Strakowski SM, Adler CM, Holland SK, Mills N, DelBello MP 2004. 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: 7.05). 10/2004; 29(9):1734-40. DOI: 10.1038/sj.npp.1300492
Source: PubMed


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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    ABSTRACT: This preliminary study investigated the neurofunctional effects of carbamazepine-extended release (XR) treatment in 11 manic youth with bipolar disorder during performance of a sustained attention task, the Continuous Performance Task – Identical Pairs version, during functional magnetic resonance imaging (fMRI). All patients underwent baseline fMRI, and 10 patients were scanned again at endpoint. Nine demographically matched normal youth, who were scanned once, served as controls. Carbamazepine-XR treatment was associated with normalization of activation in right Brodmann Area 10. These results suggest that carbamazepine-XR treatment may correct prefrontal dysfunction in adolescent mania.
    Full-text · Article · Sep 2014 · Psychiatry Research: Neuroimaging
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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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    ABSTRACT: We used functional magnetic resonance imaging (fMRI) to examine affective control longitudinally in a group of patients with bipolar disorder (BD). Participants comprised 12 BD patients who underwent repeated fMRI scans in euthymic (n=11), depressed (n=9), or hypomanic (n=9) states, and were compared with 12 age-matched healthy controls. During fMRI, participants performed an emotional face-word interference task with either low or high attentional demands. Relative to healthy controls, patients showed decreased activation of the cognitive control network normally associated with conflict processing, more severely during hypomania than during depression, but regardless of level of task demand in both cases. During euthymia, a decreased response to conflict was observed only during the high load condition. Additionally, unlike healthy participants, patients exhibited deactivation in several key areas in response to emotion-conflict trials – including the rostral anterior cingulate cortex during euthymia, the hippocampus during depression, and the posterior cingulate cortex during hypomania. Our results indicate that the ability of BD patients to recruit control networks when processing affective conflict, and the abnormal suppression of activity in distinct components of the default mode network, may depend on their current clinical state and attentional demand.
    Full-text · Article · Jan 2014
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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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    ABSTRACT: The ability to recognize facial emotions is altered in patients with Bipolar Disorder (BD) during mood episodes and even in euthymia, while cognitive functioning is similarly impaired. This recognition is considered a fundamental skill for successful social interaction. However, it is unclear whether the ability to recognize facial emotions is correlated with the cognitive deficits observed in BD. The objective of this study was to evaluate Facial Emotion Recognition (FER) and its correlation with executive function (EF) in BD I patients during mania, depression and euthymia compared to healthy controls. A total of 110 patients with BD I, 18-40 years old were included (41 in manic episode; 31 in depressive episode and 38 euthymic). Patients were assessed for FER and EF (Wisconsin card sorting test - WCST), along with 96 healthy volunteers (18-40 years old) recruited from the University of São Paulo. The results showed that BD I patients had lower FER performance compared to controls on fear subtests, happiness, the surprise test, and FER total scores. Moreover, BD I manic patients showed poorer performance for EF compared to controls. Six out of the seven variables of the WCST correlated with FER in both healthy controls and BD euthymic subjects but not in BD patients during mood episodes. Cognitive deficits and difficulties recognizing facial emotions are present in all mood episodes in BD I patients, even during remission. Although FER is not considered a cognitive domain, these results suggest that, along with EF, it has a complementary function. Hence, further studies should investigate this issue in larger samples and verify whether these similarities also occur at a neurobiological level.
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