Adler Caleb M, Delbello Melissa P, Mills Neil P, Schmithorst Vince, Holland Scott, Strakowski Stephen M
Division of Bipolar Disorders Research, Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA.
Bipolar Disord. 2005 Dec;7(6):577-88. doi: 10.1111/j.1399-5618.2005.00257.x.
Bipolar disorder is increasingly recognized as a significant source of psychiatric morbidity in children and adolescents. Younger bipolar patients symptomatically differ from adults, and frequently present with comorbid disorders, particularly attention-deficit hyperactivity disorder (ADHD). The neurophysiological relationship between these two disorders, however, remains unclear. In this study we utilized functional magnetic resonance imaging (fMRI) to compare activation patterns during performance of a simple attention task between bipolar adolescents with and without ADHD.
Eleven bipolar adolescents with comorbid ADHD and 15 bipolar adolescents without comorbidity were recruited to participate in fMRI scans. A single-digit continuous performance task alternated with a control task in a block-design paradigm. between-group comparisons were made using voxel-by-voxel analysis. Follow-up correlations were made between performance and activation.
Group performance did not significantly differ in percentage correct (p = 0.36) or discriminability (p = 0.11). ADHD comorbidity was associated with less activation in the ventrolateral prefrontal cortex (Brodmann 10) and anterior cingulate, and greater activation in posterior parietal cortex and middle temporal gyrus. Comorbid ADHD was associated with substantial differences in patterns of correlation between performance and voxel-by-voxel activation.
Our findings suggest that comorbid ADHD in bipolar adolescents is associated with activation of alternative pathways during performance of a simple attention task. The pattern of differences suggests that bipolar adolescents with comorbid ADHD demonstrate decreased activation of prefrontal regions, compared with bipolar adolescents without ADHD, and preferentially recruit portions of posterior parietal and temporal cortex.
双相情感障碍日益被认为是儿童和青少年精神疾病的重要来源。较年轻的双相情感障碍患者在症状上与成年人不同，且常伴有共病，尤其是注意力缺陷多动障碍（ADHD）。然而，这两种疾病之间的神经生理关系仍不清楚。在本研究中，我们利用功能磁共振成像（fMRI）来比较患有和未患有ADHD的双相情感障碍青少年在执行简单注意力任务时的激活模式。
招募了11名患有共病ADHD的双相情感障碍青少年和15名无共病的双相情感障碍青少年参与fMRI扫描。在组块设计范式中，一位数连续作业任务与对照任务交替进行。采用逐体素分析进行组间比较。对表现与激活之间进行后续相关性分析。
两组在正确百分比（p = 0.36）或辨别力（p = 0.11）方面的表现无显著差异。ADHD共病与腹外侧前额叶皮质（布罗德曼区10）和前扣带回的激活减少以及顶叶后皮质和颞中回的激活增加有关。共病ADHD与表现和逐体素激活之间的相关性模式存在实质性差异。
我们的研究结果表明，双相情感障碍青少年中的ADHD共病与简单注意力任务执行期间替代通路的激活有关。差异模式表明，与无ADHD的双相情感障碍青少年相比，患有共病ADHD的双相情感障碍青少年前额叶区域的激活减少，且优先募集顶叶后皮质和颞皮质的部分区域。
