipolar Disorder Program, Department of Psychiatry, University of Sao Paulo Medical School, Sao Paulo, SP, Brazil
| | - Mariangeles Berutti
- Bipolar Disorder Program, Department of Psychiatry, University of Sao Paulo Medical School, Sao Paulo, SP, Brazil
| | - Karla M Almeida
- Bipolar Disorder Program, Department of Psychiatry, University of Sao Paulo Medical School, Sao Paulo, SP, Brazil
| | - Camila de Godoi Carneiro
- Laboratory of Neuroimage in Psychiatry (LIM 21), Research in Applied Neuroscience, Support Core of the University of Sao Paulo (NAPNA-USP), Brazil
| | - Fabio Luis Souza Duran
- Laboratory of Neuroimage in Psychiatry (LIM 21), Research in Applied Neuroscience, Support Core of the University of Sao Paulo (NAPNA-USP), Brazil
| | - Maria G Otaduy
- Laboratory of Neuroradiology (LIM 44), Department of Radiology and Oncology, University of Sao Paulo Medical School, Sao Paulo, SP, Brazil
| | - Claudia Costa Leite
- Laboratory of Neuroradiology (LIM 44), Department of Radiology and Oncology, University of Sao Paulo Medical School, Sao Paulo, SP, Brazil
| | - Geraldo Busatto
- Laboratory of Neuroimage in Psychiatry (LIM 21), Research in Applied Neuroscience, Support Core of the University of Sao Paulo (NAPNA-USP), Brazil
| | - Beny Lafer
- Bipolar Disorder Program, Department of Psychiatry, University of Sao Paulo Medical School, Sao Paulo, SP, Brazil
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Power BD, Wilkes FA, Hunter-Dickson M, van Westen D, Santillo AF, Walterfang M, Nilsson C, Velakoulis D, Looi JC. Validation of a protocol for manual segmentation of the thalamus on magnetic resonance imaging scans. Psychiatry Res 2015; 232:98-105. [PMID: 25752844 DOI: 10.1016/j.pscychresns.2015.02.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 10/14/2014] [Accepted: 02/04/2015] [Indexed: 01/18/2023]
Abstract
We present a validated protocol for manual segmentation of the thalamus on T1-weighted magnetic resonance imaging (MRI) scans using brain image analysis software. The MRI scans of five normal control subjects were randomly selected from a larger cohort recruited from Lund University Hospital and Landskrona Hospital, Sweden. MRIs were performed using a 3.0T Philips MR scanner, with an eight-channel head coil, and high resolution images were acquired using a T1-weighted turbo field echo (T1 TFE) pulse sequence, with resulting voxel size 1×1×1 mm3. Manual segmentation of the left and right thalami and volume measurement was performed on 28-30 contiguous coronal slices, using ANALYZE 11.0 software. Reliability of image analysis was performed by measuring intra-class correlations between initial segmentation and random repeated segmentation of the left and right thalami (in total 10 thalami for segmentation); inter-rater reliability was measured using volumes obtained by two other experienced tracers. Intra-class correlations for two independent raters were 0.95 and 0.98; inter-class correlations between the expert rater and two independent raters were 0.92 and 0.98. We anticipate that mapping thalamic morphology in various neuropsychiatric disorders may yield clinically useful disease-specific biomarkers.
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Sköld M, Källstrand J, Nehlstedt S, Nordin A, Nielzén S, Holmberg J, Adolfsson R. Thalamocortical abnormalities in auditory brainstem response patterns distinguish DSM-IV bipolar disorder type I from schizophrenia. J Affect Disord 2014; 169:105-11. [PMID: 25173433 DOI: 10.1016/j.jad.2014.08.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 07/14/2014] [Accepted: 08/03/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND Bipolar disorder type I (BP-I) belongs to a spectrum of affective disorders that are expressed in many different ways and therefore can be difficult to distinguish from other conditions, especially unipolar depression, schizoaffective disorder, schizophrenia (SZ), but also anxiety and personality disorders. Since early diagnosis and treatment have shown to improve the long-term prognosis, complementary specific biomarkers are of great value. The auditory brainstem response (ABR) has previously been applied successfully to identify specific abnormal ABR patterns in SZ and Asperger syndrome. METHODS The current study investigated the early auditory processing of complex sound stimuli e.g. forward masking, in BP-I compared to SZ patients. The ABR curves of BP-I patients (n=23) and SZ patients (n=20) were analyzed in terms of peak amplitudes and correlation with an ABR norm curve based on a non-psychiatric control group (n=20). RESULTS BP-I patients had significantly higher wave III (p=0.0062) and wave VII (p=0.0472) amplitudes compared with SZ patients. Furthermore, BP-I patients, and to a lesser extent SZ patients, showed low correlation with the norm ABR curve in the part of the curve comprising waves VI-VII. LIMITATIONS Sample size was relatively small and study groups were not matched for age and gender. CONCLUSIONS BP-I patients showed specific aberrances, specifically in the latter part of the ABR curve, implicating abnormalities in thalamocortical circuitry. The abnormal ABR wave patterns significantly separated BP-I patients from SZ patients suggesting that ABR might serve as a biomarker for BP-I.
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Affiliation(s)
| | | | | | - Annelie Nordin
- Division of Psychiatry, Department of Clinical Sciences, Umeå University, Umeå, Sweden
| | | | | | - Rolf Adolfsson
- Division of Psychiatry, Department of Clinical Sciences, Umeå University, Umeå, Sweden.
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Abstract
There is mounting evidence that recurrent mood disorders - once considered “good prognosis diseases”- are, in fact, often very severe and life-threatening illnesses. Furthermore, although mood disorders have traditionally been conceptualized as neurochemical disorders, there is now evidence from a variety of sources demonstrating regional reductions in central nervous system (CNS) volume, as well as reductions in the numbers and/or sizes ofglia and neurons in discrete brain areas. Although the precise cellular mechanisms underlying these morphometric changes remain to be fully elucidated, the data suggest that mood disorders are associated with impairments of synaptic plasticity and cellular resilience. In this context, it is noteworthy that there is increasing preclinical evidence that antidepressants regulate the function of the glutamatergic system. Moreover, although clearly preliminary, the available clinical data suggest that attenuation of N-methyl-D-aspartate (NMDA) function has antidepressant effects. Recent preclinical and clinical studies have shown that signaling pathways involved in regulating cell survival and cell death are long-term targets for the actions of antidepressant agents. Antidepressants and mood stabilizers indirectly regulate a number of factors involved in cell survival pathways, including cyclic adenosine monophosphate (cAMP) response element binding protein (CREB), brain-derived neurotrophic factor (BDNF), the antiapoptotic protein bcl-2, and mitogen-activated protein (MAP) kinases, and may thus bring about some of their delayed long-term beneficial effects via underappreciated neurotrophic effects. There is much promise for the future development of treatments that more directly target molecules in critical CNS signaling pathways regulating synaptic plasticity and cellular resilience. These will represent improved long-term treatments for mood disorders.
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Affiliation(s)
- Jorge A Quiroz
- Laboratory of Molecular Pathophysiology, National Institute of Mental Health, Bethesda, Md, USA
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12
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Abstract
OBJECTIVE Recent theories regarding the neuropathology of bipolar disorder suggest that both neurodevelopmental and neurodegenerative processes may play a role. While magnetic resonance imaging has provided significant insight into the structural, functional, and connectivity abnormalities associated with bipolar disorder, research assessing longitudinal changes has been more limited. However, such research is essential to elucidate the pathophysiology of the disorder. The aim of our review is to examine the extant literature for developmental and progressive structural and functional changes in individuals with and at risk for bipolar disorder. METHODS We conducted a literature review using MEDLINE and the following search terms: bipolar disorder, risk, child, adolescent, bipolar offspring, MRI, fMRI, DTI, PET, SPECT, cross-sectional, longitudinal, progressive, and developmental. Further relevant articles were identified by cross-referencing with identified manuscripts. CONCLUSIONS There is some evidence for developmental and progressive neurophysiological alterations in bipolar disorder, but the interpretation of correlations between neuroimaging findings and measures of illness exposure or age in cross-sectional studies must be performed with care. Prospective longitudinal studies placed in the context of normative developmental and atrophic changes in neural structures and pathways thought to be involved in bipolar disorder are needed to improve our understanding of the neurodevelopmental underpinnings and progressive changes associated with bipolar disorder.
