Altamura A C, Delvecchio G, Marotta G, Oldani L, Pigoni A, Ciappolino V, Caletti E, Rovera C, Dobrea C, Arici C, Benatti B, Camuri G, Prunas C, Paoli R A, Dell'osso B, Cinnante C, Triulzi F M, Brambilla P
Department of Neurosciences and Mental Health, Institute of Psychiatry, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
Scientific Institute IRCCS "E. Medea", San Vito al Tagliamento (PN), Italy.
Eur Psychiatry. 2017 Mar;41:85-94. doi: 10.1016/j.eurpsy.2016.09.009. Epub 2016 Dec 31.
Bipolar disorder (BD) may be characterized by the presence of psychotic symptoms and comorbid substance abuse. In this context, structural and metabolic dysfunctions have been reported in both BD with psychosis and addiction, separately. In this study, we aimed at identifying neural substrates differentiating psychotic BD, with or without substance abuse, versus substance-induced psychosis (SIP) by coupling, for the first time, magnetic resonance imaging (MRI) and positron emission tomography (PET).
Twenty-seven BD type I psychotic patients with (n=10) or without (n=17) substance abuse, 16 SIP patients and 54 healthy controls were enrolled in this study. 3T MRI and 18-FDG-PET scanning were acquired.
Gray matter (GM) volume and cerebral metabolism reductions in temporal cortices were observed in all patients compared to healthy controls. Moreover, a distinct pattern of fronto-limbic alterations were found in patients with substance abuse. Specifically, BD patients with substance abuse showed volume reductions in ventrolateral prefrontal cortex, anterior cingulate, insula and thalamus, whereas SIP patients in dorsolateral prefrontal cortex and posterior cingulate. Common alterations in cerebellum, parahippocampus and posterior cingulate were found in both BD with substance abuse and SIP. Finally, a unique pattern of GM volumes reduction, with concomitant increased of striatal metabolism, were observed in SIP patients.
These findings contribute to shed light on the identification of common and distinct neural markers associated with bipolar psychosis and substance abuse. Future longitudinal studies should explore the effect of single substances of abuse in patients at the first-episode of BD and substance-induced psychosis.
双相情感障碍（BD）可能以存在精神病性症状和合并物质滥用为特征。在这种情况下，分别在伴有精神病的BD和成瘾中都报告了结构和代谢功能障碍。在本研究中，我们旨在通过首次将磁共振成像（MRI）和正电子发射断层扫描（PET）相结合，识别区分伴有或不伴有物质滥用的精神病性BD与物质所致精神病（SIP）的神经基质。
本研究纳入了27例伴有（n = 10）或不伴有（n = 17）物质滥用的I型BD精神病患者、16例SIP患者和54名健康对照。进行了3T MRI和18-FDG-PET扫描。
与健康对照相比，所有患者颞叶皮质的灰质（GM）体积和脑代谢均降低。此外，在有物质滥用的患者中发现了一种独特的额-边缘改变模式。具体而言，伴有物质滥用的BD患者腹外侧前额叶皮质、前扣带回、岛叶和丘脑体积减小，而SIP患者背外侧前额叶皮质和后扣带回体积减小。在伴有物质滥用的BD和SIP患者中，小脑、海马旁回和后扣带回均有共同改变。最后，在SIP患者中观察到一种独特的GM体积减小模式，同时纹状体代谢增加。
这些发现有助于阐明与双相情感障碍精神病和物质滥用相关的共同和独特神经标志物。未来的纵向研究应探讨单一滥用物质对BD首发患者和物质所致精神病患者的影响。
