Mood and Emotion Disorders Across the Lifespan Center, Department of Psychiatry, Indiana University School of Medicine, Indianapolis, USA.
Biol Psychiatry. 2012 Apr 1;71(7):603-10. doi: 10.1016/j.biopsych.2011.10.038. Epub 2011 Dec 28.
Studies incorporating direct comparisons across all phases of bipolar (BP) disorder are needed to elucidate the pathophysiology of bipolar disorder. However, functional neuroimaging studies that differentiate bipolar mood states from each other and from healthy subjects are few and have yielded inconsistent findings.
One hundred five unmedicated adults were recruited: 30 with current bipolar depression (BPD), 30 with current bipolar hypomania or mania (BPM), 15 bipolar euthymic (BPE), and 30 healthy control subjects (HC). All subjects were diagnosed with DSM-IV BP (type I or II) using a structured clinical interview. Groups were age- and gender-ratio matched. In 3T functional magnetic resonance imaging experiments, subjects completed a negative facial emotion matching task.
Bipolar euthymic and BPD groups exhibited increased amygdala activation compared with HCs in response to the negative faces; however, in the BPM group, this increase was not seen. Conversely, both BPE and BPM groups had increased activation in the insula relative to HCs, but in the BPD group, this effect was not seen. All three BP groups exhibited increased activation of the putamen compared with HCs. In the cortical areas, the BPM group exhibited decreased left lateral orbitofrontal cortex activation compared with both BPEs and HCs, increased dorsal anterior cingulate cortex activation compared with the BPD group, and increased dorsolateral prefrontal cortical activation compared with all other groups.
Both state- and trait-related abnormalities in corticolimbic activation were seen in response to the negative facial emotion processing in a large sample of unmedicated adults across BP mood states.
需要纳入躁狂症（BP）所有阶段的直接比较研究来阐明双相情感障碍的病理生理学。然而，区分双相心境状态彼此以及与健康受试者的功能神经影像学研究很少，并且得出的结果不一致。
招募了 105 名未接受治疗的成年人：30 名目前患有双相抑郁症（BPD），30 名目前患有双相轻躁狂或躁狂（BPM），15 名双相情感稳定（BPE）和 30 名健康对照组（HC）。所有受试者均通过结构化临床访谈诊断为 DSM-IV BP（I 型或 II 型）。组间年龄和性别比例匹配。在 3T 功能磁共振成像实验中，受试者完成了负性面部表情匹配任务。
与 HC 相比，双相情感稳定和 BPD 组在对负性面孔的反应中表现出杏仁核激活增加；然而，BPM 组没有出现这种增加。相反，BPE 和 BPM 组相对于 HC 在内侧岛叶的激活增加，但在 BPD 组中，这种效应没有出现。与 HC 相比，所有三组 BP 组的纹状体激活增加。在皮质区域，BPM 组的左侧外侧眶额皮质激活较 BPE 和 HC 组减少，背侧前扣带回皮质激活较 BPD 组增加，背外侧前额叶皮质激活较所有其他组增加。
在未接受治疗的成年人大样本中，对负性面部情绪处理的反应中，观察到与状态和特质相关的皮质边缘激活异常，涉及 BP 心境状态。