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Affiliation(s)
- Marguerite Reid Schneider
- Physician Scientist Training Program, Neuroscience Graduate Program Department, University of Cincinnati College of Medicine, Cincinnati, OH 45219-0516, USA
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Janssen J, Alemán-Gómez Y, Reig S, Schnack HG, Parellada M, Graell M, Moreno C, Moreno D, Mateos-Pérez JM, Udias JM, Arango C, Desco M. Regional specificity of thalamic volume deficits in male adolescents with early-onset psychosis. Br J Psychiatry 2012; 200:30-6. [PMID: 22116979 DOI: 10.1192/bjp.bp.111.093732] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Thalamic volume deficits are associated with psychosis but it is unclear whether the volume reduction is uniformly distributed or whether it is more severe in particular thalamic regions. AIMS To quantify whole and regional thalamic volume in males with early-onset psychosis and healthy male controls. METHOD Brain scans were obtained for 80 adolescents: 46 individuals with early-onset psychosis with a duration of positive symptoms less than 6 months and 34 healthy controls. All participants were younger than 19 years. Total thalamic volumes were assessed using FreeSurfer and FSL-FIRST, group comparisons of regional thalamic volumes were studied with a surface-based approach. RESULTS Total thalamic volume was smaller in participants with early-onset psychosis relative to controls. Regional thalamic volume reduction was most significant in the right anterior mediodorsal area and pulvinar. CONCLUSIONS In males with minimally treated early-onset psychosis, thalamic volume deficits may be most pronounced in the anterior mediodorsal and posterior pulvinar regions, adding strength to findings from post-mortem studies in adults with psychosis.
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Affiliation(s)
- Joost Janssen
- Unidad de Medicina y Cirugía Experimental, Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón and Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain.
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14
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Karchemskiy A, Garrett A, Howe M, Adleman N, Simeonova DI, Alegria D, Reiss A, Chang K. Amygdalar, hippocampal, and thalamic volumes in youth at high risk for development of bipolar disorder. Psychiatry Res 2011; 194:319-325. [PMID: 22041532 PMCID: PMC3225692 DOI: 10.1016/j.pscychresns.2011.03.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2010] [Revised: 02/28/2011] [Accepted: 03/15/2011] [Indexed: 10/15/2022]
Abstract
Children of parents with bipolar disorder (BD), especially those with attention deficit hyperactivity disorder (ADHD) and symptoms of depression or mania, are at significantly high risk for developing BD. As we have previously shown amygdalar reductions in pediatric BD, the current study examined amygdalar volumes in offspring of parents (BD offspring) who have not yet developed a full manic episode. Youth participating in the study included 22 BD offspring and 22 healthy controls of comparable age, gender, handedness, and IQ. Subjects had no history of a manic episode, but met criteria for ADHD and moderate mood symptoms. MRI was performed on a 3T GE scanner, using a 3D volumetric spoiled gradient echo series. Amygdalae were manually traced using BrainImage Java software on positionally normalized brain stacks. Bipolar offspring had similar amygdalar volumes compared to the control group. Exploratory analyses yielded no differences in hippocampal or thalamic volumes. Bipolar offspring do not show decreased amygdalar volume, possibly because these abnormalities occur after more prolonged illness rather than as a preexisting risk factor. Longitudinal studies are needed to determine whether amygdalar volumes change during and after the development of BD.
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Affiliation(s)
- Asya Karchemskiy
- Center for Interdisciplinary Brain Sciences Research, Stanford University Department of Psychiatry
| | - Amy Garrett
- Center for Interdisciplinary Brain Sciences Research, Stanford University Department of Psychiatry
| | - Meghan Howe
- Pediatric Bipolar Disorders Program, Stanford University Department of Psychiatry
| | - Nancy Adleman
- Pediatric Bipolar Disorders Program, Stanford University Department of Psychiatry
| | - Diana I. Simeonova
- Child and Adolescent Mood Program, Emory University Department of Psychiatry
| | - Dylan Alegria
- Center for Interdisciplinary Brain Sciences Research, Stanford University Department of Psychiatry
| | - Allan Reiss
- Center for Interdisciplinary Brain Sciences Research, Stanford University Department of Psychiatry
| | - Kiki Chang
- Pediatric Bipolar Disorders Program, Stanford University Department of Psychiatry, Stanford, CA, United States.
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15
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Corradi-Dell'Acqua C, Tomelleri L, Bellani M, Rambaldelli G, Cerini R, Pozzi-Mucelli R, Balestrieri M, Tansella M, Brambilla P. Thalamic-insular dysconnectivity in schizophrenia: evidence from structural equation modeling. Hum Brain Mapp 2011; 33:740-52. [PMID: 21484952 DOI: 10.1002/hbm.21246] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2010] [Revised: 12/09/2010] [Accepted: 12/13/2010] [Indexed: 12/12/2022] Open
Abstract
Structural and functional studies have shown that schizophrenia is often associated with frontolimbic abnormalities in the prefrontal and mediotemporal regions. It is still unclear, however, if such dysfunctional interaction extends as well to relay regions such as the thalamus and the anterior insula. Here, we measured gray matter volumes of five right-hemisphere regions in 68 patients with schizophrenia and 77 matched healthy subjects. The regions were amygdala, thalamus, and entorhinal cortex (identified as anomalous by prior studies on the same population) and dorsolateral prefrontal cortex and anterior insula (isolated by voxel-based morphometry analysis). We used structural equation modeling and found altered path coefficients connecting the thalamus to the anterior insula, the amygdala to the DLPFC, and the entorhinal cortex to the DLPFC. In particular, patients exhibited a stronger thalamus-insular connection than healthy controls. Instead, controls showed positive entorhinal-DLPFC and negative amygdalar-DLPFC connections, both of which were absent in the clinical population. Our data provide evidence that schizophrenia is characterized by an impaired right-hemisphere network, in which intrahemispheric communication involving relay structures may play a major role in sustaining the pathophysiology of the disease.
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16
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Vyas NS, Kumra S, Puri BK. What insights can we gain from studying early-onset schizophrenia? The neurodevelopmental pathway and beyond. Expert Rev Neurother 2010; 10:1243-7. [PMID: 20662747 DOI: 10.1586/ern.10.109] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Nora S Vyas
- Department of Imaging, Imperial College Healthcare Trust, London, W12 OHS, UK
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17
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Adriano F, Spoletini I, Caltagirone C, Spalletta G. Updated meta-analyses reveal thalamus volume reduction in patients with first-episode and chronic schizophrenia. Schizophr Res 2010; 123:1-14. [PMID: 20682456 DOI: 10.1016/j.schres.2010.07.007] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2009] [Revised: 07/09/2010] [Accepted: 07/11/2010] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Although several structural MRI studies report significant thalamus volume reduction in patients with schizophrenia, many other studies do not. Therefore, the present meta-analyses aimed to clarify whether a reduction in thalamic volume characterizes patients diagnosed with schizophrenia by considering first-episode and chronic phases of the illness and right and left thalamus separately. METHODS Using Pubmed databases, we made a detailed literature search for structural MRI studies on patients with schizophrenia that reported physical volumetric measures of the right and left thalamus. Thirteen structural MRI studies were considered eligible for meta-analysis of the entire sample of patients and of the healthy control subjects. Individual meta-analyses were also performed on 6 studies of first-episode patients only and on 7 studies of chronic patients only. These were followed by additional meta-analyses to investigate the role of the factors "illness phase" and "side" on thalamic volume reduction. RESULTS Overall, the patient group showed a significant bilateral thalamus volume reduction compared to healthy control subjects. This was found in both first-episode and chronic patients. Furthermore, left thalamus was smaller than right in both patients and healthy control subjects. CONCLUSIONS When only studies that used physical volumetric measures were considered, the present meta-analyses confirmed that thalamic volume reduction characterizes patients with schizophrenia, both at the first-episode and chronic phases of the illness.
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Affiliation(s)
- Fulvia Adriano
- IRCCS Santa Lucia Foundation, Via Ardeatina, 00179 Rome, Italy
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18
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Abstract
There is an increasing body of literature fuelled by advances in high-resolution structural MRI acquisition and image processing techniques which implicates subtle neuroanatomical abnormalities in the aetiopathogenesis of bipolar disorder. This account reviews the main findings from structural neuroimaging research into regional brain abnormalities, the impact of genetic liability and mood stabilizing medication on brain structure in bipolar disorder, and the overlapping structural deviations found in the allied disorders of schizophrenia and depression. The manifold challenges extant within neuroimaging research are highlighted with accompanying recommendations for future studies. The most consistent findings include preservation of total cerebral volume with regional grey and white matter structural changes in prefrontal, midline and anterior limbic networks, non-contingent ventriculomegaly and increased rates of white matter hyperintensities, with more pronounced deficits in juveniles suffering from the illness. There is increasing evidence that medication has observable effects on brain structure, whereby lithium status is associated with volumetric increase in the medial temporal lobe and anterior cingulate gyrus. However, research continues to be confounded by the use of highly heterogeneous methodology and clinical populations, in studies employing small scale, low-powered, cross-sectional designs. Future work should investigate larger, clinically homogenous groups of patients and unaffected relatives, combining both categorical and dimensional approaches to illness classification in cross-sectional and longitudinal designs in order to elucidate trait versus state mechanisms, genetic effects and medication/illness progression effects over time.
