Structural correlates of creative thinking in patients with bipolar disorder and healthy controls-a voxel-based morphometry study.

BACKGROUND

This study investigated the structural correlates of creative thinking in patients with bipolar disorder (BD) to understand the possible neural mechanism of creative thinking in BD.

METHODS

We recruited 59 patients with BD I or BD II (35.3±8.5 y) and 56 age- and sex-matched controls (HCs; 34±7.4 y). Each participant underwent structural magnetic resonance imaging and evaluation of creative thinking, which was assessed using two validated tools: the Chinese version of the Abbreviated Torrance Test for Adults for divergent thinking and the Chinese Word Remote Associates Test for remote association. Voxel-based morphometry was performed using SPM12.

RESULTS

In patients with BD, divergent thinking positively correlated with the gray matter volume (GMV) in right medial frontal gyrus (Brodmann area [BA] 9), and remote association positively correlated with the GMV in the medial prefrontal gyrus (BA 10). In the HCs, divergent thinking negatively correlated with the GMV in left superior frontal gyrus (BA 8) and positively correlated with the GMV in the precuneus and occipital regions, and remote association positively correlated with the GMV in the hippocampus.

LIMITATIONS

Patients with BD were receiving various dosages of antipsychotics, antidepressants and mood stabilizer. These medications may confound the GMV-creative thinking relationship in patients with BD.

CONCLUSIONS

Our findings indicate that medial prefrontal cortex plays a major and positive role in creative thinking in patients with BD. By contrary, creative thinking involves more diverse structures, and the prefrontal cortex may have an opposite effect in HCs.