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A Preliminary fMRI Study of Sustained Attention in Euthymic, Unmedicated Bipolar Disorder

Bipolar and Psychotic Disorders Research Program, University of Cincinnati College of Medicine, OH 45267-0583, USA.
Neuropsychopharmacology (Impact Factor: 7.83). 10/2004; 29(9):1734-40. DOI: 10.1038/sj.npp.1300492
Source: PubMed

ABSTRACT The symptoms of bipolar disorder suggest dysfunction of anterior limbic networks that modulate emotional behavior and that reciprocally interact with dorsal attentional systems. Bipolar patients maintain a constant vulnerability to mood episodes even during euthymia, when symptoms are minimal. Consequently, we predicted that, compared with healthy subjects, bipolar patients would exhibit abnormal activation of regions of the anterior limbic network with corresponding abnormal activation of other cortical areas involved in attentional processing. In all, 10 unmedicated euthymic bipolar patients and 10 group-matched healthy subjects were studied with fMRI while performing the Continuous Performance Task-Identical Pairs version (CPT-IP). fMRI scans were obtained on a 3.0 T Bruker system using an echo planar imaging (EPI) pulse sequence, while subjects performed the CPT-IP and a control condition to contrast group differences in regional brain activation. The euthymic bipolar and healthy subjects performed similarly on the CPT-IP, yet showed significantly different patterns of brain activation. Specifically, bipolar patients exhibited increased activation of limbic, paralimbic, and ventrolateral prefrontal areas, as well as visual associational cortices. Healthy subjects exhibited relatively increased activation in fusiform gyrus and medial prefrontal cortex. In conclusion, these differences suggest that bipolar patients exhibit overactivation of anterior limbic areas with corresponding abnormal activation in visual associational cortical areas, permitting successful performance of an attentional task. Since the differences occurred in euthymia, they may represent trait, rather than state, abnormalities of brain function in bipolar disorder.

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    • "MR images were reconstructed using in-house software to convert the raw data into AFNI format, and all analysis was performed using a previously published region of interest approach. Analysis focused on Brodmann areas (BA) 10, 11, and 47 and the amygdala, which have been previously shown to exhibit abnormal activation patterns during sustained attention in both adults (Strakowski et al., 2004) and youth with bipolar disorder (Schneider et al., 2012). Statistical analyses were performed using SAS. "
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    Psychiatry Research Neuroimaging 09/2014; 223(3). DOI:10.1016/j.pscychresns.2014.04.011
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    • "Only one neuroimaging study tested euthymic as well as depressed and manic BD patients while performing a Stroop task (Blumberg et al., 2003), finding both common and differential effects of conflict in distinct ventral prefrontal areas. On the other hand, results from working memory and sustained attention paradigms suggest that patients with BD may show insufficient modulation of lateral as well as ventromedial prefrontal areas in high-demanding conditions (e.g., Strakowski et al., 2004; Townsend et al., 2010; Pomarol-Clotet et al., 2012; Fernández-Corcuera et al., 2013). Thus, in patients with BD, the processing of emotion-conflict trials in prefrontal networks might be differentially affected by the current mood state, either directly or indirectly through changes in attentional task demands. "
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    • "in line with the literature which , in light of the reciprocal connections between cognitive and emotion neural systems , proposed neurobiological theories of BD that include functional and structural abnormalities in fronto - limbic circuits ( Strakowski et al . , 2004a , 2004b , 2005 ; Ochsner and Gross , 2005 , Ochsner , 2007 ; Ochsner et al . , 2004 ; Phillips et al . , 2003 , 2008 ) . Given that deficits in executive functioning are predictors of impaired occupational and skills in daily activities ( Addington and Addington , 2000 ) as well as of poor social functioning and possibly poorer quality "
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