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Affiliation(s)
- Louise Emsell
- Department of Psychiatry, National University of Ireland Galway, Galway, Ireland
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Mustak MS, Hegde ML, Dinesh A, Britton GB, Berrocal R, Subba Rao K, Shamasundar NM, Rao KSJ, Sathyanarayana Rao TS. Evidence of altered DNA integrity in the brain regions of suicidal victims of Bipolar Depression. Indian J Psychiatry 2010; 52:220-8. [PMID: 21180406 PMCID: PMC2990821 DOI: 10.4103/0019-5545.70974] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Deoxyribonucleic acid (DNA) integrity plays a significant role in cell function. There are limited studies with regard to the role of DNA damage in bipolar affective disorder (BP). In the present study, we have assessed DNA integrity, conformation, and stability in the brain region of bipolar depression (BD) patients (n=10) compared to age-matched controls (n=8). Genomic DNA was isolated from 10 postmortem BD patients' brain regions (frontal cortex, Pons, medulla, thalamus, cerebellum, hypothalamus, Parietal, temporal, occipital lobe, and hippocampus) and from the age-matched control subjects. DNA from the frontal cortex, pons, medulla, and thalamus showed significantly higher number of strand breaks in BD (P<0.01) compared to the age-matched controls. However, DNA from the hippocampus region was intact and did not show any strand breaks. The stability studies also indicated that the melting temperature and ethidium bromide binding pattern were altered in the DNA of BD patients' brain regions, except in the hippocampus. The conformation studies showed B-A or secondary B-DNA conformation (instead of the normal B-DNA) in BD patients' brain regions, with the exception of the hippocampus. The levels of redox metals such as Copper (Cu) and Iron (Fe) were significantly elevated in the brain regions of the sufferers of BD, while the Zinc (Zn) level was decreased. In the hippocampus, there was no change in the Fe or Cu levels, whereas, the Zn level was elevated. There was a clear correlation between Cu and Fe levels versus strand breaks in the brain regions of the BD. To date, as far as we are aware, this is a new comprehensive database on stability and conformations of DNA in different brain regions of patients affected with BD. The biological significance of these findings is discussed here.
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Affiliation(s)
- Mohammed S Mustak
- Department of Biochemistry and Nutrition, Central Food Technological Research Institute, Mysore, India
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Vasudevaraju P, Bharathi, T J, Shamasundar NM, Subba Rao K, Balaraj BM, KSJ R, T.S SR. New evidence on iron, copper accumulation and zinc depletion and its correlation with DNA integrity in aging human brain regions. Indian J Psychiatry 2010; 52:140-4. [PMID: 20838501 PMCID: PMC2927883 DOI: 10.4103/0019-5545.64590] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Deoxyribonucleic acid (DNA) conformation and stability play an important role in brain function. Earlier studies reported alterations in DNA integrity in the brain regions of neurological disorders like Parkinson's and Alzheimer's diseases. However, there are only limited studies on DNA stability in an aging brain and the factors responsible for genomic instability are still not clear. In this study, we assess the levels of Copper (Cu), Iron (Fe) and Zinc (Zn) in three age groups (Group I: below 40 years), Group II: between 41-60 years) and Group III: above 61 years) in hippocampus and frontal cortex regions of normal brains. The number of samples in each group was eight. Genomic DNA was isolated and DNA integrity was studied by nick translation studies and presented as single and double strand breaks. The number of single strand breaks correspondingly increased with aging compared to double strand breaks. The strand breaks were more in frontal cortex compared to hippocampus. We observed that the levels of Cu and Fe are significantly elevated while Zn is significantly depleted as one progresses from Group I to Group III, indicating changes with aging in frontal cortex and hippocampus. But the elevation of metals was more in frontal cortical region compared to hippocampal region. There was a clear correlation between Cu and Fe levels versus strand breaks in aging brain regions. This indicates that genomic instability is progressive with aging and this will alter the gene expressions. To our knowledge, this is a new comprehensive database to date, looking at the levels of redox metals and corresponding strand breaks in DNA in two brain regions of the aging brain. The biological significance of these findings with relevance to mental health will be discussed.
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Affiliation(s)
- P. Vasudevaraju
- Department of Biochemistry and Nutrition, Central Food and Technological Research Institute, Mysore -570 020, India
| | - Bharathi
- Department of Biochemistry and Nutrition, Central Food and Technological Research Institute, Mysore -570 020, India
- Department of Neurosciences, Institute for Cell Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, 21205, USA
| | - Jyothsna T
- Department of Psychiatry, JSS Medical College and Hospital, JSS University, Mysore - 570 004, India
| | - N. M. Shamasundar
- Department of Anatomy, JSS Medical College, JSS University, Mysore, India
| | - K. Subba Rao
- Jawaharlal Nehru Technological University, Hyderabad, India
| | - B. M. Balaraj
- Department of Forensic Science, JSS Medical College, JSS University, Mysore, India
| | - Rao KSJ
- Department of Biochemistry and Nutrition, Central Food and Technological Research Institute, Mysore -570 020, India
| | - Sathyanarayana Rao T.S
- Department of Psychiatry, JSS Medical College and Hospital, JSS University, Mysore - 570 004, India
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21
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Hendrie C, Pickles A. Depression as an evolutionary adaptation: Anatomical organisation around the third ventricle. Med Hypotheses 2010; 74:735-40. [DOI: 10.1016/j.mehy.2009.10.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2009] [Accepted: 10/14/2009] [Indexed: 11/20/2022]
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22
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Janssen J, Diaz-Caneja A, Reig S, Bombín I, Mayoral M, Parellada M, Graell M, Moreno D, Zabala A, Vazquez VG, Desco M, Arango C. Brain morphology and neurological soft signs in adolescents with first-episode psychosis. Br J Psychiatry 2009; 195:227-33. [PMID: 19721112 DOI: 10.1192/bjp.bp.108.052738] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Adolescents with first-episode psychosis have increased severity of neurological soft signs when compared with controls, but it is unclear whether increased severity of neurological soft signs is an expression of specific structural brain deficits. AIMS To examine whether increased severity of neurological soft signs was associated with decreased brain volumes in adolescents with first-episode psychosis. METHOD Brain scans were obtained for 70 adolescents (less than 18 years of age) with first-episode psychosis (duration of positive symptoms less than 6 months). Volumes were assessed using voxel-based morphometry and through segmentation of anatomical structures. RESULTS Increased severity of sensory integration neurological soft signs correlated with smaller right and left thalamus volume, whereas increased severity of sequencing of complex motor acts neurological soft signs correlated with smaller right caudate volume. CONCLUSIONS Neurological soft signs may be an easy-to-assess marker of region-specific structural brain deficits in adolescents with first-episode psychosis.
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Affiliation(s)
- Joost Janssen
- Department of Experimental Medicine and Psychiatry, Adolescent Unit Hospital General Universitario Gregorio Marañon (AU-HGUGM), 28007 Madrid, Spain.
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23
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Arnone D, Cavanagh J, Gerber D, Lawrie SM, Ebmeier KP, McIntosh AM. Magnetic resonance imaging studies in bipolar disorder and schizophrenia: meta-analysis. Br J Psychiatry 2009; 195:194-201. [PMID: 19721106 DOI: 10.1192/bjp.bp.108.059717] [Citation(s) in RCA: 310] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Several magnetic resonance imaging (MRI) studies have identified structural abnormalities in association with bipolar disorder. The literature is, however, heterogeneous and there is remaining uncertainty about which brain areas are pivotal to the pathogenesis of the condition. AIMS To identify, appraise and summarise volumetric MRI studies of brain regions comparing bipolar disorder with an unrelated control group and individuals with schizophrenia. METHOD A systematic review and random-effects meta-analysis was carried out to identify key areas of structural abnormality in bipolar disorder and whether the pattern of affected areas separated bipolar disorder from schizophrenia. Significant heterogeneity was explored using meta-regression. RESULTS Participants with bipolar disorder are characterised by whole brain and prefrontal lobe volume reductions, and also by increases in the volume of the globus pallidus and lateral ventricles. In comparison with schizophrenia, bipolar disorder is associated with smaller lateral ventricular volume and enlarged amygdala volume. Heterogeneity was widespread and could be partly explained by clinical variables and year of publication, but generally not by differences in image acquisition. CONCLUSIONS There appear to be robust changes in brain volume in bipolar disorder compared with healthy volunteers, although most changes do not seem to be diagnostically specific. Age and duration of illness appear to be key issues in determining the magnitude of observed effect sizes.
