Abnormal anterior cingulate cortical activity during emotional n-back task performance distinguishes bipolar from unipolar depressed females

Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Psychological Medicine (Impact Factor: 5.94). 11/2011; 42(7):1417-28. DOI: 10.1017/S003329171100242X
Source: PubMed


Depression in the context of bipolar disorder (BDd) is often misdiagnosed as unipolar disorder depression (UDd) leading to poor clinical outcomes for many bipolar sufferers. We examined neural circuitry supporting emotion regulation in females with either BDd or UDd as a first stage toward identifying biomarkers that may differentiate BDd from UDd.
Fifty-seven females aged 18-45 years participated in this study: 23 with UDd, 18 with bipolar disorder type I depression (BDId) and 16 healthy females. During 3-T functional magnetic resonance imaging (fMRI), the participants performed an emotional face n-back (EFNBACK) task, that is an n-back task with high (2-back) and low (0-back) memory load conditions flanked by two positive, negative or neutral face distracters. This paradigm examines executive control with emotional distracters-emotion regulation.
High memory load with neutral face distracters elicited greater bilateral and left dorsal anterior midcingulate cortex (dAMCC) activity in UDd than in healthy and BDId females respectively, and greater bilateral putamen activity in both depressed groups versus healthy females. High memory load with happy face distracters elicited greater left putamen activity in UDd than in healthy females. Psychotropic medication was associated with greater putamen activity to these contrasts in UDd females.
During high memory load with neutral face distracters, elevated dAMCC activity in UDd suggests abnormal recruitment of attentional control circuitry to maintain task performance, whereas elevated putamen activity unrelated to psychotropic medication in BDId females may suggest an attentional bias toward ambiguous neutral face distracters. Differential patterns of functional abnormalities in neural circuitry supporting attentional control during emotion regulation, especially in the dAMCC, is a promising neuroimaging measure to distinguish UDd from BDId in females.

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Available from: Michele Bertocci, Mar 03, 2014
    • "However, few neuroimaging studies have directly compared patterns of abnormal function in BD and MDD (Taylor Tavares et al., 2008; Almeida et al., 2009, 2010; Bertocci et al., 2012). For example, Bertocci and colleagues (2012) showed that individuals with unipolar depression had elevated dorsal anterior mid-cingulate cortical activity compared to the BD and healthy control (HC) groups, suggesting abnormal recruitment of attentional control. Putamen activation, on the other hand, was higher in both patient groups relative to healthy controls in the context of equivalent performance, which may represent a task-independent, shared disease biomarker. "
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    • "D. Delle-Vigne et al. disorder) and have distinct demographic features, prevalence , and costs [173]. Furthermore, bipolar depression is often undetected, recognized only after a long delay or misdiagnosed as unipolar depression or major depressive disorder, with the consequence of suboptimal treatment and poor outcome [14] [121] [192]. Because mood disorder patients present different subtypes (e.g., melancholia, bipolar depression, psychotic depression, etc.), comorbidities (e.g., anxiety), pathophysiology, etiology, and treatment responses, some authors have argued that there may be clinical features that differentiate bipolar from unipolar depression that are otherwise not DSM-IV symptoms of depression, such as anxiety [18]. "
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    • "Thus, it is possible that learning mechanisms involving the DS may be preferentially engaged by emotional stimuli, perhaps due to their intrinsic value or affective salience. In line with this possibility, namely that the DS may display some selective susceptibility to emotionally salient stimuli, some recent studies have indeed observed dorsal striatal responses specific to emotional distracters and clinical status, distinguishing between bipolar and unipolar depressed individuals (Bertocci et al., 2012) and biploar patients and healthy controls (Mullin et al., 2012). Ultimately, however, the precise functional role the DS plays in the modulation of conflict responses by global control context still needs to be studied further. "
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