Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O’Hara Street, Pittsburgh, PA 15213, USA.
J Am Acad Child Adolesc Psychiatry. 2011 Dec;50(12):1275-89.e2. doi: 10.1016/j.jaac.2011.09.023. Epub 2011 Nov 16.
The functioning of neural systems supporting emotion processing and regulation in youth with bipolar disorder not otherwise specified (BP-NOS) remains poorly understood. We sought to examine patterns of activity and connectivity in youth with BP-NOS relative to youth with bipolar disorder type I (BP-I) and healthy controls (HC).
Participants (18 BP-I youth, 16 BP-NOS youth, and 18 HC) underwent functional magnetic resonance imaging while performing two emotional-face gender labeling tasks (happy/neutral, fearful/neutral). Analyses focused on a priori neural regions supporting emotion processing (amygdala) and emotion regulation (ventromedial prefrontal cortex (VMPFC), dorsolateral prefrontal cortex (DLPFC). Connectivity analyses used VMPFC as a seed region.
During the happy-face task, BP-I youth had greater amygdala, VMPFC, and DLPFC activity to happy faces whereas BP-NOS youth had reduced VMPFC and DLPFC activity to neutral faces relative to HC, and reduced amygdala, VMPFC, and DLPFC activity to neutral faces versus BP-I. During the fearful-face task, BP-I youth had reduced DLPFC activity to fearful faces whereas BP-NOS youth had reduced DLPFC activity to neutral faces relative to HC. BP-NOS youth showed greater VMPFC-DLPFC connectivity to happy faces relative to HC and BP-I youth. BP-I youth showed reduced VMPFC-amygdala connectivity to fearful faces relative to HC and BP-NOS youth.
This is the first study to document differential patterns of abnormal neural activity in, and connectivity between, neural regions supporting emotion processing and regulation in BP-NOS versus BP-I youth. Findings suggest that despite similarities in symptom presentation, there are differential patterns of abnormal neural functioning in BP-NOS and BP-I relative to HC, which might reflect an "intermediate state" in the course of BP-I illness. Future longitudinal studies are needed to relate these findings with future conversion to BP-I/II.
目前对于未特定型双相障碍（BP-NOS）青少年的神经情绪处理和调节系统的功能仍知之甚少。我们旨在比较 BP-NOS 青少年、I 型双相障碍（BP-I）青少年和健康对照（HC）者在情绪面孔性别识别任务中的活动和连接模式。
参与者（18 名 BP-I 青少年、16 名 BP-NOS 青少年和 18 名 HC）接受功能磁共振成像，同时执行两种情绪面孔性别识别任务（高兴/中性，恐惧/中性）。分析集中于支持情绪处理（杏仁核）和情绪调节（腹内侧前额叶皮质（VMPFC），背外侧前额叶皮质（DLPFC））的预先设定的神经区域。使用 VMPFC 作为种子区域进行连接分析。
在高兴面孔任务中，与 HC 相比，BP-I 青少年在面对高兴面孔时杏仁核、VMPFC 和 DLPFC 活动增加，而 BP-NOS 青少年在面对中性面孔时 VMPFC 和 DLPFC 活动减少，且杏仁核、VMPFC 和 DLPFC 对中性面孔的活动减少；在恐惧面孔任务中，与 HC 相比，BP-I 青少年在面对恐惧面孔时 DLPFC 活动减少，而 BP-NOS 青少年在面对中性面孔时 DLPFC 活动减少。与 HC 和 BP-I 青少年相比，BP-NOS 青少年在面对高兴面孔时 VMPFC-DLPFC 连接增加。与 HC 和 BP-NOS 青少年相比，BP-I 青少年在面对恐惧面孔时 VMPFC-杏仁核连接减少。
这是第一项研究，记录了 BP-NOS 与 BP-I 青少年在支持情绪处理和调节的神经区域中异常神经活动和连接的差异模式。研究结果表明，尽管症状表现相似，但与 HC 相比，BP-NOS 和 BP-I 青少年存在不同的异常神经功能模式，这可能反映了 BP-I 疾病进程中的“中间状态”。需要进一步进行纵向研究，将这些发现与未来向 BP-I/II 的转变联系起来。