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Affiliation(s)
- Danilo Arnone
- Neuroscience and Psychiatry Unit, University of Manchester, Manchester M13 9PT, UK.
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Vermeire S, Audenaert K, Dobbeleir A, De Meester R, Vandermeulen E, Waelbers T, Peremans K. Regional Cerebral Blood Flow Changes in Dogs with Anxiety Disorders, Measured with SPECT. Brain Imaging Behav 2009. [DOI: 10.1007/s11682-009-9076-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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26
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Pavuluri MN, Yang S, Kamineni K, Passarotti AM, Srinivasan G, Harral EM, Sweeney JA, Zhou XJ. Diffusion tensor imaging study of white matter fiber tracts in pediatric bipolar disorder and attention-deficit/hyperactivity disorder. Biol Psychiatry 2009; 65:586-93. [PMID: 19027102 PMCID: PMC2677389 DOI: 10.1016/j.biopsych.2008.10.015] [Citation(s) in RCA: 186] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2008] [Revised: 09/25/2008] [Accepted: 10/15/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND To investigate microstructure of white matter fiber tracts in pediatric bipolar disorder (PBD) and attention-deficit/hyperactivity disorder (ADHD). METHODS A diffusion tensor imaging (DTI) study was conducted at 3 Tesla on age- and IQ-matched children and adolescents with PBD (n = 13), ADHD (n = 13), and healthy control subjects (HC) (n = 15). Three DTI parameters, fractional anisotropy (FA), apparent diffusion coefficient (ADC), and regional fiber coherence index (r-FCI), were examined in eight fiber tracts: anterior corona radiata (ACR), anterior limb of the internal capsule (ALIC), superior region of the internal capsule (SRI), posterior limb of the internal capsule (PLIC), superior longitudinal fasciculus (SLF), inferior longitudinal fasciculus (ILF), cingulum (CG), and splenium (SP). RESULTS Significantly lower FA was observed in ACR in both PBD and ADHD relative to HC. In addition, FA and r-FCI values were significantly lower in ADHD relative to PBD and HC in both the ALIC and the SRI. Further, ADC was significantly greater in ADHD relative to both the PBD and HC in ACR, ALIC, PLIC, SRI, CG, ILF, and SLF. CONCLUSIONS Decreased FA in ACR implies an impaired fiber density or reduced myelination in both PBD and ADHD in this prefrontal tract. These abnormalities, together with the reduced fiber coherence, extended to corticobulbar tracts in ADHD. Increased ADC across multiple white matter tracts in ADHD indicates extensive cellular abnormalities with less diffusion restriction in ADHD relative to PBD.
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Affiliation(s)
- Mani N. Pavuluri
- Center for Cognitive Medicine, University of Illinois Medical Center at Chicago, Chicago, Illinois, USA, Institute for Juvenile Research, University of Illinois Medical Center at Chicago, Chicago, Illinois, USA, Department of Psychiatry, University of Illinois Medical Center at Chicago, Chicago, Illinois, USA
| | - Shuohui Yang
- Center for MR Research, University of Illinois Medical Center at Chicago, Chicago, Illinois, USA
| | - Kiran Kamineni
- Center for Cognitive Medicine, University of Illinois Medical Center at Chicago, Chicago, Illinois, USA, Institute for Juvenile Research, University of Illinois Medical Center at Chicago, Chicago, Illinois, USA, Department of Psychiatry, University of Illinois Medical Center at Chicago, Chicago, Illinois, USA
| | - Alessandra M. Passarotti
- Center for Cognitive Medicine, University of Illinois Medical Center at Chicago, Chicago, Illinois, USA, Institute for Juvenile Research, University of Illinois Medical Center at Chicago, Chicago, Illinois, USA, Department of Psychiatry, University of Illinois Medical Center at Chicago, Chicago, Illinois, USA
| | - Girish Srinivasan
- Center for MR Research, University of Illinois Medical Center at Chicago, Chicago, Illinois, USA, Department of Bioengineering, University of Illinois Medical Center at Chicago, Chicago, Illinois, USA
| | - Erin M. Harral
- Center for Cognitive Medicine, University of Illinois Medical Center at Chicago, Chicago, Illinois, USA, Institute for Juvenile Research, University of Illinois Medical Center at Chicago, Chicago, Illinois, USA, Department of Psychiatry, University of Illinois Medical Center at Chicago, Chicago, Illinois, USA
| | - John A. Sweeney
- Center for Cognitive Medicine, University of Illinois Medical Center at Chicago, Chicago, Illinois, USA, Department of Psychiatry, University of Illinois Medical Center at Chicago, Chicago, Illinois, USA, Department of Bioengineering, University of Illinois Medical Center at Chicago, Chicago, Illinois, USA
| | - Xiaohong Joe Zhou
- Center for MR Research, University of Illinois Medical Center at Chicago, Chicago, Illinois, USA, Department of Bioengineering, University of Illinois Medical Center at Chicago, Chicago, Illinois, USA, Department of Radiology, University of Illinois Medical Center at Chicago, Chicago, Illinois, USA, Department of Neurosurgery, University of Illinois Medical Center at Chicago, Chicago, Illinois, USA
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Abstract
Over the past 5-10 years, advances in neuroimaging methods and study designs have begun to appear in the literature of early-onset bipolar disorder (onset before 18 years of age). This article contains an updated review of the literature regarding neuroimaging in youths with bipolar disorder (BPD), highlighting important new study designs and techniques. Overall, structural, functional (fMRI) and magnetic resonance spectroscopy (MRS) report consistent abnormalities in regions of the frontal lobe and limbic structures. Functional MRI and MRS studies also frequently report striatal and thalamic abnormalities in early-onset BPD. Future neuroimaging studies in youths with BPD should include longitudinal studies incorporating multimodal neuroimaging techniques.
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Affiliation(s)
- Janine Terry
- The Brain Institute, University of Utah, 383 Colorow Drive, Salt Lake City, UT 84108, USA
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28
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Sanches M, Keshavan MS, Brambilla P, Soares JC. Neurodevelopmental basis of bipolar disorder: a critical appraisal. Prog Neuropsychopharmacol Biol Psychiatry 2008; 32:1617-27. [PMID: 18538910 DOI: 10.1016/j.pnpbp.2008.04.017] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2007] [Revised: 04/24/2008] [Accepted: 04/29/2008] [Indexed: 11/29/2022]
Abstract
Neurodevelopmental factors have been implicated in the pathophysiology of mental disorders. However, the evidence regarding their role in bipolar disorder is controversial. We reviewed the pertinent literature searching for evidence regarding a neurodevelopmental origin of bipolar disorder. Findings from clinical, epidemiological, neuroimaging, and post-mortem studies are discussed, as well as the implications of the available data for a better understanding of the mechanisms involved in the genesis of bipolar disorder. While some evidence exists for developmental risk factors in bipolar disorder, further research is needed to determine the precise extent of their contribution to pathogenesis. The timing and course of such developmentally mediated neurobiological alterations also need to be determined. Of particular importance for further study is the possibility that bipolar disorder may be mediated by an abnormal maturation of brain structures involved in affect regulation.
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Affiliation(s)
- Marsal Sanches
- MOOD-CNS Program, Division of Mood and Anxiety Disorders, Department of Psychiatry, The University of Texas Health Science Center at San Antonio, South Texas Veterans Health Care System, Audie L. Murphy Division, San Antonio, Texas, USA
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29
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Abstract
OBJECTIVE To evaluate the absence and size of massa intermedia (MI), a midline thalamic structure, and its gender-specific alteration in patients with schizophrenia and bipolar disorder. METHODS Thirty-five patients with schizophrenia (17 females and 18 males), 21 patients with bipolar disorder (15 females and 6 males) and 89 healthy controls (50 females and 39 males) were evaluated by magnetic resonance imaging. Thin-slice magnetic resonance images of the brain were evaluated. MI was determined in coronal and sagittal images, and area of the MI was measured on the sagittal plane. RESULTS Females had a significantly lower incidence of absent MI compared with males in the healthy control group. The absence of MI in schizophrenia and bipolar patients was not higher than the incidence in healthy controls. The size of MI showed a gender difference. The mean MI area size was smaller in female schizophrenia patients than in female controls, while no significant difference was observed between male schizophrenia patients and their controls. CONCLUSIONS The size of MI, a gender difference midline structure, is smaller in females with schizophrenia, and the results of this study support other studies of structural aberration of the thalamus and other midline structures in the brains of patients with schizophrenia.
