Journal
BIPOLAR DISORDERS
Volume 23, Issue 5, Pages 500-508Publisher
WILEY
DOI: 10.1111/bdi.13025
Keywords
anterior cingulate cortex; bipolar disorder; functional connectivity; lithium; mania; quetiapine
Categories
Funding
- NIMH CIDAR award [P50 MH077138]
- NIAAA Mentored Research Scientist Career Development Award [K01 AA027573]
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This study found altered functional connectivity in the anterior cingulate, amygdala, and caudate in non-remitted bipolar disorder patients during a first manic episode, with changes in anterior cingulate connectivity associated with remission after treatment.
Objectives Altered activity in the ventrolateral prefrontal and anterior cingulate cortices, as well as subcortical and amygdala projection sites, was previously reported during a first manic episode in youth with bipolar disorder and observed to be associated with treatment response. To extend these findings, we investigated functional connectivity among these regions in first-episode manic participants who remitted after 8 weeks of treatment compared to those who did not. Methods Forty-two participants with bipolar disorder (60% female) during their first manic episode were recruited and received 8 weeks of treatment. Twenty-one remitted following treatment. Participants completed fMRI scans, at baseline and following 8 weeks of treatment, while performing a continuous performance task with emotional and neutral distractors. A healthy comparison group (n = 41) received fMRI evaluations at the same intervals. Differences in functional connectivity of the amygdala and caudate with the rostral anterior cingulate and ventrolateral prefrontal cortices at baseline (and changes in functional connectivity following treatment) were modeled between groups. Results At baseline, non-remitters showed an increase in positive connectivity between right anterior cingulate and caudate and a loss of negative connectivity between right anterior cingulate and amygdala, compared to healthy participants. Individuals who remitted following treatment showed an increase in negative connectivity between amygdala and left anterior cingulate 8 weeks following treatment. Conclusions Results provide evidence of alterations in anterior cingulate amygdala and caudate functional connectivity in bipolar disorder non-remitters during a first manic episode and changes in anterior cingulate functional connectivity associated with remission suggesting targets to predict treatment response. Registered at ClinicalTrials.Gov; Functional and Neurochemical Brain Changes in First-episode Bipolar Mania. NCT00609193. URL: .
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