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Affiliation(s)
- Meltem Ceyhan
- 1Department of Radiology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Baki Adapınar
- 2Department of Radiology, Faculty of Medicine, Osmangazi University, Eskişehir, Turkey
| | - Gokay Aksaray
- 3Department of Psychiatry, Faculty of Medicine, Osmangazi University, Eskişehir, Turkey
| | - Figen Ozdemir
- 3Department of Psychiatry, Faculty of Medicine, Osmangazi University, Eskişehir, Turkey
| | - Ertugrul Colak
- 4Department of Biostatistics, Faculty of Medicine, Osmangazi University, Eskişehir, Turkey
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30
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Abstract
OBJECTIVE To find, review, and critically evaluate evidence pertaining to the phenomenology of pediatric bipolar disorder and its validity as a diagnosis. METHODS The present qualitative review summarizes and synthesizes available evidence about the phenomenology of bipolar disorder (BD) in youths, including description of the diagnostic sensitivity and specificity of symptoms, clarification about rates of cycling and mixed states, and discussion about chronic versus episodic presentations of mood dysregulation. The validity of the diagnosis of BD in youths is also evaluated based on traditional criteria including associated demographic characteristics, family environmental features, genetic bases, longitudinal studies of youths at risk of developing BD as well as youths already manifesting symptoms on the bipolar spectrum, treatment studies and pharmacologic dissection, neurobiological findings (including morphological and functional data), and other related laboratory findings. Additional sections review impairment and quality of life, personality and temperamental correlates, the clinical utility of a bipolar diagnosis in youths, and the dimensional versus categorical distinction as it applies to mood disorder in youths. RESULTS A schema for diagnosis of BD in youths is developed, including a review of different operational definitions of 'bipolar not otherwise specified.' Principal areas of disagreement appear to include the relative role of elated versus irritable mood in assessment, and also the limits of the extent of the bipolar spectrum--when do definitions become so broad that they are no longer describing 'bipolar' cases? CONCLUSIONS In spite of these areas of disagreement, considerable evidence has amassed supporting the validity of the bipolar diagnosis in children and adolescents.
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Affiliation(s)
- Eric A Youngstrom
- Department of Psychology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-3270, USA.
| | - Boris Birmaher
- Child and Adolescent Mood Disorders, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Robert L Findling
- Child and Adolescent Psychiatry, Case Western Reserve University and University Hospitals Case Medical Center, Cleveland, OH, USA
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Abstract
Early onset schizophrenia (with onset before adulthood) represents a rarer and possibly more severe form of the disorder which has received particular attention in the last two decades. Current evidence strongly suggest continuity with adult onset schizophrenia, with phenomenological, cognitive, genetic and neuroimaging data pointing towards similar neurobiological correlates and clinical deficits but worse long term outcome. Future research in early onset cases is likely to increase further our insight into the neurodevelopmental origins of schizophrenia and the complex gene-environment interactions affecting its emergence.
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Affiliation(s)
- Marinos Kyriakopoulos
- Section of Neurobiology of Psychosis, Institute of Psychiatry, De Crespigny Park, King's College, London, UK
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Abstract
PURPOSE OF REVIEW Schizoaffective disorder was named as a compromise diagnosis in 1933, and remains popular as judged by its place in the International Classification of Diseases and the Diagnostic and Statistical Manual of Mental Disorders, its frequent use in clinical practice, and its extensive discussion in the literature. Some, however, have questioned the validity of schizoaffective disorder as separate from psychotic mood disorder. We examined the literature to assess the rationale for the continuation of schizoaffective disorder as a legitimate diagnostic category. RECENT FINDINGS The diagnosis of schizoaffective disorder depends on the disease specificity of the diagnostic criteria for schizophrenia; however, the psychotic symptoms for schizophrenia, traditionally held as specific, can be accounted for by psychotic bipolar. Further, the interrater reliability for diagnosing schizoaffective disorder is very low. A recent and expanding body of comparative evidence from a wide range of clinical and basic science studies, especially genetic, reveals multiple similarities between schizoaffective disorder, schizophrenia and psychotic bipolar. SUMMARY Schizoaffective disorder unifies schizophrenia and bipolar, blurring the zones of rarity between them and suggesting that schizoaffective disorder is not a separate, 'bona-fide' disease. Patients diagnosed with schizoaffective disorder likely suffer from a psychotic mood disorder. The diagnosis of schizoaffective disorder, which can result in substandard treatment, should be eliminated from the diagnostic nomenclature.
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Affiliation(s)
- Charles Ray Lake
- Department of Psychiatry and Behavioral Sciences, University of Kansas School of Medicine, Kansas City, Kansas 66160, USA.
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Abstract
OBJECTIVE In order to compare their validity, this review applies scientific standards for sustaining the neuroses, the schizophrenias and bipolar disorders as separate "bona-fide" psychiatric diseases. The standards for disease validation demand specific and unique symptoms. METHOD We review a wide variety of clinical and basic science comparisons between schizophrenia and psychotic bipolar in a select English-language literature. RESULTS Like covered wagons, the neuroses once served us well but became obsolete and were discarded or reorganized based on what was known about commonalities of symptoms, causation and pharmacological responsivity. Bipolar patients meet unique and specific diagnostic criteria and demonstrate consistent results across a variety of scientific disciplines. Neither the neuroses nor the schizophrenias have such unique or disease specific diagnostic criteria. Psychotic mood disorders account for the DSM diagnostic criteria for schizophrenia. A recent, selected but diverse basic science literature demonstrates surprising similarities between schizophrenia and psychotic bipolar which should not exist if these disorders are distinct. CONCLUSIONS Like the neuroses, there is stigma, confusion and misunderstanding about the condition called schizophrenia, resulting in substantial negative impact on bipolar patients misdiagnosed as having schizophrenia. The psychoses, including the schizophrenias, likely are explained by a single disease, psychotic bipolar disorder, that has demonstrated a wide spectrum of severity of symptoms and chronicity of course, not traditionally recognized.
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Affiliation(s)
- C Raymond Lake
- Department of Psychiatry, University of Kansas Medical Center, Kansas City, KS, USA.
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Monkul ES, Nicoletti MA, Spence D, Sassi RB, Axelson D, Brambilla P, Hatch JP, Keshavan M, Ryan N, Birmaher B, Soares JC. MRI study of thalamus volumes in juvenile patients with bipolar disorder. Depress Anxiety 2007; 23:347-52. [PMID: 16688738 DOI: 10.1002/da.20161] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
In vivo imaging studies suggest functional abnormalities of the thalamus in adult patients with bipolar disorder, but the presence of anatomical abnormalities is controversial. Our objective in this study was to compare the thalamus volumes of children and adolescents with bipolar disorder versus healthy controls to determine whether any morphological abnormalities exist early in illness course. We studied 16 patients with bipolar disorder according to DSM-IV criteria (mean age+/-SD=15.5+/-3.4 years) and 21 healthy control subjects (mean age+/-SD=16.9+/-3.8 years). Blinded examiners measured thalamic gray matter volumes with a semiautomated technique. Analysis of covariance, with age, gender, and intracranial brain volume as covariates, revealed no significant differences in left and right thalamic volumes between patients with bipolar disorder and healthy controls. Our findings indicate there are no significant differences in thalamus size between children and adolescents with bipolar disorder and healthy comparison subjects, in contrast to available findings for schizophrenia and first-break psychosis. Any differences in thalamus size that may exist between patients with bipolar disorder and healthy controls must amount to small effect sizes.
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Affiliation(s)
- E Serap Monkul
- MOOD-CNS Program, Division of Mood and Anxiety Disorders, Department of Psychiatry, The University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229, USA
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Pardo PJ, Georgopoulos AP, Kenny JT, Stuve TA, Findling RL, Schulz SC. Classification of adolescent psychotic disorders using linear discriminant analysis. Schizophr Res 2006; 87:297-306. [PMID: 16797923 DOI: 10.1016/j.schres.2006.05.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2005] [Revised: 05/06/2006] [Accepted: 05/10/2006] [Indexed: 01/01/2023]
Abstract
BACKGROUND The differential diagnosis between schizophrenia and bipolar disorder during adolescence presents a major clinical problem. Can these two diagnoses be differentiated objectively early in the courses of illness? METHODS We used linear discrimination analysis (LDA) to classify 28 adolescent subjects into one of three diagnostic categories (healthy, N=8; schizophrenia, N=10; bipolar, N=10) using subsets from a pool of 45 variables as potential predictors (22 neuropsychological test scores and 23 quantitative structural brain measurements). The predictor variables were adjusted for age, gender, race, and psychotropic medication. All possible subsets composed of k=2-12 variables, from the set of 45 variables available, were evaluated using the robust leaving-one-subject-out method. RESULTS The highest correct classification (96%) of the 3 diagnostic categories was yielded by 9 sets of k=12 predictors, comprising both neuropsychological and brain structural measures. Although each one of these sets misclassified one case, each set correctly classified (100%) at least one group, such that a fully correct diagnosis could be reached by a tree-type decision procedure. CONCLUSIONS We conclude that LDA with 12 predictor variables can provide correct and robust classification of subjects into the three diagnostic categories above. This robust classification relies upon both neuropsychological and brain structural information. Our results demonstrate that, despite overlapping clinical symptoms, schizophrenia and bipolar disorder can be differentiated early in the course of disease. This finding has two important implications. Firstly, schizophrenia and bipolar disorder are different illnesses. If schizophrenia and bipolar are dissimilar clinical manifestations of the same disease, we would not be able to use non-clinical information to classify ('diagnose') schizophrenia and bipolar disorder. Secondly, if this study's findings are replicated, brain structure (MRI) and brain function (neuropsychological) used together may be useful in the diagnosis of new patients.
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Affiliation(s)
- Patricia J Pardo
- The Domenici Research Center for Mental Illness, Brain Sciences Center, Minneapolis Veterans Affairs Medical Center, Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, 55454, USA.
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Abstract
OBJECTIVES The aims of this paper are to provide an overview of neuroimaging findings specific to bipolar disorder and suicide, and to consider rational approaches to the design of future in vivo studies in youth at risk. METHODS Neuroimaging and related neurobiological literature pertaining to bipolar disorder and suicide in adult and pediatric samples was reviewed in a non-quantitative manner. RESULTS Specific structural and functional brain findings in bipolar disorder are described, where possible in the context of relevant current neurobiological theories of etiology. Diagnostic and prognostic implications are discussed. CONCLUSIONS The simultaneous use of complementary neurobiological approaches may be a powerful way of identifying and validating factors reliably associated with bipolar disorder and suicide. A profile of neurobiological markers with which to screen for bipolar disorder and suicide risk may provide for earlier and more accurate diagnosis, perhaps even in the pre- or subsyndromal stages in high-risk youth.
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Affiliation(s)
- M Elizabeth Sublette
- Department of Neuroscience, New York State Psychiatric Institute, Columbia University, New York, NY 10032, USA
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37
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Lake CR, Hurwitz N. Schizoaffective disorders are psychotic mood disorders; there are no schizoaffective disorders. Psychiatry Res 2006; 143:255-87. [PMID: 16857267 DOI: 10.1016/j.psychres.2005.08.012] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2004] [Revised: 07/02/2005] [Accepted: 08/16/2005] [Indexed: 12/22/2022]
Abstract
Schizoaffective disorder (SA D/O), introduced in 1933 by Dr. Jacob Kasanin, represented a first, modest change in our concept about the diagnoses of psychotic patients away from the beliefs of E. Bleuler, i.e., that hallucinations and delusions define schizophrenia, and toward the recognition of a significant role for mood disorders. SA D/O established a connection between schizophrenia and mood disorders, traditionally considered mutually exclusive, a connection that has strengthened progressively toward the diagnostic unity of all three disorders. A basic tenet of medicine holds that if discrepant symptoms can be explained by one disease instead of two or more, it is likely there is only one disease. The scientific justification for SA D/O and schizophrenia as disorders distinct from a psychotic mood disorder has been questioned. The "schizo" prefix in SA D/O rests upon the presumption that the diagnostic symptoms for schizophrenia are disease specific. They are not, since patients with severe mood disorders can evince any or all of the "schizophrenic" symptoms. "Schizophrenic" symptoms mean "psychotic" and not any specific disease. These data and a very low interrater reliability for SA D/O suggest that the concepts of SA D/O and schizophrenia as valid diagnoses are flawed. Clinically SA D/O remains popular because it encompasses both schizophrenia and psychotic mood disorder when there is a diagnostic question. We present a review of the literature in table form based on an assignment of each article assigned to one of five categories that describe the possible relationships between SA D/O, schizophrenia and psychotic mood disorders. We conclude that the data overall are compatible with the hypothesis that a single disease, a mood disorder, with a broad spectrum of severity, rather than three different disorders, accounts for the functional psychoses.
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Affiliation(s)
- C Raymond Lake
- Psychiatry and Behavioral Sciences, University of Kansas School of Medicine, Kansas City, KS 66160-7341, USA.
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38
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Clinton SM, Haroutunian V, Meador-Woodruff JH. Up-regulation of NMDA receptor subunit and post-synaptic density protein expression in the thalamus of elderly patients with schizophrenia. J Neurochem 2006; 98:1114-25. [PMID: 16762023 DOI: 10.1111/j.1471-4159.2006.03954.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Numerous studies have described structural and functional abnormalities of the thalamus in schizophrenia, but surprisingly few studies have examined neurochemical abnormalities that accompany these pathological changes. We previously identified abnormalities of multiple molecules associated with glutamatergic neurotransmission, including changes in NMDA receptor subunit transcripts and binding sites and NMDA receptor-associated post-synaptic density (PSD) protein transcripts in the thalamus of elderly patients with schizophrenia. In the present study, we performed western blot analysis to determine whether protein levels of NMDA receptor subunits (NR1, NR2A, NR2B) and associated PSD proteins (NF-L, PSD95, SAP102) are altered in schizophrenia. Thalamic tissue from each subject was grossly dissected into two regions: a dorsomedial region containing limbic-associated dorsomedial, anterior and central medial thalamic nuclei; and a ventral thalamus region that primarily consisted of the ventral lateral nucleus. We observed increased protein expression of the NR2B NMDA receptor subunit and its associated intracellular protein, PSD95, in the dorsomedial thalamus of patients with schizophrenia, but the other molecules were unchanged, and we found no changes in the ventral thalamus. These data provide additional evidence of thalamic neurochemical abnormalities, particularly in thalamic nuclei which project to limbic regions of the brain. Further, these findings provide additional evidence of NMDA receptor alterations in schizophrenia, which may play an important role in the neurobiology of the illness.
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Affiliation(s)
- Sarah M Clinton
- Department of Psychiatry, Molecular and Behavioral Neuroscience Institute, University of Michigan Medical School, Ann Arbor, 48109, USA.
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39
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Abstract
INTRODUCTION Children and adolescents with bipolar disorder often present with higher rates of mixed episodes, rapid cycling, and co-occurring attention-deficit/hyperactivity disorder than adults with bipolar disorder. It is unclear whether the differences in clinical presentation between youth and adults with bipolar disorder are due to differences in underlying etiologies or developmental differences in symptom manifestation. Neuroimaging studies of children and adolescents with bipolar disorder may clarify whether neurobiological abnormalities associated with early- and adult-onset bipolar disorder are distinct. Moreover, children and adolescents with bipolar disorder are typically closer to their illness onset than bipolar adults, providing a window of opportunity for identifying core neurobiological characteristics of the illness (ie, disease biomarkers) that are independent of repeated affective episodes and other confounding factors associated with illness course. METHODS Peer-reviewed publications of neuroimaging studies of bipolar children and adolescents were reviewed. RESULTS Structural, neurochemical, and neurofunctional abnormalities in prefrontal and medical temporal and subcortical limbic structures, including the striatum, amygdala, and possibly hippocampus, are present in children and adolescents with bipolar disorder. CONCLUSION Differences between neurobiological abnormalities in bipolar youth and adults as well as recommendations for future research directions are discussed.
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Affiliation(s)
- Melissa P DelBello
- Division of Bipolar Disorder Research, University of Cincinnati College of Medicine, Cincinnati, OH 45267-0559, USA.
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40
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Abstract
This article reviews the current state of magnetic resonance imaging techniques as applied to bipolar disorder. Addressed are conventional methods of structural neuroimaging and recently developed techniques. This latter group comprises volumetric analysis, voxel-based morphometry, the assessment of T2 white matter hyperintensities, shape analysis, cortical surface-based analysis, and diffusion tensor imaging. Structural analysis methods used in magnetic resonance imaging develop exponentially, and now present opportunities to identify disease-specific neuroanatomic alterations. Greater acuity and complementarity in measuring these alterations has led to the generation of further hypotheses regarding the pathophysiology of bipolar disorder. Included in the summary of findings is consideration of a resulting neuroanatomic model. Integrative issues and future directions in this relatively young field, including multi-modal approaches enabling us to produce more comprehensive results, are discussed.
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Affiliation(s)
- In Kyoon Lyoo
- Department of Psychiatry, Seoul National University, South Korea, Seoul, South Korea
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41
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Abstract
Volumetric neuroimaging studies of the elderly with affective disorders provide important insights into the underlying physiology of the illnesses. Advantages of studying the elderly include the ability to make various assessments and obtain a history differentiating subtypes of illness. However, challenges to studying the elderly include the heterogeneity of affective illnesses and confounds of medical comorbidity and medications. Volumetric assessments have provided important information in the neural mechanisms of mood regulation, especially in the overlap of cognitive disorders. This article reviews articles describing findings of volumetric analyses in elderly with unipolar depression and bipolar disorders, and compares and contrasts these findings with the larger volumetric research in affective disorders.
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Bielau H, Trübner K, Krell D, Agelink MW, Bernstein HG, Stauch R, Mawrin C, Danos P, Gerhard L, Bogerts B, Baumann B. Volume deficits of subcortical nuclei in mood disorders A postmortem study. Eur Arch Psychiatry Clin Neurosci 2005; 255:401-12. [PMID: 16080015 DOI: 10.1007/s00406-005-0581-y] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2004] [Accepted: 02/03/2005] [Indexed: 10/25/2022]
Abstract
Structural changes in subcortical nuclei may underlie clinical symptoms of mood disorders. The goal was to determine whether macrostructural changes exist in brain areas assumed to be involved in regulation of mood and whether such changes differ between major depressive disorder and bipolar disorder. A case-control design was used to compare volumes of all major subcortical nuclei. Brains of patients with major depressive disorder (n = 9) or bipolar disorder (n = 11) or of individuals without a neuropsychiatric disorder (n = 22) were included. Exclusion criteria were a history of substance abuse or histological signs of neurodegenerative disorders. Volumes of the striato-pallidal nuclei, of the hypothalamus, thalamus, amygdala, hippocampus and basal limbic forebrain were determined in the right and left hemisphere by planimetry of 20 mum whole brain serial paraffin sections. Comparisons between patients with bipolar disorder, major depressive disorder and controls showed a significant (Lambda = 0.35, F(20,56) = 1.93, P = 0.028) overall difference in volumes of all investigated regions with strong effect sizes ( f > 0.40) contributed by the hypothalamus, external pallidum, putamen and thalamus. As compared to controls, a strong effect size (f > 0.40) was found in the bipolar group for smaller volumes of the hypothalamus, external pallidum, putamen and thalamus,whereas in patients with major depressive disorder a strong effect size was only found for a smaller volume of the external pallidum. In conclusion our data suggest that pathways presumably involved in mood regulation have structural pathology in affective disorders with more pronounced abnormalities in bipolar disorder.
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Affiliation(s)
- Hendrik Bielau
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Otto-von-Guericke-University of Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany.
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Frazier JA, Breeze JL, Makris N, Giuliano AS, Herbert MR, Seidman L, Biederman J, Hodge SM, Dieterich ME, Gerstein ED, Kennedy DN, Rauch SL, Cohen BM, Caviness VS. Cortical gray matter differences identified by structural magnetic resonance imaging in pediatric bipolar disorder. Bipolar Disord 2005; 7:555-69. [PMID: 16403181 PMCID: PMC2072813 DOI: 10.1111/j.1399-5618.2005.00258.x] [Citation(s) in RCA: 103] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Few magnetic resonance imaging (MRI) studies of bipolar disorder (BPD) have investigated the entire cerebral cortex. Cortical gray matter (GM) volume deficits have been reported in some studies of adults with BPD; this study assessed the presence of such deficits in children with BPD. METHODS Thirty-two youths with DSM-IV BPD (mean age 11.2 +/- 2.8 years) and 15 healthy controls (HC) (11.2 +/- 3.0 years) had structured and clinical interviews, neurological examinations, neurocognitive testing, and MRI scanning on a 1.5 T GE Scanner. Image parcellation divided the neocortex into 48 gyral-based units per hemisphere, and these units were combined into frontal (FL), temporal (TL), parietal (PL), and occipital (OL) lobe volumes. Volumetric differences were examined using univariate linear regression models with alpha = 0.05. RESULTS Relative to controls, the BPD youth had significantly smaller bilateral PL, and left TL. Analysis of PL and TL gyri showed significantly smaller volume in bilateral postcentral gyrus, and in left superior temporal and fusiform gyri, while the parahippocampal gyri were bilaterally increased in the BPD group. Although the FL overall did not differ between groups, an exploratory analysis showed that the right middle frontal gyrus was also significantly smaller in the BPD group. CONCLUSIONS Children with BPD showed deficits in PL and TL cortical GM. Further analyses of the PL and TL found differences in areas involved in attentional control, facial recognition, and verbal and declarative memory. These cortical deficits may reflect early age of illness onset.
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Affiliation(s)
- Jean A Frazier
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
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Sim K, Cullen T, Ongur D, Heckers S. Testing models of thalamic dysfunction in schizophrenia using neuroimaging. J Neural Transm (Vienna) 2005; 113:907-28. [PMID: 16252070 DOI: 10.1007/s00702-005-0363-8] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2005] [Accepted: 07/23/2005] [Indexed: 01/03/2023]
Abstract
Neural models of schizophrenia have implicated the thalamus in deficits of early sensory processing and multimodal integration. We have reviewed the existing neuroimaging literature for evidence in support of models that propose abnormalities of thalamic relay nuclei, the mediodorsal thalamic nucleus, and large-scale cortico-thalamic networks. Thalamic volume reduction was found in some but not all studies. Studies of the early stages of schizophrenia suggest that thalamic volume reduction is present early in the course of the illness. Functional imaging studies have revealed task related abnormalities in several cortical and subcortical areas including the thalamus, suggesting a disruption of distributed thalamocortical networks. Chemical imaging studies have provided evidence for a loss of thalamic neuronal integrity in schizophrenia. There is, at present, inadequate data to support the hypothesis that schizophrenia is associated with abnormalities of sensory relay or association nuclei. There is evidence for a perturbation of cortico-thalamic networks, but further research is needed to elucidate the underlying mechanisms at the cellular and systems levels. The challenges ahead include better delineation of thalamic structure and function in vivo, the combination of genetic and imaging techniques to elucidate the genetic contributions to a thalamic phenotype of schizophrenia, and longitudinal studies of thalamic structure and function.
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Affiliation(s)
- K Sim
- Schizophrenia and Bipolar Disorder Program, McLean Hospital/Harvard Medical School, Belmont, MA 02478, USA.
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Abstract
OBJECTIVE Neuroimaging studies show structural brain abnormalities in bipolar patients. Some of the abnormalities may represent biological risk factors conveying vulnerability for the disease. This paper aims to identify neuroanatomical risk factors for bipolar disorder (BD). METHODS We reviewed magnetic resonance imaging (MRI) findings in populations in which the effects of the disease or treatment are minimal or where the chances of finding genetically coded risk factors shared within the families are increased. Such populations include unaffected relatives of bipolar patients, first-episode patients, children or adolescents with BD and patients with familial BD. RESULTS MEDLINE search revealed 30 relevant scientific papers. Abnormalities in the volume of the striatum, left hemispheric white matter, thalamus and anterior cingulate as well as quantitative MRI signal hyperintensities were identified already in unaffected relatives of bipolar patients. Subjects in the early stages of the disease showed volume changes of the ventricles, white matter, caudate, putamen, amygdala, hippocampus and the subgenual prefrontal cortex. Reduction in the subgenual prefrontal cortex volume was replicated in three of four studies in patients with familial BD. CONCLUSIONS Possible candidates for neuroanatomical risk factors for BD are volumetric abnormalities of the subgenual prefrontal cortex, striatum, white matter, and probably also the hippocampus and amygdala. Qualitative finding of white matter hyperintensities was already utilized as an endophenotype.
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Affiliation(s)
- Tomas Hajek
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada.
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Caetano SC, Olvera RL, Glahn D, Fonseca M, Pliszka S, Soares JC. Fronto-limbic brain abnormalities in juvenile onset bipolar disorder. Biol Psychiatry 2005; 58:525-31. [PMID: 16018982 DOI: 10.1016/j.biopsych.2005.04.027] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2004] [Revised: 04/01/2005] [Accepted: 04/13/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Advances in brain imaging techniques and cognitive neuropsychology have brought new possibilities for the in vivo study of the pathophysiology of neuropsychiatric disorders, including bipolar disorder (BD). Recently, such studies have been extended to the pediatric age range. Here we review the neuroimaging and neuropsychological studies conducted in BD children and adolescents. METHODS A review of the peer-reviewed published literature was conducted in Medline for the period of 1966 to April 2005. RESULTS Magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) studies suggest abnormalities in fronto-limbic structures in pediatric BD patients, similar to those found in adults. A notable exception in pediatric BD patients is smaller amygdala volumes compared to healthy controls, contrary to what has been reported in most adult studies. CONCLUSIONS Further research evaluating children and adolescents is needed to study the normal neurodevelopmental process and to answer how and when the illness processes that result in bipolar disorder exert their effects on the developing brain.
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Affiliation(s)
- Sheila C Caetano
- Department of Psychiatry, The University of Texas Health Science Center at San Antonio, 78229, USA
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Abstract
OBJECTIVE To review the literature of the past decade covering the epidemiology, clinical characteristics, assessment, longitudinal course, biological and psychosocial correlates, and treatment and prevention of pediatric bipolar disorder (BD). METHOD A computerized search for articles published during the past 10 years was made and selected studies are presented. RESULTS Pediatric BD is increasingly recognized, and there are several prevailing views on core features of this disorder. The incidence and prevalence of the disorder and the associated comorbidities vary according to study setting and criteria used. This disorder is highly recurrent and accompanied by substantial psychiatric and psychosocial morbidity. Familial studies, including "top down" (offspring of parents with BD) and "bottom up" (relatives of youths with BD) studies indicate that pediatric BD is aggregated in families with adult or later-onset BD and suggest the existence of genetic predisposition. Greater understanding of the risk factors for early onset BD and recognition of the phenomenology of prodromal symptoms offers hope for early identification and prevention. Neuroimaging studies indicate frontotemporal and frontostriatal pathology, but none of these findings seems to be disorder specific. Combination pharmacotherapies appear promising, and the field awaits further short- and long-term randomized, placebo-controlled trials. Preliminary studies of various psychotherapies, including psychoeducation strategies tailored specifically for BD in youths, look encouraging. CONCLUSIONS Considerable advances have been made in our knowledge of pediatric BD; however, differing viewpoints on the clinical presentation of BD in children are the rule. Phenomenological and longitudinal studies and biological validation using genetic, neurochemical, neurophysiological, and neuroimaging methods may strengthen our understanding of the phenocopy. Randomized, controlled treatment studies for the acute and maintenance treatment of BD disorder are warranted.
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Affiliation(s)
- Mani N Pavuluri
- Pediatric Mood Disorders Clinic and Bipolar Research Program, Department of Psychiatry, University of Illinois at Chicago, 60612-7327, USA.
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48
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Abstract
The MR findings reviewed in this article suggest structural, chemical, and functional abnormalities in specific brain regions participating in mood and cognitive regulation, such as the DLPFC, anterior cingulate, amygdala,STG, and corpus callosum in subjects with bipolar disorder. These abnormalities would represent an altered anterior-limbic network disrupting inter- and intrahemispheric communication and underlying the expression of bipolar disorder. Available studies are limited by several confounding variables, such as small and heterogeneous patient samples, differences in clinical and medication status, and cross-sectional design. It is still unclear whether abnormalities in neurodevelopment or neurodegeneration play a major role in the pathophysiology of bipolar disorder. These processes could act together in a unitary model of the disease, with excessive neuronal pruning/apoptosis during childhood and adolescence being responsible for the onset of the disorder and subsequent neurotoxic mechanisms and impaired neuroplasticity and cellular resilience being responsible for further disease progression. Future MR studies should investigate larger samples of first-episode drug-free patients, pediatric patients, subjects at high risk for bipolar disorder, and unaffected family members longitudinally. Such a study population is crucial to examine systematically whether brain changes are present before the appearance of symptoms (eg, maldevelopment) or whether they develop afterwards, as a result of illness course (eg, neurodegeneration). These studies will also be instrumental in minimizing potentially confounding factors commonly found in adult samples, such as the effects of long-term medication, chronicity, and hospitalizations. Juvenile bipolar patients often have a strong family history of bipolar disorder. Future studies could help elucidate the relevance of brain abnormalities as reflections of genetic susceptibility to the disorder. MR studies associated with genetic, post-mortem, and neuropsychologic studies will be valuable in separating state from trait brain abnormalities and in further characterizing the genetic determinants, the neuropathologic underpinnings, and the cognitive disturbances of bipolar disorder.
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Affiliation(s)
- Paolo Brambilla
- Section of Psychiatry, Department of Pathology and Experimental & Clinical Medicine, University of Udine, Udine, Italy
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49
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Abstract
OBJECTIVE Subcortical limbic structures have been proposed to be involved in the pathophysiology of adult and pediatric bipolar disorder (BD). We sought to study morphometric characteristics of these structures in pediatric subjects with familial BD compared with healthy controls. METHOD Twenty children and adolescents with BD I (mean age = 14.6 years, four females) and 20 healthy age, gender, and IQ-matched controls underwent high-resolution magnetic resonance imaging at 3 T. Patients were mostly euthymic and most were taking medications. Amygdala, hippocampus, thalamus, and caudate volumes were determined by manual tracings from researchers blinded to diagnosis. Analyses of covariance were performed, with total brain volume, age, and gender as covariates. RESULTS No differences were found in the volumes of hippocampus, caudate, and thalamus between subjects with BD and controls. Subjects with BD had smaller volumes in the left and right amygdala, driven by reductions in gray matter volume. Exploratory analyses revealed that subjects with BD with past lithium or valproate exposure tended to have greater amygdalar gray matter volume than subjects with BD without such exposure. CONCLUSIONS Children and adolescents with early-onset BD may have reduced amygdalar volumes, consistent with other studies in this population. Prolonged medication exposure to lithium or valproate may account for findings in adults with BD of increased amygdalar volume relative to controls.
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Affiliation(s)
- Kiki Chang
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305-5540, USA.
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50
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Abstract
Neurodevelopmental models of schizophrenia that identify longitudinal precursors of illness have been of great heuristic importance focusing most etiologic research over the past two decades. These models have varied considerably with respect to specificity and timing of hypothesized genetic and environmental 'hits', but have largely focused on insults to prenatal brain development. With heritability around 80%, nongenetic factors impairing development must also be part of the model, and any model must also account for the wide range of age of onset. In recent years, longitudinal brain imaging studies of both early and adult (to distinguish from late ie elderly) onset populations indicate that progressive brain changes are more dynamic than previously thought, with gray matter volume loss particularly striking in adolescence and appearing to be an exaggeration of the normal developmental pattern. This supports an extended time period of abnormal neurodevelopment in schizophrenia in addition to earlier 'lesions'. Many subtle cognitive, motor, and behavioral deviations are seen years before illness onset, and these are more prominent in early onset cases. Moreover, schizophrenia susceptibility genes and chromosomal abnormalities, particularly as examined for early onset populations (ie GAD1, 22q11DS), are associated with premorbid neurodevelopmental abnormalities. Several candidate genes for schizophrenia (eg dysbindin) are associated with lower cognitive abilities in both schizophrenic and other pediatric populations more generally. Postmortem human brain and developmental animal studies document multiple and diverse effects of developmental genes (including schizophrenia susceptibility genes), at sequential stages of brain development. These may underlie the broad array of premorbid cognitive and behavioral abnormalities seen in schizophrenia, and neurodevelopmental disorders more generally. Increased specificity for the most relevant environmental risk factors such as exposure to prenatal infection, and their interaction with susceptibility genes and/or action through phase-specific altered gene expression now both strengthen and modify the neurodevelopmental theory of schizophrenia.
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Affiliation(s)
- J L Rapoport
- Child Psychiatry Branch, NIMH, NIH, Bethesda, MD 20892-1600, USA.
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